Chemotherapy Response Evaluation with ¹⁸F-FDG PET in Patients with Non-Small Cell Lung Cancer

¹ Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
² Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
³ Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
⁴ Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
⁵ Department of Medical Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

^* To whom correspondence should be addressed. E-mail: L.degeus-oei{at}nucmed.umcn.nl.

	Abstract

The aim of this prospective study was to evaluate the value of ¹⁸F-FDG PET for the assessment of chemotherapy response in patients with non–small cell lung cancer. Furthermore, part of the objective of this study was to compare 2 methods to quantify changes in glucose metabolism. Methods: In 51 patients, dynamic ¹⁸F-FDG PET was performed before and at 5–8 wk into treatment. Simplified methods to measure glucose metabolism (standardized uptake value [SUV]) and quantitative measures (metabolic rate of glucose [MR_Glu]), derived from Patlak analysis, were evaluated. The overall survival and progression-free survival with respect to MR_Glu and SUV were calculated using Kaplan–Meier estimates. Fractional changes in tumor glucose use were stratified by the median value and also the predefined EORTC (European Organization for Research and Treatment of Cancer) metabolic response criteria, and criteria applying cutoff levels similar to those of RECIST (Response Evaluation Criteria in Solid Tumors) were evaluated. Results: When stratifying at the median value of MR_Glu and SUV, the difference in overall survival (P = 0.017 for MR_Glu, P = 0.018 for SUV) and progression-free survival (P = 0.002 for MR_Glu, P = 0.0009 for SUV) was highly significant. When applying the predefined criteria for metabolic response, the cutoff levels as also used for size measurement (RECIST) showed significant differences for SUV between response categories in progression-free survival (P = 0.0003) as well as overall survival (P = 0.027). Conclusion: The degree of chemotherapy-induced changes in tumor glucose metabolism as determined by ¹⁸F-FDG PET is highly predictive for patient outcome, stratifying patients into groups with widely differing overall survival and progression-free survival probabilities. The use of ¹⁸F-FDG PET for therapy monitoring seems clinically feasible, because simplified methods to measure tumor glucose use (SUV) are sufficiently reliable and can replace more complex, quantitative measures (MR_Glu) in this patient population.

Key Words: chemotherapy response monitoring, ¹⁸F-FDG PET, non–small cell lung cancer, standardized uptake value, Patlak analysis

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