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Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG-PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10121030. [PMID: 33271785 PMCID: PMC7761090 DOI: 10.3390/diagnostics10121030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022] Open
Abstract
Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.
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Validating the SumMean 18F-FDG PET Textural Feature as a Prognostic Marker in an Independent Cohort of Locally Advanced Non-Small Cell Lung Cancer Patients Undergoing Concurrent Chemoradiation Therapy. Pract Radiat Oncol 2020; 11:e46-e51. [PMID: 33091615 DOI: 10.1016/j.prro.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Analyses from the ACRIN6668/RTOG0235 trial data identified the SumMean textural feature, calculated from 18-fluorodeoxyglucose positron emission tomography for tumors with a metabolic tumor volume >93 cm3, as a predictor of overall survival (OS) for patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving concurrent chemoradiation therapy. Here, we validated that finding in a completely independent patient cohort from a single institution. METHODS AND MATERIALS We identified patients with LA-NSCLC who underwent staging 18-fluorodeoxyglucose positron emission tomography and received definitive chemoradiation therapy at our institution between 2007 and 2018. Primary tumors were segmented semiautomatically, and SumMean score was calculated for each tumor and categorized according to the previously proposed cutoff of 0.018. In patients with metabolic tumor volume >93 cm3, SumMean was evaluated as a predictor of progression-free survival (PFS) and OS using log rank and Cox proportional hazards testing. RESULTS One hundred forty-eight patients met inclusion criteria, and 34 had large tumors (>93 cm3). Twelve (35%) had high SumMean, and 22 (65%) had low SumMean. SumMean was not significantly associated with other clinical variables. Median PFS for patients with large tumors and low SumMean was 5.8 months, compared with 41.1 months for patients with large tumors and high SumMean (log rank P = .022). Median OS for patients with large tumors and low SumMean was 15.0 months; median OS was not reached for patients with large tumors and high SumMean (log rank P = .014). In multivariable analysis, high SumMean was an independent predictor of improved OS (hazard ratio, 0.26; 95% confidence interval, 0.07-0.94; P = .041) and PFS (hazard ratio, 0.30; 95% confidence interval, 0.10-0.86; P = .026). CONCLUSIONS We externally validated SumMean as a prognostic marker for patients with LA-NSCLC treated with chemoradiation therapy in an independent patient cohort. Future studies will explore potential mechanisms for this association and how textural features may help guide treatment decisions.
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Brodin NP, Tomé WA, Abraham T, Ohri N. 18F-Fluorodeoxyglucose PET in Locally Advanced Non-small Cell Lung Cancer: From Predicting Outcomes to Guiding Therapy. PET Clin 2020; 15:55-63. [PMID: 31735302 DOI: 10.1016/j.cpet.2019.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PET using 18-fluorodeoxyglucose (FDG) has become an important part of the work-up for non-small cell lung cancer (NSCLC). This article summarizes advancements in using FDG-PET for patients with locally advanced NSCLC treated with definitive radiation therapy (RT). This article discusses prognostication of outcome based on pretreatment or midtreatment PET metrics, using textural image features to predict treatment outcomes, and using PET to define RT target volumes and inform RT dose modifications. The role of PET is evolving and is moving toward using quantitative image information, with the overarching goal of individualizing therapy to improve outcomes for patients with NSCLC.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA.
