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High FDG uptake predicts poorer survival in locally advanced nonsmall cell lung cancer patients undergoing curative radiotherapy, independently of tumor size

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Abstract

Objectives

Despite radical radiotherapy and chemotherapy (CT), the prognosis of locally advanced nonsmall cell lung cancer (NSCLC) is poor. New prognostic indicators are being looked forward to improve the survival. [18F]-fluorodeoxyglucose (FDG) uptake on PET/CT has been observed as a prognostic marker mainly in early-stage disease. Our aim was to examine the prognostic value of FDG uptake in locally advanced NSCLC.

Materials and methods

Between 2009 and 2011, 103 NSCLC patients underwent disease staging using FDG PET/CT before conformal radiotherapy. Thoracic radiation was administered at a daily fraction of 2 Gy. Total dose was prescribed according to the tumor response against CT. All patients underwent CT. Survival was estimated using the Kaplan–Meier method.

Results

The median age of the patients was 59 years (range 39–83). The median follow-up time was 22.63 months (range 6–48.03 months). There was a statistically significant difference in overall survival (OS) between the low (<10.7) and high (≥10.7) standardized uptake value (SUVmax) groups (p = 0.006) on univariate analysis (3-year OS was 42 % in the low (<10.7) and 23 % in the high (≥10.7) SUVmax groups). On multivariate analysis with determining tumor size, tumor SUVmax provided additional significant prognostic information on OS (HR 1.046; 95 % CI 1.009–1.085, p = 0.015).

Conclusions

FDG uptake has predictive value in locally advanced NSCLC, independently of tumor size.

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References:

  • Ahuja V, Coleman RE, Herndon J et al (1998) The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 83(5):918–924

    Article  CAS  PubMed  Google Scholar 

  • Atkins CD (2005) Overestimation of the prognostic significance of SUV measurement by positron emission tomography for non-small-cell lung cancer. J Clin Oncol 23:6799–6800

    Article  PubMed  Google Scholar 

  • Brown JM, Giaccia AJ (1998) The unique physiology of solid tumors: opportunities (and problems) for cancer therapy. Cancer Res 58:1408–1416

    CAS  PubMed  Google Scholar 

  • Brundage MD, Davies D, Mackillop WJ (2002) Prognostic factors in non-small cell lung cancer—a decade of progress. Chest 122:1037–1057

    Article  PubMed  Google Scholar 

  • Cher LM, Murone C, Lawrentschuk N et al (2006) Correlation of hypoxic cell fraction and angiogenesis with glucose metabolic rate in gliomas using 18F-fluoromisonidazole, 18F FDG PET, and immunohistochemical studies. J Nucl Med 47(3):410–418

    CAS  PubMed  Google Scholar 

  • Cherk MH, Foo SS, Poon AM et al (2006) Lack of correlation of hypoxic cell fraction and angiogenesis with glucose metabolic rate in non-small cell lung cancer assessed by 18F-Fluoromisonidazole and 18F-FDG PET. J Nucl Med 47(12):1921–1926

    CAS  PubMed  Google Scholar 

  • Chung JK, Lee YJ, Kim SK et al (2004) Comparison of [18F]fluorodeoxyglucose uptake with glucose transporter-1 expression and proliferation rate in human glioma and non-small-cell lung cancer. Nucl Med Commun 25(1):11–17

    Article  CAS  PubMed  Google Scholar 

  • Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  CAS  PubMed  Google Scholar 

  • Dhital K, Saunders CA, Seed PT et al (2000) [F-18]fluorodeoxyglucose positron emission tomography and its prognostic value in lung cancer. Eur J Cardio-Thoracic Surg 18:425–428

    Article  CAS  Google Scholar 

  • Downey RJ, Akhurst T, Gonen M et al (2004) Preoperative F-18 fluorodeoxyglucose-positron emission tomography maximal standardized uptake value predicts survival after lung cancer resection. J Clin Oncol 22:3255–3260

    Article  PubMed  Google Scholar 

  • Erdi YE, Nehmeh SA, Pan T et al (2004) The CT motion quantitation of lung lesions and its impact on PET-measured SUVs. J Nucl Med 45(8):1287–1292

    PubMed  Google Scholar 

  • Eschmann SM, Friedel G, Paulsen F et al (2006) Is standardised F-18-FDG uptake value an outcome predictor in patients with stage III non-small cell lung cancer? Eur J Nucl Med Mol Imaging 33:263–269

    Article  CAS  PubMed  Google Scholar 

  • Geworski L, Knoop BO, de Cabrejas ML et al (2000) Recovery correction for quantitation in emission tomography: a feasibility study. Eur J Nucl Med 27:161–169

    Article  CAS  PubMed  Google Scholar 

  • Goldstraw P, Ball D, Jett JR et al (2011) Non-small-cell lung cancer. Lancet 378:1727–1740

    Article  PubMed  Google Scholar 

  • Graves EE, Maity A, Le QT (2010) The tumor microenvironment in non-small-cell lung cancer. Semin Radiat Oncol 20(3):156–163

    Article  PubMed Central  PubMed  Google Scholar 

  • Hickeson M, Yun M, Matthies A et al (2002) Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET. Eur J Nucl Med Mol Imaging 29:1639–1647

    Article  PubMed  Google Scholar 

  • Higashi K, Ueda Y, Sakurai A et al (2000) Correlation of Glut-1 glucose transporter expression with [F-18]FDG uptake in non-small cell lung cancer. Eur J Nucl Med 27:1778–1785

