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EJNMMI Res. 2017 Dec;7(1):8. doi: 10.1186/s13550-017-0258-3. Epub 2017 Jan 19.

A comparison of FLT to FDG PET/CT in the early assessment of chemotherapy response in stages IB-IIIA resectable NSCLC.

Author information

1
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA.
2
Medical Imaging Department, King Fahad Specialist Hospital, P.O. Box 15215, Dammam, 31444-34, Saudi Arabia.
3
Juravinski Cancer Centre, McMaster University, 699 Concession Street, Fourth, Hamilton, Ontario, L8V 5C2, Canada.
4
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St, CRB I Room G-94, Baltimore, MD, 21287, USA.
5
Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, 633 3rd Ave, New York, NY, 10017, USA.
6
Department of Radiology, Georgetown University Hospital, 3800 Reservoir Road NW CCC Bldg., Washington, DC, 20007, USA.
7
Department of Medicine, Georgetown University Hospital, 3800 Reservoir Road NW LCCC Bldg., Second Floor Pod B, Washington, DC, 20007, USA.
8
Department of Radiology, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Room 430, Columbus, OH, 43210, USA.
9
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 116 Donner, HUP 3400 Spruce Street, Philadelphia, PA, 19104, USA.
10
The Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
11
The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Nelson B1-160, 600 N. Wolfe St., Baltimore, MD 21287, USA.
12
Department of Nuclear Medicine, Seoul St. Mary's Hospital, Catholic Medical Center, Seocho-gu, Banpo-daero 222, Seoul, 06591, Korea.
13
Department of Pathology, Johns Hopkins University School of Medicine, 1550 Orleans Street, 304 CRB II, Baltimore, MD, 21287, USA.
14
National Cancer Institute, 6130 Executive Boulevard, MSC 7412, Bethesda, MD, 20892, USA.
15
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA. rwahl@wustl.edu.
16
The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Nelson B1-160, 600 N. Wolfe St., Baltimore, MD 21287, USA. rwahl@wustl.edu.

Abstract

BACKGROUND:

The aim of this study was to compare the percentage change in 18F-fluorothymidine (FLT) standard uptake value (SUV) between baseline and after one cycle of chemotherapy in patients categorized by RECIST 1.1 computed tomography (CT) as responders or non-responders after two cycles of therapy. Change in 18F-fluorodeoxyglucose (FDG) uptake was also compared between these time points. Nine patients with newly diagnosed, operable, non-small cell lung cancer (NSCLC) were imaged with FDG positron emission tomography/CT (PET), FLT PET/CT, and CT at baseline, following one cycle of neoadjuvant therapy (75 mg/m2 docetaxel + 75 mg/m2 cisplatin), and again after the second cycle of therapy. All patients had a biopsy prior to enrollment and underwent surgical resection within 4 weeks of post-cycle 2 imaging.

RESULTS:

Between baseline and post-cycle 1, non-responders had mean SULmax (maximum standard uptake value adjusted for lean body mass) increases of 7.0 and 3.4% for FDG and FLT, respectively. Responders had mean decreases of 44.8 and 32.0% in FDG and FLT SULmax, respectively, between baseline and post-cycle 1 imaging. On post-cycle 1 imaging, primary tumor FDG SUL values were significantly lower in responders than in non-responders (P = 0.016). Primary tumor FLT SUL values did not differ significantly between these groups. Using the change from baseline to post-cycle 1, receiver-operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.94 for FDG and 0.78 for FLT in predicting anatomic tumor response after the second cycle of therapy.

CONCLUSIONS:

Fractional decrease in FDG SULmax from baseline to post-cycle 1 imaging was significantly different between anatomic responders and non-responders, while percentage changes in FLT SULmax were not significantly different between these groups over the same period of time.

KEYWORDS:

Early treatment response monitoring; FDG PET/CT; FLT PET/CT; Non-small cell lung cancer

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