Increased 18F-deoxyglucose uptake in the lung during the first weeks of radiotherapy is correlated with subsequent Radiation-Induced Lung Toxicity (RILT): A prospective pilot study

doi:10.1016/j.radonc.2009.01.004

Radiotherapy and Oncology

Volume 91, Issue 3, June 2009, Pages 415-420

https://doi.org/10.1016/j.radonc.2009.01.004 Get rights and content

Abstract

Purpose

As Radiation-Induced Lung Toxicity (RILT) is dose-limiting for radiotherapy (RT) of lung cancer and current parameters are only moderately associated with RILT, we sought for novel parameters associated with RILT.

Patients and methods

In this prospective study, FDG-PET-CT scans were taken on days 0, 7 and 14 after initiation of high-dose RT in 18 patients with stage III non-small cell lung cancer. The maximal Standardized Uptake Value (SUV_max) in the lung outside of the GTV was used as a measure of FDG uptake. At the same time-points, the serum IL-6 concentrations were measured. RILT was defined as dyspnea score ⩾2 (CTCAE3.0).

Results

Six of 18 patients developed RILT. Before RT, SUV_max in the lung was not significantly different between patients who developed RILT and those who did not develop RILT. Patients who developed RILT post-radiation had a significant increased SUV on days 7 and 14 during RT, whereas the group that did not experience RILT showed no significant SUV changes. The SUV_max of the lungs increased significantly more in the group that later developed RILT compared to those who did not develop RILT. Neither the IL-6 concentration nor the mean lung dose was associated with RILT.

Conclusions

The increase in FDG uptake in the normal lung early during RT was highly associated with the subsequent development of clinical RILT. This may help to identify patients at high risk for RILT at a time when adjustments of the treatment or strategies to prevent RILT are still possible.

Section snippets

Patients

Patients had to have pathologically proven stage III non-small cell lung cancer (NSCLC), received induction chemotherapy, World Health Organization (WHO) performance score 0 or 1, weight loss less than 10% in 6 months, and reasonable lung function (forced expiratory volume in 1 s [FEV1] ⩾50% of predicted value and carbon monoxide diffusion capacity [DLCO] ⩾50%). Chronic Obstructive Pulmonary Disease (COPD) was classified according to the Global Initiative for Chronic Obstructive Lung Disease

Patient characteristics

Eighteen patients were included, all with UICC stage III NSCLC, treated with three cycles of induction chemotherapy, followed by definitive radiotherapy. All patients were current smokers. Nine patients had no COPD, 4 GOLD stage I and 5 GOLD stage II. None of the patients had dyspnea at the beginning of radiotherapy. The main patients’ characteristics are depicted in Table 1.

No patients developed dyspnea during the course of radiotherapy. Six of 18 patients developed RILT, i.e. dyspnea ⩾ grade 2

Discussion

In the presently used clinical dose–volume histogram ranges of the MLD or the V₂₀, being mostly less than 20 Gy or below 35% [34], no robust predictors for the development of RILT are available [24]. As irradiation induces an inflammatory response in the lung, which can be visualized by FDG-uptake [35], we hypothesized that uptake of FDG early during radiotherapy would reflect subclinical RILT and hence be predictive for subsequent development of clinical RILT.

To the best of our knowledge, we

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Ghobadi et al. [42] used a new CT-based method, namely the△S method, which involves a single measure combining mean density changes with the standard deviation of the density to predict the development of RILT, and showed some value. A prospective pilot study by De et al. [43] showed that an increase in fluorodeoxyglucose (FDG) uptake in the normal lung on days 7 and 14 during RT was highly associated with the development of RILT. Petit et al. [44] found that RILT was more likely to be seen in lung tissue with high FDG uptake (excluding CTV) before RT.
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Lung cancer RT morbidityIncreased 18F-deoxyglucose uptake in the lung during the first weeks of radiotherapy is correlated with subsequent Radiation-Induced Lung Toxicity (RILT): A prospective pilot study

Abstract

Purpose

Patients and methods

Results

Conclusions

Section snippets

Patients

Patient characteristics

Discussion

Lung Cancer

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Rad Oncol Biol Phys

Int J Rad Oncol Biol Phys

Int J Rad Oncol Biol Phys

Radiother Oncol

Int J Rad Oncol Biol Phys

Int J Rad Oncol Biol Phys

Int J Rad Oncol Biol Phys

Radiother Oncol

Semin Radiat Oncol

Int J Radiat Oncol Biol Phys

Lung Cancer

Radiother Oncol

Lung cancer RT morbidity
Increased ¹⁸F-deoxyglucose uptake in the lung during the first weeks of radiotherapy is correlated with subsequent Radiation-Induced Lung Toxicity (RILT): A prospective pilot study