Timing and intensity of changes in FDG uptake with symptomatic esophagitis during radiotherapy or chemo-radiotherapyReport as inadecuate

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Radiation Oncology

, 9:37

Clinical Radiation Oncology


PurposeTo study whether esophageal FDG activity changes by time of mid-course of fractionated radiotherapy RT, and whether these changes are associated with radiation esophagitis in patients with non-small cell lung cancer NSCLC.

MethodsFifty patients with stage I-III NSCLC were enrolled prospectively and, all received ≥60 Gy RT. FDG-PET-CT scans were acquired prior to, and during-RT after delivery of 45 Gy. Normalized standardized uptake values NSUV, defined by the esophageal maximum SUV relative to intravascular background level in the aortic arch, were sampled in the esophagus at the level of the primary tumor, sternal notch, aortic arch, carina, and gastro-esophageal junction. Symptomatic radiation esophagitis was defined as an event.

ResultsCompared to baseline, esophageal NSUV increased significantly during-RT at the level of the primary tumor 1.09 ± 0.05 vs.1.28 ± 0.06, p = 0.001, but did not change at other levels in the esophagus. 16 patients had radiation esophagitis events and these patients had significantly higher during-RT to baseline NSUV ratios than those without esophagitis 1.46 ± 0.12, 95% CI 1.20-1.71; vs. 1.11 ± 0.05, 95% CI 1.01-1.21, p = 0.002. Maximum esophageal dose p = 0.029, concurrent chemotherapy p = 0.022 and esophageal FDG PET NSUV ratio during-RT to baseline, p = 0.007, were independent factors associated with esophagitis and area under curves AUC were 0.76, 0.70 and 0.78, respectively. Combining esophageal maximum dose and FDG PET NSUV Ratio at the tumor level increased AUC to 0.85 p = 0.016.

ConclusionFDG uptake increased in esophagus during-RT and this increase may predict radiation esphagitis during later course of treatment.

KeywordsNon-small cell lung cancer FDG PET Standard uptake value SUV Radiation esophagitis Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-37 contains supplementary material, which is available to authorized users.

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Author: Shuanghu Tiger Yuan - Richard KJ Brown - Lujun Zhao - Randall K Ten Haken - Milton Gross - Kemp B Cease - Matt Schipper

Source: https://link.springer.com/

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