Sarah Everitt1, David Ball2, Rodney J Hicks3, Jason Callahan4, Nikki Plumridge5, Jenny Trinh5, Alan Herschtal6, Tomas Kron7, Michael Mac Manus2. 1. Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia. Electronic address: sarah.everitt@petermac.org. 2. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 3. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 4. Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 5. Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 6. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 7. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Abstract
PURPOSE: To investigate the associations between interim tumor responses on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-fluorothymidine (18F-FLT) PET and patient outcomes, especially progression-free survival (PFS) and overall survival (OS), in non-small cell lung cancer (NSCLC) patients. METHODS AND MATERIALS: Patients with FDG-PET/computed tomography stage I-III NSCLC were prescribed concurrent chemotherapy and radiation therapy (60 Gy in 30 fractions). Scans were acquired at baseline (FDG-PET/computed tomography [FDGBL] for radiation therapy planning and FLT-PET [FLTBL]), week 2 (FDGwk2 and FLTwk2), and week 4 (FDGwk4 and FLTwk4) of chemoradiation therapy. Tumor responses were categorized as complete or partial responses or stable or progressive disease (SD, PD) using European Organization for Research and Treatment of Cancer criteria. Associations between response, OS, and PFS were analyzed with univariate Cox regressions and plotted using Kaplan-Meier curves. RESULTS: Between 2009 and 2013, 60 patients were recruited. Thirty-seven (62%) were male, and the median age was 66 years (range, 31-86 years). Two-year OS and PFS were 0.51 and 0.26, respectively. Unexpectedly, SD on FLTwk2 compared with complete response/partial response was associated with longer OS (hazard ratio [95% confidence interval] 2.01 [0.87-4.65], P=.082) and PFS (2.01 [0.92-4.36], P=.061). Weeks 2 and 4 FDG PET/CT were not significantly associated with survival. Study scans provided additional information to FDGBL in 21 patients (35%). Distant metastases detected in 3 patients on FLTBL and in 2 patients on FDG/FLTwk2 changed treatment intent from curative to palliative. Locoregional progression during radiation therapy was observed in 5 (8%) patients, prompting larger radiation therapy fields. CONCLUSIONS: Stable uptake of 18F-FLT at week 2 was paradoxically associated with longer OS and PFS. This suggests that suppression of tumor cell proliferation may protect against radiation-induced tumor cell killing. Baseline FLT, FLTwk2, and FDGwk2 detected rapid distant and locoregional progression in 10 patients (17%), prompting changes in management.
PURPOSE: To investigate the associations between interim tumor responses on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-fluorothymidine (18F-FLT) PET and patient outcomes, especially progression-free survival (PFS) and overall survival (OS), in non-small cell lung cancer (NSCLC) patients. METHODS AND MATERIALS: Patients with FDG-PET/computed tomography stage I-III NSCLC were prescribed concurrent chemotherapy and radiation therapy (60 Gy in 30 fractions). Scans were acquired at baseline (FDG-PET/computed tomography [FDGBL] for radiation therapy planning and FLT-PET [FLTBL]), week 2 (FDGwk2 and FLTwk2), and week 4 (FDGwk4 and FLTwk4) of chemoradiation therapy. Tumor responses were categorized as complete or partial responses or stable or progressive disease (SD, PD) using European Organization for Research and Treatment of Cancer criteria. Associations between response, OS, and PFS were analyzed with univariate Cox regressions and plotted using Kaplan-Meier curves. RESULTS: Between 2009 and 2013, 60 patients were recruited. Thirty-seven (62%) were male, and the median age was 66 years (range, 31-86 years). Two-year OS and PFS were 0.51 and 0.26, respectively. Unexpectedly, SD on FLTwk2 compared with complete response/partial response was associated with longer OS (hazard ratio [95% confidence interval] 2.01 [0.87-4.65], P=.082) and PFS (2.01 [0.92-4.36], P=.061). Weeks 2 and 4 FDG PET/CT were not significantly associated with survival. Study scans provided additional information to FDGBL in 21 patients (35%). Distant metastases detected in 3 patients on FLTBL and in 2 patients on FDG/FLTwk2 changed treatment intent from curative to palliative. Locoregional progression during radiation therapy was observed in 5 (8%) patients, prompting larger radiation therapy fields. CONCLUSIONS: Stable uptake of 18F-FLT at week 2 was paradoxically associated with longer OS and PFS. This suggests that suppression of tumor cell proliferation may protect against radiation-induced tumor cell killing. Baseline FLT, FLTwk2, and FDGwk2 detected rapid distant and locoregional progression in 10 patients (17%), prompting changes in management.
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