Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated with Better Survival of Patients with Locally Advanced Non–Small Cell Lung Cancer

Abstract

We evaluated potential associations between maximum standardized uptake value (SUV max ) on 18 F-FDG PET before and after radiation therapy (RT) and survival outcomes for patients with locally advanced non-small cell lung cancer. Methods: Patients with stage III non-small cell lung cancer (n 5 49) who had undergone 18 F-FDG PET at the M.D. Anderson Cancer Center both before and up to 3.5 mo after undergoing radiochemotherapy were studied; exclusion criteria were patients with a history of thoracic surgery, RT, or other cancer or those who had received a total radiation dose less than 60 Gy. We assessed associations between overall survival (OS) or disease-free survival (DFS) and post-RT SUV max and the extent of decrease in SUV max in the primary tumor (PT) and regional lymph nodes (LNs). SUV max was assessed as a continuous variable by Cox proportional hazards regression analysis. Results: Univariate and multivariate analyses showed that having a high post-RT SUV max (either PT or LNs) was associated with a higher risk of death (univariate analyses: hazard ratio [HR] for PT SUV max , 1.27, P , 0.0001; HR for LN SUV max , 1.32, P 5 0.004) and disease recurrence (univariate analyses: HR for PT SUV max , 1.16, P 5 0.004; HR for LN SUV max , 1.32, P 5 0.001). Moreover, after definitive RT, the greater the decrease in SUV max in the lesion that had the highest SUV max at diagnosis, the longer the OS (HR, 0.06; P 5 0.002), DFS (HR, 0.03; P 5 0.001), local-regional control (HR, 0.04; P 5 0.002), and distant metastasis-free survival (HR, 0.07; P 5 0.028). Conclusion: The post-RT SUV max in both the PT and the LNs was a predictor of survival-specifically, the higher the residual SUV max after RT, the poorer the OS and DFS; and the greater the decrease in SUV max in the lesion with the highest SUV max at diagnosis, the longer the OS and DFS. This information should help to identify patients who are at high risk of recurrence and for whom additional treatments can be designed accordingly.

Primary Tumor Standardized Uptake Value Measured on F18-Fluorodeoxyglucose Positron Emission Tomography Is of Prediction Value for Survival and Local Control in Non–Small-Cell Lung Cancer Receiving Radiotherapy: Meta-Analysis

“…The threshold level was 150 mg/dl 24–26,30,34 in five studies, 200 mg/dl in three, 23,33,36 130 mg/dl 31 in one, 175 mg/dl 22 in one, and not given in the other three publications. 32,35,37 All the studies obtained emission and transmission scans 60 minutes after the injection of 18 F-FDG; however, the dose of 18 F-FDG varied across the studies: 5 MBq/kg in three studies, 22,35,36 10 to 20 mCi in four, 26,33,34,37 10 to 15 mCi in three, 25,31,32 and 3, 30 3.5, 23 and 7.4 MBq/kg 32 in the remaining three studies, respectively. Primary tumor SUV max was normalized by body weight in all studies to minimize the partial volume effect.…”

“…25,26,36,37 If the HR was not given explicitly, 24 p value and total events were used to calculate the HR based on a method reported by Tierney et al 38 The final combination of HR was the effect value to show the prognostic significance.…”

“…15–18 For NSCLC, 18 F-FDG PET/CT has been found useful for diagnosing, restaging at recurrence, 19 delineating radiotherapeutic targets, 20 and evaluating radiotherapeutic or chemotherapeutic effects. 19–21 Maximum standardized uptake value (SUV max ) derived from 18 F-FDG PET/CT has been reported by some, 22–24 but not all, 25,26 to predict the responses to RT in patients with NSCLC.…”

Potentially Functional Variants of ATG16L2 Predict Radiation Pneumonitis and Outcomes in Patients with Non–Small Cell Lung Cancer after Definitive Radiotherapy

“…RP intervals were calculated from the date that treatment began to the time of incidence of severe RP (grade ≥3); LRFS intervals were calculated from the date that treatment began to the time of tumor recurrence or death (LRFS) or the time of progression or death (PFS); and the patients were censored at the time of the final follow-up. 38 The OS interval was calculated from the date of diagnosis until death or the date of last contact. Multivariate Cox proportional hazards regression models were performed to calculate hazards ratios (HRs) and 95% confidence intervals (CIs) of each genotype to estimate its effect on RP, LRFS, PFS, and OS with adjustment for confounding factors.…”

Use Of Pet In Radiationtreatment Planning For Thoracic Malingnancies

“…Metabolik cevap veren grupta genel sağkalım cevap vermeyen grupla karşılaştırıldığında daha yüksek bulunmuştur. SUDmax değerindeki azalma oranı hastalıksız sağ kalım ile direkt ilişkilidir (63).…”