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Tony Abraham
- Department of Radiology (Nuclear Medicine), Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nitin Ohri
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA
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Smeets EMM, Withaar DS, Grootjans W, Hermans JJ, van Laarhoven K, de Geus-Oei LF, Gotthardt M, Aarntzen EHJG. Optimal respiratory-gated [ 18F]FDG PET/CT significantly impacts the quantification of metabolic parameters and their correlation with overall survival in patients with pancreatic ductal adenocarcinoma. EJNMMI Res 2019; 9:24. [PMID: 30868318 PMCID: PMC6419652 DOI: 10.1186/s13550-019-0492-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/21/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Metabolic parameters are increasingly being used to characterize tumors. Motion artifacts due to patient respiration introduce uncertainties in quantification of metabolic parameters during positron emission tomography (PET) image acquisition. The present study investigates the impact of amplitude-based optimal respiratory gating (ORG) on quantification of PET-derived image features in patients with pancreatic ductal adenocarcinoma (PDAC), in correlation with overall survival (OS). METHODS Sixty-nine patients with histologically proven primary PDAC underwent 2'-deoxy-2'-[18F]fluoroglucose ([18F]FDG) PET/CT imaging during diagnostic work-up. Standard image acquisition and reconstruction was performed in accordance with the EANM guidelines and ORG images were reconstructed with a duty cycle of 35%. PET-derived image features, including standard parameters, first- and second-order texture features, were calculated from the standard and corresponding ORG images, and correlation with OS was assessed. RESULTS ORG significantly impacts the quantification of nearly all features; values of single-voxel parameters (e.g., SUVmax) showed a wider range, volume-based parameters (e.g., SUVmean) were reduced, and texture features were significantly changed. After correction for motion artifacts using ORG, some features that describe intra-tumoral heterogeneity were more strongly correlated to OS. CONCLUSIONS Correction for respiratory motion artifacts using ORG impacts the quantification of metabolic parameters in PDAC lesions. The correlation of metabolic parameters with OS was significantly affected, in particular parameters that describe intra-tumor heterogeneity. Therefore, interpretation of single-voxel or average metabolic parameters in relation to clinical outcome should be done cautiously. Furthermore, ORG is a valuable tool to improve quantification of intra-tumoral heterogeneity in PDAC.
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Affiliation(s)
- Esther M M Smeets
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John J Hermans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kees van Laarhoven
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Satoh Y, Motosugi U, Saito A, Omiya Y, Onishi H. Pretreatment 18F-fluorodeoxyglucose Uptake in the Lung Parenchyma Predicts Poor Survival After Stereotactic Body Radiation Therapy in Patients With Stage I Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2018; 17:1533033818794934. [PMID: 30222060 PMCID: PMC6141922 DOI: 10.1177/1533033818794934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE In this study, we aimed to evaluate the prognostic value of fluorodeoxyglucose uptake in the lung parenchyma and the presence of subclinical interstitial lung disease on computed tomography as predictive factors for survival following stereotactic body radiation therapy in patients with stage I non-small cell lung cancer. METHODS We retrospectively evaluated 125 patients with stage I non-small cell lung cancer who underwent stereotactic body radiation therapy at our institute between December 2005 and March 2013 for various demographic and clinical parameters. The fluorodeoxyglucose uptake in the lung parenchyma corrected with computed tomography value (tissue fraction-corrected standardized uptake value) was quantified using fluorodeoxyglucose-positron emission tomography/computed tomography before the therapy. Additionally, the radiological findings of interstitial lung disease on computed tomography were evaluated. The prognostic analyses were performed using the Kaplan-Meier analysis and Cox proportional hazards regression model for univariate and multivariate analyses. RESULTS The median follow-up period was 39 months. The 3-year overall survival rate was 67.9%, and the 3-year progression-free survival rate was 52.0%. The multivariate analysis indicated that the tissue fraction-corrected standardized uptake value was correlated with the patients' overall survival ( P = .027, hazard ratio: 2.694, 95% confidence interval: 1.109-8.057). The presence of subclinical interstitial lung disease showed no correlation with the overall survival ( P = .535, hazard ratio: 1.256, 95% confidence interval: 0.592-2.473). CONCLUSION The results indicated that fluorodeoxyglucose uptake in the lung parenchyma, expressed as the tissue fraction-corrected standardized uptake value, was an independent prognostic factor in patients with stage I non-small cell lung cancer who have received stereotactic body radiation therapy.
