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Novruzov E, Mori Y, Antke C, Dabir M, Schmitt D, Kratochwil C, Koerber SA, Haberkorn U, Giesel FL. A Role of Non-FDG Tracers in Lung Cancer? Semin Nucl Med 2022; 52:720-733. [PMID: 35803770 DOI: 10.1053/j.semnuclmed.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022]
Abstract
Since the introduction of PET/CT hybrid imaging about two decades ago the landscape of oncological imaging has fundamentally changed, opening a new era of molecular imaging with emphasis on functional characterization of biological processes such as metabolism, cellular proliferation, hypoxia, apoptosis, angiogenesis and immune response. The most commonly assessed functional hallmark of cancer is the increased metabolism in tumor cells due to well-known Warburg effect, because of which FDG has been the most employed radiotracer, the so-called pan-cancer agent, in oncological imaging. However, several limitations such as low specificity and low sensitivity for several histopathological forms of lung cancer as well as high background uptake in the normal tissue of FDG imaging lead to numerous serious pitfalls. This restricts its utilization and diagnostic value in lung cancer imaging, even though this is currently considered to be the method of choice in pulmonary cancer imaging. Accurate initial tumor staging and therapy response monitoring with respect to the TNM criteria plays a crucial role in therapy planning and management in patients with lung cancer. To this end, many efforts have been made for decades to develop novel PET radiopharmaceuticals with innovative approaches that go beyond the assessment of increased glycolytic activity alone. Radiopharmaceuticals targeting DNA synthesis, amino acid metabolism, angiogenesis, or hypoxia have been extensively studied, leading to the emergence of indications for specific clinical questions or as a complementary imaging tool alongside existing conventional or FDG imaging. Nevertheless, despite some initial encouraging results, these tracers couldn't gain a widespread use and acceptance in clinical routine. However, given its mechanism of action and some initial pilot studies regarding lung cancer imaging, FAPI has emerged as a very promising alternative tool that could provide superior or comparable diagnostic performance to FDG imaging in lung cancer entities. Thus, in this review article, we summarized the current PET radiopharmaceuticals, different imaging approaches and discussed the potential benefits and clinical applications of these agents in lung cancer imaging.
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Affiliation(s)
- Emil Novruzov
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Yuriko Mori
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Christina Antke
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Mardjan Dabir
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Dominik Schmitt
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Dusseldorf, Dusseldorf, Germany.
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Nishii R, Saga T, Sudo H, Togawa T, Kuyama J, Tani T, Maeda T, Kobayashi M, Iizasa T, Shingyoji M, Itami M, Kawamura K, Hashimoto H, Yamazaki K, Tamura K, Higashi T. Clinical value of PET/CT with carbon-11 4DST in the evaluation of malignant and benign lung tumors. Ann Nucl Med 2021; 35:211-222. [PMID: 33387282 DOI: 10.1007/s12149-020-01554-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/13/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to assess the clinical value of [11C]4DST uptake in patients with lung nodules, including benign and malignant tumors, and to assess the correlation between [11C]4DST uptake and proliferative activity of tumors in comparison with [18F]FDG uptake. METHODS Twenty-six patients (22 males and 4 females, mean age of 65.5-year-old) were analyzed in this prospective study. Patients underwent [11C]4DST and [18F]FDG PET/CT imaging on the same day. Diagnosis of each lung nodule was confirmed by histopathological examination of tissue specimens at surgery, or during clinical follow-up after the PET/CT studies. To assess the utility of the semi-quantitative evaluation method, the SUVmax was calculated of [11C]4DST and [18F]FDG uptake by the lesion. Proliferative activities of each tumor as indicated by the immunohistochemical Ki-67 index was also estimated using surgical specimens of patients. Then the relationship between the SUVmax of both PET/CT and the Ki-67 index was examined. Furthermore, the relationship between the uptake of [11C]4DST or [18F]FDG and the histopathological findings, the clinical stage, and the clinical outcome of patients were also assessed. RESULTS There was a positive linear relationship between the SUVmax of [11C]4DST images and the Ki-67 index (Correlation coefficients = 0.68). The SUVmax of [11C]4DST in the 26 lung nodules were 1.65 ± 0.40 for benign lesions, 3.09 ± 0.83 for adenocarcinomas (P < 0.001 between benign and adenocarcinoma), and 2.92 ± 0.58 for SqCCs (P < 0.001 between benign and SqCC). Whereas, the SUVmax of [18F]FDG were 2.38 ± 2.27 for benign lesions, 6.63 ± 4.24 for adenocarcinomas (n.s.), and 7.52 ± 2.84 for SqCCs (n.s.). The relationship between TNM tumor stage and the SUVmax of [11C]4DST were 2.54 ± 0.37 for T1, 3.48 ± 0.57 for T2, and 4.17 ± 0.72 for T3 (P < 0.005 between T1 and T2, and P < 0.001 between T1 and T3). In comparison with the TNM pathological stage, SUVmax of [11C]4DST were 2.63 ± 0.49 for stage I, 3.36 ± 0.23 for stage II, 3.40 ± 1.12 for stage III, and 4.65 for stage IV (P < 0.05 between stages I and II). In comparison of the clinical outcome, the SUVmax of [11C]4DST were 2.72 ± 0.56 for the no recurrence (No Rec.) group, 3.10 ± 0.33 for the recurrence-free with adjuvant chemotherapy after the surgery (the No Rec. Adjv. CTx. group) and 4.66 ± 0.02 for the recurrence group (Rec. group) (P < 0.001 between the No Rec and Rec. groups, and P < 0.005 between the No Rec. Adjv. CTx. and Rec. groups). CONCLUSIONS PET/CT with [11C]4DST is as feasible for imaging of lung tumors as [18F]FDG PET/CT. For diagnosing lung tumors, [11C]4DST PET is useful in distinguishing benign nodules from malignancies. [11C]4DST uptake in lung carcinomas is correlated with the proliferative activity of tumors, indicating a promising noninvasive PET imaging of DNA synthesis in malignant lung tumors.
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Affiliation(s)
- Ryuichi Nishii
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan.
| | - Tsuneo Saga
- Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, 54 ShogoinKawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Hitomi Sudo
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Takashi Togawa
- Department of Nuclear Medicine, Cancer Institute Hospital for JFCR, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Junpei Kuyama
- Chiba Cancer Center, 666-2 Nitona-cho Chuo-ku, Chiba, Chiba, 260-8717, Japan
| | - Toshiaki Tani
- Radiological Technology Section, QST Hospital, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Takamasa Maeda
- Radiological Technology Section, QST Hospital, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Masato Kobayashi
- School of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Toshihiko Iizasa
- Chiba Cancer Center, 666-2 Nitona-cho Chuo-ku, Chiba, Chiba, 260-8717, Japan
| | - Masato Shingyoji
- Chiba Cancer Center, 666-2 Nitona-cho Chuo-ku, Chiba, Chiba, 260-8717, Japan
| | - Makiko Itami
- Chiba Cancer Center, 666-2 Nitona-cho Chuo-ku, Chiba, Chiba, 260-8717, Japan
| | - Kazunori Kawamura
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Hiroki Hashimoto
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Kana Yamazaki
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Kentaro Tamura
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan
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Chassagnon G, Martini K, Giraud P, Revel MP. Radiological assessment after stereotactic body radiation of lung tumours. Cancer Radiother 2020; 24:379-387. [PMID: 32534799 DOI: 10.1016/j.canrad.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
The increasing use of stereotactic body radiation therapy for lung tumours comes along with new post-therapeutic imaging findings that should be known by physicians involved in patient follow-up. Radiation-induced lung injury is much more frequent than after conventional radiation therapy, it can also be delayed and has a different radiological presentation. Radiation-induced lung injury after stereotactic body radiation therapy involves the lung parenchyma surrounding the target tumour and appears as a dynamic process continuing for years after completion of the treatment. Thus, the radiological pattern and the severity of radiation-induced lung injury are prone to changes during follow-up, which can make it difficult to differentiate from local recurrence. Contrary to radiation-induced lung injury, local recurrence after stereotactic body radiation therapy is rare. Other complications mainly depend on tumour location and include airway complications, rib fractures and organizing pneumonia. The aim of this article is to provide a wide overview of radiological changes occurring after SBRT for lung tumours. Awareness of changes following stereotactic body radiation therapy should help avoiding unnecessary interventions for pseudo tumoral presentations.
