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Title: {sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT

Abstract

Purpose: Positron emission tomography (PET), in addition to computed tomography (CT), has an effect in target volume definition for radical radiotherapy (RT) for non-small-cell lung cancer (NSCLC). In previously PET-CT staged patients with NSCLC, we assessed the effect of using an additional planning PET-CT scan for gross tumor volume (GTV) definition. Methods and Materials: A total of 28 patients with Stage IA-IIIB NSCLC were enrolled. All patients had undergone staging PET-CT to ensure suitability for radical RT. Of the 28 patients, 14 received induction chemotherapy. In place of a RT planning CT scan, patients underwent scanning on a PET-CT scanner. In a virtual planning study, four oncologists independently delineated the GTV on the CT scan alone and then on the PET-CT scan. Intraobserver and interobserver variability were assessed using the concordance index (CI), and the results were compared using the Wilcoxon signed ranks test. Results: PET-CT improved the CI between observers when defining the GTV using the PET-CT images compared with using CT alone for matched cases (median CI, 0.57 for CT and 0.64 for PET-CT, p = .032). The median of the mean percentage of volume change from GTV{sub CT} to GTV{sub FUSED} was -5.21% for the induction chemotherapymore » group and 18.88% for the RT-alone group. Using the Mann-Whitney U test, this was significantly different (p = .001). Conclusion: PET-CT RT planning scan, in addition to a staging PET-CT scan, reduces interobserver variability in GTV definition for NSCLC. The GTV size with PET-CT compared with CT in the RT-alone group increased and was reduced in the induction chemotherapy group.« less

Authors:
 [1];  [2];  [3];  [4];  [3];  [5];  [3];  [5];  [6];  [4];  [3];  [1];  [2]
  1. Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, Northern Ireland (United Kingdom)
  2. (United Kingdom)
  3. Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland (United Kingdom)
  4. Northern Ireland Regional Medical Physics Agency, Royal Victoria Hospital, Belfast, Northern Ireland (United Kingdom)
  5. Northern Ireland Regional Medical Physics Agency, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland (United Kingdom)
  6. Department of Nuclear Medicine, Belfast City Hospital, Belfast, Northern Ireland (United Kingdom)
Publication Date:
OSTI Identifier:
21372235
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 77; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2009.04.045; PII: S0360-3016(09)00621-X; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CAT SCANNING; CHEMOTHERAPY; FLUORINE 18; FLUORODEOXYGLUCOSE; LUNGS; NEOPLASMS; POSITRON COMPUTED TOMOGRAPHY; RADIOTHERAPY; SIMULATION; ANTIMETABOLITES; BETA DECAY RADIOISOTOPES; BETA-PLUS DECAY RADIOISOTOPES; BODY; COMPUTERIZED TOMOGRAPHY; DIAGNOSTIC TECHNIQUES; DISEASES; DRUGS; EMISSION COMPUTED TOMOGRAPHY; FLUORINE ISOTOPES; HOURS LIVING RADIOISOTOPES; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; LIGHT NUCLEI; MEDICINE; NANOSECONDS LIVING RADIOISOTOPES; NUCLEAR MEDICINE; NUCLEI; ODD-ODD NUCLEI; ORGANS; RADIOISOTOPES; RADIOLOGY; RESPIRATORY SYSTEM; THERAPY; TOMOGRAPHY

