Stability of 18F-Deoxyglucose Uptake Locations Within Tumor During Radiotherapy for NSCLC: A Prospective Study

Aerts, Hugo J.W.L.; Bosmans, Geert; Baardwijk, Angela A.W. van; Dekker, André; Oellers, M.; Lambin, Philippe; Ruysscher, Dirk De

doi:10.1016/j.ijrobp.2007.11.049

Cited by 76 publications

(51 citation statements)

References 30 publications

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“…After Aerts' first study (22) comparing overlap fractions of subvolumes defined with 34%, 40%, 50%, 60%, 70%, and 80% SUV max at baseline (PET A ), at the seventh day of radiotherapy (PET B ), and at the 14th day of radiotherapy (PET C ), our results confirmed that the topography of the high 18 F-FDG uptake subvolumes within the tumor remains stable during the course of radiotherapy, despite large variations in absolute volumes. On the basis of these results, we conclude that residual metabolically active and relapse areas within the tumor can be identified using initial 18 F-FDG PET/CT scans.…”

Section: Discussionmentioning

confidence: 99%

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

et al. 2015

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The high rates of failure in the radiotherapy target volume suggest that patients with stage II or III non-small cell lung cancer (NSCLC) should receive an increased total dose of radiotherapy. Areas of high 18 F-FDG uptake on preradiotherapy 18 F-FDG PET/CT have been reported to identify intratumor subvolumes at high risk of relapse after radiotherapy. We wanted to confirm these observations on a cohort of patients included in 3 sequential prospective studies. Our aim was to assess an appropriate threshold (percentage of maximum standardized uptake value [SUV max ]) to delineate subvolumes on staging 18 F-FDG PET/CT scans assuming that a smaller target volume would facilitate isotoxic radiotherapy dose escalation. Methods: Thirty-nine patients with inoperable stage II or III NSCLC, treated with chemoradiation or with radiotherapy alone, were extracted from 3 prospective studies (ClinicalTrials. gov identifiers NCT01261585, NCT01261598, and RECF0645). All patients underwent 18 F-FDG PET/CT at initial staging, before radiotherapy, during radiotherapy, and during systematic follow-up in a single institution. All 18 F-FDG PET/CT acquisitions were coregistered on the initial scan. Various subvolumes in the initial acquisition (30%, 40%, 50%, 60%, 70%, 80%, and 90% SUV max thresholds) and in the 3 subsequent acquisitions (40% and 90% SUV max thresholds) were pasted on the initial scan and compared. Results: Seventeen patients had a local relapse. The SUV max measured during radiotherapy was significantly higher in locally relapsed tumors than in locally controlled tumors (mean, 6.8 vs. 4.6; P 5 0.02). The subvolumes delineated on initial PET/CT scans with 70%-90% SUV max thresholds were in good agreement with the recurrent volume at a 40% SUV max threshold (common volume/baseline volume, 0.60-0.80). The subvolumes delineated on initial PET/CT scans with 30%-60% SUV max thresholds were in good to excellent agreement with the core volume of the relapse (90% SUV max threshold) (common volume/recurrent volume and overlap fraction indices, 0.60-0.93). The agreement was moderate (.0.51) when a 70% SUV max threshold was used to delineate on initial PET/CT scans. Conclusion: High 18 F-FDG uptake areas on pretreatment PET/ CT scans identify tumor subvolumes at greater risk of relapse in patients with NSCLC treated by concomitant chemoradiation. We propose a 70% SUV max threshold to delineate areas of high 18 F-FDG uptake on initial PET/CT scans as the target volumes for potential radiotherapy dose escalation.

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Section: Discussionmentioning

confidence: 99%

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

et al. 2015

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“…The biologic rationale for this approach is that FDG uptake is heterogeneous within a tumor; it reflects tumor areas with high cell density, which are highly metabolically active, and may identify the regions of radioresistant tumor cells owing to hypoxia or other mechanisms of radioresistance (4)(5)(6)(7)(8). The hypothesis of a more radioresistant tumor phenotype within high FDG uptake regions is also supported by the observation that (i) FDG uptake before or early during treatment is an independent prognostic factor for the outcome of (chemo-) radiotherapy in various tumor entities (9)(10)(11); (ii) regions of high FDG uptake remain stable during radiotherapy (12), and (iii) the residual metabolically active regions and local recurrences after radiotherapy remain or appear in the high pretreatment FDG uptake areas within the irradiated target volume (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 97%

Preclinical Assessment of Efficacy of Radiation Dose Painting Based on Intratumoral FDG-PET Uptake

Trani

Yaromina

Dubois

et al. 2015

Clinical Cancer Research

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“…About one third of those patients present with locally advanced disease at diagnosis (stage IIIA and B). In this heterogeneous group the average 5-year-survival rate has been in the range of 15% -27% at best [1]- [5]. A very important factor for survival is a good local and regional, especially mediastinal control [1] [2] [4] [5].…”

Section: Introductionmentioning

confidence: 99%

Is <sup>18</sup>F-FDG-PET/CT a Valid Non-Invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?

Klass¹,

Baüm²,

Schmuecking³

et al. 2014

JCT

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Stability of 18F-Deoxyglucose Uptake Locations Within Tumor During Radiotherapy for NSCLC: A Prospective Study

Cited by 76 publications

References 30 publications

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Preclinical Assessment of Efficacy of Radiation Dose Painting Based on Intratumoral FDG-PET Uptake

Is <sup>18</sup>F-FDG-PET/CT a Valid Non-Invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?

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Stability of 18F-Deoxyglucose Uptake Locations Within Tumor During Radiotherapy for NSCLC: A Prospective Study

Cited by 76 publications

References 30 publications

Areas of High 18F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High 18F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Preclinical Assessment of Efficacy of Radiation Dose Painting Based on Intratumoral FDG-PET Uptake

Is &lt;sup&gt;18&lt;/sup&gt;F-FDG-PET/CT a Valid Non-Invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?

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Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Is <sup>18</sup>F-FDG-PET/CT a Valid Non-Invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?