Pretreatment [18F]-fluoro-2-deoxy-glucose Positron Emission Tomography Maximum Standardized Uptake Value as Predictor of Distant Metastasis in Early-Stage Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy: Rethinking the Role of Positron Emission Tomography in Personalizing Treatment Based on Risk Status

Nair, Vimoj; MacRae, Robert; Sirisegaram, Abby; Pantarotto, Jason

doi:10.1016/j.ijrobp.2013.10.029

Cited by 35 publications

(24 citation statements)

References 26 publications

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“…In contrast, multiple studies have shown that SUVmax is prognostic for tumor recurrence 13, 14, 15, 16, 17. Clarke et al 14 showed that SUVmax greater than 5 was the most significant cutoff point for predicting distant metastasis ( P =.01).…”

Section: Discussionmentioning

confidence: 98%

“…In these patients, with the limited prognostic information available other than tumor size, metabolic parameters from pretreatment positron emission tomography (PET) have been evaluated as promising prognosticators. Investigators have found mixed results, however, regarding the prognostic capability of different PET parameters: some studies have found no prognostic value,9, 10, 11, 12 whereas others have found that PET parameters such as maximum standardized uptake value (SUVmax), total lesion glycolysis, and metabolic tumor volume may predict disease control as well as survival 13, 14, 15, 16, 17…”

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confidence: 99%

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Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Hobbs

Paryani

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non–small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes.Patients and MethodsWe retrospectively reviewed the cases of consecutive patients with FDG-PET–staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models.ResultsAmong 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02).ConclusionDisease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Hobbs

Paryani

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Nair et al demonstrated a strong association between SUV max and DM in the largest prior such analysis of patients treated with radiotherapy. Unfortunately, over one-third of the 180 lesions included in their analysis received conventionally fractionated radiotherapy [25], which is associated with different failure patterns than SBRT. Similarly, studies by Clarke et al and Takeda et al included a substantial number of patients without biopsy-proven carcinoma [23, 27].…”

Section: Discussionmentioning

confidence: 99%

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

Wu¹,

Zhang²,

Foster³

et al. 2015

Lung Cancer

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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.

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“…Previous studies on surgical series showed thata higher pre-treatment SUVmaxcould be associated to worse sur-vival [16]. After several reports failing to show a correlation, Nairet al recently reported that a SUVmaxvalue > 7 was an independentprognostic factor for distant metastases-free survival after SABR [17]. In our experience the mean SUVmaxvalue, available in patientswho performed a CT-PET scan before SABR, did not reach statisti-cal significance (a trend toward significance with a cut-off of 7.8 isevident at multivariate analysis, Table 3).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Ablative Radiotherapy for stage I histologically proven non-small cell lung cancer: An Italian multicenter observational study

et al. 2014

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Cited by 35 publications

References 26 publications

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

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

Stereotactic Ablative Radiotherapy for stage I histologically proven non-small cell lung cancer: An Italian multicenter observational study

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