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Clin Transl Radiat Oncol. 2017 Jun 15;4:57-63. doi: 10.1016/j.ctro.2017.04.002. eCollection 2017 Jun.

Assessment of pulmonary 18F-FDG-PET uptake and cytokine profiles in non-small cell lung cancer patients treated with radiotherapy and erlotinib.

Author information

Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
Department of Physics, University of Oslo, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.



To investigate effects of radiotherapy (RT) and erlotinib on pulmonary glucose uptake using 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET) during and after treatment of non-small cell lung cancer (NSCLC) and to identify associations between serum cytokine levels and lung glucose uptake.

Material and methods:

Twenty-seven patients with advanced NSCLC, receiving RT alone or concomitant RT and erlotinib therapy, were examined by 18F-FDG PET before, during, and after treatment. A total of 57 18F-FDG PET scans were analyzed. Pulmonary 18F-FDG uptake and radiotherapy dose mapping were used to acquire dose-response curves for each patient, where subsequent linear regression gave a glucose uptake level in the un-irradiated parts of the lungs (SUV0) and a response slope (ΔSUV). Serum cytokine levels at corresponding time points were assessed using a multiplex bioassay. Correlations between the most robust cytokines and lung 18F-FDG dose response parameters were further investigated.


From the dose response analysis, SUV0 at post-therapy was significantly higher (P < 0.001) than at mid- and pre-therapy (45% and 58%, respectively) for the group receiving RT + erlotinib. Also, SUV0 at post-therapy was higher for patients receiving RT + erlotinib compared to RT alone (42%; P < 0.001). No differences in ΔSUV were seen with treatments or time. SUV0 was positively associated (r = 0.47, P = 0.01) with serum levels of the chemokine C-C motif ligand 21 (CCL21) for patients receiving RT + erlotinib.


Concomitant RT and erlotinib causes an elevation in pulmonary 18F-FDG uptake post treatment compared to RT alone. Pulmonary glucose uptake is associated with an upregulation of a chemokine (CCL21) involved in inflammatory reactions.


18F-FDG; 18F-FDG, 2-deoxy-2-(18F)fluoro-D-glucose; CCL, Chemokine (CC motif) ligand; CT, Computed tomography; EGFR, Epidermal growth factor receptor; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; EORTC QLQ-LC13, EORTC QLQ Lung Cancer 13; Erlotinib; GTV, Gross tumor volume; HU, Hounsfield Unit; IL, Interleukin; Lung cancer; MMP, Matrix metalloproteinase; NSCLC, Non-small cell lung cancer; PET, Positron emission tomography; Positron emission tomography; RILT, Radiation induced lung toxicity; RT, Radiotherapy; SUV, Standard uptake value; Standardized uptake value; Thoracic radiotherapy

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