Metabolic Tumor Burden Predicts for Disease Progression and Death in Lung Cancer

Journal Article · Mon Oct 01 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.04.036· OSTI ID:21036230

Lee, Percy; Weerasuriya, Dilani K ^[1]; Lavori, Philip W ^[2]; Quon, Andrew ^[3]; Hara, Wendy; Maxim, Peter G; Le, Quynh-Thu ^[1]; Wakelee, Heather A ^[4]; Donington, Jessica S ^[5]; Graves, Edward E ^[1]

---

1. Department of Radiation Oncology, Stanford University, Stanford, CA (United States)
2. Department of Health Research and Policy, Stanford University, Stanford, CA (United States)
3. Department of Radiology, Division of Nuclear Medicine, Stanford University, Stanford, CA (United States)
4. Department of Medicine, Division of Oncology, Stanford University, Stanford, CA (United States)
5. Department of Cardiothoracic Surgery, Stanford University, Stanford, CA (United States)

Purpose: In lung cancer, stage is an important prognostic factor for disease progression and survival. However, stage may be simply a surrogate for underlying tumor burden. Our purpose was to assess the prognostic value of tumor burden measured by {sup 18}F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging. Patients and Methods: We identified 19 patients with lung cancer who had staging PET-CT scans before any therapy, and adequate follow-up (complete to time of progression for 18, and death for 15 of 19). Metabolically active tumor regions were segmented on pretreatment PET scans semi-automatically using custom software. We determined the relationship between times to progression (TTP) and death (OS) and two PET parameters: total metabolic tumor volume (MTV), and standardized uptake value (SUV). Results: The estimated median TTP and OS for the cohort were 9.3 months and 14.8 months. On multivariate Cox proportional hazards regression analysis, an increase in MTV of 25 ml (difference between the 75th and 25th percentiles) was associated with increased hazard of progression and of death (5.4-fold and 7.6-fold), statistically significant (p = 0.0014 and p = 0.001) after controlling for stage, treatment intent (definitive or palliative), age, Karnofsky performance status, and weight loss. We did not find a significant relationship between SUV and TTP or OS. Conclusions: In this study, high tumor burden assessed by PET MTV is an independent poor prognostic feature in lung cancer, promising for stratifying patients in randomized trials and ultimately for selecting risk-adapted therapies. These results will need to be validated in larger cohorts with longer follow-up, and evaluated prospectively.

• OSTI ID: 21036230
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 69; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
COMPUTER CODES
COMPUTERIZED TOMOGRAPHY
DEATH
FLUORINE 18
FLUORODEOXYGLUCOSE
IMAGE PROCESSING
LUNGS
MULTIVARIATE ANALYSIS
PATIENTS
POSITRON COMPUTED TOMOGRAPHY
REGRESSION ANALYSIS
THERAPY