ABSTRACT
Assessing response to treatment is an important parameter in oncology practice and there is a growing body of evidence for use of F-18 fludeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) to evaluate response during or after the treatment. The use of FDG PET/CT for this indication is increasing due to its advantages such as enabling rapid evaluation of all lesions and body parts in a single session, assessing viability in residual masses, not being limited to size measurements and low inter-observer variability. Many evaluation criteria have been proposed for standardization and interpretation of PET/CT findings. This guideline aims to provide a brief overview of proposed criteria and assist Nuclear Medicine Physicians in interpreting FDG PET/CT findings for the evaluation of the response.
Keywords:
FDG PET/CT, response assessment, RECIST, PERCIST
References
1
Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-247.
2
Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009;(Suppl 1)122S-150S.
3
Joo Hyun O, Lodge MA, Wahl RL. Practical percist: A simplified guide to PET response criteria in solid tumors 1.0. Radiology 2016;280:576-584.
4
Kim JH, Park SHü, Yoon SN. Comparison of the EORTC criteria and PERCIST in solid tumors. Ann Oncol 2016;27(Suppl 6)vi100-vi102.
5
Pinker K, Riedl C, Weber WA. Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments. Eur J Nucl Med Mol Imaging 2017;44:55-66.
6
Fledelius J, Khalil A, Hjorthaug K, Frøkiær J. Inter-observer agreement improves with PERCIST 1.0 as opposed to qualitative evaluation in non-small cell lung cancer patients evaluated with F-18-FDG PET/CT early in the course of chemo-radiotherapy. EJNMMI Res 2016;6:71.
7
Morris PG, Lynch C, Feeney JN, et al. Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol 2010;28:3154-3159.
8
Thatcher N, Chang A, Parikh P, et al. Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: Results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet 2005;366:1527-1537.
9
Ding Q, Cheng X, Yang L, et al. PET/CT evaluation of response to chemotherapy in non-small cell lung cancer: PET response criteria in solid tumors (PERCIST) versus response evaluation criteria in solid tumors (RECIST). J Thorac Dis 2014;6:677-683.
10
Fendler WP, Lehmann M, Todica A, et al. PET Response Criteria in Solid Tumors predicts progression-free survival and time to local or distant progression after chemotherapy with regional hyperthermia for soft-tissue sarcoma. J Nucl Med 2015;56:530-537.
11
Yanagawa M, Tatsumi M, Miyata H, et al. Evaluation of response to neoadjuvant chemotherapy for esophageal cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors. J Nucl Med 2012;53:872-880.
12
Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999;17:1244.
13
Juweid ME, Wiseman GA, Vose JM, et al. Response assessment of aggressive non-Hodgkin’s lymphoma by integrated International Workshop Criteria and fluorine-18-fluorodeoxyglucose positron emission tomography. J Clin Oncol 2005;23:4652-4661.
14
Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma. Leuk Lymphoma 2009;50:1257-1260.
15
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of hodgkin and non-hodgkin lymphoma: the lugano classification. J Clin Oncol 2014;32:1-10.
16
Khong PL, Huang B, Lee EYP, Chan WKS, Kwong YL. Midtreatment 18F-FDG PET/CT scan for early response assessment of SMILE therapy in natural killer/T-cell lymphoma: A prospective study from a single center. J Nucl Med 2014;55:911-916.
17
Li YJ, Li ZM, Xia XY, et al. Prognostic value of interim and posttherapy 18F-FDG PET/CT in patients with mature T-cell and natural killer cell lymphomas. J Nucl Med 2013;54:507-515.
18
Biggi A, Gallamani A, Chauvie S, et al. International validation study for interim PET in ABVD-treated, advanced-stage Hodgkin lymphoma: Interpretation criteria and concordance rate among reviewers. J Nucl Med 2013;54:683-690.
19
Younes A, Hilden P, Coiffier B, et al. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017). Ann Oncol 2017;28:1436-1447.
20
Carr R, Fanti S, Paez D, et al. Prospective international cohort study demonstrates inability of interim PET to predict treatment failure in diffuse large B-cell lymphoma. J Nucl Med 2014;55:1936-1944.
21
Cheson BD, Ansell S, Schwartz L, et al. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. Blood 2016;128:2489-2497.
