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Time Course of Early Response to Chemotherapy in Non–Small Cell Lung Cancer Patients with ¹⁸F-FDG PET/CT

¹ Departments of Medicine and Radiology, University of Tennessee, Knoxville, Tennessee; and ² Department of Applied Mathematics, University of Western Ontario, London, Ontario, Canada

Correspondence: For correspondence or reprints contact: Claude Nahmias, PhD, Molecular Imaging and Tracer Development Program, Graduate School of Medicine, University of Tennessee, 1924 Alcoa Hwy., Box 93, Knoxville, TN 37920-6999. E-mail: CNahmias{at}mc.utmck.edu

PET and ¹⁸F-FDG have the potential to follow the early metabolic response to chemotherapy in patients with non–small cell lung cancer and to predict success or failure of the therapy. Methods: We studied 16 patients with non–small cell lung cancer as they followed 2 courses of docetaxel and carboplatin. Each patient was studied weekly for 7 wk, and tissue activity was assessed by the amount of radioactivity retained 90 min after the intravenous injection of ¹⁸F-FDG. In a prospective analysis, the linear least-squares method was used to evaluate the time course of metabolic activity in tumor and liver, bone marrow, and unaffected lung tissues; a metabolic response was defined as a response in which the slope of the regression was negative and significantly different from zero. Our hypothesis was that patients who exhibited a tumor metabolic response would survive longer than those who did not. In a retrospective examination of our data, we grouped our patients into those who survived <6 mo and those who survived longer and calculated the difference in the standardized uptake value (SUV) between day 7 and subsequent time points to determine the most appropriate timing of 2 PET studies in predicting response to therapy. Results: Fifteen of 16 patients completed the study. In the prospective study, 8 patients were classified as nonresponders as the slope of the regression of tumor SUV versus time was not different from zero; they all died within 35 wk of the end of their study. Seven patients were classified as responders; 5 survived and 2 died, one at 25 wk and the other at 76 wk. In the retrospective study, a decrease of 0.5 SUV between studies performed at 1 and 3 wk after the initiation of chemotherapy was predictive of those patients who survived >6 mo and in whom chemotherapy was presumably successful. Conclusion: Patients with non–small cell lung cancer who had a positive outcome, as exhibited by prolonged survival, were those who showed a tumor metabolic response assessed using weekly ¹⁸F-FDG PET studies. ¹⁸F-FDG PET studies performed at 1 and 3 wk after the initiation of chemotherapy allowed prediction of the response to therapy.

Key Words: ¹⁸F-FDG • PET • non–small cell lung cancer • treatment monitoring

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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