Presentation Clinical value of FAZA-PET/CT in advanced lung cancer patients: comparison with FDG-PET/CT

Saga, Tsuneo  ,  Inubushi, Masayuki  ,  Koizumi, Mitsuru  ,  Yoshikawa, Kyosan  ,  Ming-Rong, Zhang  ,  Horiike, Atsushi  ,  Yanagitani, Noriko  ,  Ohyanagi, Fumiyoshi  ,  Nishio, Makoto

2015-09-03
Description
Objective: The presence of hypoxia in cancer tissue is known to increase not only their refractoriness to treatment, but also their malignant potential. The information of cancer hypoxia, therefore, is important for the management of cancer patients such as prediction of treatment response and the selection of appropriate treatment strategy. The aim of the present study was to evaluate the clinical value of PET/CT with FAZA, a PET probe to detect cancer hypoxia, in advanced non-small cell lung cancer patients, in comparison to FDG-PET/CT, especially on the prediction of patients’ prognosis. Methods: Thirty eight patients with advanced non-small cell lung cancer (clinical stage: stage III - 23 patients and stage IV - 15 patients; histology: squamous cell carcinoma (SCC) - 11 patients, adenocarcinoma (Adeno) - 19 patients, large cell carcinoma (LC) - 8 patients) received FAZA- and FDG-PET/CT before treatment. Patients were followed to determine the treatment response and survival. Uptake parameters of FAZA (tumor-muscle ratio at 2h (T/M)) and FDG (SUVmax at 1h (SUV)) in primary lesion and lymph node (LN) metastasis were compared with various clinical parameters (histology, clinical stage, etc.). Progression-free survival (PFS) periods and overall survival (OS) periods were compared with various clinical and FAZA/FDG uptake parameters. Kaplan-Meier analyses with Log Rank test were performed for all (stage III + IV) patients and for stage III (IIIA + IIIB) patients. Study protocol was approved by the institutional review board, and informed consent was obtained from all patients. Results: There was a weak correlation between FAZA T/M and FDG SUV of primary lesion (p = 0.040), but intra-tumoral distribution patterns of FAZA and FDG for individual patients were not identical for three histological subtypes, SCC, Adeno and LC. There was a significant difference in FAZA T/M among histological subtypes (p = 0.036). As for the prognosis, clinical stage (stage IV vs. III, p = 0.017; stage IIIA vs. IIIB, p = 0.046) and FAZA T/M in LN metastasis (> 1.800 vs. </= 1.800, p = 0.007 in stage III + IV patients; > 1.800 vs. </= 1.800, p = 0.018 in stage IIIA + IIIB patients) were significant predictors of PFS, while other parameters including FDG uptake parameters were not. Cox’s proportional hazard analysis had shown that clinical stage (stage IV vs. III, p = 0.002, HR = 4.610, stage IIIA vs. IIIB, p = 0.024, HR = 3.595) and FAZA T/M in LN metastasis (> 1.800 vs. </= 1.800, p < 0.001, HR = 5.985 in stage III + IV, p = 0.009, HR = 6.338 in stage IIIA + IIIB patients) were significant predictor of PFS. For OS, FAZA T/M in LN metastasis was an only significant predictor in stage IIIA + IIIB patients (> 1.800 vs. </= 1.800, p = 0.034). No significant predictor of OS was detected in stage III + IV patients. Conclusion: FAZA T/M in LN metastasis was a strong predictor of survival of advanced lung cancer patients. PET/CT with FAZA is expected to afford useful information on the management of lung cancer patients.
2015 World Molecular Imaging Congress (WMIC)

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