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Radiother Oncol. 2016 Jun;119(3):454-60. doi: 10.1016/j.radonc.2016.05.007. Epub 2016 Jun 3.

Pre-treatment non-target lung FDG-PET uptake predicts symptomatic radiation pneumonitis following Stereotactic Ablative Radiotherapy (SABR).

Author information

1
Department of Radiation Oncology, Stanford University School of Medicine, United States.
2
Quantitative Sciences Unit, Stanford University School of Medicine, United States.
3
Department of Radiation Oncology, Stanford University School of Medicine, United States; Stanford Cancer Institute, Stanford University School of Medicine, United States.
4
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, United States.
5
Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Canada.
6
Department of Radiation Oncology, University of Southern California School of Medicine, United States.
7
Department of Radiation Oncology, Stanford University School of Medicine, United States; Stanford Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States. Electronic address: diehn@stanford.edu.
8
Department of Radiation Oncology, Stanford University School of Medicine, United States; Stanford Cancer Institute, Stanford University School of Medicine, United States. Electronic address: BWLoo@stanford.edu.
9
Department of Radiology and Nuclear Medicine, Stanford University School of Medicine, United States. Electronic address: henryguo@stanford.edu.

Abstract

PURPOSE:

To determine if pre-treatment non-target lung FDG-PET uptake predicts for symptomatic radiation pneumonitis (RP) following lung stereotactic ablative radiotherapy (SABR).

METHODS:

We reviewed a 258 patient database from our institution to identify 28 patients who experienced symptomatic (grade ⩾ 2) RP after SABR, and compared them to 57 controls who did not develop symptomatic RP. We compared clinical, dosimetric and functional imaging characteristics between the 2 cohorts including pre-treatment non-target lung FDG-PET uptake.

RESULTS:

Median follow-up time was 26.9 months. Patients who experienced symptomatic RP had significantly higher non-target lung FDG-PET uptake as measured by mean SUV (p < 0.0001) than controls. ROC analysis for symptomatic RP revealed area under the curve (AUC) of 0.74, with sensitivity 82.1% and specificity 57.9% with cutoff mean non-target lung SUV > 0.56. Predictive value increased (AUC of 0.82) when mean non-target lung SUV was combined with mean lung dose (MLD). We developed a 0-2 point model using these 2 variables, 1 point each for SUV > 0.56 or MLD > 5.88 Gy equivalent dose in 2 Gy per fraction (EQD2), predictive for symptomatic RP in our cohort with hazard ratio 10.01 for score 2 versus 0 (p < 0.001).

CONCLUSIONS:

Patients with elevated pre-SABR non-target lung FDG-PET uptake are at increased risk of symptomatic RP after lung SABR. Our predictive model suggests patients with mean non-target lung SUV > 0.56 and MLD > 5.88 Gy EQD2 are at highest risk. Our predictive model should be validated in an external cohort before clinical implementation.

KEYWORDS:

Fluorodeoxyglucose positron emission tomography (FDG-PET); Lung cancer; Mean lung dose; Mean non-target lung SUV; Radiation pneumonitis; Stereotactic ablative radiotherapy (SABR)

PMID:
27267049
DOI:
10.1016/j.radonc.2016.05.007
[Indexed for MEDLINE]

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