Abstract
Purpose
Radiation pneumonitis is the most severe dose-limiting complication in patients receiving thoracic radiation therapy. The aim of this study was to quantify global lung inflammation following radiation therapy using FDG PET/CT.
Methods
We studied 20 subjects with stage III non-small-cell lung carcinoma who had undergone FDG PET/CT imaging before and after radiation therapy. On all PET/CT studies, the sectional lung volume (sLV) of each lung was calculated from each slice by multiplying the lung area by slice thickness. The sectional lung glycolysis (sLG) was calculated by multiplying the sLV and the lung sectional mean standardized uptake value (sSUVmean) on each slice passing through the lung. The lung volume (LV) was calculated by adding all sLVs from the lung, and the global lung glycolysis (GLG) was calculated by adding all sLGs from the lung. Finally, the lung SUVmean was calculated by dividing the GLG by the LV. The amount of inflammation in the lung parenchyma directly receiving radiation therapy was calculated by subtracting tumor measurements from GLG.
Results
In the lung directly receiving radiation therapy, the lung parenchyma SUVmean and global lung parenchymal glycolysis were significantly increased following therapy. In the contralateral lung (internal control), no significant changes were observed in lung SUVmean or GLG following radiation therapy.
Conclusion
Global lung parenchymal glycolysis and lung parenchymal SUVmean may serve as potentially useful biomarkers to quantify lung inflammation on FDG PET/CT following thoracic radiation therapy.
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References
Palma DA, Senan S, Tsujino K, Barriger RB, Rengan R, Moreno M, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2013;85(2):444–50. doi:10.1016/j.ijrobp.2012.04.043.
Echeverria AE, McCurdy M, Castillo R, Bernard V, Ramos NV, Buckley W, et al. Proton therapy radiation pneumonitis local dose–response in esophagus cancer patients. Radiother Oncol. 2013;106(1):124–9. doi:10.1016/j.radonc.2012.09.003.
Mac Manus MP, Ding Z, Hogg A, Herschtal A, Binns D, Ball DL, et al. Association between pulmonary uptake of fluorodeoxyglucose detected by positron emission tomography scanning after radiation therapy for non-small-cell lung cancer and radiation pneumonitis. Int J Radiat Oncol Biol Phys. 2011;80(5):1365–71. doi:10.1016/j.ijrobp.2010.04.021.
Zhang XJ, Sun JG, Sun J, Ming H, Wang XX, Wu L, et al. Prediction of radiation pneumonitis in lung cancer patients: a systematic review. J Cancer Res Clin Oncol. 2012;138(12):2103–16. doi:10.1007/s00432-012-1284-1.
Kocak Z, Evans ES, Zhou SM, Miller KL, Folz RJ, Shafman TD, et al. Challenges in defining radiation pneumonitis in patients with lung cancer. Int J Radiat Oncol Biol Phys. 2005;62(3):635–8. doi:10.1016/j.ijrobp.2004.12.023.
Yirmibesoglu E, Higginson DS, Fayda M, Rivera MP, Halle J, Rosenman J, et al. Challenges scoring radiation pneumonitis in patients irradiated for lung cancer. Lung Cancer. 2012;76(3):350–3. doi:10.1016/j.lungcan.2011.11.025.
Marks LB, Spencer DP, Bentel GC, Ray SK, Sherouse GW, Sontag MR, et al. The utility of SPECT lung perfusion scans in minimizing and assessing the physiologic consequences of thoracic irradiation. Int J Radiat Oncol Biol Phys. 1993;26(4):659–68.
Hicks RJ, Mac Manus MP, Matthews JP, Hogg A, Binns D, Rischin D, et al. Early FDG-PET imaging after radical radiotherapy for non-small-cell lung cancer: inflammatory changes in normal tissues correlate with tumor response and do not confound therapeutic response evaluation. Int J Radiat Oncol Biol Phys. 2004;60(2):412–8. doi:10.1016/j.ijrobp.2004.03.036.
McCurdy MR, Wazni MW, Martinez J, McAleer MF, Guerrero T. Exhaled nitric oxide predicts radiation pneumonitis in esophageal and lung cancer patients receiving thoracic radiation. Radiother Oncol. 2011;101(3):443–8. doi:10.1016/j.radonc.2011.08.035.
McCurdy MR, Castillo R, Martinez J, Al Hallack MN, Lichter J, Zouain N, et al. [18F]-FDG uptake dose–response correlates with radiation pneumonitis in lung cancer patients. Radiother Oncol. 2012;104(1):52–7.
De Ruysscher D, Dehing C, Yu S, Wanders R, Ollers M, Dingemans AM, et al. Dyspnea evolution after high-dose radiotherapy in patients with non-small cell lung cancer. Radiother Oncol. 2009;91(3):353–9. doi:10.1016/j.radonc.2008.10.006.