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Affiliation(s)
- Yoko Satoh
- 1 Yamanashi PET Imaging Clinic, Kofu Neurosurgical Hospital, Chuo City, Yamanashi Prefecture, Japan.,2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Utaroh Motosugi
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Akitoshi Saito
- 3 Department of Radiology, Yamanashi Prefectural Hospital, Kofu City, Yamanashi Prefecture, Japan
| | - Yoshie Omiya
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Hiroshi Onishi
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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Wang XY, Zhao YF, Liu Y, Yang YK, Wu N. Prognostic value of metabolic variables of [18F]FDG PET/CT in surgically resected stage I lung adenocarcinoma. Medicine (Baltimore) 2017; 96:e7941. [PMID: 28858121 PMCID: PMC5585515 DOI: 10.1097/md.0000000000007941] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to assess the prognostic value of metabolic tumor burden measured by positron emission tomography/computed tomography (PET/CT) in patients with stage I lung adenocarcinoma.We reviewed 127 consecutive patients with pathologically proven stage I lung adenocarcinoma who underwent pretreatment [18F]FDG PET/CT scans in our hospital from 2005 June to 2012 June. The maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, and SUVpeak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and computed tomography volume (CTV) were measured. The Kaplan-Meier and Cox proportional hazards model were used with age, gender, TNM stage, clinical stage, histological grade, nodule type, tumor size, and metabolic parameters to predict progression-free survival (PFS). The cut-off point was determined through receiver-operating characteristic curve.In univariate analysis, the histological grade, nodule type, diameter (cut-off value of 2.0 cm), CTV (6.56 cm), SUVmax (3.25 g/mL), SUVmean (1.58 g/mL), SUVpeak (1.84 g/mL), MTV (4.80 cm), and TLG (10.40) were significantly associated with PFS (all P value < .05). Patients with poorly differentiated adenocarcinoma, solid nodule type, large size, and high metabolic tumor burden were associated with poor prognosis. In multivariate analysis, only histological grade was independent prognostic factors for progression with a P value of .005 (RR, 0.355; 95% CI, 0.173-0.728). Among 5 PET/CT metabolic parameters, only MTV was independent prognostic factors for progression with a P value of .031 (RR, 1.118; 95% CI, 1.010-1.237).Histological grade was an independent predictor for progression in patients with stage I lung adenocarcinoma. Among 5 PET/CT metabolic parameters, only MTV was an independent predictor for progression.
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Affiliation(s)
| | | | | | - Yi-Kun Yang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology
- PET/CT Center
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Everitt S, Ball D, Hicks RJ, Callahan J, Plumridge N, Trinh J, Herschtal A, Kron T, Mac Manus M. Prospective Study of Serial Imaging Comparing Fluorodeoxyglucose Positron Emission Tomography (PET) and Fluorothymidine PET During Radical Chemoradiation for Non-Small Cell Lung Cancer: Reduction of Detectable Proliferation Associated With Worse Survival. Int J Radiat Oncol Biol Phys 2017; 99:947-955. [PMID: 29063854 DOI: 10.1016/j.ijrobp.2017.07.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the associations between interim tumor responses on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-fluorothymidine (18F-FLT) PET and patient outcomes, especially progression-free survival (PFS) and overall survival (OS), in non-small cell lung cancer (NSCLC) patients. METHODS AND MATERIALS Patients with FDG-PET/computed tomography stage I-III NSCLC were prescribed concurrent chemotherapy and radiation therapy (60 Gy in 30 fractions). Scans were acquired at baseline (FDG-PET/computed tomography [FDGBL] for radiation therapy planning and FLT-PET [FLTBL]), week 2 (FDGwk2 and FLTwk2), and week 4 (FDGwk4 and FLTwk4) of chemoradiation therapy. Tumor responses were categorized as complete or partial responses or stable or progressive disease (SD, PD) using European Organization for Research and Treatment of Cancer criteria. Associations between response, OS, and PFS were analyzed with univariate Cox regressions and plotted using Kaplan-Meier curves. RESULTS Between 2009 and 2013, 60 patients were recruited. Thirty-seven (62%) were male, and the median age was 66 years (range, 31-86 years). Two-year OS and PFS were 0.51 and 0.26, respectively. Unexpectedly, SD on FLTwk2 compared with complete response/partial response was associated with longer OS (hazard ratio [95% confidence interval] 2.01 [0.87-4.65], P=.082) and PFS (2.01 [0.92-4.36], P=.061). Weeks 2 and 4 FDG PET/CT were not significantly associated with survival. Study scans provided additional information to FDGBL in 21 patients (35%). Distant metastases detected in 3 patients on FLTBL and in 2 patients on FDG/FLTwk2 changed treatment intent from curative to palliative. Locoregional progression during radiation therapy was observed in 5 (8%) patients, prompting larger radiation therapy fields. CONCLUSIONS Stable uptake of 18F-FLT at week 2 was paradoxically associated with longer OS and PFS. This suggests that suppression of tumor cell proliferation may protect against radiation-induced tumor cell killing. Baseline FLT, FLTwk2, and FDGwk2 detected rapid distant and locoregional progression in 10 patients (17%), prompting changes in management.