22
Costelloe CM, Chuang HH, Madewell JE, Ueno NT. Cancer response criteria and bone metastases: RECIST 1.1, MDA and PERCIST. J Cancer 2010;1:80-92.
23
van Vliet EI, Hermans JJ, de Ridder MA, et al. Tumor response assessment to treatment with [177Lu-DOTA0,Tyr3]octreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors: differential response of bone versus soft-tissue lesions. J Nucl Med 2012;53:1359-66.
24
Cliffe H, Patel C, Prestwich R, Scarsbrook A. Radiotherapy response evaluation using FDG PET-CT-established and emerging applications. Br J Radiol 2017;90:20160764 .
25
Helsen N, Roothans D, Van Den Heuvel B, et al. 18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy. PLoS One 2017;12:e0182350.
26
Liu HYH, Milne R, Lock G, et al. Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy. Oral Oncol 2019;88:153-159.
27
Van den Wyngaert T, Helsen N, Carp L, et al. Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography After Concurrent Chemoradiotherapy in Locally Advanced Head-and-Neck Squamous Cell Cancer: The ECLYPS Study. J Clin Oncol 2017;35:3458-3464.
28
Cremonesi M, Gilardi L, Ferrari ME, et al. Role of interim 18F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review. Eur J Nucl Med Mol Imaging 2017;44:1915-1927.
29
Cremonesi M, Garibaldi C, Timmerman R, et al. Interim 18F-FDG-PET/CT during chemo-radiotherapy in the management of oesophageal cancer patients. A systematic review. Radiother Oncol 2017;125:200-212.
30
Turgeon GA, Iravani A, Akhurst T, et al. What 18 F-FDG PET response-assessment method best predicts survival after curative-intent chemoradiation in non-small cell lung cancer: EORTC, PERCIST, Peter Mac criteria, or Deauville criteria? J Nucl Med 2019;60:328-334.
31
Wray R, Sheikhbahaei S, Marcus C, et al. Therapy response assessment and patient outcomes in head and neck squamous cell carcinoma: FDG PET hopkins criteria versus residual neck node size and morphologic features. Am J Roentgenol 2016;207:641-647.
32
Scarsbrook A, Vaidyanathan S, Chowdhury, et al. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy. Eur J Nucl Med Mol Imaging 2017;44:581-588.
33
Ronden MI, Palma D, Slotman BJ, Senan S. Brief Report on Radiological Changes following Stereotactic Ablative Radiotherapy (SABR) for Early-Stage Lung Tumors: A Pictorial Essay. J Thorac Oncol 2018;13:855-862.
34
Borcoman E, Kanjanapan Y, Champiat S, et al. Novel patterns of response under immunotherapy. Ann Oncol 2019;30:385-396.
35
Seymour L, Bogaerts J, Perrone A, et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol 2017;18:e143-e152.
36
Lee G, Bak SH, Lee HY, Choi JY, Park H. Radiomics and Imaging Genomics for Evaluation of Tumor Response. In Medical Radiology. Switzerland: Springer Cham:2020. pp. 221-238. doi:10.1007/978-3-030-31171-1_13.
37
Nishino M. Response Evaluations for Precision Cancer Therapy and Immunotherapy. In Medical Radiology. Switzerland: Springer Cham:2020. pp.15-27. doi:10.1007/978-3-030-31171-1_2.
38
Goldfarb L, Duchemann B, Chouahnia K, Zelek L, Soussan M. Monitoring anti-PD-1-based immunotherapy in non-small cell lung cancer with FDG PET: introduction of iPERCIST. EJNMMI Res 2019;9:1-10.
39
Cho SY, Lipson EJ, Im HJ, et al. Prediction of response to immune checkpoint inhibitor therapy using early-time-point 18F-FDG PET/CT imaging in patients with advanced melanoma. J Nucl Med 2017;58:1421-1428.
40
Park H, Nishino M. Drug Toxicity, Approach to Cancer as a Systemic Disease, and Imaging Modality-Specific Considerations. Therapy Response Imaging in Oncology. Springer International Publishing, 2020. doi:10.1007/978-3-030-31171-1.
41
Clark MS, Packard AT, Johnson DR, Johnson GB. Pitfalls of a mixed metabolic response at PET/CT. Radiographics 2019;39:1461-1475.