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Affiliation(s)
- G Chassagnon
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - K Martini
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Giraud
- Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, centre université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Ding M, Zollinger W, Ebeling R, Heard D, Posey R. Using max standardized uptake value from positron emission tomography to assess tumor responses after lung stereotactic body radiotherapy for different prescriptions. J Appl Clin Med Phys 2018; 19:226-233. [PMID: 30216639 PMCID: PMC6236840 DOI: 10.1002/acm2.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To retrospectively investigate tumor responses of lung SBRT patients for different prescriptions. To analyze the relation between optimal biologically equivalent dose (BED) and tumor responses. METHODS AND MATERIALS Tumor responses after lung SBRT were compared by examining 48 treatments used four prescriptions. This study used simplified tumor response criteria: (a) Complete Response (CR) - post max SUV (SUVpost ) after SBRT in the treated tumor region was almost the same as the SUVs in the surrounding regions; (b) Partial Response (PR) - SUVpost was smaller than previous max SUV (SUVpre ), but was greater than the SUVs in the surrounding regions; (c) No Response (NR) - SUVpost was the same as or greater than SUVpre . Some SUVpost reported as mild or favorable responses were classified as CR/PR. BED calculated using α/β of 10 Gy were analyzed with assessments of tumor responses for SBRT prescriptions. RESULTS For the prescriptions (9 Gy × 5, 10 Gy × 5, 11 Gy × 5, and 12 Gy × 4) historically recommended by RTOG, we observed that higher BED10 and lower tumor volume would achieve a higher complete response rate. The highest complete response rate was observed for smallest tumor volume (PTVave = 6.8 cc) with higher BED10 (105.6) of 12 Gy × 4 prescription. For 11 Gy × 5 prescription, the BED10 (115.5) was the highest, but its complete response rate (58%) was lower than 79% of 12 Gy × 4 prescription. We observed the PTVave of 11 Gy × 5 prescription was more than double of the PTVave of 12 Gy × 4 prescription. For the same lung SBRT prescription (BED10 > 100) earlier staging tumor had more favorable local control. CONCLUSION We demonstrated post max SUV read from PET/CT could efficiently and accurately assess tumor response after lung SBRT. Although SBRT with prescriptions resulting in a BED10 > 100 experienced favorable tumor responses for early staging cancer, escalation of BED10 to higher levels would be beneficial for lung cancer patients with later staging and larger volume tumors.
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Affiliation(s)
- Meisong Ding
- Department of Radiation OncologyTulane University Medical CenterNew OrleansLAUSA
| | | | | | - David Heard
- Northeast Louisiana Cancer CenterMonroeLAUSA
| | - Ryan Posey
- Northeast Louisiana Cancer CenterMonroeLAUSA
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Ellis S, Reader AJ. Penalized maximum likelihood simultaneous longitudinal PET image reconstruction with difference-image priors. Med Phys 2018; 45:3001-3018. [PMID: 29697144 DOI: 10.1002/mp.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/27/2018] [Accepted: 04/12/2018] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Many clinical contexts require the acquisition of multiple positron emission tomography (PET) scans of a single subject, for example, to observe and quantitate changes in functional behaviour in tumors after treatment in oncology. Typically, the datasets from each of these scans are reconstructed individually, without exploiting the similarities between them. We have recently shown that sharing information between longitudinal PET datasets by penalizing voxel-wise differences during image reconstruction can improve reconstructed images by reducing background noise and increasing the contrast-to-noise ratio of high-activity lesions. Here, we present two additional novel longitudinal difference-image priors and evaluate their performance using two-dimesional (2D) simulation studies and a three-dimensional (3D) real dataset case study. METHODS We have previously proposed a simultaneous difference-image-based penalized maximum likelihood (PML) longitudinal image reconstruction method that encourages sparse difference images (DS-PML), and in this work we propose two further novel prior terms. The priors are designed to encourage longitudinal images with corresponding differences which have (a) low entropy (DE-PML), and (b) high sparsity in their spatial gradients (DTV-PML). These two new priors and the originally proposed longitudinal prior were applied to 2D-simulated treatment response [18 F]fluorodeoxyglucose (FDG) brain tumor datasets and compared to standard maximum likelihood expectation-maximization (MLEM) reconstructions. These 2D simulation studies explored the effects of penalty strengths, tumor behaviour, and interscan coupling on reconstructed images. Finally, a real two-scan longitudinal data series acquired from a head and neck cancer patient was reconstructed with the proposed methods and the results compared to standard reconstruction methods. RESULTS Using any of the three priors with an appropriate penalty strength produced images with noise levels equivalent to those seen when using standard reconstructions with increased counts levels. In tumor regions, each method produces subtly different results in terms of preservation of tumor quantitation and reconstruction root mean-squared error (RMSE). In particular, in the two-scan simulations, the DE-PML method produced tumor means in close agreement with MLEM reconstructions, while the DTV-PML method produced the lowest errors due to noise reduction within the tumor. Across a range of tumor responses and different numbers of scans, similar results were observed, with DTV-PML producing the lowest errors of the three priors and DE-PML producing the lowest bias. Similar improvements were observed in the reconstructions of the real longitudinal datasets, although imperfect alignment of the two PET images resulted in additional changes in the difference image that affected the performance of the proposed methods. CONCLUSION Reconstruction of longitudinal datasets by penalizing difference images between pairs of scans from a data series allows for noise reduction in all reconstructed images. An appropriate choice of penalty term and penalty strength allows for this noise reduction to be achieved while maintaining reconstruction performance in regions of change, either in terms of quantitation of mean intensity via DE-PML, or in terms of tumor RMSE via DTV-PML. Overall, improving the image quality of longitudinal datasets via simultaneous reconstruction has the potential to improve upon currently used methods, allow dose reduction, or reduce scan time while maintaining image quality at current levels.
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Affiliation(s)
- Sam Ellis
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, SE1 7EH, UK
| | - Andrew J Reader
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, SE1 7EH, UK
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Pierson C, Grinchak T, Sokolovic C, Holland B, Parent T, Bowling M, Arastu H, Walker P, Ju A. Response criteria in solid tumors (PERCIST/RECIST) and SUV max in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy. Radiat Oncol 2018; 13:34. [PMID: 29486779 PMCID: PMC5830069 DOI: 10.1186/s13014-018-0980-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to evaluate the prognostic impact of Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) and Response Evaluation Criteria in Solid Tumors (RECIST) and of pre- and post-treatment maximum Standard Uptake Value (SUVmax) in regards to survival and tumor control for patients treated for early-stage non-small cell lung cancer (ES-NSCLC) with stereotactic body radiotherapy (SBRT). Methods This is a retrospective review of patients with ES-NSCLC treated at our institution using SBRT. Lobar, locoregional, and distant failures were evaluated based on PERCIST/RECIST and clinical course. Univariate analysis of the Kaplan-Meier curves for overall survival (OS), progression free survival (PFS), lobar control (LC), locoregional control (LRC), and distant control (DC) was conducted using the log-rank test. Pre- and post-treatment SUVmax were evaluated using cutoffs of < 5 and ≥ 5, < 4 and ≥ 4, and < 3 and ≥ 3. ∆SUVmax was also evaluated at various cutoffs. Cox regression analysis was conducted to evaluate survival outcomes based on age, gender, pre-treatment gross tumor volume (GTV), longest tumor dimension on imaging, and Charlson Comorbidity Index (CCI). Results This study included 95 patients (53 female, 42 male), median age 75. Lung SBRT was delivered in 3–5 fractions to a total of 48–60 Gy, with a BEDα/β = 10Gy of at least 100 Gy. Median OS and PFS from the end of SBRT was 15.4 and 11.9 months, respectively. On univariate analysis, PERCIST/RECIST response correlated with PFS (p = 0.039), LC (p = 0.007), and LRC (p = 0.015) but not OS (p = 0.21) or DC (p = 0.94). Pre-treatment SUVmax and post-treatment SUVmax with cutoff values of < 5 and ≥ 5, < 4 and ≥ 4, and < 3 and ≥ 3 did not predict for OS, PFS, LC, LRC, or DC. ∆SUVmax did not predict for OS, PFS, LC, LRC, or DC. On multivariate analysis, pre-treatment GTV ≥ 30 cm3 was significantly associated with worse survival outcomes when accounting for other confounding variables. Conclusions PERCIST/RECIST response is associated with improved LC and PFS in patients treated for ES-NSCLC with SBRT. In contrast, pre- and post-treatment SUVmax is not predictive of disease control or survival.
