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Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment

  • Oncology
  • Published:
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Abstract

Objectives

To investigate the relationship of dual-phase dual-energy CT (DE-CT) and tumour size in the evaluation of the response to anti-EGFR therapy in patients with advanced non-small cell lung cancer (NSCLC).

Methods

Dual-phase DE-CT was performed in 31 patients with NSCLC before the onset of anti-EGFR (erlotinib) therapy and as follow-up (mean 8 weeks). Iodine uptake (IU; mg/mL) was quantified using prototype software in arterial and venous phases; arterial enhancement fraction (AEF) was calculated. The change of IU before and after therapy onset was compared with anatomical evaluation in maximal transverse diameter and volume (responders vs. non-responders).

Results

A significant decrease of IU in venous phase was proved in responders according to all anatomical parameters (p=0.002–0.016). In groups of non-responders, a significant change of IU was not proved with variable trends of development. The most significant change was observed using the anatomical parameter of volume (cut-off 73 %). A significant difference of percentage change in AEF was proved between responding and non-responders (p=0.019–0.043).

Conclusion

Dual-phase DE-CT with iodine uptake quantification is a feasible method with potential benefit in advanced assessment of anti-EGFR therapy response. We demonstrated a decrease in vascularization in the responding primary tumours and non-significant variable development of vascularization in non-responding tumours.

Key Points

• Dual-phase DE-CT is feasible for vascularization assessment of NSCLC with anti-EGFR therapy.

• There was a significant decrease of iodine uptake in responding tumours.

• There was a non-significant and variable development in non-responding tumours.

• There was significant difference of AEF percentage change between responders and non-responders.

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Acknowledgments

The scientific guarantor of this publication is univ. prof. Jiří Ferda, Ph.D. The authors of this manuscript declare relationships with the following companies: T. Flohr, B. Schmidt and M.Sedlmair are employees of Siemens HealthCare, Germany. This research was supported by the Charles University Research Fund (project number P36) and by the Ministry of Health, Czech Republic – the project of conceptual development of research organization (Faculty Hospital in Pilsen – FNPl, 00669806). One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No subjects or cohorts have been previously reported. Methodology: prospective, diagnostic and prognostic, performed at one institution.

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Authors and Affiliations

  1. Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Pilsen, Czech Republic

    Jan Baxa, Tana Matouskova, Jiri Bejcek & Jiri Ferda

  2. Department of Pulmonary Diseases, Faculty of Medicine and University Teaching Hospital in Pilsen, Pilsen, Czech Republic

    Gabriela Krakorova

  3. Siemens Healthcare, CT division, Forchheim, Germany

    Bernhard Schmidt, Thomas Flohr & Martin Sedlmair

Authors
  1. Jan Baxa
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  2. Tana Matouskova
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  3. Gabriela Krakorova
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  4. Bernhard Schmidt
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  5. Thomas Flohr
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  6. Martin Sedlmair
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  7. Jiri Bejcek
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  8. Jiri Ferda
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Correspondence to Jan Baxa.

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Baxa, J., Matouskova, T., Krakorova, G. et al. Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment. Eur Radiol 26, 2828–2836 (2016). https://doi.org/10.1007/s00330-015-4092-6

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  • DOI: https://doi.org/10.1007/s00330-015-4092-6

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