Hart JP, McCurdy MR, Ezhil M, Wei W, Khan M, Luo D, et al. Radiation pneumonitis: correlation of toxicity with pulmonary metabolic radiation response. Int J Radiat Oncol Biol Phys. 2008;71(4):967–71. doi:10.1016/j.ijrobp.2008.04.002.
Jadvar H, Alavi A, Gambhir SS. 18F-FDG uptake in lung, breast, and colon cancers: molecular biology correlates and disease characterization. J Nucl Med. 2009;50(11):1820–7. doi:10.2967/jnumed.108.054098.
Salavati A, Basu S, Heidari P, Alavi A. Impact of fluorodeoxyglucose PET on the management of esophageal cancer. Nucl Med Commun. 2009;30(2):95–116. doi:10.1097/MNM.0b013e32831af204.
Tchou J, Sonnad SS, Bergey MR, Basu S, Tomaszewski J, Alavi A, et al. Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer. Mol Imaging Biol. 2010;12(6):657–62. doi:10.1007/s11307-009-0294-0.
De Ruysscher D, Nestle U, Jeraj R, Macmanus M. PET scans in radiotherapy planning of lung cancer. Lung Cancer. 2012;75(2):141–5. doi:10.1016/j.lungcan.2011.07.018.
Muijs CT, Schreurs LM, Busz DM, Beukema JC, van der Borden AJ, Pruim J, et al. Consequences of additional use of PET information for target volume delineation and radiotherapy dose distribution for esophageal cancer. Radiother Oncol. 2009;93(3):447–53. doi:10.1016/j.radonc.2009.08.030.
MacManus M, Nestle U, Rosenzweig KE, Carrio I, Messa C, Belohlavek O, et al. Use of PET and PET/CT for radiation therapy planning: IAEA expert report 2006–2007. Radiother Oncol. 2009;91(1):85–94. doi:10.1016/j.radonc.2008.11.008.
Basu S, Zhuang H, Torigian DA, Rosenbaum J, Chen W, Alavi A. Functional imaging of inflammatory diseases using nuclear medicine techniques. Semin Nucl Med. 2009;39(2):124–45. doi:10.1053/j.semnuclmed.2008.10.006.
McCurdy M, McAleer MF, Wei W, Ezhil M, Johnson V, Khan M, et al. Induction and concurrent taxanes enhance both the pulmonary metabolic radiation response and the radiation pneumonitis response in patients with esophagus cancer. Int J Radiat Oncol Biol Phys. 2010;76(3):816–23. doi:10.1016/j.ijrobp.2009.02.059.
Kanzaki R, Higashiyama M, Maeda J, Okami J, Hosoki T, Hasegawa Y, et al. Clinical value of F18-fluorodeoxyglucose positron emission tomography-computed tomography in patients with non-small cell lung cancer after potentially curative surgery: experience with 241 patients. Interact Cardiovasc Thorac Surg. 2010;10(6):1009–14. doi:10.1510/icvts.2009.227538.
Teo BK, Abelson J, Teo A, Graves EE, Guerrero T, et al. Time interval to FDG PET/CT after mediastinal radiation impacts the dose response of pneumonitis related metabolic activity. Int J Radiat Oncol Biol Phys. 2008;72(1):S67–S8. doi:10.1016/j.ijrobp.2008.06.919.
Hofheinz F, Langner J, Petr J, Beuthien-Baumann B, Oehme L, Steinbach J, et al. A method for model-free partial volume correction in oncological PET. EJNMMI Res. 2012;2(1):16. doi:10.1186/2191-219X-2-16.
Hofheinz F, Dittrich S, Potzsch C, Hoff J. Effects of cold sphere walls in PET phantom measurements on the volume reproducing threshold. Phys Med Biol. 2010;55(4):1099–113. doi:10.1088/0031-9155/55/4/013.
Hofheinz F, Potzsch C, Oehme L, Beuthien-Baumann B, Steinbach J, Kotzerke J, et al. Automatic volume delineation in oncological PET. Evaluation of a dedicated software tool and comparison with manual delineation in clinical data sets. Nuklearmedizin. 2012;51(1):9–16. doi:10.3413/Nukmed-0419-11-07.
Schaefer A, Kim YJ, Kremp S, Mai S, Fleckenstein J, Bohnenberger H, et al. PET-based delineation of tumour volumes in lung cancer: comparison with pathological findings. Eur J Nucl Med Mol Imaging. 2013;40(8):1233–44. doi:10.1007/s00259-013-2407-x.
Schaefer A, Kremp S, Hellwig D, Rube C, Kirsch CM, Nestle U. A contrast-oriented algorithm for FDG-PET-based delineation of tumour volumes for the radiotherapy of lung cancer: derivation from phantom measurements and validation in patient data. Eur J Nucl Med Mol Imaging. 2008;35(11):1989–99. doi:10.1007/s00259-008-0875-1.
