Positron Emission Tomography for Assessing Local Failure After Stereotactic Body Radiotherapy for Non-Small-Cell Lung Cancer

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
International journal of radiation oncology, biology, physics (Impact Factor: 4.26). 05/2012; 83(5):1558-65. DOI: 10.1016/j.ijrobp.2011.10.035
Source: PubMed


We analyzed whether positron emission tomography (PET)/computed tomography standardized uptake values (SUVs) after stereotactic body radiotherapy (SBRT) could predict local recurrence (LR) in non-small-cell lung cancer (NSCLC).
This study comprised 128 patients with Stage I (n = 68) or isolated recurrent/secondary parenchymal (n = 60) NSCLC treated with image-guided SBRT to 50 Gy over 4 consecutive days; prior radiotherapy was allowed. PET/computed tomography scans were obtained before therapy and at 1 to 6 months after therapy, as well as subsequently as clinically indicated. Continuous variables were analyzed with Kruskal-Wallis tests and categorical variables with Pearson chi-square or Fisher exact tests. Actuarial local failure rates were calculated with the Kaplan-Meier method.
At a median follow-up of 31 months (range, 6-71 months), the actuarial 1-, 2-, and 3-year local control rates were 100%, 98.5%, and 98.5%, respectively, in the Stage I group and 95.8%, 87.6%, and 85.8%, respectively, in the recurrent group. The cumulative rates of regional nodal recurrence and distant metastasis were 8.8% (6 of 68) and 14.7% (10 of 68), respectively, for the Stage I group and 11.7% (7 of 60) and 16.7% (10 of 60), respectively, for the recurrent group. Univariate analysis showed that SUVs obtained 12.1 to 24 months after treatment for the Stage I group (p = 0.007) and 6.1 to 12 months and 12.1 to 24 months after treatment for the recurrent group were associated with LR (p < 0.001 for both). Of the 128 patients, 17 (13.3%) had ipsilateral consolidation after SBRT but no elevated metabolic activity on PET; none had LR. The cutoff maximum SUV of 5 was found to have 100% sensitivity, 91% specificity, a 50% positive predictive value, and a 100% negative predictive value for predicting LR.
PET was helpful for distinguishing SBRT-induced consolidation from LR. SUVs obtained more than 6 months after SBRT for NSCLC were associated with local failure. A maximum SUV greater than 5, especially at more than 6 months after SBRT, should prompt biopsy to rule out LR.


Available from: Hui Liu, Apr 04, 2014
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    • "On peut cependant retenir qu'une SUV max supérieure à 5 doit faire suspecter une récidive. En effet, un seuil de SUV max égale à 5 à 6 mois du traitement présente une sensibilité de 100 %, une spécificité de 91 %, une valeur prédictive positive de 50 % et une valeur prédictive négative de 100 % dans la détection de la récidive [46] "
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    ABSTRACT: Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.
    Cancer/Radiothérapie 10/2015; DOI:10.1016/j.canrad.2015.05.027 · 1.41 Impact Factor
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    • "Une SUV max de moins de 2, ou une diminution de plus de 2,55 sur la première TEP-scanogarphie d'évaluation à trois mois étaient prédictives d'un moindre risque de rechute métastatique [74]. Zhang et al. ont estimé qu'une valeur de SUV max , 6 mois après le traitement supérieure à 5, avait une sensibilité de 100 %, une spécificité de 91 %, une valeur prédictive positive de 50 % et une valeur prédictive négative de 100 % [75]. Les conclusions de Bollineni et al., sur 132 patients traités, semblent aller dans le même sens : la SUV max , lors d'une TEP au ( 18 F)-FDG 12 semaines après l'irradiation était prédictive du contrôle local à 2 ans, avec pour les patients avec une valeur inférieure à 5, un taux de contrôle local de 97,7 % contre 80 % pour ceux dont la SUV max était supérieure ou égale à cette valeur [76]. "
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    ABSTRACT: Stereotactic radiotherapy for lung cancer is a technique that is now well established in the therapeutic arsenal. Protocols are effective, with very high local control rate and an acceptable rate of survival if one takes into account the patient's age and comorbidities. Complications are rare. This review of the literature analyses the whole process of the therapeutic indications and future prospects.
    Cancer/Radiothérapie 07/2014; 18(4). DOI:10.1016/j.canrad.2014.05.002 · 1.41 Impact Factor
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    • "Given that SBRT-induced consolidation can be very difficult to distinguish from local recurrence using post-treatment CT based RECIST criteria, PET scan was obtained on all patients at follow-up. Residual PET uptake and maximal SUVs were used to distinguish fibrosis from residual disease [12,13]. "
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    ABSTRACT: Low survival outcomes have been reported for the treatment of locally advanced non small cell lung cancer (LA-NSCLC) with the standard of care treatment of concurrent chemoradiation (cCRT). We present our experience of dose escalation using stereotactic body radiosurgery (SBRT) following conventional cCRT for patients with LA-NSCLC. Sixteen patients with a median age of 67.5 treated with fractionated SBRT from 2010 to 2012 were retrospectively analyzed. Nine (56%) of the patients had stage IIIB, 6 (38%) has stage IIIA, and 1 (6%) had recurrent disease. Majority of the patients (63%) presented with N2 disease. All patients had a PET CT for treatment planning. Patients received conventional cCRT to a median dose of 50.40 Gy (range 45--60) followed by an SBRT boost with an average dose of 25 Gy (range 20--30) given over 5 fractions. With a median follow-up of 14 months (range, 1--14 months), 1-year overall survival (OS), progression free survival (PFS), local control (LC), regional control (RC), and distant control (DC) rates were, 78%, 42%, 76%, 79%, and 71%, respectively. Median times to disease progression and regional failure were 10 months and 18 months, respectively. On univariate analysis, advanced age and nodal status were worse prognostic factors of PFS (p < 0.05). Four patients developed radiation pneumonitis and one developed hemoptysis. Treatment was interrupted in one patient who required hospitalization due to arrhythmias and pneumonia. Risk adaptive dose escalation with SBRT following external beam radiotherapy is possible and generally tolerated treatment option for patients with LA-NSCLC.
    Radiation Oncology 07/2013; 8(1):179. DOI:10.1186/1748-717X-8-179 · 2.55 Impact Factor
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