Abstract
The clinical usefulness of FDG-PET in the prediction and assessment of response to radiation therapy in patients with bronchogenic carcinoma was evaluated. Thirty patients with untreated bronchogenic carcinoma were included in the study. All patients received FDG-PET before the initiation of radiation therapy, while 20 also received it after completing the therapy. The tumor to muscle ratio (TMR) was used as an index of the FDG uptake. The tumor response to therapy was classified as either a partial response (PR, n = 21) or no change (NC, n = 9) according to changes in the tumor size. Prognosis was made 6 months after the initiation of therapy, and was classified as either relapse (n = 19) or non-relapse (n = 9). The FDG uptakes both before and after therapy were compared with tumor response and prognosis. A high FDG uptake was noted in all 30 lesions before therapy. No significant differences in the uptake before therapy was observed according to the histological types nor T factors (UICC). The lesions with a higher uptake (TMR more than 7) responded better to therapy than those with a lower uptake (p < 0.05). The decrease in the uptake after therapy tended to be more prominent in the PR group than in the NC group. The rate of relapse was higher in lesions with a higher uptake before therapy (TMR more than 10) than in those with a lower uptake. The relapse group also showed a higher uptake after therapy than the non-relapse group. In addition, all 6 lesions showing a higher uptake (TMR more than 5) after therapy eventually relapsed (p < 0.05). Two lesions demonstrating a lower uptake both before and after therapy did not relapse, although no tumor regression due to the therapy was observed. These results indicate that FDG-PET plays a complementary role in both predicting and assessing the therapeutic response and prognosis in patients with bronchogenic carcinoma.
Similar content being viewed by others
References
Emami B, Perez CA. Lung.In Principals and Practice of Radiation Oncology, Perez CA, Brady LW (eds.), 2nd ed., Philadelphia, pp. 806–836, 1992.
Cox JD, Azamia N, Byhardt RW, Shin KH, Emoni B, Pajak TF. A randomized phase I/II trial of hyperfractionated radiation therapy with total doses of 60.0 Gy to 79.2 Gy: Possible survival benefit with > 69.6 Gy in favorable patients with radiation therapy oncology group stage III non-small cell lung carcinoma: Report of radiation therapy oncology group 83-11.J Clin Oncol 8: 1543–1555, 1990.
Kubota K, Matsuzawa T, Fujiwara T, Ito M, Hatazawa J, Ishiwata K, et al. Differential diagnosis of lung tumor with positron emission tomography: A prospective study.J Nucl Med 31: 1927–1933, 1990.
Gupta NC, Frank AR, Dewan NA, Redepenning LS, Rothberg ML, Mailliard JA, et al. Solitary pulmonary nodules: Detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-D-glucose.Radiology 184: 441–444, 1992.
Patz EF Jr, Lowe VL, Hoffman JM, Paine SS, Burrowes S, Coleman RE, et al. Focal pulmonary abnormalities: Evaluation with F-l8 fluorodeoxyglucose PET scanning.Radiology 188: 487–490, 1993.
Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP. Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules.Chest 104: 997–1002, 1993.
Patz EF Jr, Lowe VL, Hoffman JM, Paine SS, Harris LK, Goodman PC. Persistent or recurrent bronchogenic carcinoma: Detection with PET and 2-[F-18]-2-deoxy-D-glucose.Radiology 191: 379–382, 1994.
Lowe VL, Hoffman JM, DeLong DM, Patz EF, Coleman RE. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities.J Nucl Med 35: 1771–1776, 1994.
Strauss LG, Conti PS. The application of PET in clinical oncology.J Nucl Med 32: 623–648, 1991.
Rege SD, Hoh CK, Glaspy JA, Aberle DR, Dahbom M, Razavi ML, et al. Imaging of pulmonary mass lesions with whole body positron emission tomography and Fluorodeoxy-glucose.Cancer 72: 82–90, 1993.
Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: Preliminary prospective evaluation.Radiology 191: 371–377, 1994.
Iosilevsly GI, Front D, Bettman L, Hardoff R, Ben-Arieh Y. Uptake of Gallium-67 citrate and 2-[H-3]deoxyglucose in the tumor model, following chemotherapy and radiotherapy.J Nucl Med 26: 278–282, 1985.
Abe Y, Matsuzawa T, Fujiwara T, Fukuda H, Itoh M, Yamada K, et al. Assessment of radiotherapeutic effects on experimental tumors using18F-2-fluoro-2-deoxy-D-glucose.EurJ Nucl Med 12: 325–328, 1986.
Abe Y, Matsuzawa T, Fujiwara T, Itoh M, Fukuda H, Yamaguchi K, et al. Clinical assessment of therapeutic effects on cancer using18F-2-fluoro-2-deoxy-D-glucose and positron emission tomography: Preliminary study of lung cancer.Int J Radiation Oncology Biol Phys 19: 1005-y1010, 1990.
Di Chiro G. Positron emission tomography using [F-18] fluorodeoxyglucose in brain tumors. A powerful diagnostic and prognostic tool.Investigative Radiology 22: 360–371, 1987.
Alavi JB, Alavi A, Chawluk J, Kushner M, Powe J, Hickey W, et al. Positron emission tomography in patients with glioma. A predictor of prognosis.Cancer 62: 1074–1078, 1988.
