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

Abstract

Introduction:The 2-[18F]-Fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) has become an imaging tool for clinical assessment of tumor, node, metastasis in non–small-cell lung cancer (NSCLC). Primary tumor maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT before and after radiation therapy (RT) has been studied as a potential prognostic factor for NSCLC patients receiving radiotherapy. However, the sample sizes of most studies were small, and the results of the prediction value of SUVmax remained undetermined, which lead us to perform a meta-analysis to improve the precision in estimating its effect.Methods:We performed a meta-analysis of published literature for primary tumor SUVmax-based biomarkers of the outcome of NSCLC receiving radiotherapy. The required data for estimation of individual hazard ratios (HRs) to compare patients with a low and a high SUVmax were extracted from each publication. A combined HR was calculated by Stata statistical software (Version 11). All of the results were verified by two persons to ensure its accuracy.Results:Thirteen studies were finally included into this meta-analysis; data are available in 13 studies for pre-RT primary tumor SUVmax and in five studies for post-RT. For overall survival, the combined HR estimate was 1.05 (95% confidence interval [CI], 1.02–1.08) and 1.32 (95% CI, 1.15–1.51) for pre-RT SUVmax and post-RT SUVmax, respectively; 1.26 (95% CI, 1.05–1.52) and 2.01 (95% CI, 1.16–3.46) for local control (LC). In stereotactic body radiotherapy (SBRT) group, HR for LC was 1.11 (95% CI, 1.06–1.18) and 2.19 (95% CI, 1.34–3.60) for pre-SBRT SUVmax and post-SBRT SUVmax, respectively.Conclusion:Both pre-RT and post-RT primary tumor SUVmax can predict the outcome of patients with NSCLC treated with radiotherapy. Patients with high levels of pre-RT SUVmax seemed to have poorer overall survival and LC.

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

“…A previous study has indicated that an SUV max of 5-7 in tumors was important for predicting outcomes (26). However, these values depend on patient characteristics, treatments and radiation doses.…”

“…A previous meta-analysis of 13 studies on NSCLC treated with radiotherapy revealed that a high pre-treatment SUV max was significantly associated with unfavorable local control in patient treated with SBRT (hazard ratio, 1.11; 95% confidence interval, 1.06-1.18) (26). In the present study, the higher SUV max group did not exhibit worse local control compared with the lower SUV max group, possibly as the local control rate of C-ion RT was high and the difference between two groups was not significant.…”

Biological 18[F]-FDG-PET image-guided dose painting by numbers for painful uncomplicated bone metastases: A 3-arm randomized phase II trial

“…We hypothesized that positron emitting tomography (PET) with 18-[F]-fluoro-D-glucose ( 18 F-FDG), a commonly used surrogate for tumor cell burden and inflammation [25], can define our radiotherapy target and direct dose prescription in accordance to tumor heterogeneity. Intratumor regions of increased radioresistance, presumably indicated by higher standardized uptake value (SUV) of 18 F-FDG [1,18,22], receive escalated dose levels, whereas radiation-sensitive regions outside the target receive conventional or even de-escalated dose levels. This concept is referred to as dose-painting [4,13] and a theoretical example is presented in Fig.…”

18F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients

“…Studies have also shown that preoperative staging PET/CT leads to change in the treatment planning and reduces the frequency of futile thoracotomies and the total number of thoracotomies (6,7). PET-based quantitative parameters have been proposed as reliable indicators of survival in patients with lung cancer in both pretreatment and posttreatment settings (8)(9)(10)(11)(12). In the posttherapy setting, several studies point to the usefulness of monitoring the treatment response based on decreased SUVs on serial 18 F-FDG PET imaging of the primary tumor (4,8).…”