Cardiac metabolic changes on ¹⁸F‐positron emission tomography after thoracic radiotherapy predict for overall survival in esophageal cancer patients

Abstract

PurposeHeart doses have been shown to be predictive of cardiac toxicity and overall survival (OS) for esophageal cancer patients. There is potential for functional imaging to provide valuable cardiac information. The purpose of this study was to evaluate the cardiac metabolic dose–response using 18F‐deoxyglucose (FDG)–PET and to assess whether standard uptake value (SUV) changes in the heart were predictive of OS.MethodsFifty‐one patients with esophageal cancer treated with radiation who underwent pre‐ and post‐treatment FDG–PET scans were retrospectively evaluated. Pre‐ and post‐treatment PET‐scans were rigidly registered to the planning CT for each patient. Pre‐treatment to post‐treatment absolute mean SUV (SUVmean) changes in the heart were calculated to assess dose–response. A dose–response curve was generated by binning each voxel in the heart into 10 Gy dose‐bins and analyzing the SUVmean changes in each dose‐bin. Multivariate cox proportional hazard models were used to assess whether pre‐to‐post treatment cardiac SUVmean changes predicted for OS.ResultsThe cardiac dose–response curve demonstrated a trend of increasing cardiac SUV changes as a function of dose with an average increase of 0.044 SUV for every 10 Gy dose bin. In multivariate analysis, disease stage and SUVmean change in the heart were predictive (p < 0.05) for OS.ConclusionsChanges in pre‐ to post‐treatment cardiac SUV were predictive of OS with patients having a higher pre‐ to post‐treatment cardiac SUV change surviving longer.

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

“…The median age ranged from 45.3 to 62.2 years. The primary cancers included thoracic malignancies ( 34 ), esophageal cancer ( 32 , 35 , 39 , 40 ), lung cancer ( 33 , 37 , 38 ), and BC ( 36 ). The KPS was reported in two studies, with median values of 80% ( 39 ) and 90% ( 37 ).…”

“…The primary cancers included thoracic malignancies ( 34 ), esophageal cancer ( 32 , 35 , 39 , 40 ), lung cancer ( 33 , 37 , 38 ), and BC ( 36 ). The KPS was reported in two studies, with median values of 80% ( 39 ) and 90% ( 37 ). The ECOG status was reported in one study, with 69% of patients classified as ECOG 1 and 31% as ECOG 2 ( 35 ).…”

“…All studies observed changes in FDG intake after RT, with most showing an increase in myocardial standardized uptake value (SUV) ( 33 – 40 ). However, three studies reported both FDG increase and decrease ( 37 , 39 , 40 ), and one study found only FDG decrease ( 32 ). Cho et al.…”

“…reported that in a population of 24 patients irradiated for esophageal cancer, the average SUV ratio (SUVR) increased in five patients, decreased in 13 patients, and did not change significantly in six patients ( 40 ). SUV uptake appeared to be correlated with dose, with an average increase of 1.7% 37 or 0.044 SUV for every 10 Gy dose bin ( 39 ). Jo et al.…”

Impact of Blood Parameters and Normal Tissue Dose on Treatment Outcome in Esophageal Cancer Patients Undergoing Neoadjuvant Radiochemotherapy

“…So far, only limited data exist regarding the evaluation of functional imaging parameters and their association with normal tissue doses or blood values in esophageal cancer patients. One smaller retrospective study with 51 patients demonstrated a trend of increasing cardiac SUV changes as a function of applied heart dose with a predictive value for overall survival [ 33 ]. Another prospective study in 12 patients using single photon emission computed tomography (SPECT imaging) revealed significant correlations between radiation dose to the heart and myocardium metabolism [ 34 ].…”