Early FDG-PET imaging after radical radiotherapy for non-small cell lung cancer: Inflammatory changes in normal tissues correlate with tumor response and do not confound therapeutic response evaluation

Hicks, Rodney J.; MacManus, Michael; Matthews, Jane De Hart; Hogg, Annette; Binns, David; Rischin, Danny; Ball, David; Peters, L.J.

doi:10.1016/s0360-3016(04)01203-9

Cited by 18 publications

(22 citation statements)

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“…2 Previous investigators have noted radiation induced 18 F-FDG PET inflammatory changes in normal lung tissue. 3,4 We found with statistical modeling a linear relationship between normalized 18 F-FDG uptake and radiation dose in normal lung after thoracic radiotherapy. 5 The slope of this linear relation, which we refer to as the pulmonary metabolic radiation response (PMRR), provides an objective, quantifiable measure of the inflammation response to radiation.…”

Section: Introductionmentioning

confidence: 80%

Radiation Pneumonitis: Correlation of Toxicity With Pulmonary Metabolic Radiation Response

Hart

McCurdy

Ezhil

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To characterize the relationship between radiation pneumonitis (RP) clinical symptoms and pulmonary metabolic activity on post-treatment [ 18 F]-fluorodeoxyglucose positron emission tomography (FDG PET).Methods-We retrospectively studied 101 esophageal cancer patients who underwent restaging FDG PET/CT imaging between 3 and 12 weeks after completing thoracic radiotherapy. The Common Toxicity Criteria version 3 (CTC3) was used to score RP clinical symptoms. Linear regression was applied to the FDG PET/CT images to determine the normalized FDG uptake versus radiation dose. The pulmonary metabolic radiation response (PMRR) was quantified as this slope. Modeling was performed to determine the interaction of PMRR, mean lung dose (MLD), and percentage of lung receiving greater than 20 Gy (V20) with RP outcomes.Results-Of the 101 patients, 25 had grade 0, 10 had grade 1, 60 had grade 2, 5 had grade 3, and 1 had grade 5 RP symptoms. Logistic regression demonstrated that increased values of both MLD and PMRR were associated with a higher probability of RP clinical symptoms (P=0.032 and P=0.033, respectively). Spearman's rank correlation found no association between the PMRR and dosimetric parameters (PTV, MLD, V5 through V30). Two-fold cross validation demonstrated the combination of MLD and PMRR was superior to either alone for assessing the development of Conflict of Interest Notification:The authors declare that they have no commercial or financial interests related to this study to disclose.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-This study demonstrated a significant correlation between RP clinical symptoms and the PMRR measured by FDG PET/CT following thoracic radiotherapy. NIH Public Access

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Section: Introductionmentioning

confidence: 80%

Radiation Pneumonitis: Correlation of Toxicity With Pulmonary Metabolic Radiation Response

Hart

McCurdy

Ezhil

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…In a prospective study, PET and CT assessments performed at a median of 70 days after RT, were concordant in only 40% of cases [81]. PET response was the best predictor of survival, was strongly-correlated with patterns of failure [82] and was not confounded by normal tissue reactions [83] .…”

Section: Tumor Movementmentioning

confidence: 98%

Use of PET and PET/CT for Radiation Therapy Planning: IAEA expert report 2006–2007

MacManus

Nestle

Rosenzweig

et al. 2009

Radiotherapy and Oncology

334

197

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“…Increased FDG uptake in normal tissues following irradiation has also been described for the lungs (23,28) and heart (29). Data from lung treatment suggests not only is there a dose response between radiation delivered to normal lung and subsequent FDG uptake (23), but the degree of FDG uptake in adjacent normal lung is also directly correlated with local control.…”

Section: Discussionmentioning

confidence: 93%

Posttreatment FDG-PET Uptake in the Supraglottic and Glottic Larynx Correlates With Decreased Quality of Life After Chemoradiotherapy

Dornfeld

Hopkins

Simmons

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Inflammation and increased metabolic activity associated with oxidative stress in irradiated normal tissues may contribute to both complications following radiotherapy and increased glucose uptake as detected by post-therapy FDG PET imaging. We sought to determine if increased glucose uptake in normal tissues after chemoradiotherapy is associated with increased toxicity.Methods-Consecutive patients with locoregionally advanced head and neck cancers treated with IMRT and free of recurrence at one year were studied. FDG-PET imaging was obtained at 3 and 12 months post-treatment. SUV levels were determined at various head and neck regions. Functional outcome was measured using a quality of life questionnaire and weight loss and type of diet tolerated one year after therapy. A one-tailed Pearson correlation test was used to examine associations between SUV levels and functional outcome measures.Results-SUV levels in the supraglottic and glottic larynx from FDG PET imaging obtained 12 months post-treatment were inversely associated with quality of life measures and were correlated with a more restricted diet one year after therapy. SUV levels at 3 months after therapy did not correlate with functional outcome. Increases in SUV levels in normal tissues between 3 and 12 months were commonly found in the absence of recurrence.Conclusion-Altered metabolism in irradiated tissues persists one year after therapy. FDG PET scans may be used to assess normal tissue damage following chemoradiotherapy. These data support investigating hypermetabolic conditions associated with inflammation and\or oxidative stress as causal agents for radiation induced normal tissue damage.

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Early FDG-PET imaging after radical radiotherapy for non-small cell lung cancer: Inflammatory changes in normal tissues correlate with tumor response and do not confound therapeutic response evaluation

Cited by 18 publications

References 0 publications

Radiation Pneumonitis: Correlation of Toxicity With Pulmonary Metabolic Radiation Response

Radiation Pneumonitis: Correlation of Toxicity With Pulmonary Metabolic Radiation Response

Use of PET and PET/CT for Radiation Therapy Planning: IAEA expert report 2006–2007

Posttreatment FDG-PET Uptake in the Supraglottic and Glottic Larynx Correlates With Decreased Quality of Life After Chemoradiotherapy

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