Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer

Feng Ming (Spring) Kong, Ling Li, Weili Wang, Jeff Campbell, Jennifer L Waller, Morand Piert, Milton Gross, Monica Cheng, Dawn Owen, Matthew Stenmark, Ke Colin Huang, Kirk A. Frey, Randall K. Ten Haken, Theodore S. Lawrence

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Abstract

Background and purpose: This study tested the hypotheses that 1) changes in mid-treatment fluorodeoxyglucose (FDG)-positron emission tomography (PET) parameters are predictive of overall survival (OS) and 2) mid-treatment FDG-PET–adapted treatment has the potential to improve survival in patients with non-small cell lung cancer (NSCLC). Material and methods: Patients with stage I-III NSCLC requiring daily fractionated radiation were eligible. FDG-PET-CT scans were obtained prior to and mid-treatment with radiotherapy at 40–50 Gy. The normalized maximum standardized uptake value (NSUVmax), normalized mean SUV (NSUVmean), PET-metabolic tumor volume (MTV), total lesion glycolysis (TLG), and computed tomography-based gross tumor volume (CT-GTV) were consistently measured for all patients. The primary study endpoint was OS. Results: The study is comprised of 102 patients who received 3-dimensional conformal radiotherapy, among whom 30 patients who received mid-treatment PET-adapted dose escalation radiotherapy. All PET-CT parameters decreased significantly (P < 0.001) mid-treatment, with greater reductions in FDG-volumetric parameters compared to FDG-activity factors. Mid-treatment changes in MTV (P = 0.053) and TLG (P = 0.021) were associated with OS, while changes in NSUVmax, NSUVmean, and CT-GTV were not (all Ps>0.1). Patients receiving conventional radiation (60-70 Gy) with MTV reductions greater than the mean had a median survival of 14 months, compared to those with MTV reductions less than the mean who had a median survival of 22 months. By contrast, patients receiving mid-treatment PET-adapted radiation with MTV reductions greater than the mean had a median survival of 33 months, compared to those with MTV reductions less than the mean who had a median survival of 19 months. Overall, PET-adapted treatment resulted in a 19% better 5-year survival than conventional radiation. Conclusion: Changes in mid-treatment PET-volumetric parameters were significantly associated with survival in NSCLC. A greater reduction in the mid-treatment MTV was associated with worse survival in patients treated with standard radiation, but with better survival in patients who received mid-treatment PET-adapted treatment.

Original languageEnglish (US)
Pages (from-to)241-249
Number of pages9
JournalRadiotherapy and Oncology
Volume132
DOIs
StatePublished - Mar 2019

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Keywords

  • FDG-PET
  • Metabolic tumor volume
  • Mid-treatment
  • Non-small cell lung cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Kong, F. M. S., Li, L., Wang, W., Campbell, J., Waller, J. L., Piert, M., Gross, M., Cheng, M., Owen, D., Stenmark, M., Huang, K. C., Frey, K. A., Ten Haken, R. K., & Lawrence, T. S. (2019). Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer. Radiotherapy and Oncology, 132, 241-249. https://doi.org/10.1016/j.radonc.2018.10.006