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DIFFERENTIAL UPTAKE BETWEEN 64 Cu-ATSM AND 18 F-FDG IN CERVICAL CANCER

DIFFERENTIAL UPTAKE BETWEEN 64 Cu-ATSM AND 18 F-FDG IN CERVICAL CANCER. Albert J. Chang, MD, PhD 1 Farrokh Dehdashti , MD 2 Perry W. Grigsby, MD, MS 1 Department of Radiation Oncology 1 Department of Radiology and Nuclear Medicine 2 Washington University School of Medicine.

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DIFFERENTIAL UPTAKE BETWEEN 64 Cu-ATSM AND 18 F-FDG IN CERVICAL CANCER

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  1. DIFFERENTIAL UPTAKE BETWEEN 64Cu-ATSM AND 18F-FDG IN CERVICAL CANCER Albert J. Chang, MD, PhD1 FarrokhDehdashti, MD2 Perry W. Grigsby, MD, MS1 Department of Radiation Oncology1 Department of Radiology and Nuclear Medicine2 Washington University School of Medicine

  2. 18FDG-PET in Cervical Cancer • Standard of care for initial staging. • Prognostic factors for lymph node involvement, response to therapy, and recurrence • SUVmax • Metabolic tumor volume • Intratumoral heterogeneity

  3. Tumoral Hypoxia • Plays a significant role in tumor heterogeneity • Correlated with increased angiogenic, growth, and survival factors such as VEGFR, EGFR, and COX-2 • Associated with poor patient survival, therapeutic resistance, and aggressive tumor phenotype

  4. 64Cu-ATSM • Non-invasive agent for PET imaging of intratumoral hypoxia • Improved sensitivity and kinetics compared with prior hypoxia PET imaging agents (18F-MISO and 64Cu-PTSM) • Elevated uptake assocaited with poor response to therapy in head and neck, lung, rectal, and cervical cancer

  5. PURPOSE:To evaluate the relationship between 64Cu-ATSM and 18F-FDG intratumoral uptake in cervical cancer.

  6. METHODS • Ten patients with squamous cell carcinoma (SCC) of the cervix underwent 64Cu-ATSM and 18F-FDG PET/CT before beginning treatment. • 64Cu-ATSM and 18F-FDG images were coregistered. At the level of the tumor epicenter, metabolic tumor volumes were auto-contoured at 9 different thresholds on the 64Cu-ATSM and also on the 18F-FDG set of images: SUV 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%. • Concordance indexes (C.I.) were generated to evaluate the relationship between intratumoral distribution of 64Cu-ATSM and 18F-FDG, concordance indexes were generated. Volume of overlap from 64Cu-ATSM and 18F-FDG C.I. = Tumor Volume as determined by 40% threshold contour from 18F-FDG

  7. PATIENT CHARACTERISTICS

  8. CORRELATION OF AUTOCONTOURED VOLUMES FROM 64Cu-ATSM AND 18F-FDG IMAGES

  9. SPATIAL MISMATCH OF 64Cu-ATSM in 18F-FDG UPTAKE A B C

  10. SUMMARY • 64Cu-ATSM MTV generated by 30% SUVmax correlates well with 18F-FDG MTV generated by 40% SUVmax and may be utilized to estimate tumor volume. • Intratumoral uptake patterns of 64Cu-ATSM and 18F-FDG were discordant indicating that regions of increased hypoxia have low levels of glucose metabolism. • The differential uptake between 64Cu-ATSM and 18F-FDG within tumors may be utilized to tailor future therapies.

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