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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

1
Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
2
Department of Physics, University of Oslo, Oslo, Norway.
3
Department of Oncology, Oslo University Hospital, Oslo, Norway.
4
Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
5
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

Purpose:

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.

Results:

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.

Conclusions:

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.

KEYWORDS:

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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