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

Research output: Contribution to journalArticle

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 1 2019

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Non-Small Cell Lung Carcinoma
Positron-Emission Tomography
Tumor Burden
Survival
Radiation
Therapeutics
Radiotherapy
Conformal Radiotherapy
Glycolysis
Tomography

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

Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer. / Kong, Feng Ming (Spring); Li, Ling; Wang, Weili; Campbell, Jeff; Waller, Jennifer L; Piert, Morand; Gross, Milton; Cheng, Monica; Owen, Dawn; Stenmark, Matthew; Huang, Ke Colin; Frey, Kirk A.; Ten Haken, Randall K.; Lawrence, Theodore S.

In: Radiotherapy and Oncology, Vol. 132, 01.03.2019, p. 241-249.

Research output: Contribution to journalArticle

Kong, FMS, Li, L, Wang, W, Campbell, J, Waller, JL, Piert, M, Gross, M, Cheng, M, Owen, D, Stenmark, M, Huang, KC, Frey, KA, Ten Haken, RK & Lawrence, TS 2019, 'Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer', Radiotherapy and Oncology, vol. 132, pp. 241-249. https://doi.org/10.1016/j.radonc.2018.10.006
Kong, Feng Ming (Spring) ; Li, Ling ; Wang, Weili ; Campbell, Jeff ; Waller, Jennifer L ; Piert, Morand ; Gross, Milton ; Cheng, Monica ; Owen, Dawn ; Stenmark, Matthew ; Huang, Ke Colin ; Frey, Kirk A. ; Ten Haken, Randall K. ; Lawrence, Theodore S. / Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer. In: Radiotherapy and Oncology. 2019 ; Vol. 132. pp. 241-249.
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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.",
keywords = "FDG-PET, Metabolic tumor volume, Mid-treatment, Non-small cell lung cancer",
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T1 - Greater reduction in mid-treatment FDG-PET volume may be associated with worse survival in non-small cell lung cancer

AU - Kong, Feng Ming (Spring)

AU - Li, Ling

AU - Wang, Weili

AU - Campbell, Jeff

AU - Waller, Jennifer L

AU - Piert, Morand

AU - Gross, Milton

AU - Cheng, Monica

AU - Owen, Dawn

AU - Stenmark, Matthew

AU - Huang, Ke Colin

AU - Frey, Kirk A.

AU - Ten Haken, Randall K.

AU - Lawrence, Theodore S.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - FDG-PET

KW - Metabolic tumor volume

KW - Mid-treatment

KW - Non-small cell lung cancer

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