Chemotherapy Response Evaluation with 18F-FDG PET in Patients with Non-Small Cell Lung Cancer

Abstract

The aim of this prospective study was to evaluate the value of 18 F-FDG PET for the assessment of chemotherapy response in patients with non-small cell lung cancer. Furthermore, part of the objective of this study was to compare 2 methods to quantify changes in glucose metabolism. Methods: In 51 patients, dynamic 18 F-FDG PET was performed before and at 5-8 wk into treatment. Simplified methods to measure glucose metabolism (standardized uptake value [SUV]) and quantitative measures (metabolic rate of glucose [MR Glu ]), derived from Patlak analysis, were evaluated. The overall survival and progression-free survival with respect to MR Glu and SUV were calculated using Kaplan-Meier estimates. Fractional changes in tumor glucose use were stratified by the median value and also the predefined EORTC (European Organization for Research and Treatment of Cancer) metabolic response criteria, and criteria applying cutoff levels similar to those of RECIST (Response Evaluation Criteria in Solid Tumors) were evaluated. Results: When stratifying at the median value of DMR Glu and DSUV, the difference in overall survival (P 5 0.017 for DMR Glu , P 5 0.018 for DSUV) and progressionfree survival (P 5 0.002 for DMR Glu , P 5 0.0009 for DSUV) was highly significant. When applying the predefined criteria for metabolic response, the cutoff levels as also used for size measurement (RECIST) showed significant differences for DSUV between response categories in progression-free survival (P 5 0.0003) as well as overall survival (P 5 0.027). Conclusion: The degree of chemotherapy-induced changes in tumor glucose metabolism as determined by 18 F-FDG PET is highly predictive for patient outcome, stratifying patients into groups with widely differing overall survival and progression-free survival probabilities. The use of 18 F-FDG PET for therapy monitoring seems clinically feasible, because simplified methods to measure tumor glucose use (SUV) are sufficiently reliable and can replace more complex, quantitative measures (MR Glu ) in this patient population.

Comparison of Tumor Volumes Derived from Glucose Metabolic Rate Maps and SUV Maps in Dynamic 18F-FDG PET

“…Patients with diabetes mellitus were excluded. The PET scans were performed as part of a response monitoring study (12), which was approved by the Institutional Review Board of the Radboud University Nijmegen Medical Centre. Written informed consent was obtained from all patients.…”

Prognostic stratification using F-18 FDG PET/CT in patients with advanced stage (Stage III and IV) non-small cell lung cancer

“…However, morphologic imaging modalities have limitations in differentiating necrotic tumor or fibrotic tissue from residual tumor tissue [10]. Metabolic tumor response using F-18 FDG PET after chemotherapy has a significant correlation with survival in NSCLC [11]. Moreover, metabolic tumor response is more accurate in early assessment of tumor response to treatment of NSCLC than structural imaging modalities.…”

Chemotherapy Response Monitoring of Colorectal Liver Metastases by Dynamic Gd-DTPA–Enhanced MRI Perfusion Parameters and 18F-FDG PET Metabolic Rate

“…18 F-FDG uptake can be quantified by glucose metabolic rates (MR glc ) derived from dynamic 18 F-FDG PET data. The value of baseline MR glc as a predictive parameter for treatment outcome has been shown for several tumor types, including non-small cell lung carcinoma and CRC (9), and its predictive value using changes in MR glc for the early evaluation of response during chemotherapy has been shown in many tumor types, including non-small cell lung carcinoma (10) and CRC (11).…”