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Affiliation(s)
- Cory Pierson
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Taras Grinchak
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | | | - Brandi Holland
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Teresa Parent
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mark Bowling
- Department of Internal Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Hyder Arastu
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Paul Walker
- Department of Internal Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Andrew Ju
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA.
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Challapalli A, Aboagye EO. Positron Emission Tomography Imaging of Tumor Cell Metabolism and Application to Therapy Response Monitoring. Front Oncol 2016; 6:44. [PMID: 26973812 PMCID: PMC4770188 DOI: 10.3389/fonc.2016.00044] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/12/2022] Open
Abstract
Cancer cells do reprogram their energy metabolism to enable several functions, such as generation of biomass including membrane biosynthesis, and overcoming bioenergetic and redox stress. In this article, we review both established and evolving radioprobes developed in association with positron emission tomography (PET) to detect tumor cell metabolism and effect of treatment. Measurement of enhanced tumor cell glycolysis using 2-deoxy-2-[(18)F]fluoro-D-glucose is well established in the clinic. Analogs of choline, including [(11)C]choline and various fluorinated derivatives are being tested in several cancer types clinically with PET. In addition to these, there is an evolving array of metabolic tracers for measuring intracellular transport of glutamine and other amino acids or for measuring glycogenesis, as well as probes used as surrogates for fatty acid synthesis or precursors for fatty acid oxidation. In addition to providing us with opportunities for examining the complex regulation of reprogramed energy metabolism in living subjects, the PET methods open up opportunities for monitoring pharmacological activity of new therapies that directly or indirectly inhibit tumor cell metabolism.
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Affiliation(s)
| | - Eric O. Aboagye
- Department of Surgery and Cancer, Imperial College London, London, UK
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[Positron emission tomography and stereotactic body radiation therapy for lung cancer: From treatment planning to response evaluation]. Cancer Radiother 2015; 19:790-4; quiz 795-9. [PMID: 26476702 DOI: 10.1016/j.canrad.2015.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/01/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022]
Abstract
Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.
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Siva S, Callahan JW, Kron T, Chesson B, Barnett SA, Macmanus MP, Hicks RJ, Ball DL. Respiratory-gated (4D) FDG-PET detects tumour and normal lung response after stereotactic radiotherapy for pulmonary metastases. Acta Oncol 2015; 54:1105-12. [PMID: 25833329 DOI: 10.3109/0284186x.2015.1027409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Response assessment after stereotactic ablative body radiotherapy (SABR) in lung can be confounded by radiation-induced inflammation, fibrosis and subsequent alteration of tumour motion. The purpose of this prospective pilot study was to evaluate the utility of four-dimensional (4D) FDG-PET/CT for post-SABR tumour and normal lung response assessment in pulmonary oligometastases. MATERIAL AND METHODS Patients enrolled from February 2010 to December 2011 in this prospective ethics approved study had 1-2 pulmonary metastases on staging FDG-PET. Serial contemporaneous 3D and 4D FDG-PET/CT scans were performed at baseline, 14 days and 70 days after a single fraction of 26 Gy SABR. Tumour response was evaluated in 3D and 4D using SUVmax, RECIST and PERCIST criteria. Normal lung radiotoxicity was evaluated using SUVmean within 0-2 Gy, 2-5 Gy, 5-10 Gy, 10-20 Gy and 20 + Gy isodose volumes. RESULTS In total, 17 patients were enrolled of which seven were ineligible due to interval progression from staging PET to baseline 4D-PET. The mean time between scans was 62 days. At a median follow-up of 16 months, 10 patients with 13 metastases received SABR, with no patient having local progression. The vector of tumour motion was larger in patients with discordant 3D and 4D PET PERCIST response (p < 0.01), with a mean (± SEM) motion of 10.5 mm (± 0.96 mm) versus 6.14 mm (± 0.81 mm) in those patients with concordant 3D and 4D response. Surrounding normal lung FDG uptake at 70 days was strongly correlated to delivered radiation dose (r(2) = 0.99, p < 0.01), with significant elevations across all dose levels (p ≤ 0.05), except the < 2 Gy volume (p = 0.30). CONCLUSIONS We demonstrate high rates of interval progression between staging PET scans in patients with oligometastases. We found that tumour response on conventional 3D PET is not concordant with 4D PET for tumours with large motion. Normal lung metabolic uptake is strongly dose dependent after SABR, a novel finding that should be further validated.
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Affiliation(s)
- Shankar Siva
- a Sir Peter MacCallum Department of Oncology , The University of Melbourne , Parkville, Victoria , Australia
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Santyr G, Fox M, Thind K, Hegarty E, Ouriadov A, Jensen M, Scholl TJ, Van Dyk J, Wong E. Anatomical, functional and metabolic imaging of radiation-induced lung injury using hyperpolarized MRI. NMR IN BIOMEDICINE 2014; 27:1515-1524. [PMID: 25156928 DOI: 10.1002/nbm.3180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
MRI of hyperpolarized (129)Xe gas and (13)C-enriched substrates (e.g. pyruvate) presents an unprecedented opportunity to map anatomical, functional and metabolic changes associated with lung injury. In particular, inhaled hyperpolarized (129)Xe gas is exquisitely sensitive to changes in alveolar microanatomy and function accompanying lung inflammation through decreases in the apparent diffusion coefficient (ADC) of alveolar gas and increases in the transfer time (T(tr)) of xenon exchange from the gas and into the dissolved phase in the lung. Furthermore, metabolic changes associated with hypoxia arising from lung injury may be reflected by increases in lactate-to-pyruvate signal ratio obtained by magnetic resonance spectroscopic imaging following injection of hyperpolarized [1-(13)C]pyruvate. In this work, the application of hyperpolarized (129)Xe and (13)C MRI to radiation-induced lung injury (RILI) is reviewed and results of ADC, T(tr) and lactate-to-pyruvate signal ratio changes in a rat model of RILI are summarized. These results are consistent with conventional functional (i.e. blood gases) and histological (i.e. tissue density) changes, and correlate significantly with inflammatory cell counts (i.e. macrophages). Hyperpolarized MRI may provide an earlier indication of lung injury associated with radiotherapy of thoracic tumors, potentially allowing adjustment of treatment before the onset of severe complications and irreversible fibrosis.
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Affiliation(s)
- Giles Santyr
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Mattonen SA, Palma DA, Haasbeek CJA, Senan S, Ward AD. Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer. Med Phys 2014; 41:033502. [PMID: 24593744 DOI: 10.1118/1.4866219] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. METHODS A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). RESULTS For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months post-treatment were binned based on their recorded scan dates into 2-5 month and 5-8 month follow-up time ranges. At 2-5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79-0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%-77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively. CONCLUSIONS Texture measures of the GGO appearance following SABR demonstrated the ability to predict recurrence in individual patients within 5 months of SABR treatment. Appearance changes were also shown to be more accurately predictive of recurrence, as compared to size measures within the same time period. With further validation, these results could form the substrate for a clinically useful computer-aided diagnosis tool which could provide earlier salvage of patients with recurrence.