Torigian DA, Lopez RF, Alapati S, Bodapati G, Hofheinz F, van den Hoff J, et al. Feasibility and performance of novel software to quantify metabolically active volumes and 3D partial volume corrected SUV and metabolic volumetric products of spinal bone marrow metastases on 18F-FDG-PET/CT. Hell J Nucl Med. 2011;14(1):8–14.
Musiek ES, Saboury B, Mishra S, Chen Y, Reddin JS, Newberg AB, et al. Feasibility of estimation of brain volume and 2-deoxy-2-(18)F-fluoro-D-glucose metabolism using a novel automated image analysis method: application in Alzheimer’s disease. Hell J Nucl Med. 2012;15(3):190–6. doi:10.1967/s002449910052.
Kwee TC, Torigian DA, Alavi A. Nononcological applications of positron emission tomography for evaluation of the thorax. J Thorac Imaging. 2013;28(1):25–39. doi:10.1097/RTI.0b013e31827882a9.
Subramanian DR, Jenkins L, Edgar R, Quraishi N, Stockley RA, Parr DG. Assessment of pulmonary neutrophilic inflammation in emphysema by quantitative positron emission tomography. Am J Respir Crit Care Med. 2012;186(11):1125–32. doi:10.1164/rccm.201201-0051OC.
Torigian DA, Dam V, Chen X, Saboury B, Udupa JK, Rashid A, et al. In vivo quantification of pulmonary inflammation in relation to emphysema severity via partial volume corrected (18)F-FDG-PET using computer-assisted analysis of diagnostic chest CT. Hell J Nucl Med. 2013;16(1):12–8. doi:10.1967/s0024499100066.
Basu S, Zaidi H, Houseni M, Bural G, Udupa J, Acton P, et al. Novel quantitative techniques for assessing regional and global function and structure based on modern imaging modalities: implications for normal variation, aging and diseased states. Semin Nucl Med. 2007;37(3):223–39. doi:10.1053/j.semnuclmed.2007.01.005.
Basu S, Alavi A. Partial volume correction of standardized uptake values and the dual time point in FDG-PET imaging: should these be routinely employed in assessing patients with cancer? Eur J Nucl Med Mol Imaging. 2007;34(10):1527–9. doi:10.1007/s00259-007-0467-5.
Bural G, Torigian DA, Houseni M, Basu S, Srinivas S, Alavi A. Tumor metabolism measured by partial volume corrected standardized uptake value varies considerably in primary and metastatic sites in patients with lung cancer. A new observation. Hell J Nucl Med. 2009;12(3):218–22.
Petit SF, van Elmpt WJ, Oberije CJ, Vegt E, Dingemans AM, Lambin P, et al. [18F]fluorodeoxyglucose uptake patterns in lung before radiotherapy identify areas more susceptible to radiation-induced lung toxicity in non-small-cell lung cancer patients. Int J Radiat Oncol Biol Phys. 2011;81(3):698–705. doi:10.1016/j.ijrobp.2010.06.016.
Kong FM, Frey KA, Quint LE, Ten Haken RK, Hayman JA, Kessler M, et al. A pilot study of [18F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non small-cell lung cancer. J Clin Oncol. 2007;25(21):3116–23. doi:10.1200/JCO.2006.10.3747.
De Ruysscher D, Houben A, Aerts HJ, Dehing C, Wanders R, Ollers M, et al. Increased (18)F-deoxyglucose uptake in the lung during the first weeks of radiotherapy is correlated with subsequent Radiation-Induced Lung Toxicity (RILT): a prospective pilot study. Radiother Oncol. 2009;91(3):415–20. doi:10.1016/j.radonc.2009.01.004.
Guerrero T, Johnson V, Hart J, Pan T, Khan M, Luo D, et al. Radiation pneumonitis: local dose versus [18F]-fluorodeoxyglucose uptake response in irradiated lung. Int J Radiat Oncol Biol Phys. 2007;68(4):1030–5. doi:10.1016/j.ijrobp.2007.01.031.
Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48(6):932–45. doi:10.2967/jnumed.106.035774.
Erlandsson K, Buvat I, Pretorius PH, Thomas BA, Hutton BF. A review of partial volume correction techniques for emission tomography and their applications in neurology, cardiology and oncology. Phys Med Biol. 2012;57(21):R119–59. doi:10.1088/0031-9155/57/21/R119.
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Sarah Abdulla, Ali Salavati, and Babak Saboury contributed equally to this study.
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Abdulla, S., Salavati, A., Saboury, B. et al. Quantitative assessment of global lung inflammation following radiation therapy using FDG PET/CT: a pilot study. Eur J Nucl Med Mol Imaging 41, 350–356 (2014). https://doi.org/10.1007/s00259-013-2579-4
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DOI: https://doi.org/10.1007/s00259-013-2579-4