Serial assessment of FDG-PET FDG uptake and functional volume during radiotherapy (RT) in patients with non-small cell lung cancer (NSCLC)

Edet-Sanson, Agathe; Dubray, Bernard; Doyeux, Kaya; Back, Adeline; Hapdey, Sébastien; Modzelewski, Romain; Bohn, Pierre; Gardin, I.; Véra, Pierre

doi:10.1016/j.radonc.2011.07.023

Cited by 54 publications

(61 citation statements)

References 32 publications

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“…A study with larger patient numbers would be required to validate any recommendations. Another study by Edet-Sanson et al 29 investigated the use of serial PET images acquired throughout treatment. This was a small study which evaluated 10 patients, half of whom also had chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients

Duffton

Harrow

McJury

2016

BJR

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Objective: To investigate the potential use of cone beam CT (CBCT) in adaptive radiotherapy (ART) planning process for non-small-cell lung cancer (NSCLC). Methods: 17 retrospective patients with NSCLC Stage T1-T4, who had completed a course of radiotherapy with weekly CBCT imaging were selected for the study. The patients had been delineated and planned for threedimensional (3D) conformal treatment (prescription: 55 Gy in 20 fractions) based on free-breathing fourdimensional CT data. Of these initial 17 patients, 12 had full quantitative data on gross tumour volume (GTV) position and volume throughout treatment. GTV delineation was carried out on weekly CBCT by a clinical oncologist. For each patient, mean percentage change in GTV and centre of mass (COM) displacement (based on 3D vectors) were calculated throughout treatment. Volume overlap between GTVs was calculated. Correlation of the COM displacement and planning GTV (pGTV) was assessed. A linear mixed model with patients as random effects was fitted to the data to assess potential benefit from using ART for these patients. Results: Comparison of CBCT-based GTV acquired prior to Fraction 1 (cbctGTV1) to pGTV showed mean 20 6 19%

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Section: Discussionmentioning

confidence: 99%

An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients

Duffton

Harrow

McJury

2016

BJR

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“…The images were evaluated by 1 nuclear physician. 18 F-FDG PET/CT imaging was evaluable only when scans were acquired with the same scanner, acquisition protocol, and reconstruction software and with similar intervals from tracer injection to scanning.…”

Section: Imaging Datamentioning

confidence: 99%

mentioning

confidence: 99%

“…18 F-FDG PET/CT provides information about tumor metabolic activity, which may be useful for monitoring molecular changes associated with the treatment response (15,16). An early assessment of the tumor response with 18 F-FDG PET/CT performed during therapy was recently proposed as a criterion for treatment modulation or modification (17,18). Early decision making about the effect of treatment can help avoid overtreatment or ineffective treatment, lower health care costs, reduce side effects and, ultimately, improve outcomes (17,19,20).…”

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confidence: 99%

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Timing of Metabolic Response Monitoring During Erlotinib Treatment in Non–Small Cell Lung Cancer

et al. 2014

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The purpose of this study was to prospectively evaluate the timing of metabolic response monitoring with 18 F-FDG PET of (neoadjuvant) erlotinib treatment in patients with early-stage non-small cell lung cancer. Methods: This study was designed as an open-label phase II trial performed in 4 hospitals in The Netherlands. Patients received preoperative erlotinib (150 mg) once daily for 3 wk. Response evaluation was performed after 4-7 d and at 3 wk with 18 F-FDG PET/CT scans. Tumor 18 F-FDG uptake and changes were measured as standardized uptake values (SUVs). The metabolic response was classified on the basis of European Organization for Research and Treatment of Cancer criteria (.25% decrease in the maximum SUV) and was compared with histopathologic regression as observed in the resection specimen. Results: From December 2006 to November 2010, 60 patients with non-small cell lung cancer eligible for surgical resection were enrolled in this study. For 43 patients (18 men and 25 women), baseline 18 F-FDG PET/CT scans as well as both monitoring scans and histopathologic response monitoring were available. A partial metabolic response on 18 F-FDG PET/CT scans was observed for 10 patients (23%) after 1 wk and for 14 patients (33%) after 3 wk. Histopathologic examination revealed regression (necrosis of .50%) in 11 patients (26%). In these patients, the maximum SUV decreased by a mean of 17% within 1 wk and a mean of 31% at 3 wk. Seven patients were identified as responders within 1 wk. Conclusion: Response monitoring with 18 F-FDG PET/CT within 1 wk after the start of erlotinib treatment identified approximately 64% of histopathologic responders on the basis of European Organization for Research and Treatment of Cancer criteria.

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“…In contrast, changes in SUV max for responding patients were negligible during radiotherapy and notably negative after radiotherapy. 18 F-FDG uptake and functional volume for both primary tumors and lymph nodes in NSCLC generally decrease during the course of radiotherapy, roughly linearly with time or dose, suggesting that 18 F-FDG PET/CT images can be acquired during radiotherapy without artifacts that hamper image interpretation and quantification (85).…”

Section: Prognostic Role Of Molecular Imaging In Radiation Therapymentioning

confidence: 99%

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

2015

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) how to acquire high-quality molecular images for use in radiation therapy; (2) how molecular imaging can be used to plan radiotherapy and evaluate treatment efficacy; and (3) the limitations and challenges to widespread use of molecular imaging in radiation oncology.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through November 2018.Molecular imaging plays a central role in the management of radiation oncology patients. Specific uses of imaging, particularly to plan radiotherapy and assess its efficacy, require an additional level of reproducibility and image quality beyond what is required for diagnostic imaging. Specific requirements include proper patient preparation, adequate technologist training, careful imaging protocol design, reliable scanner technology, reproducible software algorithms, and reliable data analysis methods. As uncertainty in target definition is arguably the greatest challenge facing radiation oncology, the greatest impact that molecular imaging can have may be in the reduction of interobserver variability in target volume delineation and in providing greater conformity between target volume boundaries and true tumor boundaries. Several automatic and semiautomatic contouring methods based on molecular imaging are available but still need sufficient validation to be widely adopted. Biologically conformal radiotherapy (dose painting) based on molecular imaging-assessed tumor heterogeneity is being investigated, but many challenges remain to fully exploring its potential. Molecular imaging also plays increasingly important roles in both early (during treatment) and late (after treatment) response assessment as both a predictive and a prognostic tool. Because of potentially confounding effects of radiation-induced inflammation, treatment response assessment requires careful interpretation. Although molecular imaging is already strongly embedded in radiotherapy, the path to widespread and all-inclusive use is still long. The lack of solid clinical evidence is the main impediment to broader use. Recommendations for practicing physicians are still rather scarce. 18 F-FDG PET/CT remains the main molecular imaging modality in radiation oncology applications. Although other molecular imaging options (e.g., proliferation imaging) are becoming more common, their widespread use is limited ...

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Serial assessment of FDG-PET FDG uptake and functional volume during radiotherapy (RT) in patients with non-small cell lung cancer (NSCLC)

Cited by 54 publications

References 32 publications

An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients

An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients

Timing of Metabolic Response Monitoring During Erlotinib Treatment in Non–Small Cell Lung Cancer

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

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