FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer

Abstract

Objectives Glucose metabolic activity measured by [18F]-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) has shown prognostic value in multiple malignancies, but results are often confounded by the inclusion of patients with various disease stages and undergoing various therapies. This study was designed to evaluate the prognostic value of tumor FDG uptake quantified by maximum standardized uptake value (SUVmax) in a large group of early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) using consistent treatment techniques. Materials and Methods 219 lesions in 211 patients treated with definitive SBRT for stage I NSCLC were analyzed after a median follow-up of 25.2 months. Cox regression was used to determine associations between SUVmax and overall survival (OS), disease-specific survival (DSS), and freedom from local recurrence (FFLR) or distant metastasis (FFDM). Results SUVmax >3.0 was associated with worse OS (p<0.001), FFLR (p=0.003) and FFDM (p=0.003). On multivariate analysis, OS was associated with SUVmax (HR 1.89, p=0.03), gross tumor volume (GTV) (HR 1.94, p=0.005) and Karnofsky performance status (KPS) (HR 0.51, p=0.008). DSS was associated only with SUVmax (HR 2.58, p=0.04). Both LR (HR 11.47, p=0.02) and DM (HR 3.75, p=0.006) were also associated with higher SUVmax. Conclusion In a large patient population, SUVmax >3.0 was associated with worse survival and a greater propensity for local recurrence and distant metastasis after SBRT for NSCLC.

Image‐based management of empiric lung stereotactic body radiotherapy (SBRT) without biopsy: Predictors from a 10‐year single institution experience

“…Pre‐treatment maximum SUV ≥ 4.1 was the lone predictor of PD in our series, based on both multivariate and univariate analysis. Most studies use a maximum SUV > 2.5 as the threshold for malignancy, and prognostic thresholds are 3–3.5 …”

Guideline for Radiotherapy with Curative Intent in Patients with Early-Stage Medically Inoperable Non-Small-Cell Lung Cancer

“…However, the cut-off was difficult to determine. Several studies suggested that a bed cut-off of approximately 100 is significantly correlated with patient outcome 17,[19][20][21][22]26 ; however, other studies, including the meta-regression by Zhang et al, did not show that association 18,24,25,27,29 .…”

“…Twelve retrospective observational studies investigated the most appropriate bed cut-off in association with patient outcomes [17][18][19][20][21][22][23][24][25][26][27][28] . Again, the studies were considered to be very low quality because of their retrospective design.…”

“…Although variability in the results with the use of a bed cut-off of approximately 100 was evident, the largest studies suggested that a bed close to 100 was associated with os and local control 17,[19][20][21][22]26 . The dsg believed that recommending a minimal bed threshold would maximize the beneficial outcomes associated with sbrt without increasing harm.…”

“…The dsg believed that recommending a minimal bed threshold would maximize the beneficial outcomes associated with sbrt without increasing harm. They chose to use 100 as the bed threshold because most of the larger cohort studies found an association of patient outcomes with bed cut-offs of 100, 105, and 106 17,[19][20][21][22]26 . The dsg selected the lowest value because the Zhang meta-analysis found that, compared with lower values, medium values between 83.2 and 106 were associated with significantly better survival 29 .…”