Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

Radiation-induced changes may cause a non-malignant high 2-deoxy-2-[18F]fluoro-d-glucose (FDG)-uptake. The 3′-deoxy-3′-[18F]fluorothymidine (FLT)-PET/CT performs better in the differential diagnosis of inflammatory changes and lung lesions with a higher specificity than FDG-PET/CT. We investigated the association between post-radiotherapy FDG-PET-parameters, FLT-PET-parameters, and outcome. Sixty-one patients suspected for having a relapse after definitive radiotherapy for lung cancer were included. All the patients had FDG-PET/CT and FLT-PET/CT. FDG-PET- and FLT-PET-parameters were collected from within the irradiated high-dose volume (HDV) and from recurrent pulmonary lesions. For associations between PET-parameters and relapse status, respectively, the overall survival was analyzed. Thirty patients had a relapse, of these, 16 patients had a relapse within the HDV. FDG-SUVmax and FLT-SUVmax were higher in relapsed HDVs compared with non-relapsed HDVs (median FDG-SUVmax: 12.8 vs. 4.2; p < 0.001; median FLT-SUVmax 3.9 vs. 2.2; p < 0.001). A relapse within HDV had higher FDG-SUVpeak (median FDG-SUVpeak: 7.1 vs. 3.5; p = 0.014) and was larger (median metabolic tumor volume (MTV50%): 2.5 vs. 0.7; 0.014) than the relapsed lesions outside of HDV. The proliferative tumor volume (PTV50%) was prognostic for the overall survival (hazard ratio: 1.07 pr cm3 [1.01–1.13]; p = 0.014) in the univariate analysis, but not in the multivariate analysis. FDG-SUVmax and FLT-SUVmax may be helpful tools for differentiating the relapse from radiation-induced changes, however, they should not be used definitively for relapse detection.

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18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial

Journal of Nuclear Medicine ◽

10.2967/jnumed.120.247742 ◽

2020 ◽

pp. jnumed.120.247742

Author(s):

Tine Noehr Christensen ◽

Seppo W Langer ◽

Gitte F Persson ◽

Klaus Richter Larsen ◽

Annika Loft ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trial ◽

Fdg Pet ◽

Prospective Clinical Trial ◽

Definitive Radiotherapy ◽

Flt Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Total metabolic tumor volume by 18F-FDG PET/CT for the prediction of outcome in patients with non-small cell lung cancer

Annals of Nuclear Medicine ◽

10.1007/s12149-019-01407-z ◽

2019 ◽

Vol 33 (12) ◽

pp. 937-944 ◽

Cited By ~ 3

Author(s):

Sara Pellegrino ◽

Rosa Fonti ◽

Emanuela Mazziotti ◽

Luisa Piccin ◽

Eleonora Mozzillo ◽

...

Keyword(s):

Lung Cancer ◽

Fdg Pet ◽

Tumor Volume ◽

Metabolic Tumor Volume ◽

Small Cell ◽

Small Cell Lung ◽

Prediction Of Outcome ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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An Ontario Clinical Oncology Group (OCOG) randomized trial (PET START) of FDG PET/CT in patients with stage III non-small cell lung cancer (NSCLC): Predictors of overall survival.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.15_suppl.7018 ◽

2011 ◽

Vol 29 (15_suppl) ◽

pp. 7018-7018 ◽

Cited By ~ 7

Author(s):

Y. Ung ◽

C. Gu ◽

K. Cline ◽

A. Sun ◽

R. M. MacRae ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Randomized Trial ◽

Fdg Pet ◽

Small Cell ◽

Oncology Group ◽

Small Cell Lung ◽

Pet Ct ◽

Fdg Pet Ct

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Comparison of Tumor Target Volume on Four-Dimensional Computed Tomography and 18F-FDG PET/CT in Lung Cancer

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2018.36.3.18 ◽

2018 ◽

Vol 36 (3) ◽

pp. 223

Author(s):

Keeratikarn Boonyawan ◽

Sasipilai Naivikul ◽

Putipun Puataweepong ◽

Wichana Chamroonrat ◽

Thiti Swangsilpa ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Volume Change ◽

