Differential (18)F-FDG and (18)F-FLT Uptake on Serial PET/CT Imaging Before and During Definitive Chemoradiation for Non-Small Cell Lung Cancer

Sarah J Everitt; David L Ball; Rodney J Hicks; Jason Callahan; Nikki Plumridge; Marnie Collins; Alan Herschtal; David Binns; Tomas Kron; Michal Schneider; Michael MacManus

doi:10.2967/jnumed.113.131631

Differential (18)F-FDG and (18)F-FLT Uptake on Serial PET/CT Imaging Before and During Definitive Chemoradiation for Non-Small Cell Lung Cancer

J Nucl Med. 2014 Jul;55(7):1069-74. doi: 10.2967/jnumed.113.131631. Epub 2014 May 15.

Authors

Affiliations

¹ Radiation Therapy, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia sarah.everitt@petermac.org.
² Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
³ Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
⁴ Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
⁵ Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
⁶ Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; and.
⁷ Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
⁸ Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
⁹ Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.

PMID: 24833494
DOI: 10.2967/jnumed.113.131631

Abstract

We aimed to prospectively observe cellular metabolism and proliferation in patients with non-small-cell lung cancer (NSCLC) during radical chemoradiation therapy using serial PET/CT with (18)F-FDG and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT).

Methods: Twenty patients with stage I-III NSCLC and candidates for radical chemoradiation therapy (60 Gy in 30 fractions over 6 wk) were recruited. (18)F-FDG and (18)F-FLT PET/CT were performed at baseline and during therapy (weeks 2 and 4). Tumor response was assessed semiquantitatively and using visual response criteria.

Results: The median and range for primary tumor volume (cm(3)) at baseline on (18)F-FDG were 28 and 2-241, respectively, and on (18)F-FLT 31 and 2-184, respectively. At week 2, (18)F-FDG was 26 (range, 2-164), and (18)F-FLT was 11 (range, 0-111). At week 4, (18)F-FDG was 19 (1-147), and (18)F-FLT was 7 (0-48). The median and range of maximum standardized uptake value (SUVmax) at baseline on (18)F-FDG were 14 and 4-31, respectively, and on (18)F-FLT 6 and 2-12, respectively. Week 2 (18)F-FDG median SUVmax was 10 (2-31), and (18)F-FLT median SUVmax was 3 (1-15); week 4 (18)F-FDG median SUVmax was 10 (2-15), and (18)F-FLT median SUVmax was 2 (2-9). There was fair agreement between visual tumor response on (18)F-FDG and (18)F-FLT during therapy (Cohen's unweighted κ statistic, 0.27 at week 2 and 0.355 at week 4). Cerebral metastases were detected on 1 baseline (18)F-FLT scan, resulting in palliative management. Progressive disease was detected on week 2 scans in 3 patients, resulting in changes to radiation therapy (2 patients) and treatment intent (1 patient).

Conclusion: This study demonstrates that (18)F-FLT PET/CT is a more sensitive tracer of early treatment response than (18)F-FDG PET/CT. The ability of these tracers to detect distinct biologic processes may lead to their use as biomarkers for personalized radiation therapy and prognosis in the future.

Keywords: FDG: 18F-fluorodeoxyglucose; FLT: 18F-fluorodeoxythymidine; non-small cell lung cancer; positron emission tomography; radiation therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Biological Transport
Carcinoma, Non-Small-Cell Lung / diagnosis
Carcinoma, Non-Small-Cell Lung / metabolism
Carcinoma, Non-Small-Cell Lung / pathology
Carcinoma, Non-Small-Cell Lung / therapy*
Cell Proliferation / drug effects
Cell Proliferation / radiation effects
Chemoradiotherapy*
Dideoxynucleosides / metabolism*
Disease Progression
Female
Fluorodeoxyglucose F18 / metabolism*
Follow-Up Studies
Humans
Lung Neoplasms / diagnosis
Lung Neoplasms / metabolism
Lung Neoplasms / pathology
Lung Neoplasms / therapy*
Male
Middle Aged
Multimodal Imaging
Neoplasm Staging
Positron-Emission Tomography*
Survival Analysis
Tomography, X-Ray Computed*

Substances

Dideoxynucleosides
Fluorodeoxyglucose F18
alovudine