    Article  CAS  PubMed  Google Scholar 

  • Higashi T, Saga T, Nakamoto Y et al (2002) Relationship between retention index in dual-phase F-18-FDG PET, and hexokinase-II and glucose transporter-1 expression in pancreatic cancer. J Nucl Med 43:173–180

    CAS  PubMed  Google Scholar 

  • Ichiya Y, Kuwabara Y, Sasaki M et al (1996) A clinical evaluation of FDG-PET to assess the response in radiation therapy for bronchogenic carcinoma. Ann Nucl Med 10:193–200

    Article  CAS  PubMed  Google Scholar 

  • Ikushima H, Dong L, Erasmus J et al (2010) Predictive value of 18F-fluorodeoxyglucose uptake by positron emission tomography for non-small cell lung cancer patients treated with radical radiotherapy. J Radiat Res 51:465–471

    Article  PubMed  Google Scholar 

  • Kerhet A, Small C, Quon H et al (2010) Application of machine learning methodology for PET-based definition of lung cancer. Curr Oncol 17:41–47

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kubota K, Ishiwata K, Kubota R et al (1991) Tracer feasibility for monitoring tumor-radiotherapy—a quadruple tracer study with fluorine-18-fluorodeoxyglucose or fluorine-18-fluorodeoxyuridine, L-[methyl-C-14]methionine, [6-H-3]thymidine, and Ga-67. J Nucl Med 32:2118–2123

    CAS  PubMed  Google Scholar 

  • Le QT, Denko NC, Giaccia AJ (2004) Hypoxic gene expression and metastasis. Cancer Metastasis Rev 23:293–310

    Article  CAS  PubMed  Google Scholar 

  • Lee KH, Lee SH, Kim DW et al (2006) High fluorodeoxyglucose uptake on positron emission tomography in patients with advanced non-small cell lung cancer on platinum-based combination chemotherapy. Clin Cancer Res 12:4232–4236

    Article  CAS  PubMed  Google Scholar 

  • MacManus MP, Hicks RJ, Matthews JP et al (2003) Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 21:1285–1292

    Article  Google Scholar 

  • Mamede M, Higashi T, Kitaichi M et al (2005) [F-18]FDG uptake and PCNA, glut-1, and hexokinase-II expressions in cancers and inflammatory lesions of the lung. Neoplasia 7:369–379

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Minami K, Saito Y, Imamura H, Okamura A (2002) Prognostic significance of p53, Ki-67, VEGF and Glut-1 in resected stage I adenocarcinoma of the lung. Lung Cancer 38(1):1–7

    Article  Google Scholar 

  • Nguyen XC, Lee WW, Chung JH et al (2007) FDG uptake, glucose transporter type 1, and Ki-67 expressions in non-small-cell lung cancer: correlations and prognostic values. Eur J Radiol 62(2):214–219

    Article  PubMed  Google Scholar 

  • Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  • Partridge M, Ramos M, Sardaro A et al (2011) Dose escalation for non-small cell lung cancer: analysis and modelling of published literature. Radiother Oncol 99:6–11

    Article  PubMed  Google Scholar 

  • Pisani P, Parkin DM, Ferlay J (1993) Estimates of the worldwide mortality from eighteen major cancers in 1985. Implications for prevention and projections of future burden. Int J Cancer 55:891–903

    Article  CAS  PubMed  Google Scholar 

  • Ries LAG, Eisner MP, Kosary CL et al. (2002) SEER cancer statistics review, 1973–1999. National Cancer Institute, Bethesda, MD. [http://seer.cancer.gov/csr/1973_1999/. cited 14 Dec 2009

  • Rodríguez N, Sanz X, Trampal C et al (2010) 18FFDG PET definition of gross tumor volume for radiotherapy of lung cancer: is the tumor uptake value-based approach appropriate for lymph node delineation? Int J Radiat Oncol Biol Phys 78:659–666

    Article  PubMed  Google Scholar 

  • Vesselle H, Freeman JD, Wiens L et al (2007) Fluorodeoxyglucose uptake of primary non-small cell lung cancer at positron emission tomography: new contrary data on prognostic role. Clin Cancer Res 13:3255–3263

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Faculty of Medicine, Gazi University Hospital, Gazi University, 06500, Besevler, Ankara, Turkey

    Sukran Ulger & Eren Cetin

  2. Department of Chest Disease, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey

    Nilgun Yilmaz Demirci & Ulku Yilmaz

  3. Department of Radiation Oncology, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey

    Fatma Nazan Eroglu, Huriye Hulya Cengiz & Mustafa Tunc

  4. Department of Nuclear Medicine, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey

    Ebru Tatci

  5. Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey

    Emine Avci

  6. Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Mustafa Cengiz

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  1. Sukran Ulger
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  2. Nilgun Yilmaz Demirci
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  3. Fatma Nazan Eroglu
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Correspondence to Sukran Ulger.

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Ulger, S., Demirci, N.Y., Eroglu, F.N. et al. High FDG uptake predicts poorer survival in locally advanced nonsmall cell lung cancer patients undergoing curative radiotherapy, independently of tumor size. J Cancer Res Clin Oncol 140, 495–502 (2014). https://doi.org/10.1007/s00432-014-1591-9

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  • DOI: https://doi.org/10.1007/s00432-014-1591-9

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