• Glucose metabolism gene
• Hypoxia
• Nasopharyngeal carcinoma
• Patient prognosis
• SUVmax

• Humans
• Nasopharyngeal Carcinoma/genetics
• Nasopharyngeal Carcinoma/metabolism
• Nasopharyngeal Carcinoma/pathology
• Nasopharyngeal Carcinoma/mortality
• Nasopharyngeal Neoplasms/genetics
• Nasopharyngeal Neoplasms/metabolism
• Nasopharyngeal Neoplasms/pathology
• Nasopharyngeal Neoplasms/mortality
• Male
• Female
• Tumor Hypoxia/genetics
• Prognosis
• Middle Aged
• Gene Expression Regulation, Neoplastic
• Biomarkers, Tumor/metabolism
• Biomarkers, Tumor/genetics
• Adult
• Transcriptome
• Aged
• Gene Expression Profiling

• 2023Y9427 This work was supported by research projects for the the Fujian Province Joint Funds for the Innovation of Science and Technology
• 2023Y9409 This work was supported by research projects for the the Fujian Province Joint Funds for the Innovation of Science and Technology
• 2022YNG02 Fujian Provincial Cancer Hospital Talent Development Program

• 18F-FDG PET/CT
• hypopharyngeal cancer
• laryngeal cancer
• prognostic value
• radiomics

• 2023-0074 Soonchunhyang University

• MTV
• PET/CT
• TLG
• [18F]FDG PET/CT vs. neck MRI
• laryngeal squamous-cell carcinoma
• metastatic lymph node
• semiquantitative PET parameters

To evaluate the prognostic value of the pretreatment maximum standardized uptake value (SUVmax) for locoregional control (LRC) of early glottic cancer treated with primary radiotherapy.

We retrospectively reviewed the medical records of 101 patients with T1-T2N0 glottic cancer treated with helical tomotherapy between 2013 and 2016. The clinical T-stages were T1 in 87 (86.1%) and T2 in 14 (13.9%) patients. The median total dose was 63 Gy (63–67.5 Gy) in 2.25 Gy per fraction. The survival outcomes were plotted using Kaplan-Meier curves. Receiver operating characteristic curves were used to assess the optimal SUVmax cut-off value for predicting locoregional recurrence.

The median follow-up period was 58 months (range, 11 to 90 months). The 5-year overall survival (OS) and locoregional recurrence-free survival rates were 96.8% and 85.4%, respectively. The median pretreatment SUVmax of the primary tumor for all 101 patients was 2.3 (range, 1.1 to 9.1). The best cut-off value for SUVmax for predicting LRC was 3.3, with a sensitivity of 78.6% and specificity of 73.6%. Univariate analysis showed that T-stage, overall treatment time (≥43 days), and high SUVmax (≥3.3) were significant predictors of LRC. Multivariate analysis showed that LRC was independently affected by a high SUVmax (≥3.3) (hazard ratio = 5.505, p = 0.020).

High pretreatment SUVmax (≥3.3) is a negative prognostic factor for LRC in early glottic cancer patients treated with primary radiotherapy.

• Laryngeal neoplasm
• Radiotherapy
• SUVmax

• (18)F-FDG
• Cáncer de laringe
• Laryngeal cancer
• PET/CT
• PET/TC
• Prognosis
• Pronóstico

Posttreatment detection of residual/recurrence disease in the head and neck cancers is not an easy task. Treatment induces changes create difficulties in diagnosis on conventional imaging (computed tomography [CT], magnetic resonance imaging) as well as macroscopic inspection (direct laryngoscopy). Hence, we evaluate the diagnostic performance of contract-enhanced F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/CT in restaging of laryngeal carcinoma Postchemotherapy-surgery and/or radiation therapy. We retrospectively analyzed patients of carcinoma larynx (n = 100) who has completed treatment and were referred for FDG PET/CT. Two reviewers performed image analysis to determine recurrence at primary site and/lymph nodes and distant metastases. Receiver operating characteristic (ROC) was used to determine the maximum standardized uptake value (SUV_max) cut off for disease detection. Histopathological examination and clinical or imaging follow-up were taken as gold standard for recurrence. One hundred laryngeal carcinoma patients with mean age of 57.2 years (range of 40–76) were included in the present study. Among the 100 patients, 96 were male and remaining 4 were female. The average interval between completion of treatment and FDG PET/CT scan was 8.5 months (minimum 6 months). Of the 100 patients, FDG PET/CT detected FDG avid lesions in 66 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of FDG PET/CT for residual/recurrence disease detection was 90.3%, 73.7%, 84.8%, 82.3%, and 84.0%, respectively (P < 0.05). In addition, in 10 patients, metachronous primaries were detected (lung-4, thyroid-2, tongue, colon, esophagus, and lymphoma-one each). On ROC curve analysis, SUVmax >6.1 had sensitivity and specificity of 80.6% and 94.7% respectively for detection of recurrent/metastatic disease. FDG PET/CT demonstrates high diagnostic accuracy for detection of residual/recurrent disease in treated laryngeal cancer patients and our findings suggest that this imaging modality should be the first-line diagnostic investigation in this cohort of patients.

• Fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography
• laryngeal carcinoma
• metabolic biopsy
• metachronous second primary
• receiver operating characteristic analysis

Positron emission tomography (PET) imaging with 2-deoxy-2-[¹⁸F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.

• FDG–PET/CT
• HNSCC
• NSCLC
• prognostication
• publication bias

• 18F-FDG
• Cancer de laringe
• Comparacion
• Comparison
• Laryngeal cancer
• PET/CT
• Prognosis
• Pronostico

• PET/CT
• head and neck cancer
• laryngeal cancer
• laryngeal squamous cell carcinoma
• radiation

• Adult
• Aged
• Antineoplastic Agents/therapeutic use
• Disease-Free Survival
• Female
• Fluorodeoxyglucose F18
• Head and Neck Neoplasms/diagnostic imaging
• Head and Neck Neoplasms/drug therapy
• Head and Neck Neoplasms/pathology
• Head and Neck Neoplasms/radiotherapy
• Humans
• Laryngeal Neoplasms/diagnostic imaging
• Laryngeal Neoplasms/drug therapy
• Laryngeal Neoplasms/pathology
• Laryngeal Neoplasms/radiotherapy
• Male
• Middle Aged
• Neoplasm Recurrence, Local/diagnostic imaging
• Neoplasm Staging
• Positron Emission Tomography Computed Tomography
• Prognosis
• Proportional Hazards Models
• Radiopharmaceuticals
• Retrospective Studies
• Squamous Cell Carcinoma of Head and Neck/diagnostic imaging
• Squamous Cell Carcinoma of Head and Neck/drug therapy
• Squamous Cell Carcinoma of Head and Neck/pathology
• Squamous Cell Carcinoma of Head and Neck/radiotherapy

• P50 CA174521 NCI NIH HHS

Standardized uptake values (SUVs) are the most widely used quantitative imaging biomarkers in PET. It is important to evaluate the variability and repeatability of measured SUVs. Phantom studies seem to be essential for this purpose; however, repetitive phantom scanning is not recommended due to the decay of radioactivity. In this study, we performed count-based image reconstruction to avoid the influence of decay using two different PET/CT scanners. By adjusting the ratio of ¹⁸F-fluorodeoxyglucose solution to tap water, a NEMA IEC body phantom was set for SUVs of 4.0 inside six hot spheres. The PET data were obtained using two scanners (Aquiduo and Celesteion; Toshiba Medical Systems, Tochigi, Japan). We set the start time for image reconstruction when the total radioactivity in the phantom was 2.53 kBq/cc, and employed the counts of the first 2-min acquisition as the standard. To maintain the number of counts for each image, we set the acquisition time for image reconstruction depending on the decay of radioactivity. We obtained 50 images, and calculated the SUV_max and SUV_peak of all six spheres in each image. The average values of the SUV_max were used to calculate the recovery coefficients to compare those measured by the two different scanners. Bland-Altman analyses of the SUVs measured by the two scanners were also performed. The measured SUVs using the two scanners exhibited a 10–30% difference, and the standard deviation (SD) of the measured SUVs was between 0.1–0.2. The Celesteion always exhibited higher values than the Aquiduo. The smaller sphere exhibited a larger SD, and the SUV_peak had a smaller SD than the SUV_max. The Bland-Altman analyses showed poor agreement between the SUVs measured by the two scanners. The recovery coefficient curves obtained from the two scanners were considerably different. The Celesteion exhibited higher recovery coefficients than the Aquiduo, especially at approximately 20-mm-diameter. Additionally, the curves were lower than those calculated from the standard 30-min acquisition images. We propound count-based image reconstruction to evaluate the variability and repeatability of measured SUVs. These results are also applicable for the standardization and harmonization of SUVs in multi-institutional studies.

• Fluorodeoxyglucose F18
• Phantoms, Imaging
• Positron-Emission Tomography
• Reproducibility of Results
• Tomography, X-Ray Computed

• PET
• QIBA
• SUV
• repeatability
• variation

• Chemoradiotherapy
• ESCC
• FDG PET
• nodal SUVmax
• treatment outcomes

• FDG PET
• Head and neck cancer
• Radiotherapy
• Standardized uptake value (SUV)

• ((18)F)-FDG-PET
• Early glottic cancer
• Petit cancer glottique
• Radiotherapy
• Radiothérapie
• SUV(max)
• TEP au ((18)F)-fluorodésoxyglucose

Aerobic glycolysis, the main pathway of energy production in tumors (Warburg effect) allows detection of tumors by positron emission tomography (PET) using ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG). Since ionizing radiation (IR) is reported to switch aerobic glycolysis to mitochondrial oxidative phosphorylation, radiotherapeutic efficacy was monitored by the activity of mitochondrial complex I (MC-I), using a new PET probe ¹⁸F-BCPP-EF, ¹⁸F-2-tert-butyl-4-chloro-5-{6-[2-(2-fluoro-ethoxy)-ethoxy] -pyridine-3-ylmethoxy}-2H-pyridazin-3-one, compared with ¹⁸F-FDG uptake and the apoptosis index.

