Detection of pseudoprogression with [ 18 F]-FDG-PET in a patient with pulmonary large cell neuroendocrine carcinoma who
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Detection of pseudoprogression with [18F]-FDG-PET in a patient with pulmonary large cell neuroendocrine carcinoma who received anti-PD-1 treatment Ou Yamaguchi 1
&
Kyoichi Kaira 1 & Kosuke Hashimoto 1 & Hiroshi Kagamu 1
Received: 30 July 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abbreviations CT Computed tomography FDG Fluorodeoxyglucose FDG-PET Fluorodeoxyglucose positron emission tomography ICI Immune checkpoint inhibitor LCNEC Large cell neuroendocrine carcinoma SUVmax Maximum standardised undervalue SUVmean Mean standardised undervalue TLG Total lesion glycolysis MTV Metabolic tumour volume ProGRP Pro-gastrin-releasing peptide
It remains unknown whether pseudoprogression-related immune checkpoint inhibitors could occur in patients with large cell neuroendocrine carcinoma (LCNEC). Moreover, little is known about the detailed information to distinguish pseudoprogression from tumour progression by [18F]-FDG-PET [1]. A 72-year-old woman with smoking history was diagnosed with stage IV LCNEC (cT3N3M1b) (Fig. 1a). Carboplatin plus etoposide was initiated as the first-line treatment. Subsequently, she was treated with amrubicin as the second-line treatment. As she experienced marked recurrence in the mediastinal lymph nodes, nivolumab was
This article is part of the Topical Collection on Oncology - Chest. * Ou Yamaguchi [email protected] 1
Department of Respiratory Medicine, Comprehensive Cancer Center, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama 350-1298, Japan
chosen as the third-line treatment. Four weeks after nivolumab administration, progressive mediastinal lymphadenopathy was observed (Fig. 1b). However, his general condition was gradually getting better without exacerbation of laboratory findings; moreover, there was a marked decrease in ProGRP. Considering the potential of pseudoprogression, nivolumab continued to be administered. Reduced [18F]-FDG accumulation and tumour shrinkage were observed 9 weeks after nivolumab treatment (Fig. 1b); therefore, a definite diagnosis of pseudoprogression was established. In this case, the degree of SUVmax and SUVmean on [18F]-FDG uptake almost did not change 4 weeks after nivolumab treatment, but that of total lesion glycolysis (TLG) and metabolic tumour volume (MTV) clearly increased. At 9 weeks after nivolumab treatment, all indices of [18F]-FDG uptake markedly decreased. Our results documented that [ 18 F]-FDG uptake by SUVmax and SUVmean did not increase despite morphological expansion, whereas metabolic tumour volume by TLG or MTV correlates with tumour diameter. As SUVmax on [18F]-FDG uptake closely correlated with tumour progression and survival in lung cancer, no increase in SUVmax or SUVmean under ICI administration may be suggestive of the potential of pseudoprogression. Our PET imaging of pseudoprogression is expected to be useful for the clinical practice of immunotherapy.
Eur J Nucl Med Mol Imaging
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