Di Chiro G, Hatazawa J, Katz DA, Rizzoli HR, De Michele JD. Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: A PET study.Radiology 164: 521–526, 1987.
Minn H, Paul R, Ahonen A. Evaluation of treatment response to radiotherapy in head and neck cancer with Fluorine-18 fluorodeoxyglucose.J Nucl Med 29: 1521–1525, 1988.
Haberkorn U, Strauss LG, Dimitrakopoulou A, Seiffeit E, Oberdorfer F, Ziegler S, et al. Fluorodeoxyglucose imaging of advanced head and neck cancer after chemotherapy.J Nucl Med 34: 12–17, 1993.
Chaiken L, Rege S, Hoh C, Choi Y, Jabour B, Juillard G, et al. Positron emission tomography with fluorodeoxyglucose to evaluate tumor response and control after radiotherapy.Int J Radiation Oncology Biol Phys 27: 455–64, 1993.
Greven KM, Williams DW III, Keyes JW Jr, McGuirt WF, Harkness BA, Watson NE Jr, et al. Distinguishing tumor recurrence from irradiation sequelae with positron emission tomography in patients with treated for larynx cancer.Int J Radiation Oncology Biol Phys 29: 841–845, 1994.
Minn H, Soimi I. [F-18]fluorodeoxyglucose scintigraphy in diagnosis and follow up of treatment in advanced breast cancer.Eur J Nucl Med 15: 61–66, 1989.
Nagata Y, Yamamoto K, Hiraoka M, Abe A, Takahashi M, Akuta K, et al. Monitoring liver tumor therapy with [F-18] FDG positron emission tomography.J Comp Assist Tomogr 14: 370–374, 1990.
Okazumi S, Isono K, Enomoto K, Kikuchi T, Ozaki M, Yamamoto H, et al. Evaluation of liver tumors using Fluorine-18-fluorodeoxyglucose PET: Characterization of tumor and assessment of effect of treatment.J Nucl Med 33: 333–339, 1992.
Torizuka T, Tamaki N, Inokuma T, Magata Y, Yonekura Y, Tanaka A, et al. Value of Fluorine-18-FDG-PET to monitor hepatocellular carcinoma after interventional therapy.J Nucl Med 35: 1965–1969, 1994.
Haberkorn U, Strauss LG, Dimitrakopoulou A, Engelhart R, Oberdorfer F, Ostertag H, et al. PET studies of fluorode-oxyglucose metabolism in patients with recurrent colorectal tumors receiving radiotherapy.J Nucl Med 32: 1485–1490, 1991.
Okada J, Yoshikawa K, Imazeki K, Minoshima S, Uno K, Itami J, et al. The use of FDG-PET in the detection and management of malignant lymphoma: Correlation of uptake with prognosis.J Nucl Med 32: 686–691, 1991.
Ichiya Y, Kuwabara Y, Otsuka M, Tahara T, Yoshikai T, Fukumura T, et al. Assessment of response to cancer therapy using Fluorine-18-fluorodeoxyglucose and positron emission tomography.J Nucl Med 32: 1655–1660, 1991.
Nolop KB, Rhodes CG, Brudin LH, Beaney RP, Krausz T, Jones T, et al. Glucose utilizationin vivo by human pulmonary neoplasms.Cancer 60: 2682–2689, 1987.
Minn H, Joensuu H, Ahonen A, Klemi P. Fluorodeoxy- glucose imaging: A method to assess the proliferative activity of human cancerin vivo.Cancer 61: 1776–1781, 1988.
Haberkorn U, Strauss LG, Reisser Ch, Haag D, Dimitrakopoulou A, Ziegler S, et al. Glucose uptake, perfusion, and cell proliferation in head and neck tumors: Relation of positron emission tomography to flow cytometry.J Nucl Med 32: 1548–1555, 1991.
Minn H, Clavo AC, Grenman R, Wahl RL.In vitro compari- son of cell proliferation kinetics and uptake of tritiated fluorodeoxyglucose and L-methionine in squamous-cell carcinoma of the head and neck.J Nucl Med 36: 252–258, 1995.
Okada J, Yoshikawa K, Itami M, Imaseki K, Uno K, Itami J, et al. Positron emission tomography using Fluorine-18-fluorodeoxyglucose in malignant lymphoma: A comparison with proliferative activity.J Nucl Med 33: 325–329, 1992.
Tahara T, Ichiya Y, Kuwabara Y, Otsuka M, Miyake Y, Gunasekera RD, et al. High [F-18]-fluorodeoxy-glucose uptake in abdominal abscesses: A PET study.J Comp Assist Tomogr 13: 829–831, 1989.
Strauss LG, Clourius JH, Schlag P, Lehner B, Kimmig B, Engenhart R, et al. Recurrence of colorectal tumors: PET evaluation.Radiology 170: 329–332, 1989.
Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T, et al. Intratumoral distribution of Fluorine-18-fluoro- deoxyglucosein vivo: High accumulation in macrophages and granulation tissues studies by microautoradiography.J Nucl Med 33: 1972–1980, 1992.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ichiya, Y., Kuwabara, Y., Sasaki, M. et al. A clinical evaluation of FDG-PET to assess the response in radiation therapy for bronchogenic carcinoma. Ann Nucl Med 10, 193–200 (1996). https://doi.org/10.1007/BF03165392
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03165392