Tumor uptake of ¹⁸F-BCPP-EF or ¹⁸F-FDG was examined in C3H/HeN mice inoculated with murine squamous cell carcinoma SCCVII at various time points after a single dose of x-ray irradiation at 0, 6, 15, or 30 Gy. Apoptosis incidence was determined by TUNEL staining in excised tumor tissue.

Tumor growth suppression was dose-dependent; tumor grew 10-fold (0 Gy), 5-fold (6 Gy), 2-fold (15 Gy), and reduced to half in its volume (30 Gy) 14 days after treatment. ¹⁸F-BCPP-EF uptake was significantly increased as early as 3 days after 15 Gy or 30 Gy, when tumor size and apoptosis index showed no difference among radiation doses. In contrast, ¹⁸F-FDG uptake was initially increased dose-dependently, remained elevated up to 7 days, and eventually decreased 10 days after 30 Gy and also 14 days after 15 Gy when tumor size was already reduced. Apoptosis index was increased after irradiation but failed to correlate with tumor response.

Tumor uptake of ¹⁸F-BCPP-EF was increased dose-dependently early after effective doses of IR when ¹⁸F-FDG uptake as well as apoptosis incidence were not indicative of tumor response. The results suggest that ¹⁸F-BCPP-EF is a promising “positive” MC-I imaging PET probe for early detection of efficacy of tumor radiotherapy.

• bone metastasis
• dose-painting-by-numbers
• palliative treatment
• stereotactic body radiotherapy
• volume analysis

Compared with normal cells, cancer cells show alterations in many cellular processes, including energy metabolism. Studies on cancer metabolism started with Otto Warburg's observation at the beginning of the last century. According to Warburg, cancer cells rely on glycolysis more than mitochondrial respiration for energy production. Considering that glycolysis yields much less energy compared with mitochondrial respiration, Warburg hypothesized that mitochondria must be dysfunctional and this is the initiating factor for cancer formation. However, this hypothesis did not convince every scientist in the field. Some believed the opposite: the reduction in mitochondrial activity is a result of increased glycolysis. This discrepancy of opinions is ongoing. In this review, we will discuss the alterations in glycolysis, pyruvate metabolism, and the Krebs cycle in cancer cells and focus on cause and consequence.

In the last decade, (18)F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET and PET/CT) has become one of the major diagnostic tools used in oncology. A significant number of patients who undergo this procedure, due to non-thyroidal reasons, present incidental uptake of (¹⁸F-FDG) in the thyroid. The aim of the study was to compare the SUV_max (standardized uptake value) of thyroid focal lesions, which were incidentally found on PET/CT, in relation to the results of thyroid fine-needle aspiration biopsy (FNAB) and/or histopathological evaluation.

Patients referred for PET/CT examination, due to non-thyroidal illness, presented focal ¹⁸F-FDG uptake in the thyroid and were advised to undergo ultrasonography (US), hormonal evaluation, FNAB and/or total thyroidectomy at our institution.

6614 PET/CT examinations performed in 5520 patients were analyzed. Of the 122 patients with focal thyroid ¹⁸F-FDG activity, 82 patients (67.2%) underwent further thyroid evaluation using FNAB. Benign lesions were diagnosed in 46 patients, malignant - in 19 patients (confirmed by post-surgical histopathology), while 17 patients had inconclusive results of cytological assessment. Mean SUV_max of benign lesions was 3.2±2.8 (median = 2.4), while the mean SUV_max value for malignant lesions was 7.1±8.2 (median = 3.5). The risk of malignancy was 16.7% for lesions with a SUV_max under 3, 43.8% for lesions with a SUV_max between 3 and 6, and 54.6% for lesions with a SUV_max over 6. In the group of malignant lesions, a positive correlation between the lesion’s diameter and SUV_max was observed (p = 0.03, r = 0.57).

Subjects with incidental focal uptake of ¹⁸F-FDG in thyroid are at a high risk of thyroid malignancy. A high value of SUV_max further increases the risk of malignancy, indicating the necessity for further cytological or histological evaluation. However, as SUV_max correlated with the diameter of malignant lesions, small lesions with focal uptake of ¹⁸F-FDG should be interpreted cautiously.