Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC): Is FDG-PET a predictor of outcome?

Clarke, K.; Taremi, Mojgan; Dahele, Max; Freeman, Marc; Fung, Sharon; Franks, K.; Bezjak, Andrea; Brade, Anthony; Cho, John; Hope, Andrew; Sun, Alexander

doi:10.1016/j.radonc.2012.04.019

Cited by 84 publications

(70 citation statements)

References 26 publications

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“…Chang et al (24) evaluated 130 patients with stage I NSCLC who underwent SBRT with 50 Gy in four fractions and concluded that a higher SUV max was markedly associated with worse PFS and OS, but not local control. In a study by Clarke et al (25) on 82 patients with inoperable stage I NSCLC treated with SBRT, it was concluded that pretreatment SUV max was associated with local relapse and distant metastases.…”

Section: Discussionmentioning

confidence: 99%

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

et al. 2017

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Abstract. The present study (University Hospital Medical Information Network study no. UMIN000003797) aimed to evaluate whether the maximum standardized uptake value (SUV max ) of pretreatment 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is prognostic factor for stage I non-small cell lung cancer (NSCLC) treated with carbon ion radiotherapy (C-ion RT). Patients treated between June 2010 and June 2013 at Gunma University Heavy Ion Medical Center (Maebashi, Japan) on a prospective protocol were included in the present study. Patients with T1a-b and T2a NSCLC were treated with C-ion RT at a dose of 52.8 Gy [relative biological effectiveness (RBE)] and 60.0 Gy (RBE), respectively, in four fractions. Prior to treatment, all patients underwent FDG-PET, in which the SUV max of primary tumors was evaluated. Local control, progression-free survival (PFS), and overall survival (OS) were calculated. A total of 45 patients were analyzed and the median follow-up period was 28.9 months. The 2-year local control, PFS and OS rates for all patients were 93, 78 and 89%, respectively. The mean SUV max of primary tumors was 5.5, and patients were divided into higher (≥5.5) and lower (<5.5) SUV max groups. The 2-year PFS rates were 61 and 89% for the higher and lower SUV max groups, respectively (P=0.01), and the 2-year OS rates for the higher and lower SUV max groups were 76 and 96%, respectively (P=0.01). The higher SUV max group exhibited a significantly worse PFS and OS compared with the lower SUV max group; however, the SUV max was not associated with the local control rate. In total, 2 patients (4%) experienced grade 2 or 3 radiation pneumonitis, with their symptoms improved through conservative treatment. No patients experienced any grade 4 or 5 toxicities. The results of the present study indicate that pretreatment SUV max is a prognostic indicator for outcomes in patients with stage I NSCLC treated with C-ion RT.

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Section: Discussionmentioning

confidence: 99%

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

et al. 2017

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“…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%

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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“…Median pre-SBRT SUV max of 7.65 (range=1.9-58.4) was similar to that for our population. Three patients in our study had an early SUV max of more than 5 and did not experience any local recurrence; of these three patients, two had more than 2-fold reduction of their SUV max , mentioned as being significant in another study of 82 patients with early-stage NSCLC treated with SBRT (24).…”

Section: Discussionmentioning

confidence: 47%

“…Two other studies evaluated early PET-CT 3 months after SBRT (13,24). In the largest series of 132 patients, residual uptake of more than 5 at 12 weeks after treatment signified increased risk of local failure (13).…”

Section: Discussionmentioning

confidence: 99%

Early PET-CT After Stereotactic Radiotherapy for Stage 1 Non-small Cell Lung Carcinoma Is Predictive of Local Control

Tyran

Charrier

Darréon

et al. 2018

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Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC): Is FDG-PET a predictor of outcome?

Cited by 84 publications

References 26 publications

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy

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

Early PET-CT After Stereotactic Radiotherapy for Stage 1 Non-small Cell Lung Carcinoma Is Predictive of Local Control

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