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Prediction of cardiac events following concurrent chemoradiation therapy for non-small-cell lung cancer using FDG PET

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Abstract

Objective

No imaging biomarkers are available for the prediction of cardiac events following concurrent chemoradiation therapy (CCRT) for non-small-cell lung cancer (NSCLC). We evaluated whether F-18 fluorodeoxyglucose positron emission tomography (FDG PET) early after CCRT, in addition to cardiac dosimetry, could predict late cardiac events in NSCLC.

Methods

We retrospectively enrolled 133 consecutive patients with locally advanced, unresectable stage III NSCLC, who underwent FDG PET early after CCRT and survived at least 6 months. The primary endpoint was cardiac event ≥ grade 2 according to the Common Terminology Criteria for Adverse Events (version 5.0). Myocardial FDG uptake was measured and its association with the risk of cardiac events was evaluated.

Results

FDG PET was performed after a median interval of 11 days of completing CCRT. Overall, 42 (32%) patients experienced cardiac events during a median follow-up of 45 months. The mean heart dose, maximum left ventricular (LV) standardized uptake value (SUV), changes in maximum and mean LV SUV, right ventricular uptake, tumor stage, white blood cell count, and diabetes were associated with cardiac events in univariable analysis. In multivariable analysis, maximum LV SUV (cutoff > 12.84; hazard ratio [95% confidence interval] = 2.140 [1.140–4.016]; p = 0.018) was an independent predictor of cardiac events along with the mean heart dose (> 11.1 Gy; 3.646 [1.792–7.417]; p < 0.001) and tumor stage (IIIB; 1.986 [1.056–3.734]; p = 0.033). It remained predictive of cardiac events in those with higher mean heart dose but not in those with lower mean heart dose.

Conclusions

Early FDG PET after CCRT for NSCLC could aid in predicting late cardiac events, especially in patients with higher mean heart dose.

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Funding

This study was supported by a research fund from the National Research Foundation funded by the Ministry of Education, the Republic of Korea (NRF2016R1D1A3B01006631, PI: Hee-Seung Bom).

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Author notes

  1. Sang-Geon Cho and Yong-Hyub Kim have contributed equally to this manuscript as co-first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea

    Sang-Geon Cho, Ki Seong Park & Jahae Kim

  2. Department of Radiation Oncology, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-gun, Jeonnam, 58128, Republic of Korea

    Yong-Hyub Kim & Sung-Ja Ahn

  3. Department of Cardiololgy, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea

    Hyukjin Park

  4. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-gun, Jeonnam, 58128, Republic of Korea

    Hee-Seung Bom

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  1. Sang-Geon Cho
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Correspondence to Sung-Ja Ahn or Hee-Seung Bom.

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Sang-Geon Cho, Yong-Hyub Kim, Hyukjin Park, Ki Seong Park, Jahae Kim, and Sung-Ja Ahn declare no conflict of interest.

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Cho, SG., Kim, YH., Park, H. et al. Prediction of cardiac events following concurrent chemoradiation therapy for non-small-cell lung cancer using FDG PET. Ann Nucl Med 36, 439–449 (2022). https://doi.org/10.1007/s12149-022-01724-w

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  • DOI: https://doi.org/10.1007/s12149-022-01724-w

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