Residual 18F-FDG-PET Uptake 12 Weeks After Stereotactic Ablative Radiotherapy for Stage I Non-Small-Cell Lung Cancer Predicts Local Control

• Published in: International journal of radiation oncology, biology, physics Vol. 83; no. 4; pp. e551 - e555
• Main Authors: Bollineni, Vikram Rao, Widder, Joachim, Pruim, Jan, Langendijk, Johannes A., Wiegman, Erwin M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2012
• Subjects: [18F]fluorodeoxyglucose positron emission tomography; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Female; Fluorodeoxyglucose F18 - pharmacokinetics; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Maximum standardized uptake value; Mediastinal Neoplasms - diagnostic imaging; Mediastinal Neoplasms - secondary; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Non-small-cell lung cancer; Positron-Emission Tomography - methods; Prognosis; Radiopharmaceuticals - pharmacokinetics; Radiosurgery - methods; Response assessment; Stereotactic ablative radiotherapy; Survival Analysis; Time Factors; Tumor Burden; Non-small-cell lung cancer; Response assessment; [18F]fluorodeoxyglucose positron emission tomography; Maximum standardized uptake value; Stereotactic ablative radiotherapy
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2012.01.012

To investigate the prognostic value of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) uptake at 12 weeks after stereotactic ablative radiotherapy (SABR) for stage I non-small-cell lung cancer (NSCLC). From November 2006 to February 2010, 132 medically inoperable patients with proven Stage I NSCLC or FDG-PET-positive primary lung tumors were analyzed retrospectively. SABR consisted of 60 Gy delivered in 3 to 8 fractions. Maximum standardized uptake value (SUVmax) of the treated lesion was assessed 12 weeks after SABR, using FDG-PET. Patients were subsequently followed at regular intervals using computed tomography (CT) scans. Association between post-SABR SUVmax and local control (LC), mediastinal failure, distant failure, overall survival (OS), and disease-specific survival (DSS) was examined. Median follow-up time was 17 months (range, 3–40 months). Median lesion size was 25 mm (range, 9–70 mm). There were 6 local failures: 15 mediastinal failures, 15 distant failures, 13 disease-related deaths, and 16 deaths from intercurrent diseases. Glucose corrected post-SABR median SUVmax was 3.0 (range, 0.55–14.50). Using SUVmax 5.0 as a cutoff, the 2-year LC was 80% versus 97.7% for high versus low SUVmax, yielding an adjusted subhazard ratio (SHR) for high post-SABR SUVmax of 7.3 (95% confidence interval [CI], 1.4–38.5; p = 0.019). Two-year DSS rates were 74% versus 91%, respectively, for high and low SUVmax values (SHR, 2.2; 95% CI, 0.8–6.3; p = 0.113). Two-year OS was 62% versus 81% (hazard ratio [HR], 1.6; 95% CI, 0.7–3.7; p = 0.268). Residual FDG uptake (SUVmax ≥5.0) 12 weeks after SABR signifies increased risk of local failure. A single FDG-PET scan at 12 weeks could be used to tailor further follow-up according to the risk of failure, especially in patients potentially eligible for salvage surgery.