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Affiliation(s)
- Sarah A Mattonen
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - David A Palma
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Oncology, The University of Western Ontario, London, Ontario N6A 4L6, Canada; and Division of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Aaron D Ward
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada and Department of Oncology, The University of Western Ontario, London, Ontario N6A 4L6, Canada
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12
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Evaluation of the bubble point test of a 0.22-μm membrane filter used for the sterilizing filtration of PET radiopharmaceuticals. Ann Nucl Med 2014; 28:586-92. [DOI: 10.1007/s12149-014-0830-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/19/2014] [Indexed: 12/17/2022]
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13
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Lo SS, Teh BS, Wang JZ, Huang Z, Zook J, Price T, Mayr NA, Grecula JC, Timmerman RD, Cardenes HR. Imaging changes after stereotactic body radiation therapy for lung and liver tumors. Expert Rev Anticancer Ther 2014; 11:613-20. [PMID: 21504327 DOI: 10.1586/era.10.164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simon S Lo
- Department of Radiation Oncology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Lerner Tower B181, Cleveland, OH 44106, USA.
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14
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Nakamoto Y, Kurihara K, Nishizawa M, Yamashita K, Nakatani K, Kondo T, Takaori-Kondo A, Togashi K. Clinical value of ¹¹C-methionine PET/CT in patients with plasma cell malignancy: comparison with ¹⁸F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2013; 40:708-15. [PMID: 23340595 DOI: 10.1007/s00259-012-2333-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 12/21/2012] [Indexed: 01/24/2023]
Abstract
PURPOSE PET/CT using FDG has been widely used for the imaging of various malignant tumours, including plasma cell malignancy (PCM), but (11)C-methionine (MET), as a radiolabelled amino acid tracer, may also be useful because PCM is able to activate protein synthesis. The purpose of this study was to evaluate the clinical value of PET/CT imaging using MET in PCM, including multiple myeloma, compared with that of FDG PET/CT. METHODS The study group comprised 20 patients with histologically proven PCM who underwent FDG PET/CT and MET PET/CT scans before (n = 6) or after (n = 14) treatment. Semiquantitative analysis was performed on a lesion basis. We also visually evaluated the scans qualitatively using a five-point scale (0, negative; 1, probably negative; 2, equivocal; 3, probably positive; 4, positive) on a lesion and a patient basis. The results were compared between the two scans. RESULTS Active PCM was confirmed in 15 patients, including two patients with extramedullary lesions. Uptake of MET tended to be higher (maximum standardized uptake value 10.3 ± 5.6, mean ± SD) than that of FDG (3.4 ± 2.7, p < 0.001), and more lesions of grade 3 or 4 were depicted by MET (MET 156 lesions vs. FDG 58 lesions). On a patient basis, two patients were accurately diagnosed only by MET. In the remaining 18 patients, consistent results were obtained, but potential upgrade of staging or restaging was necessary in 6 of 11 positive patients because more abnormal lesions were demonstrated by MET. The patient-based sensitivity, specificity and accuracy of MET for restaging were 89 %, 100 % and 93 %, respectively, while those of FDG were 78 %, 100 % and 86 %, respectively. CONCLUSION MET revealed an equal or greater number of lesions in PCM than FDG. MET may be especially useful when negative or inconclusive findings are obtained by FDG despite highly suspicious indications of recurrence.
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Affiliation(s)
- Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto 606-8507, Japan.
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15
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Singhvi M, Lee P. Illustrative cases of false positive biopsies after stereotactic body radiation therapy for lung cancer based on abnormal FDG-PET-CT imaging. BMJ Case Rep 2013; 2013:bcr2012007967. [PMID: 23345491 PMCID: PMC3604475 DOI: 10.1136/bcr-2012-007967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) for early stage lung cancer has made significant strides as an alternative to surgery.1 We present two cases of non-small cell lung cancer treated with SBRT and then followed serially with imaging in which suspicion of recurrence led to biopsies.
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Affiliation(s)
- Mamta Singhvi
- Department of Radiation Oncology, 200 UCLA Medical Plaza, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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16
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Solanki AA, Weichselbaum RR, Appelbaum D, Farrey K, Yenice KM, Chmura SJ, Salama JK. The utility of FDG-PET for assessing outcomes in oligometastatic cancer patients treated with stereotactic body radiotherapy: a cohort study. Radiat Oncol 2012; 7:216. [PMID: 23244066 PMCID: PMC3551831 DOI: 10.1186/1748-717x-7-216] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/08/2012] [Indexed: 12/13/2022] Open
Abstract
Background Studies suggest that patients with metastases limited in number and destination organ benefit from metastasis-directed therapy. Stereotactic body radiotherapy (SBRT) is commonly used for metastasis directed therapy in this group. However, the characterization of PET response following SBRT is unknown in this population. We analyzed our cohort of patients to describe the PET response following SBRT. Methods Patients enrolled on a prospective dose escalation trial of SBRT to all known sites of metastatic disease were reviewed to select patients with pre- and post-therapy PET scans. Response to SBRT was characterized on PET imaging based on standard PET response criteria and compared to CT based RECIST criteria for each treated lesion. Results 31 patients had PET and CT data available before and after treatment for analysis in this study. In total, 58 lesions were treated (19 lung, 11 osseous, 11 nodal, 9 liver, 6 adrenal and 2 soft tissue metastases). Median follow-up was 14 months (range: 3–41). Median time to first post-therapy PET was 1.2 months (range; 0.5-4.1). On initial post-therapy PET evaluation, 96% (56/58) of treated metastases responded to therapy. 60% (35/58) had a complete response (CR) on PET and 36% (21/58) had a partial response (PR). Of 22 patients with stable disease (SD) on initial CT scan, 13 had CR on PET, 8 had PR, and one had SD. Of 21 metastases with PET PR, 38% became CR, 52% remained PR, and 10% had progressive disease on follow-up PET. 10/35 lesions (29%) with an initial PET CR progressed on follow-up PET scan with median time to progression of 4.11 months (range: 2.75-9.56). Higher radiation dose correlated with long-term PET response. Conclusions PET response to SBRT enables characterization of metastatic response in tumors non-measurable by CT. Increasing radiation dose is associated with prolonged complete response on PET.
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Affiliation(s)
- Abhishek A Solanki
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 South Maryland Ave., MC 9006, Chicago IL 60637, US
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Abelson JA, Murphy JD, Trakul N, Bazan JG, Maxim PG, Graves EE, Quon A, Le QT, Diehn M, Loo BW. Metabolic imaging metrics correlate with survival in early stage lung cancer treated with stereotactic ablative radiotherapy. Lung Cancer 2012; 78:219-24. [PMID: 23009727 DOI: 10.1016/j.lungcan.2012.08.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/14/2012] [Accepted: 08/27/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To test whether (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) imaging metrics correlate with outcomes in patients with stage I non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR). MATERIAL AND METHODS Fifty-four patients with stage I NSCLC underwent pre-SABR PET at simulation and/or post-SABR PET within 6 months. We analyzed maximum standardized uptake value (SUV(max)) and metabolic tumor volume defined using several thresholds (MTV50%, or MTV2, 4, 7, and 10). Endpoints included primary tumor control (PTC), progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS). We performed Kaplan-Meier, competing risk, and Cox proportional hazards survival analyses. RESULTS Patients received 25-60 Gy in 1 to 5 fractions. Median follow-up time was 13.2 months. The 1-year estimated PTC, PFS, OS and CSS were 100, 83, 87 and 94%, respectively. Pre-treatment SUV(max) (p=0.014), MTV(7) (p=0.0077), and MTV(10) (p=0.0039) correlated significantly with OS. In the low-MTV(7)vs. high-MTV(7) sub-groups, 1-year estimated OS was 100 vs. 78% (p=0.0077) and CSS was 100 vs. 88% (p=0.082). CONCLUSIONS In this hypothesis-generating study we identified multiple pre-treatment PET-CT metrics as potential predictors of OS and CSS in patients with NSCLC treated with SABR. These could aid risk-stratification and treatment individualization if validated prospectively.
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Affiliation(s)
- Jonathan A Abelson
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA 94305, USA
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18
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Radiation-induced myositis mimicking chest wall tumor invasion in two patients with lung cancer: a PET/CT study. Clin Nucl Med 2012; 37:168-9. [PMID: 22228342 DOI: 10.1097/rlu.0b013e3181d6249f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two patients with lung cancer who had undergone stereotactic body radiation therapy (SBRT) exhibited increased F-18 FDG uptake in the chest wall after 6 months and 18 months, respectively, after SBRT. The prescribed dose of 50 Gy to the planning target volume was delivered on 4 consecutive days in each patient. It is important for nuclear medicine physicians to be familiar with F-18 FDG PET/CT findings ascribed to radiation-induced myositis in lung cancer patients treated with SBRT so that an appropriate differential diagnosis can be established.