Citation Formats

Hanna, Gerard G., E-mail: Gerry.Hanna@googlemail.co, Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, McAleese, Jonathan, Carson, Kathryn J., Stewart, David P., Cosgrove, Vivian P., Eakin, Ruth L., Zatari, Ashraf, Lynch, Tom, Jarritt, Peter H., Young, V.A. Linda D.C.R., O'Sullivan, Joe M., and Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland. {sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2009.04.045.
Hanna, Gerard G., E-mail: Gerry.Hanna@googlemail.co, Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, McAleese, Jonathan, Carson, Kathryn J., Stewart, David P., Cosgrove, Vivian P., Eakin, Ruth L., Zatari, Ashraf, Lynch, Tom, Jarritt, Peter H., Young, V.A. Linda D.C.R., O'Sullivan, Joe M., & Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland. {sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT. United States. doi:10.1016/j.ijrobp.2009.04.045.
Hanna, Gerard G., E-mail: Gerry.Hanna@googlemail.co, Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, McAleese, Jonathan, Carson, Kathryn J., Stewart, David P., Cosgrove, Vivian P., Eakin, Ruth L., Zatari, Ashraf, Lynch, Tom, Jarritt, Peter H., Young, V.A. Linda D.C.R., O'Sullivan, Joe M., and Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland. 2010. "{sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT". United States. doi:10.1016/j.ijrobp.2009.04.045.
@article{osti_21372235,
title = {{sup 18}F-FDG PET-CT Simulation for Non-Small-Cell Lung Cancer: Effect in Patients Already Staged by PET-CT},
author = {Hanna, Gerard G., E-mail: Gerry.Hanna@googlemail.co and Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland and McAleese, Jonathan and Carson, Kathryn J. and Stewart, David P. and Cosgrove, Vivian P. and Eakin, Ruth L. and Zatari, Ashraf and Lynch, Tom and Jarritt, Peter H. and Young, V.A. Linda D.C.R. and O'Sullivan, Joe M. and Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland},
abstractNote = {Purpose: Positron emission tomography (PET), in addition to computed tomography (CT), has an effect in target volume definition for radical radiotherapy (RT) for non-small-cell lung cancer (NSCLC). In previously PET-CT staged patients with NSCLC, we assessed the effect of using an additional planning PET-CT scan for gross tumor volume (GTV) definition. Methods and Materials: A total of 28 patients with Stage IA-IIIB NSCLC were enrolled. All patients had undergone staging PET-CT to ensure suitability for radical RT. Of the 28 patients, 14 received induction chemotherapy. In place of a RT planning CT scan, patients underwent scanning on a PET-CT scanner. In a virtual planning study, four oncologists independently delineated the GTV on the CT scan alone and then on the PET-CT scan. Intraobserver and interobserver variability were assessed using the concordance index (CI), and the results were compared using the Wilcoxon signed ranks test. Results: PET-CT improved the CI between observers when defining the GTV using the PET-CT images compared with using CT alone for matched cases (median CI, 0.57 for CT and 0.64 for PET-CT, p = .032). The median of the mean percentage of volume change from GTV{sub CT} to GTV{sub FUSED} was -5.21% for the induction chemotherapy group and 18.88% for the RT-alone group. Using the Mann-Whitney U test, this was significantly different (p = .001). Conclusion: PET-CT RT planning scan, in addition to a staging PET-CT scan, reduces interobserver variability in GTV definition for NSCLC. The GTV size with PET-CT compared with CT in the RT-alone group increased and was reduced in the induction chemotherapy group.},
doi = {10.1016/j.ijrobp.2009.04.045},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 77,
place = {United States},
year = 2010,
month = 5
}
  • Patients with limited stage small cell lung cancer were initially randomized to receive either three courses of Cyclophosphamide, Adriamycin, and Vincristine (CAV) followed by three courses of VP-16 and Cis-platin (VP-PT) or six courses of alternating CAV and VP-PT. Responding patients received prophylactic cranial radiation (PCI) after three courses of chemotherapy (CT) and loco-regional thoracic radiation (LRTR) after six courses. No maintenance chemotherapy was given. Patients receiving LRTR were randomized to receive either 25 Gy in ten fractions over 2 weeks (SD) or 37.5 Gy in 15 fractions over 3 weeks (HD). In both arms the pre-chemotherapy disease was treatedmore » with a 2 cm margin around the primary tumor volume. The mediastinum was included in the treatment volume and the supraclavicular nodes were also included if involved originally. The spinal cord was shielded after 32 Gy. Of the 333 patients enrolled by the time the trial closed in October 1984, 168 were eventually randomized to LRTR and are eligible for response assessment. The overall response rate after combined RT and CT was 94% (CR 67%, PR 27%). The CR rate for SD was 65% and for HD 69%. The combined treatment was well tolerated by most patients. Forty-nine percent of HD patients developed dysphagia compared to 26% of those SD (p less than 0.01). At the time of this analysis the median duration of follow-up since randomization to radiotherapy is 30 months. The median local progression-free survival on HD is 49 weeks. On SD it is 38 weeks (p = 0.05, one sided). The actuarial incidence of local progression by 2 years is 69% on HD and 80% on LD. There is as yet no significant difference in overall survival between the two arms. It appears that HD radiotherapy as administered in this study may have an impact on local control, but it is too early to determine if this will translate into a survival benefit.« less
