Local and regional treatment response by 18FDG-PET-CT-scans 4 weeks after concurrent hypofractionated chemoradiotherapy in locally advanced NSCLC

Judi N A van Diessen; Matthew La Fontaine; Michel M van den Heuvel; Erik van Werkhoven; Iris Walraven; Wouter V Vogel; José S A Belderbos; Jan-Jakob Sonke

doi:10.1016/j.radonc.2019.10.008

Local and regional treatment response by ¹⁸FDG-PET-CT-scans 4 weeks after concurrent hypofractionated chemoradiotherapy in locally advanced NSCLC

Radiother Oncol. 2020 Feb:143:30-36. doi: 10.1016/j.radonc.2019.10.008. Epub 2019 Nov 22.

Authors

Judi N A van Diessen¹, Matthew La Fontaine¹, Michel M van den Heuvel², Erik van Werkhoven³, Iris Walraven¹, Wouter V Vogel⁴, José S A Belderbos¹, Jan-Jakob Sonke⁵

Affiliations

¹ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
² Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
³ Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁴ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁵ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: j.sonke@nki.nl.

PMID: 31767474
DOI: 10.1016/j.radonc.2019.10.008

Abstract

Background and purpose: To investigate associations of early post-treatment ¹⁸Fluorodeoxyglucose-positron-emission-tomography (FDG-PET)-scans with local (LF), regional (RF), distant failure (DF) and overall survival (OS) in locally advanced non-small cell lung cancer (LA-NSCLC)-patients treated with concurrent chemoradiotherapy.

Materials and methods: Forty-seven stage IIIA-B NSCLC-patients included in a randomized phase II-trial (NTR2230) received 66 Gy (24x2.75 Gy) with low dose Cisplatin +/- Cetuximab. FDG-PET-scans were performed at baseline and 4 weeks post-treatment (range, 1.6-10.1). SUV_max, SUV_mean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and gross tumor volume were calculated separately for the primary tumor and the involved lymph nodes to generate baseline, post-treatment, and relative response metrics defined as (metric_pre-metric_post)/metric_pre. Univariable cox regression analyses were performed to investigate associations between PET-metrics and outcomes.

Results: Metrics resulted from the post-treatment scan and relative response were associated with outcome, but baseline metrics were not. Primary tumor metrics were stronger associated with all outcomes than lymph node metrics. Both the volumetric (TLG/MTV) and intensity (SUV_max/SUV_mean) PET-metrics were associated with OS. The intensity metrics were associated with LF, while the volumetric PET-metrics were associated with RF/DF. This was in contrast to the nodal metrics, demonstrating only an association between RF and the relative response of TLG/MTV. No preference was found between PET volumetric and intensity metrics associated with outcome.

Conclusion: Early post-treatment PET-metrics are associated with treatment outcome in LA-NSCLC patients treated with chemoradiotherapy. Both volumetric and intensity PET-metrics are useful, but more for the primary tumor than for lymph nodes.

Keywords: (18)FDG-PET-scan; Distant failure; Early post-treatment assessment; Local failure; Locally advanced NSCLC; Regional failure.

Publication types

Clinical Trial, Phase II
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung* / diagnostic imaging
Carcinoma, Non-Small-Cell Lung* / therapy
Chemoradiotherapy
Fluorodeoxyglucose F18
Humans
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / therapy
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Prognosis
Radiopharmaceuticals
Retrospective Studies

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18