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19
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Zhu A, Marcus DM, Shu HKG, Shim H. Application of metabolic PET imaging in radiation oncology. Radiat Res 2012; 177:436-48. [PMID: 22339451 DOI: 10.1667/rr2702.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides functional or metabolic assessment of normal tissue or disease conditions and is playing an increasing role in cancer radiotherapy planning. (18)F-Fluorodeoxyglucose PET imaging (FDG-PET) is widely used in the clinic for tumor imaging due to increased glucose metabolism in most types of tumors; its role in radiotherapy management of various cancers is reviewed. In addition, other metabolic PET imaging agents at various stages of preclinical and clinical development are reviewed. These agents include radiolabeled amino acids such as methionine for detecting increased protein synthesis, radiolabeled choline for detecting increased membrane lipid synthesis, and radiolabeled acetate for detecting increased cytoplasmic lipid synthesis. The amino acid analogs choline and acetate are often more specific to tumor cells than FDG, so they may play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with either low FDG uptake or high background FDG uptake. PET imaging with FDG and other metabolic PET imaging agents is playing an increasing role in complementary radiotherapy planning.
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Affiliation(s)
- Aizhi Zhu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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20
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Huang K, Dahele M, Senan S, Guckenberger M, Rodrigues GB, Ward A, Boldt RG, Palma DA. Radiographic changes after lung stereotactic ablative radiotherapy (SABR)--can we distinguish recurrence from fibrosis? A systematic review of the literature. Radiother Oncol 2012; 102:335-42. [PMID: 22305958 DOI: 10.1016/j.radonc.2011.12.018] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/15/2011] [Accepted: 12/23/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Changes in lung density on computed tomography (CT) are common after stereotactic ablative radiotherapy (SABR) and can confound the early detection of recurrence. We performed a systematic review to describe post-SABR findings on computed tomography (CT) and positron-emission tomography (PET), identify imaging characteristics that predict recurrence and propose a follow-up imaging algorithm. METHODS A systematic review was conducted of studies providing detailed radiologic descriptions of anatomic and metabolic lung changes after SABR. Our search returned 824 studies; 26 met our inclusion criteria. Data are presented according to PRISMA guidelines. RESULTS Acute changes post-SABR predominantly appear as consolidation or ground glass opacities. Late changes often demonstrate a modified conventional pattern of fibrosis, evolving beyond 2years after treatment. Several CT features, including an enlarging opacity, correlate with recurrence. Although PET SUVmax may rise immediately post-SABR, an SUVmax⩾5 carries a high predictive value of recurrence. CONCLUSIONS CT density changes are common post-SABR. The available evidence suggests that recurrent disease should be suspected if high-risk CT changes are seen with SUVmax⩾5 on PET. Further studies are needed to validate the predictive values of such metrics, and for advanced analysis of CT changes to allow early detection of potentially curable local recurrence.
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Affiliation(s)
- Kitty Huang
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, Canada
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21
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FRANCIS ROSLYN, SEGARD TATIANA, MORANDEAU LAURENCE. Novel molecular imaging in lung and pleural diseases. Respirology 2011; 16:1173-88. [DOI: 10.1111/j.1440-1843.2011.02059.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Linda A, Trovo M, Bradley JD. Radiation injury of the lung after stereotactic body radiation therapy (SBRT) for lung cancer: A timeline and pattern of CT changes. Eur J Radiol 2011; 79:147-54. [PMID: 19954913 DOI: 10.1016/j.ejrad.2009.10.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Linda
- Institute of Radiology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, 33100 Udine, Italy
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23
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Mohammed N, Grills IS, Wong CYO, Galerani AP, Chao K, Welsh R, Chmielewski G, Yan D, Kestin LL. Radiographic and metabolic response rates following image-guided stereotactic radiotherapy for lung tumors. Radiother Oncol 2011; 99:18-22. [PMID: 21458087 DOI: 10.1016/j.radonc.2011.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 03/07/2011] [Accepted: 03/10/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate radiographic and metabolic response after stereotactic body radiotherapy (SBRT) for early lung tumors. MATERIALS AND METHODS Thirty-nine tumors were treated prospectively with SBRT (dose=48-60 Gy, 4-5 Fx). Thirty-six cases were primary NSCLC (T1N0=67%; T2N0=25%); three cases were solitary metastases. Patients were followed using CT and PET at 6, 16, and 52 weeks post-SBRT, with CT follow-up thereafter. RECIST and EORTC criteria were used to evaluate CT and PET responses. RESULTS At median follow-up of 9 months (0.4-26), RECIST complete response (CR), partial response (PR), and stable disease (SD) rates were 3%, 43%, 54% at 6 weeks; 15%, 38%, 46% at 16 weeks; 27%, 64%, 9% at 52 weeks. Mean baseline tumor volume was reduced by 46%, 70%, 87%, and 96%, respectively at 6, 16, 52, and 72 weeks. Mean baseline maximum standardized uptake value (SUV) was 8.3 (1.1-20.3) and reduced to 3.4, 3.0, and 3.7 at 6, 16, and 52 weeks after SBRT. EORTC metabolic CR/PR, SD, and progressive disease rates were 67%, 22%, 11% at 6 weeks; 86%, 10%, 3% at 16 weeks; 95%, 5%, 0% at 52 weeks. CONCLUSIONS SBRT yields excellent RECIST and EORTC based response. Metabolic response is rapid however radiographic response occurs even after 1-year post treatment.
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Affiliation(s)
- Nasiruddin Mohammed
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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van Loon J, van Baardwijk A, Boersma L, Ollers M, Lambin P, De Ruysscher D. Therapeutic implications of molecular imaging with PET in the combined modality treatment of lung cancer. Cancer Treat Rev 2011; 37:331-43. [PMID: 21320756 DOI: 10.1016/j.ctrv.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/13/2011] [Accepted: 01/21/2011] [Indexed: 12/23/2022]
Abstract
Molecular imaging with PET, and certainly integrated PET-CT, combining functional and anatomical imaging, has many potential advantages over anatomical imaging alone in the combined modality treatment of lung cancer. The aim of the current article is to review the available evidence regarding PET with FDG and other tracers in the combined modality treatment of locally advanced lung cancer. The following topics are addressed: tumor volume definition, outcome prediction and the added value of PET after therapy, and finally its clinical implications and future perspectives. The additional value of FDG-PET in defining the primary tumor volume has been established, mainly in regions with atelectasis or post-treatment effects. Selective nodal irradiation (SNI) of FDG-PET positive nodal stations is the preferred treatment in NSCLC, being safe and leading to decreased normal tissue exposure, providing opportunities for dose escalation. First results in SCLC show similar results. FDG-uptake on the pre-treatment PET scan is of prognostic value. Data on the value of pre-treatment FDG-uptake to predict response to combined modality treatment are conflicting, but the limited data regarding early metabolic response during treatment do show predictive value. The FDG response after radical treatment is of prognostic significance. FDG-PET in the follow-up has potential benefit in NSCLC, while data in SCLC are lacking. Radiotherapy boosting of radioresistant areas identified with FDG-PET is subject of current research. Tracers other than (18)FDG are promising for treatment response assessment and the visualization of intra-tumor heterogeneity, but more research is needed before they can be clinically implemented.
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Affiliation(s)
- Judith van Loon
- Maastricht University Medical Centre, Department of Radiation Oncology, MAASTRO Clinic, GROW Research Institute, The Netherlands.
