Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer.
Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer.
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DOI：
10.1186/1748-717x-9-74
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发表时间：
2014-03-13
期刊：
影响因子：
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通讯作者：
Guerrero T
中科院分区：
文献类型：
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作者：
Castillo R;Pham N;Ansari S;Meshkov D;Castillo S;Li M;Olanrewaju A;Hobbs B;Castillo E;Guerrero T
进行回顾性分析以确定治疗前[18F]-2-氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）图像衍生参数是否可以预测肺癌患者的放射性肺炎（RP）临床症状。我们回顾性研究了100例非小细胞肺癌（NSCLC）患者，这些患者在开始放疗（RT）前接受了FDG PET/CT成像。使用5名临床医生达成共识的不良事件通用术语标准版本4.0（CTCAEv 4）评价了腹膜炎症状。使用肺内治疗前标准摄取值（SUV）的累积分布，确定第80至第95百分位数SUV值（SUV 80至SUV 95）。采用多元Logistic回归分析研究了RT前FDG摄取、剂量、患者和治疗特征对肺毒性的影响。研究受试者接受了3D适形RT（n = 23）、调强RT（n = 64）和质子治疗（n = 13）。多因素Logistic回归分析表明，放射治疗前肺FDG摄取水平升高与放射治疗后RP症状的发生有关。平均年龄和V30且SUV 95 = 1.5的患者发生≥ 2级放射性肺炎的可能性是SUV 95 = 0.5的患者的6.9倍。受试者工作特征曲线分析显示曲线下面积为0.78（95%CI = 0.69 - 0.87）。CT成像和剂量学参数被认为是RP症状的不良预测因子。在这项研究中，治疗前的肺FDG摄取，量化的SUV 95，预测RP的症状。该治疗前生物标志物的升高识别了治疗后症状性RP高风险的患者组。
A retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV80 to SUV95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. The study subjects were treated with 3D conformal RT (n = 23), intensity modulated RT (n = 64), and proton therapy (n = 13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V30 with SUV95 = 1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV95 = 0.5 of the same age and identical V30. Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI = 0.69 – 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. The pretreatment pulmonary FDG uptake, as quantified by the SUV95, predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.