Maximum standardized uptake value from staging FDG-PET/CT does not predict treatment outcome for early-stage non-small-cell lung cancer treated with stereotactic body radiotherapy.

PURPOSE To perform a retrospective review to determine whether maximum standardized uptake values (SUV(max)) from staging 2-deoxy-2- [(18)F] fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) studies are associated with outcomes for early-stage non-small-cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). METHODS AND MATERIALS Seventy-two medically inoperable patients were treated between October 17, 2003 and August 17, 2007 with SBRT for T1-2N0M0 NSCLC. SBRT was administered as 60 Gy in 3 fractions, 50 Gy in 5 fractions, or 50 Gy in 10 fractions using abdominal compression and image-guided SBRT. Cox proportional hazards regression was performed to determine whether PET SUV(max) and other variables influenced outcomes: mediastinal failure (MF), distant metastases (DM), and overall survival (OS). RESULTS Biopsy was feasible in 49 patients (68.1%). Forty-nine patients had T1N0 disease, and 23 had T2N0 disease. Median SUV(max) was 6.55 (range, 1.5-21). Median follow-up was 16.9 months (range, 0.1-37.9 months). There were 3 local failures, 8 MF, 19 DM, and 30 deaths. Two-year local control, MF, DM, and OS rates were 94.0%, 10.4%, 30.1%, and 61.3%, respectively. In univariate analysis, PET/CT SUV(max), defined either as a continuous or dichotomous variable, did not predict for MF, DM, or OS. On multivariable analysis, the only predictors for overall survival were T1 stage (hazard ratio = 0.331 [95% confidence interval, 0.156-0.701], p = 0.0039) and smoking pack-year history (hazard ratio = 1.015 [95% confidence interval, 1.004-1.026], p = 0.0084). CONCLUSIONS Pretreatment PET SUV(max) did not predict for MF, DM, or OS in patients treated with SBRT for early-stage NSCLC.

[1]  Sasa Mutic,et al.  Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. , 2004, International journal of radiation oncology, biology, physics.

[2]  H. Kato,et al.  A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. , 2004, The New England journal of medicine.

[3]  K. Ishikawa,et al.  Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer--a multicenter study. , 2005, Lung cancer.

[4]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[5]  T. Araki,et al.  Stereotactic hypofractionated high‐dose irradiation for stage I nonsmall cell lung carcinoma , 2004, Cancer.

[6]  T. Naruke,et al.  Prognostic significance of [18F]fluorodeoxyglucose uptake on positron emission tomography in patients with pathologic stage I lung adenocarcinoma , 2006, Cancer.

[7]  D. Galetta,et al.  Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[8]  O. Warburg.  On the origin of cancer cells. , 1956, Science.

[9]  T. Rice,et al.  Utility of positron emission tomography compared with mediastinoscopy for delineating involved lymph nodes in stage III lung cancer: insights for radiotherapy planning from a surgical cohort. , 2008, International journal of radiation oncology, biology, physics.

[10]  F. Gao,et al.  Prognostic Value of Preoperative Positron Emission Tomography in Resected Stage I Non-small Cell Lung Cancer , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[11]  R. Timmerman,et al.  FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. , 2005, Lung cancer.

[12]  D. Wood,et al.  Lung cancer proliferation correlates with [F-18]fluorodeoxyglucose uptake by positron emission tomography. , 2000, Clinical cancer research : an official journal of the American Association for Cancer Research.

[13]  K. Hiroshima,et al.  Smoking before surgery predicts poor long-term survival in patients with stage I non-small-cell lung carcinomas. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  I. Lax,et al.  The role of radiotherapy in treatment of stage I non-small cell lung cancer. , 2003, Lung cancer.

[15]  T. Naruke,et al.  Prognostic significance of [18F]fluorodeoxyglucose uptake on positron emission tomography in patients with pathologic stage I lung adenocarcinoma , 2006, Cancer.

[16]  Y. Liu,et al.  18F-FDG uptake as a biologic factor predicting outcome in patients with resected non-small-cell lung cancer. , 2007, Chinese medical journal.

[17]  J. Beitler,et al.  Stereotactic body radiation therapy for nonmetastatic lung cancer: an analysis of 75 patients treated over 5 years. , 2006, International journal of radiation oncology, biology, physics.

[18]  R. Timmerman,et al.  Stereotactic Body Radiation Therapy: A Comprehensive Review , 2007, American journal of clinical oncology.

[19]  W. Oyen,et al.  Prognostic Value of Different Metabolic Measurements with Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in Resectable Non-Small Cell Lung Cancer: A Two-Center Study , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[20]  Yukiko Arisaka,et al.  18F-FDG uptake as a biologic prognostic factor for recurrence in patients with surgically resected non-small cell lung cancer. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[21]  C. Dooms,et al.  Seeking a home for a PET, part 3: Emerging applications of positron emission tomography imaging in the management of patients with lung cancer. , 2004, Chest.

[22]  J. Sunderland,et al.  Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. , 1992, Radiology.

[23]  J. Wong,et al.  Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. , 2001, International journal of radiation oncology, biology, physics.

[24]  R Iwata,et al.  Differential diagnosis of lung tumor with positron emission tomography: a prospective study. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[25]  Edward Clouser,et al.  Intensity-modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. , 2010, International journal of radiation oncology, biology, physics.

[26]  M Hatanaka,et al.  Transport of sugars in tumor cell membranes. , 1974, Biochimica et biophysica acta.

[27]  E. Hall,et al.  Radiobiology for the radiologist , 1973 .

[28]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[29]  Y. Yatabe,et al.  Factors involved in lymph node metastasis in clinical stage I non-small cell lung cancer--from studies of 604 surgical cases. , 2007, Lung cancer.

[30]  C. Franzius.  FDG PET: advantages for staging the mediastinum? , 2004, Lung cancer.

[31]  M S Pepe,et al.  Kaplan-Meier, marginal or conditional probability curves in summarizing competing risks failure time data? , 1993, Statistics in medicine.

[32]  Ludy Lutgens,et al.  Increased therapeutic ratio by 18FDG-PET CT planning in patients with clinical CT stage N2-N3M0 non-small-cell lung cancer: a modeling study. , 2005, International journal of radiation oncology, biology, physics.

[33]  D. Wood,et al.  Relationship Between Non-small Cell Lung Cancer FDG Uptake at PET, Tumor Histology, and Ki-67 Proliferation Index , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[34]  N. Altorki,et al.  Risk factors for occult mediastinal metastases in clinical stage I non-small cell lung cancer. , 2007, The Annals of thoracic surgery.