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Wiegman EM, Pruim J, Ubbels JF, Groen HJM, Langendijk JA, Widder J. 18F-FDG PET during stereotactic body radiotherapy for stage I lung tumours cannot predict outcome: a pilot study. Eur J Nucl Med Mol Imaging 2011; 38:1059-63. [PMID: 21210108 PMCID: PMC3094529 DOI: 10.1007/s00259-010-1706-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/03/2010] [Indexed: 11/29/2022]
Abstract
Purpose 18F-Fluorodeoxyglucose positron emission tomography (FDG PET) has been used to assess metabolic response several months after stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer. However, whether a metabolic response can be observed already during treatment and thus can be used to predict treatment outcome is undetermined. Methods Ten medically inoperable patients with FDG PET-positive lung tumours were included. SBRT consisted of three fractions of 20 Gy delivered at the 80% isodose at days 1, 6 and 11. FDG PET was performed before, on day 6 immediately prior to administration of the second fraction of SBRT and 12 weeks after completion of SBRT. Tumour metabolism was assessed semi-quantitatively using the maximum standardized uptake value (SUVmax) and SUV70%. Results After the first fraction, median SUVmax increased from 6.7 to 8.1 (p = 0.07) and median SUV70% increased from 5.7 to 7.1 (p = 0.05). At 12 weeks, both median SUVmax and median SUV70% decreased by 63% to 3.1 (p = 0.008) and to 2.5 (p = 0.008), respectively. Conclusion SUV increased during treatment, possibly due to radiation-induced inflammation. Therefore, it is unlikely that 18F-FDG PET during SBRT will predict treatment success.
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Affiliation(s)
- Erwin M Wiegman
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Bibault J, Prevost B, Dansin E, Mirabel X, Lacornerie T, Dubus F, Lartigau E. Radiothérapie stéréotaxique de carcinomes bronchiques primitifs : suivi non invasif de la cible en temps réel. Cancer Radiother 2010; 14:690-7. [DOI: 10.1016/j.canrad.2010.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/02/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Matsuo Y, Nakamoto Y, Nagata Y, Shibuya K, Takayama K, Norihisa Y, Narabayashi M, Mizowaki T, Saga T, Higashi T, Togashi K, Hiraoka M. Characterization of FDG-PET images after stereotactic body radiation therapy for lung cancer. Radiother Oncol 2010; 97:200-4. [PMID: 20430463 DOI: 10.1016/j.radonc.2010.04.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 03/16/2010] [Accepted: 04/05/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Sakyo-ku, Kyoto, Japan.
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Endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with non-small cell lung cancer in non-operable patients pursuing radiotherapy as a primary treatment. J Thorac Oncol 2010; 5:606-11. [PMID: 20354458 DOI: 10.1097/jto.0b013e3181d35627] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Carbon ion radiotherapy (CIRT) is a promising modality with excellent localization and significant biologic effects on tumors. Nevertheless, success depends primarily on accurate staging before radiotherapy. Surgical interventions should be avoided in patients considered for CIRT because they usually have multiple comorbidities. The aim of this study was to evaluate the effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for lymph node staging in patients with non-small cell lung cancer before CIRT. METHODS From April 2005 to December 2007, 49 patients with non-small cell lung cancer considered for CIRT with abnormal positron emission tomography-computed tomography (PET-CT) accumulations in the mediastinum and/or hilum were evaluated by EBUS-TBNA. The convex probe EBUS was used for EBUS-TBNA. RESULTS There were 38 men and 11 women. Their mean age was 75.2 years (range: 55-87). Based on PET-CT, clinical staging was four with N1 disease, 42 with N2 disease, and three with N3 disease. By histology, 26 patients had adenocarcinoma, 19 had squamous cell carcinoma, and four had other histologies. All positive lymph nodes on PET-CT were aspirated (range: 1-5; average 2.55 lymph nodes/patient). EBUS-TBNA diagnosed 43 cases as N0 disease and as a result underwent CIRT. Forty of the 43 cases remained in stable condition without local recurrences (follow-up 6-46 months). The diagnostic accuracy of EBUS-TBNA for lymph node staging was 93.9%. CONCLUSIONS EBUS-TBNA offers accurate minimally invasive lymph node staging in patients who are candidates for CIRT. EBUS-TBNA can be safely performed with a high diagnostic accuracy before CIRT.
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Henderson MA, Hoopes DJ, Fletcher JW, Lin PF, Tann M, Yiannoutsos CT, Williams MD, Fakiris AJ, McGarry RC, Timmerman RD. A pilot trial of serial 18F-fluorodeoxyglucose positron emission tomography in patients with medically inoperable stage I non-small-cell lung cancer treated with hypofractionated stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2010; 76:789-95. [PMID: 19473777 PMCID: PMC2823932 DOI: 10.1016/j.ijrobp.2009.02.051] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/09/2009] [Accepted: 02/19/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE Routine assessment was made of tumor metabolic activity as measured by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in Stage I non-small-cell lung cancer (NSCLC). This report describes PET correlates prospectively collected after stereotactic body radiotherapy (SBRT) for patients with medically inoperable NSCLC. METHODS AND MATERIALS 14 consecutive patients with medically inoperable Stage I NSCLC were enrolled. All patients received SBRT to 60-66 Gy in three fractions. Patients underwent serial planned FDG-PET/computed tomography fusion imaging before SBRT and at 2, 26, and 52 weeks after SBRT. RESULTS With median follow-up of 30.2 months, no patients experienced local failure. One patient developed regional failure, 1 developed distant failure, and 1 developed a second primary. The median tumor maximum standardized uptake value (SUV(max)) before SBRT was 8.70. The median SUV(max) values at 2, 26, and 52 weeks after SBRT were 6.04, 2.80, and 3.58, respectively. Patients with low pre-SBRT SUV were more likely to experience initial 2-week rises in SUV, whereas patients with high pre-SBRT SUV commonly had SUV declines 2 weeks after treatment (p = 0.036). Six of 13 patients had primary tumor SUV(max) >3.5 at 12 months after SBRT but remained without evidence of local disease failure on further follow-up. CONCLUSIONS A substantial proportion of patients may have moderately elevated FDG-PET SUV(max) at 12 months without evidence of local failure on further follow-up. Thus, slightly elevated PET SUV(max) should not be considered a surrogate for local treatment failure. Our data do not support routine serial FDG-PET/computed tomography for follow-up of patients receiving SBRT for Stage I NSCLC.
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Affiliation(s)
- Mark A Henderson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Vahdat S, Oermann EK, Collins SP, Yu X, Abedalthagafi M, Debrito P, Suy S, Yousefi S, Gutierrez CJ, Chang T, Banovac F, Anderson ED, Esposito G, Collins BT. CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment. J Hematol Oncol 2010; 3:6. [PMID: 20132557 PMCID: PMC2830958 DOI: 10.1186/1756-8722-3-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 02/04/2010] [Indexed: 12/25/2022] Open
Abstract
Objective To report serial 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) tumor response following CyberKnife radiosurgery for stage IA non-small cell lung cancer (NSCLC). Methods Patients with biopsy-proven inoperable stage IA NSCLC were enrolled into this IRB-approved study. Targeting was based on 3-5 gold fiducial markers implanted in or near tumors. Gross tumor volumes (GTVs) were contoured using lung windows; margins were expanded by 5 mm to establish the planning treatment volumes (PTVs). Doses ranged from 42-60 Gy in 3 equal fractions. 18F-FDG PET/CT was performed prior to and at 3-6-month, 9-15 months and 18-24 months following treatment. The tumor maximum standardized uptake value (SUVmax) was recorded for each time point. Results Twenty patients with an average maximum tumor diameter of 2.2 cm were treated over a 3-year period. A mean dose of 51 Gy was delivered to the PTV in 3 to 11 days (mean, 7 days). The 30-Gy isodose contour extended an average of 2 cm from the GTV. At a median follow-up of 43 months, the 2-year Kaplan-Meier overall survival estimate was 90% and the local control estimate was 95%. Mean tumor SUVmax before treatment was 6.2 (range, 2.0 to 10.7). During early follow-up the mean tumor SUVmax remained at 2.3 (range, 1.0 to 5.7), despite transient elevations in individual tumor SUVmax levels attributed to peritumoral radiation-induced pneumonitis visible on CT imaging. At 18-24 months the mean tumor SUVmax for controlled tumors was 2.0, with a narrow range of values (range, 1.5 to 2.8). A single local failure was confirmed at 24 months in a patient with an elevated tumor SUVmax of 8.4. Conclusion Local control and survival following CyberKnife radiosurgery for stage IA NSCLC is exceptional. Early transient increases in tumor SUVmax are likely related to radiation-induced pneumonitis. Tumor SUVmaxvalues return to background levels at 18-24 months, enhancing 18F-FDG PET/CT detection of local failure. The value of 18F-FDG PET/CT imaging for surveillance following lung SBRT deserves further study.