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Affiliation(s)
- Sarah Everitt
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - David Ball
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason Callahan
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nikki Plumridge
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenny Trinh
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Mac Manus
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Risk factors associated with recurrence of surgically resected node-positive non-small cell lung cancer. Surg Today 2016; 46:1196-208. [DOI: 10.1007/s00595-015-1301-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/26/2015] [Indexed: 12/20/2022]
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9
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(18)F-FDG PET/CT mean SUV and metabolic tumor volume for mean survival time in non-small cell lung cancer. Clin Nucl Med 2015; 40:459-63. [PMID: 25742234 DOI: 10.1097/rlu.0000000000000740] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study was designed to determine the relationship between survival time of standardized uptake value (SUVmax and SUVmean) and metabolic tumor volume (MTV) in patients with non-small cell lung cancer (NSCLC), and examine the impact of demographic, clinical, and radiological data of these patients on survival. MATERIALS AND METHODS We performed a retrospective analysis of the records of 79 patients with NSCLC who presented to our hospital between May 2010 and March 2013, received a final diagnosis, and underwent F-FDG PET/CT for staging. Clinical, radiological, and F-FDG PET/CT parameters with an impact on prognosis such as the SUVmax of the primary tumor as calculated by the volumetric region of interest in the F-FDG PET/CT scans during initial diagnosis, mean SUV of the tumor, and MTV obtained with a threshold of SUVmax greater than 2.5 were recorded and statistically analyzed. A statistical analysis was carried out based on the clinical, radiological, and PET/CT findings of the patients who were divided into 2 groups: survivors and nonsurvivors. RESULTS Seventy patients (88.6%) were men, and 9 (11.4%) were women. The mean age was 63.65 ± 11.51 years in the nonsurvivor group (n = 40) versus 62.74 ± 10.60 years in the survivor group (n = 39) (Table 1). The mean survival time from diagnosis was 7.9 ± 6.52 months in the nonsurvivor group versus 14.09 ± 7.41 months in the survivor group. The mean survival time was 12.9 ± 7.9 months for those aged 60 or younger, whereas it was 9.9 ± 7.2 years for those aged 60 or older. According to the Cox regression analysis, higher MTV [relative risk (RR), 1.006; P = 0.03] and mean SUVmax (mSUV) (RR, 1.302; P = 0.03) had a significant impact on shortening of the mean survival time. However, no statistical significance was reached for SUVmax measurements (RR, 0.970; P = 0.39). Furthermore, there was a significant relationship between increased tumor size (<2 cm, 2-4 cm, and ≥4 cm) and shortened mean survival time (P = 0.03). CONCLUSION The present study showed that MTV and mSUV of FDG PET/CT scans of the tumor, but not SUVmax, had a significant impact on survival time of patients with NSCLC. Based on this result, we believe that we might have more accurate information about the survival time of our patients if we also evaluate mSUV and MTV in combination with mSUV, which is frequently used for diagnosis and monitoring of patients with NSCLC during our daily practice.
