Computed tomography texture analysis of response to second-line nivolumab in metastatic non-small cell lung cancer.

OBJECTIVES: Assess computed tomography texture analysis of patients likely to benefit from nivolumab. MATERIALS & METHODS: Texture analysis was used to quantify heterogeneity within the largest tumor before immunotherapy. Histogram analysis was classified as hyperdense (positive skewness) or hypodense (negative skewness) and subclassified on median standard deviation value or entropy measurement. RESULTS: 47 patients were included. At a median follow-up of 18 months, statistical significant differences in progression-free survival were observed when stratified by positive skewness with low entropy, hazard ratio: 0.43 (0.19-0.95); p = 0.036, and positive skewness with low standard deviation, hazard ratio: 0.42 (0.18-0.96); p = 0.04. CONCLUSION: Patients who derive a clinical benefit to Nivolumab show a computed tomography texture of a hyperdense yet homogenous tumor.

Concordance of 18F-FDG PET Uptake in Tumor and Normal Tissues on PET/MRI and PET/CT.

AIM: The aim of this study was to assess the concordance of PET measurements of F-FDG uptake in tumor and normal tissues obtained on Australia's first clinical PET/MRI scanner in comparison to PET/CT, with comparison against published data. METHODS: One hundred subjects were prospectively recruited from an unselected, heterogeneous group of cancer patients to undergo F-FDG PET/CT and PET/MRI on the same day. SUVs of physiological regions and tumor tissues obtained by PET/MRI and PET/CT were compared and benchmarked against existing published data. Physiological activity was measured in the thoracic aorta and right lobe of the liver. Tumor SUVs were analyzed by cancer type, body region, and a combined group of all lesions. RESULTS: There was an excellent correlation between SUV measurements in tumor lesions obtained by PET/MRI and PET/CT, across all body regions and in all tumor types studied. There was a less robust correlation for SUVs measured in areas of physiological activity, but the level of agreement still fell within 2 SDs of mean. Data from this study showed comparable or smaller systemic biases and narrower confidence limits than existing studies in the literature comparing SUVs from PET/MRI and PET/CT. CONCLUSIONS: F-FDG PET/MRI appears promising as an adjunct or alternative to PET/CT for quantitative evaluation in oncology, independent of body region and tumor type, across a wide range of SUVs.

Determinants of quality of life in patients with skull base chordoma.

OBJECT: Skull base chordomas can be managed by surgical intervention and adjuvant radiotherapy. As survival for this disease increases, identification of determinants of quality of life becomes an important focus for guiding comprehensive patient care. In this study the authors sought to measure functional outcome and quality of life in patients with skull base chordomas and to identify determinants of quality of life in these patients. METHODS: The authors carried out an internet-based cross-sectional survey, collecting detailed data for 83 individual patients. Demographic and clinical variables were evaluated. Functional outcomes were determined by Karnofsky Performance Scale (KPS) and Glasgow Outcome Scale Extended (GOSE), quality of life was measured using the 36-Item Short Form Health Survey (SF-36), and depression was assessed using Patient Health Questions-9 (PHQ-9) instrument. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Univariate and multivariate analysis was performed to identify determinants of the physical and mental components of the SF-36. RESULTS: Patients with skull base chordomas who have undergone surgery and/or radiation treatment had a median KPS score of 90 (range 10-100, IQR 10) and a median GOSE score of 8 (range 2-8, IQR 3). The mean SF-36 Physical Component Summary score (± SD) was 43.6 ± 11.8, the mean Mental Component Summary score was 44.2 ± 12.6, and both were significantly lower than norms for the general US population (p < 0.001). The median PHQ-9 score was 5 (range 0-27, IQR 8). A PHQ-9 score of 10 or greater, indicating moderate to severe depression, was observed in 29% of patients. The median ZBI score was 12 (range 0-27, IQR 11), indicating a low burden. Neurological deficit, use of pain medication, and requirement for corticosteroids were found to be associated with worse SF-36 Physical Component Summary score, while higher levels of depression (higher PHQ-9 score) correlated with worse SF-36 Mental Component Summary score. CONCLUSIONS: Patients with skull base chordomas have a lower quality of life than the general US population. The most significant determinants of quality of life in the posttreatment phase in this patient population were neurological deficits (sensory deficit and bowel/bladder dysfunction), pain medication use, corticosteroid use, and levels of depression as scored by PHQ-9.