Prognostic Value of Pretreatment FDG-PET Parameters in High-dose Image-guided Radiotherapy for Oligometastatic Non-Small-cell Lung Cancer.
BACKGROUND
Emerging data support aggressive local treatment of oligometastatic non-small-cell lung cancer (NSCLC) patients. We sought to determine whether the metabolic burden of disease found by fluorodeoxyglucose positron emission tomography at the time of high-dose radiotherapy (RT) for oligometastatic NSCLC can serve as a prognostic biomarker.


MATERIALS AND METHODS
We conducted a retrospective cohort study of 67 RT treatment courses in 55 patients with oligometastatic NSCLC who had undergone high-dose RT to all sites of active disease at our institution. The metabolic tumor volume, total lesion glycolysis (TLG), and maximum standardized uptake value of all lesions were measured on the pretreatment fluorodeoxyglucose positron emission tomography scans. Cox regression analysis was used to assess the influence of imaging and clinical factors on overall survival (OS).


RESULTS
On univariate analysis, a greater metabolic tumor volume and TLG were predictive of shorter OS (hazard ratio of death, 2.42 and 2.14, respectively; P = .009 and P = .004, respectively). The effects remained significant on multivariate analysis. Neither the maximum standardized uptake value nor the number of lesions was significantly associated with OS. Patients within the highest quartile of TLG values (> 86.8 units) had a shorter median OS than those within the lower 3 quartiles (12.4 vs. 30.1 months; log-rank P = .014).


CONCLUSION
The metabolic tumor burden was prognostic of OS and might help to better select oligometastatic NSCLC patients for locally ablative therapy.
['Chin|Alexander L|AL|', 'Kumar|Kiran A|KA|', 'Guo|Haiwei H|HH|', 'Maxim|Peter G|PG|', 'Wakelee|Heather|H|', 'Neal|Joel W|JW|', 'Diehn|Maximillian|M|', 'Loo|Billy W|BW|', 'Gensheimer|Michael F|MF|']
D000230:Adenocarcinoma D000328:Adult D000368:Aged D000369:Aged, 80 and over D018287:Carcinoma, Large Cell D002289:Carcinoma, Non-Small-Cell Lung D002294:Carcinoma, Squamous Cell D016022:Case-Control Studies D005260:Female D019788:Fluorodeoxyglucose F18 D005500:Follow-Up Studies D006019:Glycolysis D006801:Humans D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009362:Neoplasm Metastasis D049268:Positron-Emission Tomography D011379:Prognosis D019275:Radiopharmaceuticals D011879:Radiotherapy Dosage D011880:Radiotherapy Planning, Computer-Assisted D061089:Radiotherapy, Image-Guided D012189:Retrospective Studies
Biomarker Metabolic tumor volume Total lesion glycolysis Survival Ablative radiotherapy