¹⁸F-FDG PET Early Response Evaluation of Locally Advanced Non–Small Cell Lung Cancer Treated with Concomitant Chemoradiotherapy

Abstract

The potential of 18 F-FDG PET changes was evaluated for prediction of response to concomitant chemoradiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). Methods: For 28 patients, 18 F-FDG PET was performed before treatment, at the end of the second week of treatment, and at 2 wk and 3 mo after the completion of treatment. Standardized uptake value (SUV), maximum SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained. Early metabolic changes were defined as fractional change (DTLG) when 18 F-FDG PET at the end of the second week was compared with pretreatment 18 F-FDG PET. In-treatment metabolic changes, as measured by serial 18 F-FDG PET, were correlated with standard criteria of response evaluation of solid tumors by means of CT imaging (Response Evaluation Criteria In Solid Tumors 1.1). Parameters were analyzed for stratification in progression-free survival (PFS). Results: When compared with early metabolic nonresponders, a DTLG decrease of 38% or more was associated with a significantly longer PFS (1-y PFS 80% vs. 36%, P 5 0.02). Pretreatment TLG was found to be a prognostic factor for PFS. Conclusion: The degree of change in TLG was predictive for response to concomitant chemoradiotherapy as early as the end of the second week into treatment for patients with locally advanced NSCLC. Pretreatment TLG was prognostic for PFS.

Can an 18F-ALF-NOTA-PRGD2 PET/CT Scan Predict Treatment Sensitivity to Concurrent Chemoradiotherapy in Patients with Newly Diagnosed Glioblastoma?

“…Therefore, in our study, we chose the change of lesion volume as the evaluation criteria. (2) Contrary to other studies (8,28), it seems that all changes in 18 F-RGD parameters (DSUV max , DT/NT, and DTV) have no close relationship to short-term outcome in this study. Perhaps this mostly depends on the influence from baseline parameters.…”

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).…”

“…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). Higher volume of residual metabolically active tumor after definitive treatment appears to be associated with poorer survival (13,14).…”

Imaging-Based Treatment Adaptation in Radiation Oncology

“…Van Elmpt et al (31) assessed 18 F-FDG PET uptake patterns before and 2 wk into therapy in 34 advanced-stage NSCLC patients and reported that a marked decrease in the 18 F-FDG PET signal between the two PET scans predicted higher overall survival. In a similar Dutch study, Usmanij et al (32) showed that a decrease in total-lesion glycolysis of more than 38% during the first 2 wk of therapy was associated with a significantly longer progression-free survival.…”