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OtherClinical Investigations (Human)

18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial

Tine Noehr Christensen, Seppo W Langer, Gitte F Persson, Klaus Richter Larsen, Annika Loft, Annemarie Gjelstrup Amtoft, Anne Kiil Berthelsen, Helle Hjorth Johannesen, Sune Hoegild Keller, Andreas Kjaer and Barbara Malene Fischer
Journal of Nuclear Medicine October 2020, jnumed.120.247742; DOI: https://doi.org/10.2967/jnumed.120.247742
Tine Noehr Christensen
1 Dept. of Clinical Physiology, Nuclear Medicine PET, Copenhagen University Hospital, Rigshospitalet, Denmark;
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Seppo W Langer
2 Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark;
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Gitte F Persson
3 Dept. of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark;
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Klaus Richter Larsen
4 Dept. of Pulmonary Medicine, Bispebjerg University Hospital, Denmark;
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Annika Loft
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Annemarie Gjelstrup Amtoft
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Anne Kiil Berthelsen
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Helle Hjorth Johannesen
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Sune Hoegild Keller
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Andreas Kjaer
5 Dept. of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet;
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Barbara Malene Fischer
6 The PET Centre, School of Biomedical Engineering and Imaging Science, King's College London, United Kingdom
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Abstract

Diagnosing relapse after radiotherapy for lung cancer is challenging. The specificity of both CT and 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-PET/CT is low due to radiation-induced changes. 3’-deoxy-3’-[18F]fluorothymidine (FLT)-PET has previously demonstrated higher specificity for malignancy than FDG-PET. We investigated the value of FLT-PET/CT for diagnosing relapse in irradiated lung cancer. Methods: Patients suspected for relapse of lung cancer after definitive radiotherapy (conventional fractionated radiotherapy (cRT) or stereotactic radiotherapy (SBRT)) were included. Sensitivity and specificity were analysed within the irradiated high-dose volume (HDV) and patient-based. Marginal differences and inter-observer agreement were assessed. Results: Sixty-three patients who had received radiotherapy in 70 HDVs (34 cRT; 36 SBRT) were included. The specificity of FLT-PET/CT was higher than FDG-PET/CT (HDV: 96% [87-100] vs. 71% [57-83]; P = 0.0039; patient-based (90 % [73-98] vs. 55% [36-74]; P = 0.0020)). The difference between specificity of FLT-PET/CT and FDG-PET/CT was higher after cRT compared with SBRT. Sensitivity of FLT-PET/CT was lower than FDG-PET/CT (HDV: 69% [41-89] vs. 94% [70-100]; P = 0.1250; patient-based: 70% [51-84] vs. 94% [80-99]; P = 0.0078). Adding FLT-PET/CT when FDG-PET/CT was positive or inconclusive improved diagnostic value compared with FDG-PET/CT only. In cRT-HDVs, the probability of malignancy increased from 67% for FDG-PET/CT alone to 100% when both PETs were positive. Conclusion: FLT-PET/CT adds diagnostic value to FDG-PET/CT in patients with suspected relapse. The diagnostic impact of FLT-PET/CT was highest after cRT. We suggest adding FLT-PET/CT when FDG-PET/CT is inconclusive or positive within the previously irradiated volume to improve diagnostic value in patients where histological confirmation is not easily obtained.

  • Molecular Imaging
  • Oncology: Lung
  • PET
  • FDG-PET/CT
  • FLT-PET/CT
  • Lung cancer
  • Radiotherapy
  • Relapse
  • Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (2)
Journal of Nuclear Medicine
Vol. 62, Issue 2
February 1, 2021
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18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial
Tine Noehr Christensen, Seppo W Langer, Gitte F Persson, Klaus Richter Larsen, Annika Loft, Annemarie Gjelstrup Amtoft, Anne Kiil Berthelsen, Helle Hjorth Johannesen, Sune Hoegild Keller, Andreas Kjaer, Barbara Malene Fischer
Journal of Nuclear Medicine Oct 2020, jnumed.120.247742; DOI: 10.2967/jnumed.120.247742

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18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial
Tine Noehr Christensen, Seppo W Langer, Gitte F Persson, Klaus Richter Larsen, Annika Loft, Annemarie Gjelstrup Amtoft, Anne Kiil Berthelsen, Helle Hjorth Johannesen, Sune Hoegild Keller, Andreas Kjaer, Barbara Malene Fischer
Journal of Nuclear Medicine Oct 2020, jnumed.120.247742; DOI: 10.2967/jnumed.120.247742
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Keywords

  • molecular imaging
  • Oncology: Lung
  • PET
  • FDG-PET/CT
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  • lung cancer
  • radiotherapy
  • relapse
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