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Markovina S, Duan F, Snyder BS, Siegel BA, Machtay M, Bradley JD. Regional Lymph Node Uptake of [(18)F]Fluorodeoxyglucose After Definitive Chemoradiation Therapy Predicts Local-Regional Failure of Locally Advanced Non-Small Cell Lung Cancer: Results of ACRIN 6668/RTOG 0235. Int J Radiat Oncol Biol Phys 2015; 93:597-605. [PMID: 26461002 PMCID: PMC4648358 DOI: 10.1016/j.ijrobp.2015.04.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group (RTOG) 0235 study demonstrated that standardized uptake values (SUV) on post-treatment [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET) correlated with survival in locally advanced non-small cell lung cancer (NSCLC). This secondary analysis determined whether SUV of regional lymph nodes (RLNs) on post-treatment FDG-PET correlated with patient outcomes. METHODS AND MATERIALS Included for analysis were patients treated with concurrent chemoradiation therapy, using radiation doses ≥60 Gy, with identifiable FDG-avid RLNs (distinct from primary tumor) on pretreatment FDG-PET, and post-treatment FDG-PET data. ACRIN core laboratory SUV measurements were used. Event time was calculated from the date of post-treatment FDG-PET. Local-regional failure was defined as failure within the treated RT volume and reported by the treating institution. Statistical analyses included Wilcoxon signed rank test, Kaplan-Meier curves (log rank test), and Cox proportional hazards regression modeling. RESULTS Of 234 trial-eligible patients, 139 (59%) had uptake in both primary tumor and RLNs on pretreatment FDG-PET and had SUV data from post-treatment FDG-PET. Maximum SUV was greater for primary tumor than for RLNs before treatment (P<.001) but not different post-treatment (P=.320). Post-treatment SUV of RLNs was not associated with overall survival. However, elevated post-treatment SUV of RLNs, both the absolute value and the percentage of residual activity compared to the pretreatment SUV were associated with inferior local-regional control (P<.001). CONCLUSIONS High residual metabolic activity in RLNs on post-treatment FDG-PET is associated with worse local-regional control. Based on these data, future trials evaluating a radiation therapy boost should consider inclusion of both primary tumor and FDG-avid RLNs in the boost volume to maximize local-regional control.
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Affiliation(s)
- Stephanie Markovina
- Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Mitchell Machtay
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey D Bradley
- Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.
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Ping B, Tsuno S, Wang X, Ishihara Y, Yamashita T, Miura K, Miyoshi F, Shinohara Y, Matsuki T, Tanabe Y, Tanaka N, Ogawa T, Shiota G, Miura N. Comparative study of ¹⁸F-FDG-PET/CT imaging and serum hTERT mRNA quantification in cancer diagnosis. Cancer Med 2015; 4:1603-11. [PMID: 26275387 PMCID: PMC4618631 DOI: 10.1002/cam4.508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/11/2015] [Accepted: 07/14/2015] [Indexed: 12/18/2022] Open
Abstract
We have reported on the clinical usefulness of human telomerase reverse transcriptase (hTERT) mRNA quantification in sera in patients with several cancers. Positron emission tomography–computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) has recently become an excellent modality for detecting cancer. We performed a diagnostic comparative study of FDG-PET/CT and hTERT mRNA quantification in patients with cancer. Four hundred seventy subjects, including 125 healthy individuals and 345 outpatients with cancer who had received medical treatments for cancer in their own or other hospitals, were enrolled. The subjects were diagnosed by FDG-PET/CT, and we measured their serum hTERT mRNA levels using real-time RT-PCR, correlating the quantified values with the clinical course. In this prospective study, we statistically assessed the sensitivity and specificity, and their clinical significance. hTERT mRNA and FDG-PET/CT were demonstrated to be correlated with the clinical parameters of metastasis and recurrence (P < 0.001), and of recurrence and tumor number in cancer compared with noncancer patients, respectively. A multivariate analysis showed a significant difference in the detection by FDG-PET/CT, 18F-FDG uptake, the detection by hTERT mRNA, and age. The use of both FDG-PET/CT and hTERT mRNA resulted in a positivity of 94.4% (221/234) for the detection of viable tumor cells. FDG-PET/CT is superior to hTERT mRNA quantification in the early detection of cancer and combinative use of FDG-PET/CT and hTERT mRNA may improve the diagnostic accuracy of cancer.
