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

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• 作者：Vikram Rao Bollineni ; M.D.^&lowast ; ; ^{v.r.bollineni@umcg.nl} ; Joachim Widder ; M.D. ; Ph.D.^&lowast ; ; Jan Pruim ; M.D. ; Ph.D.^&dagger ; ; Johannes A. Langendijk ; M.D. ; Ph.D.^&lowast ; ; Erwin M. Wiegman ; M.D.^&lowast ;
• 关键词：[18F]fluorodeoxyglucose positron emission tomography ; Maximum standardized uptake value ; Non-small-cell lung cancer ; Response assessment ; Stereotactic ablative radiotherapy
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：15 July, 2012
• 卷：83
• 期：4
• 页码：e551-e555
• 文件大小：203 K

摘要

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Purpose

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).

Methods and Materials

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 (SUV_max) 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 SUV_max and local control (LC), mediastinal failure, distant failure, overall survival (OS), and disease-specific survival (DSS) was examined.

Results

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 SUV_max was 3.0 (range, 0.55-14.50). Using SUV_max 5.0 as a cutoff, the 2-year LC was 80%versus 97.7%for high versus low SUV_max, yielding an adjusted subhazard ratio (SHR) for high post-SABR SUV_max 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 SUV_max 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).

Conclusions

Residual FDG uptake (SUV_max 鈮?.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.