Early Change in Metabolic Tumor Heterogeneity during Chemoradiotherapy and Its Prognostic Value for Patients with Locally Advanced Non-Small Cell Lung Cancer

Abstract

IntroductionTo observe the early change of metabolic tumor heterogeneity during chemoradiotherapy and to determine its prognostic value for patients with locally advanced non-small cell lung cancer (NSCLC).MethodsFrom January 2007 to March 2010, 58 patients with NSCLC were included who were received 18F-fluorodeoxyglucose (18F-FDG) PET/CT before and following 40 Gy radiotherapy with the concurrent cisplatin-based chemotherapy (CCRT). Primary tumor FDG uptake heterogeneity was determined using global and local scale textural features extracted from standardized uptake value (SUV) histogram analysis (coefficient of variation [COV], skewness, kurtosis, area under the curve of the cumulative SUV histogram [AUC-CSH]) and normalized gray-level co-occurrence matrix (contrast, dissimilarity, entropy, homogeneity). SUVmax and metabolic tumor volume (MTV) were also evaluated. Correlations were analyzed between parameters on baseline or during treatments with tumor response, progression-free survival (PFS), and overall survival (OS).ResultsCompared with non-responders, responders showed significantly greater pre-treatment COV, contrast and MTV (AUC = 0.781, 0.804, 0.686, respectively). Receiver-operating-characteristic curve analysis showed that early change of tumor textural analysis serves as a response predictor with higher sensitivity (73.2%~92.1%) and specificity (80.0%~83.6%) than baseline parameters. Change in AUC-CSH and dissimilarity during CCRT could also predict response with optimal cut-off values (33.0% and 28.7%, respectively). The patients with greater changes in contrast and AUC-CSH had significantly higher 5-year OS (P = 0.008, P = 0.034) and PFS (P = 0.007, P = 0.039). In multivariate analysis, only change in contrast was found as the independent prognostic factor of PFS (HR 0.476, P = 0.021) and OS (HR 0.519, P = 0.015).ConclusionsThe metabolic tumor heterogeneity change during CCRT characterized by global and local scale textural features may be valuable for predicting treatment response and survival for patients with locally advanced NSCLC.

Mid-radiotherapy PET/CT for prognostication and detection of early progression in patients with stage III non-small cell lung cancer

“…The ongoing multicenter RTOG 1106 study will provide additional prospective data that may help to clarify this issue [23]. Another promising direction is analyzing intratumoral heterogeneity of FDG uptake [24,25].…”

Impact of contouring variability on oncological PET radiomics features in the lung

“…Previous studies on PET radiomics for lung cancer have linked PET radiomics parameters to various clinical end points including overall survival, disease specific survival, and locoregional control amongst others [6][7][8][9][10] . Successful translation of PET radiomics research into the clinic for lung cancer management in RT hinges largely on the robustness of radiomics parameters to various inter/intra-scanner image acquisition variability as well as against an array of diverse uncertainties intrinsic to radiomics analysis.…”

The Predictive Value of Early In-Treatment 18F-FDG PET/CT Response to Chemotherapy in Combination with Bevacizumab in Advanced Nonsquamous Non–Small Cell Lung Cancer

“…In oncology practice, it is important to identify effective biomarkers for prediction of failure or success of treatment. In contrast to our study, other response-monitoring studies (9)(10)(11)(12)(13)(14) did not use PERCIST for response evaluation (25). Predefined response criteria not only are important tools to assess an objective early response, but also are important in harmonization of 18 F-FDG PET/CT studies and facilitate reproducibility across response assessment trials.…”