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.

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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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    • "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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    • "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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