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Affiliation(s)
- Bingqiong Ping
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Satoshi Tsuno
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Xinhui Wang
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yoshitaka Ishihara
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Taro Yamashita
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Keigo Miura
- PEZY-Pharma, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Fuminori Miyoshi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Yuki Shinohara
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Tsutomu Matsuki
- Department of Radiology, Tottori Municipal Hospital, 1-1 Matoba, Tottori, Tottori, 680-8501, Japan
| | - Yoshio Tanabe
- Department of Radiology, Tottori Municipal Hospital, 1-1 Matoba, Tottori, Tottori, 680-8501, Japan
| | - Noriaki Tanaka
- Department of Radiology, Tottori Municipal Hospital, 1-1 Matoba, Tottori, Tottori, 680-8501, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Goshi Shiota
- Division of Molecular and Genetic Medicine, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University School of Medicine, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Norimasa Miura
- Division of Pharmacotherapeutics, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Tottori, 683-8503, Japan
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Marquez-Medina D, Martin-Marco A, Popat S. Watch the weathercock: changes in re-staging 18F-FDG PET/CT scan predict the probability of relapse in locally advanced non-small cell lung cancer. Clin Transl Oncol 2015. [PMID: 26203801 DOI: 10.1007/s12094-015-1349-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Induction treatment is be coming the gold standard for locally advanced non-small cell lung cancers (LA-NSCLC). In contrast to baseline positron emission/computed tomography scan (PET/CT scan), re-staging PET/CT scan has been poorly studied in LA-NSCLC. MATERIALS AND METHODS We retrospectively explored the efficacy of re-staging PET/CT scan to diagnose response and to predict disease-free survival (DFS) in 55 induction-treated LA-NSCLC further treated with curative surgery or radiation but not with adjuvant therapy. RESULTS Re-staging N status by PET/CT scan significantly correlated with pathological N status. Radiological or metabolic response in the re-staging PET/CT scan was associated with a significantly better DFS, which decreased from 25.8 to 19.3, to 11.2, and to 9.4 months in cN0, cN1, cN2, and cN3 patients, respectively. CONCLUSION Re-staging PET/CT scan helps to define response and consolidation treatment in induction-treated LA-NSCLC and predicts DFS. Further extended studies should confirm our results.
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Affiliation(s)
- D Marquez-Medina
- Medical Oncology Department, Arnau de Vilanova University Hospital of Lleida, Avda. Rovira Roure, 80, 25198, Lleida, Spain.
| | - A Martin-Marco
- Medical Oncology Department, Arnau de Vilanova University Hospital of Lleida, Avda. Rovira Roure, 80, 25198, Lleida, Spain
| | - S Popat
- Lung Unit, Royal Marsden Hospital, London, UK
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Ulger S, Demirci NY, Aydinkarahaliloglu E, Kahraman FC, Ozmen O, Erdogan Y, Cetin E, Avci E, Cengiz M. PET-CT guided curative conformal radiation therapy in limited stage small cell lung cancer. J Thorac Dis 2015; 7:295-302. [PMID: 25922706 DOI: 10.3978/j.issn.2072-1439.2015.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/09/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The prognosis of small cell lung cancer (SCLC) has been improving with the advances in diagnostic and therapeutic modalities. Positron emission tomography/computed tomography (FDG-PET/CT) which has been studied in non-small cell lung cancer (NSCLC) for a long time, and it has only recently been applied to SCLC. Therefore we sought to observe firstly the prognostic importance of the FDG uptake in limited disease small cell lung cancer (LD-SCLC) patients and secondly the clinical outcomes and toxicity profiles of LD-SCLC patients treated with conformal radiation therapy (RT) using FDG-PET/CT simulation. METHODS Between 2009 and 2011, 33 LD-SCLC patients with LD-SCLC underwent disease staging using FDG-PET/CT conformal RT. Thoracic radiation was administered at a daily fraction of 2 Gy. Total dose was prescribed according to the treatment protocol such as, concurrent or sequential chemotherapy and in some patients according to the response of CT. All patients underwent chemotherapy. Survival was estimated using the Kaplan-Meier method. RESULTS The median age of the patients was 58 years (range, 38-77 years). The median follow-up time was 20 months (range, 6.6-47.6 months). The 3-year overall survival (OS) and locoregional control rates were 23% and 48%, respectively. CONCLUSIONS There are few studies examining the impact of PET-CT and the prognostic significance of FDG-uptake on outcomes in patients with LD-SCLC. Higher RT doses in response to higher FDG uptake may be safely applied for the purpose of locoregional control.
