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      Prediction of 2 years-survival in patients with stage I and II non-small cell lung cancer utilizing 18F-FDG PET/CT SUV quantification

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          Abstract

          Background

          The purpose of the study was to evaluate the correlation between the maximum standardized uptake value (SUVmax), size of primary lung lesion, disease-free survival (DFS) and overall survival (OS) in patients with stage I and II non-small cell lung cancer (NSCLC) in 2 years follow-up.

          Patients and methods.

          Forty-nine patients with stage I–II NSCLC were included in this study. Pre-surgical 2-deoxy-2-[18F]fluoro-D-glucose positron-emission tomography ( 18F-FDG PET/CT) study was performed for all patients. The relationship between SUVmax, tumour size and clinical outcome was measured. The cut-off value for SUVmax and tumour size with the best prognostic significance, probability of DFS and the correlation between SUVmax and the response to therapy were calculated.

          Results

          There was a statistically significant correlation between SUVmax and DFS (p = 0.029). The optimal cut-offs were 9.00 for SUVmax (p = 0.0013) and 30mm for tumour size (p = 0.0028). Patients with SUVmax > 9 and primary lesion size > 30 mm had an expected 2years-DFS of 37.5%, while this rose to 90% if the tumour was <30 mm and/or SUVmax was <9.

          Conclusions

          In stage I-II, SUVmax and tumour size might be helpful to identify the subgroup of patients with high chance for recurrence.

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          Most cited references22

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          FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

          The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out, interpret, and document quantitative FDG PET/CT examinations, but will concentrate on the optimisation of diagnostic quality and quantitative information.
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            Anatomy of SUV. Standardized uptake value.

            S C Huang (2000)
            Standardized uptake value (SUV) for [F-18]fluorodeoxyglucose (FDG) studies that is commonly used to differentiate malignant from benign tumors and to assess the efficacy of therapy is reviewed as a simplified calculation of the more general modeling approach. Based on such a basis, the merits and limitations of the SUV approach is examined with reference to literature reports on tumor uptake of FDG. Results indicate the complexity and large variation of glucose uptake mechanism in tumors. Consistently performed procedures and more basic studies are needed to improve the utility of FDG SUV.
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              Survival in early-stage non-small cell lung cancer.

              The duration of survival in early-stage lung cancer (stages I and II) varies between reports in the literature. Several reasons account for this: patient population heterogeneity, inconsistent staging, anatomic variability, dissimilar tumor morphology, and unpredictable tumor biology. This report addresses some of the issues in early-stage non-small cell lung cancer that relate to variability between estimates of survival in end stage reporting. We review several large series since the introduction of the International Staging System in 1986 and other selected, contemporary reports that address end results in patients with pathologic stage I or stage II lung cancer. Overall survival for patients with pathologic stage I disease is 64.6% (range, 55% to 72%) and 41.2% for patients with stage II disease (range, 29% to 51%). Reducing morphologic differences by placing patients in groups based on the TNM subset and refinement in categorization by matching TNM subsets based on histology and other factors can improve considerably homogeneity and enhance prognostic predictability. The development of more accurate measures for predicting prognosis may serve to clarify the roles of primary and adjuvant treatment, particularly in those patients with early-stage disease associated with poor prognostic factors in whom the potential for long-term survival is reduced.
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                Author and article information

                Journal
                Radiol Oncol
                Radiol Oncol
                RADO
                Radiology and Oncology
                Versita, Warsaw
                1318-2099
                1581-3207
                September 2013
                30 July 2013
                : 47
                : 3
                : 219-223
                Affiliations
                [1 ] Positron Emission Tomography Centre IRMET S.p.A., Euromedic inc., Turin, Italy
                [2 ] Nuclear Medicine Unit, Department of Biomedical Sciences and of the Morphological and Functional Images, University of Messina, Messina, Italy
                [3 ] Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
                [4 ] Department of Thoracic Surgery, S. Giovanni Battista Hospital, Turin, Italy
                [5 ] Department of Nuclear Medicine, La Maddalena Hospital, Palermo, Italy
                Author notes
                Correspondence to: Angelina Cistaro, MD, Positron Emission Tomography Centre IRMET S.p.A, V.O. Vigliani 89, Turin 10136, Italy. Phone: +390113160158; Fax: +390113160828; E-mail: a.cistaro@ 123456irmet.com

                Disclosure: No potential conflicts of interest were disclosed.

                Article
                rado-47-03-219
                10.2478/raon-2013-0023
                3794876
                24133385
                7d8c76f5-96fd-4e6f-a271-3e06296411d2
                Copyright © by Association of Radiology & Oncology

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 15 October 2012
                : 04 March 2013
                Categories
                Research Article

                Oncology & Radiotherapy
                2-deoxy-2-[18f]fluoro-d-glucose positron emission tomography,non-small cell lung cancer,maximum standardized uptake value,disease-free survival,overall survival

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