Originally published as JCO Early Release 10.1200/JCO.2008.20.8405 on January 12 2009

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Standardization of Scanning for [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography

Centre for Cancer Research and Cell Biology, Queen's University of Belfast; and Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdoma

Jonathan McAleese

Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom

Tom B. Lynch

Department of Nuclear Medicine, Belfast City Hospital, Belfast, United Kingdom

Joe M. O'Sullivan

Centre for Cancer Research and Cell Biology, Queen's University of Belfast; and Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom

To the Editor:

We congratulate the authors on their interesting and informative paper.¹ We agree with the authors in urging caution for the routine use of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG PET) as a response evaluator, and in particular, using the visual interpretation method. While we concur with Patz² that the use of diagnostic imaging for response prediction has inherent limitations, it is important that the use of functional imaging for response evaluation is undertaken under rigid conditions. The National Cancer Institute has already suggested parameters for standardization of PET when used for response assessment, such as blood glucose levels, as a patient parameter, and attenuation correction factors and time between tracer administration and image acquisition as scanning parameters.³

In the article by Tanvetyanon et al, no standardization of PET scanning was possible and a potential positive association with PET response and clinical outcome may have been missed; this is acknowledged by the authors in their discussion. In another study, Nahmias et al⁴ suggest that the timing of PET response studies in relation to therapy is important and may alter the ability of such functional imaging to predict response. The timing of such response FDG PET scans may be just one of a number of parameters that requires standardization. We would urge future studies evaluating FDG PET as an evaluator or tumor response to therapy to use standardized scanning conditions between baseline and response scans.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: None Consultant or Advisory Role: None Stock Ownership: None Honoraria: Jonathan McAleese, GE Health Care Research Funding: None Expert Testimony: None Other Remuneration: None

REFERENCES

1. Tanvetyanon T, Eikman EA, Sommers E, et al: Computed tomography response, but not positron emission tomography scan response, predicts survival after neoadjuvant chemotherapy for resectable non–small-cell lung cancer. J Clin Oncol 26:4610–4616, 2008.[Abstract/Free Full Text]

2. Patz EF: Does computed tomography or positron emission tomography response after neoadjuvant chemotherapy for resectable non–small-cell lung cancer predict survival? J Clin Oncol 26:4542–4543, 2008.[Free Full Text]

3. Shankar LK, Hoffman JM, Bacharach S, et al: Consensus recommendations for the use of 18FFDG PET as an indicator of therapeutic response in patients in National Cancer Institute trials. J Nucl Med 47:1059–1066, 2006.[Free Full Text]

4. Nahmias C, Hanna WT, Wahl LM, et al: Time course of early response to chemotherapy in non–small cell lung cancer patients with 18F-FDG PET/CT. J Nucl Med 48:744–751, 2007.[Abstract/Free Full Text]

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