  • Purpose: To determine whether the effect of radiation dose varies with gross tumor volume (GTV) in patients with stage I/II non-small cell lung cancer (NSCLC). Methods and Materials: Included in the study were 114 consecutive patients with medically inoperable stage I/II NSCLC treated with three-dimensional conformal radiotherapy between 1992 and 2004. The median biologic equivalent dose (BED) was 79.2 Gy (range, 58.2-124.5 Gy). The median GTV was 51.8 cm{sup 3} (range, 2.1-727.8 cm{sup 3}). The primary endpoint was overall survival (OS). Kaplan-Meier estimation and Cox regression models were used for survival analyses. Results: Multivariate analysis showed that there was amore » significant interaction between radiation dose and GTV (p < 0.001). In patients with BED {<=}79.2 Gy (n = 68), the OS medians for patients with GTV >51.8 cm{sup 3} and {<=}51.8 cm{sup 3} were 18.2 and 23.9 months, respectively (p 0.015). If BED was >79.2 Gy (n = 46), no significant difference was found between GTV groups (p = 0.681). For patients with GTV >51.8 cm{sup 3} (n = 45), the OS medians in those with BED >79.2 Gy and {<=}79.2 Gy were 30.4 and 18.2 months, respectively (p < 0.001). If GTV was {<=}51.8 cm{sup 3} (n = 45), the difference was no longer significant (p = 0.577). Conclusion: High-dose radiation is more important for patients with larger tumors and may be effective in reducing the adverse outcome associated with large GTV. Further prospective studies are needed to confirm this finding.« less
  • Purpose: Amifostine can reduce the cytotoxic effects of chemotherapy and radiotherapy in patients with locally advanced non-small-cell lung cancer, but concerns remain regarding its possible tumor-protective effects. Studies with sufficient statistical power to address this question are lacking. Methods and Materials: We performed a meta-analysis of all published clinical trials involving locally advanced non-small-cell lung cancer patients treated with radiotherapy with or without chemotherapy, who had been randomized to treatment with amifostine vs. no amifostine or placebo. Random effects estimates of the relative risk of overall, partial, and complete response were obtained. Results: Seven randomized trials involving 601 patients weremore » identified. Response rate data were available for six studies (552 patients). The pooled relative risk (RR) estimate was 1.07 (95% confidence interval, 0.97-1.18; p = 0.18), 1.21 (95% confidence interval, 0.83-1.78; p = 0.33), and 0.99 (95% confidence interval, 0.78-1.26; p = 0.95) for overall, complete, and partial response, respectively (a RR >1 indicates improvement in response with amifostine compared with the control arm). The results were similar after sensitivity analyses. No evidence was found of treatment effect heterogeneity across the studies. Conclusions: Amifostine has no effect on tumor response in patients with locally advanced non-small-cell lung cancer treated with radiotherapy with or without chemotherapy.« less
  • Purpose: To investigate the effect of smoking during radiotherapy (RT), respiratory insufficiency before RT, hemoglobin levels during RT, and additional factors on overall survival, locoregional control (LRC), and metastasis-free survival in non-small-cell lung cancer patients. Methods and Materials: The following factors were investigated in 181 patients who underwent RT for non-small-cell lung cancer: age, gender, Karnofsky performance score, histologic type, grade, T/N stage, American Joint Committee on Cancer stage, surgery, chemotherapy, respiratory insufficiency before RT, pack-years, smoking during RT, and hemoglobin levels during RT. Additionally, in the 129 patients who did not undergo surgery, the effect of the equivalent dosemore » in 2-Gy fractions (EQD2) (<60 Gy vs. 60 Gy vs. >60 Gy) on outcome was investigated. Results: On multivariate analysis, improved overall survival was associated with a lower T stage (p = 0.004), lower N stage (p 0.040), surgery (p = 0.010), and no respiratory insufficiency (p = 0.023). A Karnofsky performance score >70 achieved borderline significance (p = 0.056). Improved LRC was associated with a lower T stage (p = 0.007) and no smoking during RT (p = 0.029). Improved metastasis-free survival was associated with lower T stage (p < 0.001) and lower N stage (p < 0.001). In those patients who did not undergo surgery, an EQD2 of {>=}60 Gy was associated with a better outcome than an EQD2 of <60 Gy. Furthermore, an EQD2 >60 Gy resulted in better LRC than did an EQD2 of {<=}60 Gy. Conclusions: Smoking during RT had a significant effect on LRC, but we did not find that hemoglobin levels or respiratory insufficiency significantly affected LRC or metastasis-free survival in our patient population. Furthermore, our data suggest a dose-effect relationship in those patients who did not undergo surgery.« less
  • Purpose: To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy). Results: Themore » median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4% and 10.0%, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3%, 7.5%, and 19.4%, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.« less