Fdg Pet ◽

Gross Tumor Volume ◽

Tumor Volume ◽

Pet Ct ◽

Centroid Shift ◽

18F Fdg ◽

Fdg Pet Ct

Objective: The correlation between 18F-fluorodexyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and four-dimensional computed tomography (4DCT) based-tumor volumes is unclear. This prospective study was conducted to determine the optimal threshold of PET/CT for gross tumor volume (GTV) delineation using 4DCT as the standard reference for locally advanced lung cancer patients.Material and Methods: Ten patients with histologically proven primary lung cancer who underwent radiotherapy fromJune 2017 to March 2018 in Ramathibodi Hospital were enrolled in the study. The 4DCT simulation and 18F-FDG PET/CT simulation were performed on the same position and same date. Eight standard uptake value (SUV) thresholds of SUV 1.5.0-2.0 and 15.0-35.0% of maximum SUV were selected for contouring in order to be compared with 4DCT based tumor volumes. The comparison methods used were the mean percentage volume change, dice similarity coefficient (DSC), and 3D-centroid shift of the targets between 18F-FDG PET/CT-based gross tumor volume (GTVPET) and internal gross tumor volume (IGTV) from 4DCT.Results: The largest and smallest volume of primary tumors were 422.6 cm3 and 5.9 cm3. GTVPET contoured using SUV 1.5 (GTVPET1.5) approximated closely to IGTV in all the parameters, including volume change, DSC, and 3D-centroid shift. The best median percentage volume change, median DSC, and median centroid shift between IGTV and GTVPET1.5 were 5.55, 0.745 and 0.37, respectively.Conclusion: GTVPET contoured by 18F-FDG PET at SUV1.5 corresponded most closely to the IGTV in all parameters. Further study with a larger sample size and clinical outcome analysis is needed.

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Necrosis, as Identified on Pre-Radiotherapy 18F-FDG PET/CT, is a Predictor for Complete Metabolic Response in Patients with Non-Small Cell Lung Cancer.

10.21203/rs.3.rs-715948/v1 ◽

2021 ◽

Author(s):

Gülnihan Eren ◽

Osman Kupik

Keyword(s):

Lung Cancer ◽

Regression Analysis ◽

Fdg Pet ◽

Tumor Volume ◽

Metabolic Response ◽

Small Cell ◽

Small Cell Lung ◽

Complete Metabolic Response ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Purpose: To investigate necrosis on pre-radiotherapy (RT) 18F-FDG PET/CT (PETNECROSİS) is a predictor for complete metabolic response (CMR) in patients with non-small cell lung cancer (NSCLC).Methods: We studied patients with inoperable stage I-III NSCLC who underwent pre- and post-radiotherapy 18F-FDG PET/CT. The relationship between CMR and PETNECROSIS, SUVmax, gross tumor volume calculated with 18F-FDG PET/CT (GTVPET-CT), tumor size, histology, metabolic tumor volume (MTV), and RT dose was assessed using logistic regression analysis. To evaluate necrosis on 18F FDG PET/CT, we drew a region of interest (ROI) in the area showing visually very low/or no fluorodeoxyglucose (FDG) uptake on PET images. If the SUVmax was lower than the blood pool SUVmax and showed significantly lower attenuation [10 to 30 Hounsfield Units (HU)] from the surrounding tissue on non-intravenous contrast-enhanced low dose correlative CT, we defined it as necrotic (PETNECROSİS).Results: Fifty-three patients were included in the study. The mean age was 68.1±9.8 years. Twenty-one patients had adenocarcinoma, 32 had squamous cell carcinoma. All parameters were independent of histologic status. Multivariate logistic regression analysis showed that, SUVmax ≤11.6vs>11.6 (p=0.003, OR:7.670, 95CI%:2.013-29.231) and PETNECROSİS absence/presence were independent predictors for CMR (p=0.028, OR:6.704, 95CI%1.214-30.394).Conclusion: The necrosis on 18F FDG PET/CT and SUVmax>11.6 could be an imaging marker for the complete metabolic response after chemoradiotherapy or RT alone in patients with NSCLC.

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