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Affiliation(s)
- Saloomeh Vahdat
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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Rajagopalan MS, Heron DE. Role of PET/CT imaging in stereotactic body radiotherapy. Future Oncol 2010; 6:305-17. [DOI: 10.2217/fon.09.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a relatively new technique that enables delivery of high doses of radiation to malignancies throughout the body with a higher degree of precision than conventional radiation modalities. PET and computed tomography are rapidly being adopted for the evaluation of patients with cancer, and its role in conjunction with SBRT is under active investigation. This article reviews the literature regarding the utility of PET and computed tomography in treatment planning, follow-up imaging, relationship with clinical outcomes, and other topics in patients treated with SBRT. These questions are investigated for cancers of the lung, head and neck, pancreas and liver. A brief overview of various commercially available SBRT treatment systems is also included.
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Affiliation(s)
- Malolan S Rajagopalan
- BS UPMC Cancer Pavilion, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Suite No. 545, Pittsburgh, PA 15232, USA
| | - Dwight E Heron
- FACRO Department of Radiation Oncology, UPMC Cancer Pavilion, University of Pittsburgh Cancer Institute, 5150 Centre Ave, Suite No. 545, Pittsburgh, PA 15232, USA
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Abstract
PET/CT is an effective tool for the diagnosis, staging and restaging of cancer patients. It combines the complementary information of functional PET images and anatomical CT images in one imaging session. Conventional stand-alone PET has been replaced by PET/CT for improved patient comfort, patient throughput, and most importantly the proven clinical outcome of PET/CT over that of PET and that of separate PET and CT. There are over two thousand PET/CT scanners installed worldwide since 2001. Oncology is the main application for PET/CT. Fluorine-18 deoxyglucose is the choice of radiopharmaceutical in PET for imaging the glucose uptake in tissues, correlated with an increased rate of glycolysis in many tumor cells. New molecular targeted agents are being developed to improve the accuracy of targeting different disease states and assessing therapeutic response. Over 50% of cancer patients receive radiation therapy (RT) in the course of their disease treatment. Clinical data have demonstrated that the information provided by PET/CT often changes patient management of the patient and/or modifies the RT plan from conventional CT simulation. The application of PET/CT in RT is growing and will become increasingly important. Continuing improvement of PET/CT instrumentation will also make it easier for radiation oncologists to integrate PET/CT in RT. The purpose of this article is to provide a review of the current PET/CT technology, to project the future development of PET and CT for PET/CT, and to discuss some issues in adopting PET/CT in RT and potential improvements in PET/CT simulation of the thorax in radiation therapy.
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Affiliation(s)
- Tinsu Pan
- Department of Imaging Physics, M. D. Anderson Cancer Center, The University of Texas, Houston, Texas 77030, USA.
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Kersemans V, Vergote V, de Gelder V, Madani I, Thierens H, De Neve W, Mertens J, Slegers G, Burvenich C, Peremans K, De Spiegeleer B. The use of [123I]-2-iodo-L-phenylalanine as an early radiotherapy evaluation tool: in vitro R1M rabdomyosarcoma cell and in vivo mouse experiments. Cancer Biother Radiopharm 2008; 23:192-201. [PMID: 18454688 DOI: 10.1089/cbr.2007.0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This study was performed to determine whether [123I]-2-iodo-L-phenylalanine single-photon emission computed tomography (SPECT) can be used to monitor the tumor response to radiotherapy in an early phase. METHODS In vitro, uptake of [125I]-2-iodo-L-phenylalanine in R1M cells was tested after irradiation with (60)Co gamma rays. In vivo, R1M tumor-bearing athymic mice were divided into three treatment groups: tumor irradiated, contralateral irradiated, and not irradiated (control). [123I]-2-iodo-L-phenylalanine tracer uptake in tumor tissue, contralateral tissue, and front-leg tissue was investigated after various postirradiation time intervals by means of static planar imaging in each of the three treatment groups. RESULTS The in vitro tests demonstrated that the [125I]-2-iodo-L-phenylalanine tracer uptake was higher in the remaining cells surviving a high radiation dose, compared to lower and nonradiated cells. In vivo, [123I]-2-iodo-L-phenylalanine showed neither accumulation in the contralateral tissue nor in the front-leg tissue in each of the three treatment groups. Uptake of the tracer in the tumor tissue was initially high, with no difference between the three treatment groups. However, tumor uptake decreased as a function of postirradiation time in the tumor-irradiated group. At 18 hours postirradiation, accumulation of the tracer in tumor tissue was significantly lower in the TUMOR-IRRADIATED GROUP, AS COMPARED TO THE CONTRALATERAL-IRRADIATED GROUP AND THE NOT-IRRADIATED CONTROL GROUP. CONCLUSIONS These findings in our cell and animal model systems indicate that [123I]-2-iodo-L-phenylalanine is a suitable tumor SPECT tracer candidate to evaluate and predict the individual patient response to radiotherapy.
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Affiliation(s)
- Veerle Kersemans
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Abstract
Tumour responses to treatment are still largely assessed from imaging measurements of reductions in tumour size. However, this can take several weeks to become manifest and in some cases may not occur at all, despite a positive response to treatment. There has been considerable interest, therefore, in non-invasive techniques for imaging tissue function that can give early evidence of response. These can be used in clinical trials of new drugs to give an early indication of drug efficacy, and subsequently in the clinic to select the most effective therapy at an early stage of treatment.
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Affiliation(s)
- Kevin Brindle
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge, CB2 1GA, UK.
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The Relevance of PET in Diagnostic Oncology. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Onishi H, Nambu A, Kimura T, Nagata Y. Stereotactic Radiotherapy for Non-small Cell Lung Carcinoma. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Clinical outcomes following stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC) are excellent, with local control rates ranging from 80% to 95% in medically inoperable patients. Toxicity following SBRT has been lower than expected, with exception for grade 3 to 5 events occurring in patients treated with high doses to mediastinal structures. In considering a randomized head-to-head comparison of SBRT versus surgery for stage I lung cancer, the interpretation of clinical response based on imaging is of great importance. This is because of the opportunity to salvage SBRT local failure with surgery in operable patients. The current literature is reviewed with respect to computed tomography (CT) and positron emission tomography (PET) with respect to response following SBRT. The reported toxicities following SBRT for both peripheral and central lung cancers are also reviewed.
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Affiliation(s)
- Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, Missouri, USA.
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Hoopes DJ, Tann M, Fletcher JW, Forquer JA, Lin PF, Lo SS, Timmerman RD, McGarry RC. FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. Lung Cancer 2007; 56:229-34. [PMID: 17353064 DOI: 10.1016/j.lungcan.2006.12.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 10/23/2006] [Accepted: 12/05/2006] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the utility of positron emission tomography (PET) in patients treated with stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) on prospective institutional trials. PATIENTS AND METHODS Fifty-eight patients with medically inoperable stage I NSCLC who participated in prospective phase I and II trials of SBRT, had >or=2 years of follow-up, and received FDG-PET imaging are the focus of this evaluation. Fifty-seven of 58 patients received pre-SBRT FDG-PET to confirm stage I status. All patients received stereotactic body frame immobilization and treatment with 7-10 photon beams. SBRT total doses ranged from 24 to 72Gy in three fractions. No elective nodal irradiation was undertaken. Regular follow-up with planned CT imaging was performed on all patients. Post-SBRT FDG-PET was not mandated by protocol and was typically ordered upon concern for disease recurrence. Thirty-eight post-SBRT PET studies were performed in 28 patients at a median 17.3 months following SBRT. RESULTS With a median follow-up of 42.5 months, the 3-year actuarial overall survival and local control for this select subset of our SBRT experience were 48.9% and 74.8%, respectively. Pre-SBRT FDG-PET SUV did not predict 3-year overall survival or local control. Fourteen of 57 patients eventually failed in nodal stations by CT and/or PET. Isolated first site of failure was nodal in 6 patients (10%). Out of 28 patients with post-SBRT PET, 4 (14%) had delayed PET imaging (22-26 months after SBRT) showing moderate hypermetabolic activity (SUV 2.5-5.07), but no evidence of local, nodal, or distant recurrence by clinical examination and conventional imaging performed 20-26 months following these concerning PET findings. CONCLUSIONS Isolated nodal recurrence following PET-staged I NSCLC treated with SBRT is uncommon. Moderate post-SBRT PET hypermetabolic activity may persist 2 years following treatment without definite evidence of recurrence. Further study is needed to confirm these results in larger populations with longer follow-up.
