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A Pilot Study of [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography Scans During and After Radiation-Based Therapy in Patients With Non–Small-Cell Lung Cancer

Feng-Ming Spring Kong, Kirk A. Frey, Leslie E. Quint, Randall K. Ten Haken, James A. Hayman, Marc Kessler, Indrin J. Chetty, Daniel Normolle, Avraham Eisbruch, Theodore S. Lawrence

From the Departments of Radiation Oncology and Radiology (Nuclear Medicine and Thoracic Radiology), University of Michigan; and Radiation Oncology, Veterans Affairs Health Center, Ann Arbor, MI

Address reprint requests to Feng-Ming Spring Kong, MD, PhD, MPH, University of Michigan, Department of Radiation Oncology, UH-B2C490, Box 0010, 1500 E Medical Center Dr, Ann Arbor, MI 48109; e-mail: Fengkong{at}med.umich.edu

Purpose To study whether changes of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) during treatment correlate with post-treatment responses in tumor and normal lung in patients with non–small-cell lung cancer (NSCLC).

Patients and Methods Patients with stage I to III NSCLC requiring a definitive dose of fractionated radiation therapy (RT) were eligible. FDG-PET/computed tomography scans were acquired before, during, and after RT. Tumor and lung metabolic responses were assessed qualitatively by physicians and quantitatively by normalized peak FDG activity (the ratio of the maximum FDG activity divided by the mean of the aortic arch background).

Results The study reached the goal of recruiting 15 patients between February 2004 and August 2005. Of these, 11 patients had partial metabolic response, two patients had complete metabolic response, and two patients had stable disease at approximately 45 Gy during RT. The mean peak tumor FDG activity was 5.2 (95% CI, 4.0 to 6.4), 2.5 (95% CI, 2.0 to 3.0), and 1.7 (95% CI, 1.3 to 2.0) on pre-, during, and post-RT scans, respectively. None of the patients had appreciable changes in the lung during RT. The peak FDG activity of the lung was 0.47 (95% CI, 0.36 to 0.59), 0.52 (95% CI, 0.40 to 0.64), and 1.29 (95% CI, 0.82 to 1.76), on pre-, during-, and post-RT scans, respectively. The qualitative response during RT correlated with the overall response post-RT (P = .03); the peak tumor FDG activity during RT correlated with those 3 months post-RT (R² = 0.7; P < .001).

Conclusion This pilot study suggests a significant correlation in tumor metabolic response and no association in lung FDG activity between during RT scans and 3 months post-RT scans in patients with NSCLC. Additional study with a large number of patients is needed to validate these findings.

Supported in part by Young Investigator Award of the American Society of Clinical Oncology, the Radiological Society of North America Seed Grant Program and National Institutes of Health Grant No. NIHP01 CA59827.

Presented in part at the 48th Annual Meeting of American Society for Therapeutic Radiology and Oncology, November 6, 2006, Philadelphia, PA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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