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Affiliation(s)
- Sukran Ulger
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgun Yilmaz Demirci
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ercan Aydinkarahaliloglu
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Caglar Kahraman
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Ozmen
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yurdanur Erdogan
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eren Cetin
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emine Avci
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cengiz
- 1 Department of Radiation Oncology, 2 Department of Chest Disease, Faculty of Medicine, Gazi University, Ankara, Turkey ; 3 Department of Radiation Oncology, 4 Department of Nuclear Medicine, 5 Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey ; 6 Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey ; 7 Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Bradshaw TJ, Bowen SR, Deveau MA, Kubicek L, White P, Bentzen SM, Chappell RJ, Forrest LJ, Jeraj R. Molecular imaging biomarkers of resistance to radiation therapy for spontaneous nasal tumors in canines. Int J Radiat Oncol Biol Phys 2015; 91:787-95. [PMID: 25752393 PMCID: PMC4355478 DOI: 10.1016/j.ijrobp.2014.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Imaging biomarkers of resistance to radiation therapy can inform and guide treatment management. Most studies have so far focused on assessing a single imaging biomarker. The goal of this study was to explore a number of different molecular imaging biomarkers as surrogates of resistance to radiation therapy. METHODS AND MATERIALS Twenty-two canine patients with spontaneous sinonasal tumors were treated with accelerated hypofractionated radiation therapy, receiving either 10 fractions of 4.2 Gy each or 10 fractions of 5.0 Gy each to the gross tumor volume. Patients underwent fluorodeoxyglucose (FDG)-, fluorothymidine (FLT)-, and Cu(II)-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM)-labeled positron emission tomography/computed tomography (PET/CT) imaging before therapy and FLT and Cu-ATSM PET/CT imaging during therapy. In addition to conventional maximum and mean standardized uptake values (SUV(max); SUV(mean)) measurements, imaging metrics providing response and spatiotemporal information were extracted for each patient. Progression-free survival was assessed according to response evaluation criteria in solid tumor. The prognostic value of each imaging biomarker was evaluated using univariable Cox proportional hazards regression. Multivariable analysis was also performed but was restricted to 2 predictor variables due to the limited number of patients. The best bivariable model was selected according to pseudo-R(2). RESULTS The following variables were significantly associated with poor clinical outcome following radiation therapy according to univariable analysis: tumor volume (P=.011), midtreatment FLT SUV(mean) (P=.018), and midtreatment FLT SUV(max) (P=.006). Large decreases in FLT SUV(mean) from pretreatment to midtreatment were associated with worse clinical outcome (P=.013). In the bivariable model, the best 2-variable combination for predicting poor outcome was high midtreatment FLT SUV(max) (P=.022) in combination with large FLT response from pretreatment to midtreatment (P=.041). CONCLUSIONS In addition to tumor volume, pronounced tumor proliferative response quantified using FLT PET, especially when associated with high residual FLT PET at midtreatment, is a negative prognostic biomarker of outcome in canine tumors following radiation therapy. Neither FDG PET nor Cu-ATSM PET were predictive of outcome.
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Affiliation(s)
- Tyler J Bradshaw
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen R Bowen
- Departments of Radiation Oncology and Radiology, University of Washington, Seattle, Washington
| | - Michael A Deveau
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | | | - Pamela White
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lisa J Forrest
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Jeraj
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin; Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
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Zhao F, Ding G, Huang W, Li M, Fu Z, Yang G, Kong L, Zhang Y, Yu J. FDG-PET Predicts Pain Response and Local Control in Palliative Radiotherapy With or Without Systemic Treatment in Patients With Bone Metastasis From Non-small-cell Lung Cancer. Clin Lung Cancer 2015; 16:e111-9. [PMID: 25736696 DOI: 10.1016/j.cllc.2015.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/18/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED The purpose of the present study was to evaluate the prognostic value of the maximal standardized uptake value (SUVmax) from serial positron emission tomography scans in patients with bone metastases from non-small-cell lung cancer. The results showed that the pre-RT SUVmax predicted the initial pain severity and local control. Moreover, the change in the SUVmax after palliative radiotherapy predicted the pain response and local control rate. INTRODUCTION We sought to evaluate the value of fluorine-18 fluorodeoxyglucose positron emission tomography (PET) in predicting the pain severity, pain response, and in-field tumor control after palliative radiotherapy (RT) in patients with non-small-cell lung cancer (NSCLC) bone metastases. MATERIALS AND METHODS The present retrospective, institutional review board-approved study involved 74 patients with NSCLC and 185 bone metastatic lesions. All patients had undergone PET-computed tomography (CT) scans before and after RT. The pain scores were determined using a numerical rating scale, and the maximal standardized uptake value (SUVmax) at each location was recorded. The pain scores and responses to RT were compared using the pre-RT SUVmax and SUVmax changes after RT. Cox regression analyses were performed to identify the prognostic factors for in-field progression-free survival (PFS) and in-field event-free survival (EFS). RESULTS The pre-RT SUVmax correlated with the initial pain scores (r = 0.885, P < .001), and the decrease in the SUVmax after RT was associated with the pain response to RT (P = .001). During the follow-up period, 47.03% and 38.92% of the lesions showed in-field tumor radiographic progression and in-field events, respectively. The Cox regression analyses showed that a higher pre-RT SUVmax (≥ 8.2) was an independent prognostic factor of worse in-field PFS and worse in-field EFS (hazard ratio [HR] 1.42 and 1.46; P = .044 and P = .005, respectively) and that a greater SUVmax decrease (≥ 28.3%) after RT was an independent prognostic factor of better in-field PFS and better in-field EFS (HR 0.59 and 0.60, respectively; P < .001 for both). CONCLUSION In patients with NSCLC osseous metastasis treated with palliative RT, the pre-RT SUVmax predicted the initial pain severity and local control. Moreover, the change in the SUVmax after RT predicted the pain response and local control.
