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Combination of FDG-PET and FMISO-PET as a treatment strategy for patients undergoing early-stage NSCLC astereotactic radiotherapy

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Title: Combination of FDG-PET and FMISO-PET as a treatment strategy for patients undergoing early-stage NSCLC astereotactic radiotherapy
Authors: Watanabe, Shiro Browse this author →KAKEN DB
Inoue, Tetsuya Browse this author →KAKEN DB
Okamoto, Shozo Browse this author →KAKEN DB
Magota, Keiichi Browse this author →KAKEN DB
Takayanagi, Ayumi Browse this author
Sakakibara-Konishi, Jun Browse this author →KAKEN DB
Katoh, Norio Browse this author →KAKEN DB
Hirata, Kenji Browse this author →KAKEN DB
Manabe, Osamu Browse this author →KAKEN DB
Toyonaga, Takuya Browse this author
Kuge, Yuji Browse this author →KAKEN DB
Shirato, Hiroki Browse this author →KAKEN DB
Tamaki, Nagara Browse this author →KAKEN DB
Shiga, Tohru Browse this author →KAKEN DB
Keywords: Non-small cell lung cancer
Stereotactic body radiation therapy
Issue Date: 4-Dec-2019
Publisher: Springer (SpringerOpen)
Journal Title: EJNMMI research
Volume: 9
Issue: 1
Start Page: 104
Publisher DOI: 10.1186/s13550-019-0578-6
Abstract: Background: We investigated the prognostic predictive value of the combination of fluorodeoxyglucose (FDG)and fluoromisonidazole (FMISO)-PET in patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiation therapy (SBRT). Patients and methods: We prospectively examined patients with pathologically proven NSCLC; all underwent FDG and FMISO PET/CT scans before SBRT. PET images were acquired using a whole-body time-of-flight PET-CT scanner with respiratory gating. We classified them into recurrent and non-recurrent groups based on their clinical followups and compared the groups' tumor diameters and PET parameters (i.e., maximum of the standardized uptake value (SUVmax), metabolic tumor volume, tumor-to-muscle ratio, and tumor-to-blood ratio). We performed univariate analysis to evaluate the impact of the PET variables on the patients' progression-free survival (PFS). We divided the patients by thresholds of FDG SUVmax and FMISO SUVmax obtained from receiver operating characteristic analysis for assessment of recurrence rate and PFS. Results: Thirty-two NSCLC patients (19 male and 13 females; median age, 83 years) were enrolled. All received SBRT. At the study endpoint, 23 patients (71.9%) were non-recurrent and nine patients (28.1%) had recurrent disease. Significant between-group differences were observed in tumor diameter and all the PET parameters, demonstrating that those were significant predictors of the recurrence in all patients. In the 22 patients with tumors > 2 cm, tumor diameter and FDG SUVmax were not significant predictors. Thirty-two patients were divided into three patterns from the thresholds of FDG SUVmax (6.81) and FMISO SUVmax (1.89); A, low FDG and low FMISO (n = 14); B, high FDG and low FMISO (n = 8); C, high FDG and high FMISO (n = 10). No pattern A patient experienced tumor recurrence, whereas two pattern B patients (25%) and seven pattern C patients (70%) exhibited recurrence. A Kaplan-Meier analysis of all patients revealed a significant difference in PFS between patterns A and B (p = 0.013) and between patterns A and C (p < 0.001). In the tumors > 2 cm patients, significant differences in PFS were demonstrated between pattern A and C patients (p = 0.002). Conclusion: The combination of FDG- and FMISO-PET can identify patients with a baseline risk of recurrence and indicate whether additional therapy might be performed to improve survival.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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