FLT-PET/CT in Non-Small Cell Lung Cancer Treated With SBRT- A Pilot Study

Objective: To correlate changes in the apparent diffusion coefficient (ADC) from diffusion-weighted (DW)-MRI and standardised uptake value (SUV) from fluorothymidine (18FLT)-PET/CT with histopathological estimates of response in patients with non-small cell lung cancer (NSCLC) treated with neoadjuvant chemotherapy and track longitudinal changes in these biomarkers in a multicentre, multivendor setting. Methods: 14 patients with operable NSCLC recruited to a prospective, multicentre imaging trial (EORTC-1217) were treated with platinum-based neoadjuvant chemotherapy. 13 patients had DW-MRI and FLT-PET/CT at baseline (10 had both), 12 were re-imaged at Day 14 (eight dual-modality) and nine after completing chemotherapy, immediately before surgery (six dual-modality). Surgical specimens (haematoxylin-eosin and Ki67 stained) estimated the percentage of residual viable tumour/necrosis and proliferation index. Results: Despite the small numbers,significant findings were possible. ADCmedian increased (p < 0.001) and SUVmean decreased (p < 0.001) significantly between baseline and Day 14; changes between Day 14 and surgery were less marked. All responding tumours (>30% reduction in unidimensional measurement pre-surgery), showed an increase at Day 14 in ADC75th centile and reduction in total lesion proliferation (SUVmean x proliferative volume) greater than established measurement variability. Change in imaging biomarkers did not correlate with histological response (residual viable tumour, necrosis). Conclusion: Changes in ADC and FLT-SUV following neoadjuvant chemotherapy in NSCLC were measurable by Day 14 and preceded changes in unidimensional size but did not correlate with histopathological response. However, the magnitude of the changes and their utility in predicting (non-) response (tumour size/clinical outcome) remains to be established. Advances in knowledge: During treatment, ADC increase precedes size reductions, but does not reflect histopathological necrosis.

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Efficacy of 18F-FDG and 18F-FLT PET/CT for Assessment of Chemoradiotherapy in Patient with Non-Small Cell Lung Cancer (Clinical Observation)

Medical Visualization ◽

10.24835/1607-0763-2017-1-53-56 ◽

2017 ◽

pp. 53-56

Author(s):

N. A. Meshcheryakova ◽

M. B. Dolgushin ◽

T. N. Borisova ◽

M. M. Davydov ◽

K. K. Laktionov

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Clinical Observation ◽

Early Response ◽

Small Cell ◽

Small Cell Lung ◽

Flt Pet ◽

Pet Ct ◽

18F Fdg

PET/CT offers the most advanced possibilities for visualization of non-small cell lung cancer (NSCLC) nowadays. 18F-FDG PET/CT plays a significant role in staging of NSCLC, choosing of treatment strategy, planning of radiation therapy and evaluation of its efficacy. Clinical observation of the patient with non-small cell lung cancer with response assessments by 18F-FDG and 18FFLT PET/CT during the course of chemoirradiation is demonstrated. There was a correlation between 18F-FDG and 18F-FLT PET/CT with advantage of 18F-FLT PET/CT for early response evaluation. The combination of 18F-FDG and 18FFLT PET/CT will be helpful to personalize chemoirradiation and to predict response more accurately. The presented clinical case demonstrated the possibilities of 18F-FDG and 18F-FLT PET/CT for assessment of treatment efficacy in patient with non-small cell lung cancer.

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