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Affiliation(s)
- Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Gang Ding
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan, Shandong, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Zheng Fu
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Guoren Yang
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Yan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
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Image-derived biomarkers and multimodal imaging strategies for lung cancer management. Eur J Nucl Med Mol Imaging 2015; 42:634-43. [DOI: 10.1007/s00259-014-2974-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 12/14/2022]
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Apostolova I, Rogasch J, Buchert R, Wertzel H, Achenbach HJ, Schreiber J, Riedel S, Furth C, Lougovski A, Schramm G, Hofheinz F, Amthauer H, Steffen IG. Quantitative assessment of the asphericity of pretherapeutic FDG uptake as an independent predictor of outcome in NSCLC. BMC Cancer 2014; 14:896. [PMID: 25444154 PMCID: PMC4265451 DOI: 10.1186/1471-2407-14-896] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/21/2014] [Indexed: 12/05/2022] Open
Abstract
Background The aim of the present study was to evaluate the predictive value of a novel quantitative measure for the spatial heterogeneity of FDG uptake, the asphericity (ASP) in patients with non-small cell lung cancer (NSCLC). Methods FDG-PET/CT had been performed in 60 patients (15 women, 45 men; median age, 65.5 years) with newly diagnosed NSCLC prior to therapy. The FDG-PET image of the primary tumor was segmented using the ROVER 3D segmentation tool based on thresholding at the volume-reproducing intensity threshold after subtraction of local background. ASP was defined as the relative deviation of the tumor’s shape from a sphere. Univariate and multivariate Cox regression as well as Kaplan-Meier (KM) analysis and log-rank test with respect to overall (OAS) and progression-free survival (PFS) were performed for clinical variables, SUVmax/mean, metabolically active tumor volume (MTV), total lesion glycolysis (TLG), ASP and “solidity”, another measure of shape irregularity. Results ASP, solidity and “primary surgical treatment” were significant independent predictors of PFS in multivariate Cox regression with binarized parameters (HR, 3.66; p < 0.001, HR, 2.11; p = 0.05 and HR, 2.09; p = 0.05), ASP and “primary surgical treatment” of OAS (HR, 3.19; p = 0.02 and HR, 3.78; p = 0.01, respectively). None of the other semi-quantitative PET parameters showed significant predictive value with respect to OAS or PFS. Kaplan-Meier analysis revealed a probability of 2-year PFS of 52% in patients with low ASP compared to 12% in patients with high ASP (p < 0.001). Furthermore, it showed a higher OAS rate in the case of low versus high ASP (1-year-OAS, 91% vs. 67%: p = 0.02). Conclusions The novel parameter asphericity of pretherapeutic FDG uptake seems to provide better prognostic value for PFS and OAS in NCSLC compared to SUV, metabolic tumor volume, total lesion glycolysis and solidity.
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Affiliation(s)
- Ivayla Apostolova
- Clinic of Radiology and Nuclear Medicine, University Hospital, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, Magdeburg, Germany.
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