Combined PET/CT image characteristics for radiotherapy tumor response in lung cancer

Radiother Oncol. 2012 Feb;102(2):239-45. doi: 10.1016/j.radonc.2011.10.014. Epub 2011 Nov 16.


Background and purpose: Prediction of local failure in radiotherapy patients with non-small cell lung cancer (NSCLC) remains a challenging task. Recent evidence suggests that FDG-PET images can be used to predict outcomes. We investigate an alternative multimodality image-feature approach for predicting post-radiotherapy tumor progression in NSCLC.

Material and methods: We analyzed pre-treatment FDG-PET/CT studies of twenty-seven NSCLC patients for local and loco-regional failures. Thirty-two tumor region features based on SUV or HU, intensity-volume-histogram (IVH) and texture characteristics were extracted. Statistical analysis was performed using Spearman's correlation (rs) and multivariable logistic regression.

Results: For loco-regional recurrence, IVH variables had the highest univariate association. In PET, IVH-slope reached rs=0.3426 (p=0.0403). Motion correction slightly improved correlation of texture features. In CT, coefficient of variation had the highest association rs=-0.2665 (p=0.0871). Similarly for local failure, a CT-IVH parameter reached rs=0.4530 (p=0.0105). For loco-regional and local failures, a 2-parameter model of PET-V(80) and CT-V(70) yielded rs=0.4854 (p=0.0067) and rs=0.5908 (p=0.0013), respectively. Addition of dosimetric variables provided improvement in cases of loco-regional but not local failures.

Conclusions: We proposed a feature-based approach to evaluate radiation tumor response. Our study demonstrates that multimodality image-feature modeling provides better performance compared to existing metrics and holds promise for individualizing radiotherapy planning.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Disease Progression
  • Female
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Male
  • Middle Aged
  • Models, Statistical
  • Multimodal Imaging*
  • Neoplasm Staging
  • Pattern Recognition, Automated
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Radiation Dosage
  • Retrospective Studies
  • Tomography, X-Ray Computed*
  • Treatment Outcome