PET in radiotherapySimultaneous positron emission tomography (PET) assessment of metabolism with 18F-fluoro-2-deoxy-d-glucose (FDG), proliferation with 18F-fluoro-thymidine (FLT), and hypoxia with 18fluoro-misonidazole (F-miso) before and during radiotherapy in patients with non-small-cell lung cancer (NSCLC): A pilot study
Section snippets
Patients
To be eligible, patients had (1) to have histological proof of invasive NSCLC, (2) to have significant FDG uptakes (i.e., higher than twice the background level) in either primary tumours or mediastinal lymphnodes at the time of inclusion, (3) to have evaluable tumour/node lesions according to RECIST criteria (Response Evaluation Criteria In Solid Tumours), (4) to be a candidate for curative-intent radiotherapy (i.e., localised non-metastatic tumours and adequate pulmonary, medical, and general
Results
Seven patients met the inclusion criteria. Patients #002 and #005 withdrew consent at the beginning of the study. Finally, 30 PET scans were performed in five patients who were fully evaluable (four males, one female) and had 4 tumours and 12 mediastinal/hilar nodes that were identified on initial FDG-PET/CT scans (Table 1). A primary tumour could not be demonstrated in patient #007 (no visible image on a contrast-enhanced CT scan and PET/CT scan, negative endoscopy with multiple biopsies, and
Discussion
The present study is the first report evaluating simultaneous investigations of three PET tracers in patients undergoing curative-intent chemo-radiotherapy for non-small-cell lung cancer. Based on SUVmax measurements made on four primary tumours and 12 lymphnodes in 30 PET-CT scans from five patients, we demonstrated significant decreases in FLT and (to a lesser extent) FDG uptakes during radiotherapy, while F-miso activity remained low and stable. The example of one patient is presented in
Conclusion
The feasibility of multi-tracer PET/CT scans performed in a short period of time prior to and during radiotherapy, as demonstrated in the present study, opens the way to a more sophisticated individualisation of NSCLC treatment. Further studies using larger sample sizes and assessing the patient outcomes are necessary.
Funding
IBA-CisBio and Cancéropole Nord-Ouest, France.
Acknowledgements
We would like to thank the patients who participated in the present study. The authors also thank the technologists of the Department of Nuclear Medicine of Rouen for their help in managing the patients for this study. We particularly thank Mr. Pierrick Gouel, Arthur Dumouchel, and Marc Thillays for their excellent collaboration. We very much appreciated the reviewers’ criticisms that contributed to significant improvements in the manuscript.
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