Mapping Bone Marrow Response in the Vertebral Column by Positron Emission Tomography Following Radiotherapy and Erlotinib Therapy of Lung Cancer
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To map functional bone marrow (BM) by 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) positron emission tomography (PET) in the vertebral column of lung cancer patients prior to, during, and after treatment. Moreover, to identify radiation- and erlotinib-induced changes in the BM.
Twenty-six patients with advanced non-small cell lung cancer, receiving radiotherapy (RT) alone or concomitantly with erlotinib, were examined by [18F]FDG PET before, during, and after treatment. A total of 61 [18F]FDG PET scans were analyzed. Vertebral column BM [18F]FDG standardized uptake value normalized to the liver (SUVBMLR) was used as uptake measure. Wilcoxon signed-rank test was used to assess changes in BM uptake of [18F]FDG between sessions. Effects of erlotinib on the BM activity during and after treatment were assessed using Mann-Whitney U test.
A homogeneous uptake of [18F]FDG was observed within the vertebral column prior to treatment. Mean SUVBMLR (± S.E.M) in the body of thoracic vertebrae receiving a total RT dose of 10 Gy or higher was 0.64 ± 0.01, 0.56 ± 0.01, and 0.59 ± 0.01 at pre-, mid-, and post-therapy, respectively. A significant reduction in the mean SUVBMLR was observed from pre- to both mid- and post-therapy (p < 0.05). Mean SUVBMLR was significantly higher at post-therapy compared to mid-therapy for patients receiving erlotinib in addition to RT (p < 0.05).
RT reduces BM [18F]FDG uptake in the vertebral column, especially in the high-dose region. Concomitant erlotinib may stimulate a recovery in BM [18F]FDG uptake from mid- to post-therapy.
Trial registration: NCT02714530. Registered 10 September 2015.
KeywordsFDG-PET Thoracic radiotherapy Bone marrow Vertebral column NSCLC Erlotinib
We gratefully thank Ingerid Skjei Knudtsen, University of Oslo, Norway for her assistance in setting up the PET/CT protocol and data collection. This study was partly funded by the faculty of Mathematics and Natural Sciences, University of Oslo, Norway and was supported by the Norwegian Cancer Society and The regional health authorities in South East Norway.
Compliance with Ethical Standards
The study was approved by the Regional Committee for Medical and Health Research Ethics. A written informed consent was received from all patients.
Conflict of Interest
The authors declare that they have no conflict of interest.
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