Increases in Serial Pretreatment18 F-FDG PET-CT Metrics Predict Survival in Early Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiation Therapy

• Published in: Advances in radiation oncology 2018, Vol.4 (2), p.429-437
• Main Authors: Prionas, Nicolas D., MD, PhD, von Eyben, Rie, MSc, Yi, Esther, BA, Aggarwal, Sonya, BA, Shaffer, Jenny, MD, Bazan, Jose, MD, Eastham, David, MD, Maxim, Peter G., PhD, Graves, Edward E., PhD, Diehn, Maximilian, MD, PhD, Gensheimer, Michael F., MD, Loo, Billy W., MD, PhD
• Format: Article
• Language: English
• Subjects: Hematology, Oncology, and Palliative Medicine
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2018.11.006

Abstract Purpose Quantitative changes in positron emission tomography with computed tomography imaging metrics over serial scans may be predictive biomarkers. We evaluated the relationship of pretreatment metabolic tumor growth rate (MTGR) and standardized uptake value velocity (SUVV) with disease recurrence or death in patients with early-stage non-small cell lung cancer treated with stereotactic ablative radiation therapy (SABR). Methods and Materials Under institutional review board approval, we retrospectively identified patients who underwent positron emission tomography with computed tomography at diagnosis and staging and simulation for SABR. Two cohorts underwent SABR between November 2005 to October 2012 (discovery) and January 2012 to April 2016 (validation). MTGR and SUVV were calculated as the daily change in metabolic tumor volume and maximum standardized uptake value, respectively. Cox proportional hazard models identified predictors of local, regional, and distant recurrence and death for the combined cohort. MTGR and SUVV thresholds dichotomizing risk of death in the discovery cohort were applied to the validation cohort. Results A total of 152 lesions were identified in 143 patients (92 lesions in 83 discovery cohort patients). In multivariable models, increasing MTGR trended toward increased hazard of distant recurrence (hazard ratio, 6.98; 95% confidence interval, 0.67-72.61; P  = .10). In univariable models, SUVV trended toward risk of death (hazard ratio, 11.8, 95% confidence interval, 0.85-165.1, P  = .07). MTGR greater than 0.04 mL/d was prognostic of decreased survival in discovery ( P  = .048) and validation cohorts ( P