Qurrat Mehmood1, Alexander Sun2, Nathan Becker1, Jane Higgins1, Andrea Marshall1, Lisa W Le3, Douglass C Vines4, Paula McCloskey1, Victoria Ford1, Katy Clarke1, Mei Yap1, Andrea Bezjak1, Jean-Pierre Bissonnette1. 1. Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada. 2. Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada. Electronic address: alex.sun@rmp.uhn.on.ca. 3. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 4. Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: Treatment of locally advanced non-small cell lung cancer with chemoradiotherapy (CRT) is limited by development of toxicity in normal tissue, including radiation esophagitis (RE). Increasingly, (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is being used for adaptive planning. Our aim was to assess changes in esophageal FDG uptake during CRT and relate the changes to the onset and severity of RE. METHODS: This prospective study in patients with stage II-III non-small cell lung cancer involved serial four-dimensional computed tomography and PET scans during CRT (60-74Gy). RE was recorded weekly using the Common Terminology Criteria for Adverse Events (v4.0), and imaging was performed at weeks 0, 2, 4, and 7. Changes in the esophagus's peak standard uptake value (SUVpeak) were analyzed for each time point and correlated with grade of RE using the Wilcoxon rank-sum test. The volume of esophagus receiving 50 Gy (V50) and volume of esophagus receiving 60 Gy (V60) were correlated with the development of RE, and the C-statistic (area under the curve [AUC]) was calculated to measure predictivity of grade 3 RE. RESULTS: RE developed in 20 of 27 patients (74%), with grade 3 reached in 6 (22%). A significant percentage increase in SUVpeak in the patients with RE was noted at week 4 (p = 0.01) and week 7 (p = 0.03). For grade 3 RE, a significant percentage increase in SUVpeak was noted at week 2 (p = 0.01) and week 7 (p = 0.03) compared with that for less than grade 3 RE. Median V50 (46.3%) and V60 (33.4%) were significantly higher in patients with RE (p = 0.04). The AUC measurements suggested that the percentage change in SUVpeak at week 2 (AUC = 0.69) and V50 (AUC = 0.67) and V60 (AUC = 0.66) were similarly predictive of grade 3 RE. CONCLUSIONS: Serial FDG-PET images during CRT show significant increases in SUVpeak for patients in whom RE develops. The changes at week 2 may predict those at risk for the development of grade 3 RE and may be informative for adaptive planning and early intervention.
INTRODUCTION: Treatment of locally advanced non-small cell lung cancer with chemoradiotherapy (CRT) is limited by development of toxicity in normal tissue, including radiation esophagitis (RE). Increasingly, (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is being used for adaptive planning. Our aim was to assess changes in esophageal FDG uptake during CRT and relate the changes to the onset and severity of RE. METHODS: This prospective study in patients with stage II-III non-small cell lung cancer involved serial four-dimensional computed tomography and PET scans during CRT (60-74Gy). RE was recorded weekly using the Common Terminology Criteria for Adverse Events (v4.0), and imaging was performed at weeks 0, 2, 4, and 7. Changes in the esophagus's peak standard uptake value (SUVpeak) were analyzed for each time point and correlated with grade of RE using the Wilcoxon rank-sum test. The volume of esophagus receiving 50 Gy (V50) and volume of esophagus receiving 60 Gy (V60) were correlated with the development of RE, and the C-statistic (area under the curve [AUC]) was calculated to measure predictivity of grade 3 RE. RESULTS: RE developed in 20 of 27 patients (74%), with grade 3 reached in 6 (22%). A significant percentage increase in SUVpeak in the patients with RE was noted at week 4 (p = 0.01) and week 7 (p = 0.03). For grade 3 RE, a significant percentage increase in SUVpeak was noted at week 2 (p = 0.01) and week 7 (p = 0.03) compared with that for less than grade 3 RE. Median V50 (46.3%) and V60 (33.4%) were significantly higher in patients with RE (p = 0.04). The AUC measurements suggested that the percentage change in SUVpeak at week 2 (AUC = 0.69) and V50 (AUC = 0.67) and V60 (AUC = 0.66) were similarly predictive of grade 3 RE. CONCLUSIONS: Serial FDG-PET images during CRT show significant increases in SUVpeak for patients in whom RE develops. The changes at week 2 may predict those at risk for the development of grade 3 RE and may be informative for adaptive planning and early intervention.
Authors: Sophie E Vollenbrock; Francine E M Voncken; Doenja M J Lambregts; Monique Maas; Maarten L Donswijk; Erik Vegt; Leon C Ter Beek; Jolanda M van Dieren; Johanna W van Sandick; Berthe M P Aleman; Regina G H Beets-Tan; Annemarieke Bartels-Rutten Journal: Eur J Nucl Med Mol Imaging Date: 2020-06-22 Impact factor: 9.236
Authors: Joshua S Niedzielski; Jinzhong Yang; Zhongxing Liao; Daniel R Gomez; Francesco Stingo; Radhe Mohan; Mary K Martel; Tina M Briere; Laurence E Court Journal: Int J Radiat Oncol Biol Phys Date: 2016-07-21 Impact factor: 7.038
Authors: Sadegh R Alam; Pengpeng Zhang; Si-Yuan Zhang; Ishita Chen; Andreas Rimner; Neelam Tyagi; Yu-Chi Hu; Wei Lu; Ellen D Yorke; Joseph O Deasy; Maria Thor Journal: Int J Radiat Oncol Biol Phys Date: 2021-01-13 Impact factor: 8.013
Authors: José Marcio Luna; Hann-Hsiang Chao; Russel T Shinohara; Lyle H Ungar; Keith A Cengel; Daniel A Pryma; Chidambaram Chinniah; Abigail T Berman; Sharyn I Katz; Despina Kontos; Charles B Simone; Eric S Diffenderfer Journal: Clin Transl Radiat Oncol Date: 2020-03-24