Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy (18)Fluorodeoxyglucose-PET-CT scan

Hugo J W L Aerts, Angela A W van Baardwijk, Steven F Petit, Claudia Offermann, Judith van Loon, Ruud Houben, Anne-Marie C Dingemans, Rinus Wanders, Liesbeth Boersma, Jacques Borger, Gerben Bootsma, Wiel Geraedts, Cordula Pitz, Jean Simons, Bradly G Wouters, Michel Oellers, Philippe Lambin, Geert Bosmans, Andre L A J Dekker, Dirk De Ruysscher
Radiotherapy and Oncology 2009, 91 (3): 386-92

BACKGROUND AND PURPOSE: Non-small cell lung cancer (NSCLC) tumours are mostly heterogeneous. We hypothesized that areas within the tumour with a high pre-radiation (18)F-deoxyglucose (FDG) uptake, could identify residual metabolic-active areas, ultimately enabling selective-boosting of tumour sub-volumes.

MATERIAL AND METHODS: Fifty-five patients with inoperable stage I-III NSCLC treated with chemo-radiation or with radiotherapy alone were included. For each patient one pre-radiotherapy and one post-radiotherapy FDG-PET-CT scans were available. Twenty-two patients showing persistent FDG uptake in the primary tumour after radiotherapy were analyzed. Overlap fractions (OFs) were calculated between standardized uptake value (SUV) threshold-based auto-delineations on the pre- and post-radiotherapy scan.

RESULTS: Patients with residual metabolic-active areas within the tumour had a significantly worse survival compared to individuals with a complete metabolic response (p=0.002). The residual metabolic-active areas within the tumour largely corresponded (OF>70%) with the 50%SUV high FDG uptake area of the pre-radiotherapy scan. The hotspot within the residual area (90%SUV) was completely within the GTV (OF=100%), and had a high overlap with the pre-radiotherapy 50%SUV threshold (OF>84%).

CONCLUSIONS: The location of residual metabolic-active areas within the primary tumour after therapy corresponded with the original high FDG uptake areas pre-radiotherapy. Therefore, a single pre-treatment FDG-PET-CT scan allows for the identification of residual metabolic-active areas.


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