Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Abstract

Objective: To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate. Methods: 55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST. Results: Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p50.001); no significant changes were found for BV (p50.3) and TTP (p50.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2634.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9622.4%), and the highest decrease of PS was shown in squamous cell carcinoma (221.5618.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p,0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (1869.6%) and BV (12.669.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6

From diagnosis to therapy in lung cancer: management of CT detected pulmonary nodules, a summary of the 2015 Chinese-German Lung Cancer Expert Panel

“…After chemo-radiation therapy, findings at perfusion CT can act as a significant predictor of early tumor response and OS among NSCLC patients. CT-perfusion can adequately evaluate therapy-induced alterations in NSCLC, and perfusion parameters correlate with therapy response assessment performed with RECIST criteria (40). Evaluating perfusion parameters, CT-perfusion can demonstrate therapy-induced changes in patients with different types of lung cancer and identify response to treatment with excellent agreement to RECIST measurements.…”

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

“…Investigative Radiology • Volume 00, Number 00, Month 2015 coworkers 36 recently showed that the comparably high BF of LCC shows the best response of all NSCLC subtypes to antiangiogenic treatment. We found significant differences in pulmonary PI max using a tumor volume cutoff of 3.5 cm 3 , with higher pulmonary PI max in larger tumors.…”

“…9,15,46-48 Tacelli et al 19,36 showed a significant reduction in total tumor vascular volume during treatment with chemotherapy using anti-vascular endothelial growth factor drugs. Fraioli et al 19,36 demonstrated a significant difference in BF and BV in LCC patients for partial response and progressive disease.…”

“…Fraioli et al 19,36 demonstrated a significant difference in BF and BV in LCC patients for partial response and progressive disease. Although we did not address therapeutic effects, the results of our study indicate that both histological subtype and tumor volume likely should be taken into account when assessing tumoral treatment response using CTP.…”

Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology

“…Two other studies [24,87] investigated the role of VPCT in therapy response monitoring in lung cancer. They compared NSCLC before and during anti-angiogenetic treatment.…”