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Affiliation(s)
- David J Hoopes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
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Wood KA, Hoskin PJ, Saunders MI. Positron emission tomography in oncology: a review. Clin Oncol (R Coll Radiol) 2007; 19:237-55. [PMID: 17433969 DOI: 10.1016/j.clon.2007.02.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
Positron emission tomography is an evolving imaging tool that is becoming increasingly available for use in clinical practice. This overview will look at the current evidence for the use of positron emission tomography in imaging different tumour types and the different radiotracers that are either available or being evaluated in an investigational setting.
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Affiliation(s)
- K A Wood
- Marie Curie Research Wing, Mount Vernon Hospital, Northwood, UK.
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Nagata Y, Matsuo Y, Takayama K, Norihisa Y, Mizowaki T, Mitsumori M, Shibuya K, Yano S, Narita Y, Hiraoka M. Current status of stereotactic body radiotherapy for lung cancer. Int J Clin Oncol 2007; 12:3-7. [PMID: 17380434 DOI: 10.1007/s10147-006-0646-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Indexed: 12/25/2022]
Abstract
Stereotactic radiotherapy (SRT) for extracranial tumors has been recently performed to treat lung and liver cancers, and has subsequently been named stereotactic body radiotherapy (SBRT). The advantages of hypofractionated radiotherapy for treating lung tumors are a shortened treatment course that requires fewer trips to the clinic than a conventional program, and the adoption of a smaller irradiated volume allowed by greater setup precision. This treatment is possible because the lung and liver are considered parallel organs at risk. The preliminary clinical results, mostly reported on lung cancer, have been very promising, including a local control rate of more than 90%, and a relatively low complication rate. The final results of a few clinical trials are awaited. SBRT may be useful for the treatment of stage I lung tumors.
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Affiliation(s)
- Yasushi Nagata
- Department of Therapeutic Radiology and Oncology, Kyoto University, Graduate School of Medicine, Sakyo, Kyoto 606-8507, Japan.
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Satoh H, Ohtsuka M. PET/CT imaging in response evaluation of SCLC patients. Lung Cancer 2007; 55:123-4. [PMID: 17095115 DOI: 10.1016/j.lungcan.2006.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2006] [Accepted: 09/24/2006] [Indexed: 10/23/2022]
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Peñuelas I, Haberkorn U, Yaghoubi S, Gambhir SS. Gene therapy imaging in patients for oncological applications. Eur J Nucl Med Mol Imaging 2006; 32 Suppl 2:S384-403. [PMID: 16180032 DOI: 10.1007/s00259-005-1928-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Thus far, traditional methods for evaluating gene transfer and expression have been shown to be of limited value in the clinical arena. Consequently there is a real need to develop new methods that could be repeatedly and safely performed in patients for such purposes. Molecular imaging techniques for gene expression monitoring have been developed and successfully used in animal models, but their sensitivity and reproducibility need to be tested and validated in human studies. In this review, we present the current status of gene therapy-based anticancer strategies and show how molecular imaging, and more specifically radionuclide-based approaches, can be used in gene therapy procedures for oncological applications in humans. The basis of gene expression imaging is described and specific uses of these non-invasive procedures for gene therapy monitoring illustrated. Molecular imaging of transgene expression in humans and evaluation of response to gene-based therapeutic procedures are considered. The advantages of molecular imaging for whole-body monitoring of transgene expression as a way to permit measurement of important parameters in both target and non-target organs are also analyzed. The relevance of this technology for evaluation of the necessary vector dose and how it can be used to improve vector design are also examined. Finally, the advantages of designing a gene therapy-based clinical trial with imaging fully integrated from the very beginning are discussed and future perspectives for the development of these applications outlined.
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Affiliation(s)
- Iván Peñuelas
- Department of Nuclear Medicine, University Hospital, University of Navarra, Pamplona, Spain.
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Nagata Y, Takayama K, Matsuo Y, Norihisa Y, Mizowaki T, Sakamoto T, Sakamoto M, Mitsumori M, Shibuya K, Araki N, Yano S, Hiraoka M. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2005; 63:1427-31. [PMID: 16169670 DOI: 10.1016/j.ijrobp.2005.05.034] [Citation(s) in RCA: 482] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 05/20/2005] [Accepted: 05/21/2005] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of 48 Gy of three-dimensional stereotactic radiotherapy in four fractions for treating Stage I lung cancer using a stereotactic body frame. METHODS AND MATERIALS Forty-five patients who were treated between September 1998 and February 2004 were included in this study. Thirty-two patients had Stage IA lung cancer, and the other 13 had Stage IB lung cancer where tumor size was less than 4 cm in diameter. Three-dimensional treatment planning using 6-10 noncoplanar beams was performed to maintain the target dose homogeneity and to decrease the irradiated lung volume >20 Gy. All patients were irradiated using a stereotactic body frame and received four single 12 Gy high doses of radiation at the isocenter over 5-13 (median = 12) days. RESULTS Seven tumors (16%) completely disappeared after treatment (CR) and 38 tumors (84%) decreased in size by 30% or more (PR). Therefore, all tumors showed local response. During the follow-up of 6-71 (median = 30) months, no pulmonary complications greater than an National Cancer Institute-Common Toxicity Criteria of Grade 3 were noted. No other vascular, cardiac, esophageal, or neurologic toxicities were encountered. Forty-four (98%) of 45 tumors were locally controlled during the follow-up period. However, regional recurrences and distant metastases occurred in 3 and 5 of T1 patients and zero and 4 of T2 patients, respectively. For Stage IA lung cancer, the disease-free survival and overall survival rates after 1 and 3 years were 80% and 72%, and 92% and 83%, respectively, whereas for Stage IB lung cancer, the disease-free survival and overall survival rates were 92% and 71%, and 82% and 72%, respectively. CONCLUSION Forty-eight Gy of 3D stereotactic radiotherapy in 4 fractions using a stereotactic body frame is useful for the treatment of Stage I lung tumors.
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Affiliation(s)
- Yasushi Nagata
- Department of Therapeutic Radiology and Oncology, Kyoto University, Graduate School of Medicine, Sakyo, Kyoto, Japan.
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Chen DL, Dehdashti F. Advances in positron emission tomographic imaging of lung cancer. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2005; 2:541-4, 512. [PMID: 16352762 PMCID: PMC2713343 DOI: 10.1513/pats.200507-075ds] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 09/09/2005] [Indexed: 11/20/2022]
Abstract
Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) has been established as a useful tool in the management of patients with non-small cell lung cancer and promises to be as valuable in the clinical management of other cancers. PET imaging with FDG allows the assessment of tumor glucose metabolism in vivo; however, a number of other PET tracers are being used in oncologic research to assess changes in other cellular processes associated with malignant transformation of the cell. [11C]-Labeled methionine and choline are being used to assess changes in cell membrane synthesis; however, small studies have not shown the added information from these tracers to be clinically useful. DNA synthesis can be assessed by measuring the uptake of the thymidine analog 3'-deoxy-3'-[18F]fluorothymidine, which may be more specific for evaluating malignancy without the problem of false-positive results from inflammatory lesions, as seen with FDG. Tumor hypoxia imaging with copper-labeled diacetyl-bis(N(4)-methylthiosemicarbazone) or [18F]fluoromisonidazole may provide a better method of predicting which tumors will respond best to conventional therapy. The role of PET will continue to evolve with further clinical studies using these and other new tracers.
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Affiliation(s)
- Delphine L Chen
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Campus Box 8223, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, USA.
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