Leonard Ong

The Impact That Number of Analyzed Metastatic Breast Cancer Lesions Has on Response Assessment by 18F-FDG PET/CT Using PERCIST

The PET Response Criteria in Solid Tumors (PERCIST) are not specific regarding the number of lesions that should be analyzed per patient. This study evaluated how the number of analyzed lesions affects response assessment in metastatic breast cancer. Methods: In 60 patients, response was assessed by the change in SUVpeak, normalized to lean body mass, of the most 18F-FDG–avid lesion (PERCIST 1) and by the change in the sum of normalized SUVpeak for up to 5 lesions (PERCIST 5). The correlation between response by PERCIST and progression-free and disease-specific survival was evaluated. Results: In responders and nonresponders, the respective progression-free survival at 2 y was 37.26% and 6.43% for PERCIST 1 (P < 0.0001) and 33.65% and 7.14% for PERCIST 5 (P < 0.0001) and the respective disease-specific survival at 4 y was 58.96% and 25.44% for PERCIST 1 (P < 0.012) and 59.12% vs 20.01% for PERCIST 5 (P < 0.002). Conclusion: The number of analyzed lesions does not appear to have a major impact on the prognostic value of response assessment with 18F-FDG PET/CT in metastatic breast cancer.

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

BACKGROUND AND PURPOSE The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation. MATERIAL AND METHODS We reviewed 283 patients with stage I-IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS. RESULTS Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk. CONCLUSIONS TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.

Successful Management of Gastric Perforation in Stage IV Diffuse Large B-Cell Lymphoma With Chemoradiation Therapy, Percutaneous Endoscopy Gastrostomy for Gastric Drainage, and Percutaneous Endoscopy Jejunostomy for Nutrition

Address for correspondence: Ariela Noy, MD, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 Clinical Pra ● Primary gastric diffuse large B cell lymphoma (DLBCL), a common form of extranodal lymphoma, is an aggressive B cell malignancy arising in the stomach. ● Modern treatment is conservative and systemic, involving a combination of chemotherapy and radiation. Primary surgical resection is no longer standard of care. Incidence of perforation is extremely rare.

Prognostic significance of PET assessment of metabolic response to therapy in oesophageal squamous cell carcinoma.

Objectives:The role of maximum standard uptake value (SUVmax) at baseline and after induction chemotherapy (CT) on positron emission tomography (PET) as an imaging biomarker has not been well established in oesophageal squamous cell carcinoma (SCC). In this retrospective analysis, we investigated the prognostic significance of various PET metrics in oesophageal SCC patients treated with induction chemotherapy followed by concurrent chemoradiotherapy (CRT).Methods:A total of 57 patients were treated with CRT; 52 patients received induction chemotherapy and 10 patients underwent surgery following CRT. Scans were independently analysed by a nuclear medicine physician blinded to patient outcome. Using region of interest analysis, SUVmax and metabolic tumour volume (MTV) were calculated for the index lesion and lymph node metastases in each patient. Kaplan–Meier analysis was used to evaluate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Cox proportional hazards regression was used to assess correlation between outcomes and PET metrics.Results:Median follow-up for those who are alive was 4.4 years, with a median survival for all patients of 2.9 years. The 3-year OS, DFS, DMFS and LRFS rates were 47, 40, 44 and 36%, respectively. Using a pre-established cutoff of a 35% decrease in SUVmax from baseline to post-induction PET, 3-year OS for responders (⩾35% decrease from baseline) was 64%, whereas non-responders (<35% decrease from baseline) had a 3-year OS of 15% (P=0.004).Conclusions:The pre-specified 35% decrease in SUVmax after induction chemotherapy was prognostic for OS. Baseline and post-induction PET metrics provide prognostic information for oesophageal SCC.

FDG-PET scan after induction chemotherapy for esophageal squamous cell cancer (ESCC) to predict for outcomes after chemoradiation (chemoRT) and to guide salvage chemotherapy during RT.

94 Background: Pre-operative or definitive chemoRT is accepted treatment for locally advanced (LA) ESCC. We have retrospectively shown that assessment by PET scan following induction chemo prior to chemoRT and surgery predicts outcomes in SCC Pts (Cancer 118:2820; 2012). Some Pts with progression on PET after induction chemo had long-term survival when changed to alternative chemo during RT. Methods: We retrospectively reviewed all Pts with LA ESCC who received induction chemo and chemoRT from 2002 to 2010; all Pts had PET scan before and after induction chemo. Results: 62 Pts were identified, median age 63, median Karnofsky performance status 80%, 75% with uN+ disease. 43 (69%) received induction chemo with platinum/irinotecan (CPT-11), 13 (21%) with platinum/paclitaxel and 6 (10%) with docetaxel/CPT-11 ± cisplatin. 38 Pts (61%) were PET responders (PETr; ≥35% decrease in mSUV of tumor) and 24 (39%) were PET non-responders (PETnr; <35% decrease). All PETr received same chemo during RT. Of PETnr, 9 contin...