Pre-radiation therapy fluorine 18 fluorodeoxyglucose pet helps identify patients with esophageal cancer at high risk for radiation pneumonitis

Richard Castillo, Ngoc Pham, Edward Castillo, Samantha Aso-Gonzalez, Sobiya Ansari, Brian Hobbs, Diana Palacio, Heath Skinner, Thomas M. Guerrero

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    14 Scopus citations

    Abstract

    Purpose: To examine the association between pre-radiation therapy (RT) fluorine 18 fluorodeoxyglucose (FDG) uptake and post-RT symptomatic radiation pneumonitis (RP). Materials and Methods: In accordance with the retrospective study protocol approved by the institutional review board, 228 esophageal cancer patients who underwent FDG PET/CT before chemotherapy and RT were examined. RP symptoms were evaluated by using the Common Terminology Criteria for Adverse Events, version 4.0, from the consensus of five clinicians. By using the cumulative distribution of standardized uptake values (SUVs) within the lungs, those values greater than 80%-95% of the total lung voxels were determined for each patient. The effect of prechemotherapy and RT FDG uptake, dose, and patient or treatment characteristics on RP toxicity was studied by using logistic regression. Results: The study subjects were treated with three-dimensional conformal RT (n = 36), intensity-modulated RT (n = 135), or proton therapy (n = 57). Logistic regression analysis demonstrated elevated FDG uptake at pre-chemotherapy and RT was related to expression of RP symptoms. Study subjects with elevated 95% percentile of the SUV (SUV<inf>95</inf>) were more likely to develop symptomatic RP (P < .000012); each 0.1 unit increase in SUV<inf>95</inf> was associated with a 1.36-fold increase in the odds of symptomatic RP. Receiver operating characteristic (ROC) curve analysis resulted in area under the ROC curve of 0.676 (95% confidence interval: 0.58, 0.77), sensitivity of 60%, and specificity of 71% at the 1.17 SUV<inf>95</inf> threshold. CT imaging and dosimetric parameters were found to be poor predictors of RP symptoms. Conclusion: The SUV<inf>95</inf>, a biomarker of pretreatment pulmonary metabolic activity, was shown to be prognostic of symptomatic RP. Elevation in this pretreatment biomarker identifies patients at high risk for posttreatment symptomatic RP.

    Original languageEnglish (US)
    Pages (from-to)822-831
    Number of pages10
    JournalRadiology
    Volume275
    Issue number3
    DOIs
    StatePublished - Jun 1 2015

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    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging

    Cite this

    Castillo, R., Pham, N., Castillo, E., Aso-Gonzalez, S., Ansari, S., Hobbs, B., Palacio, D., Skinner, H., & Guerrero, T. M. (2015). Pre-radiation therapy fluorine 18 fluorodeoxyglucose pet helps identify patients with esophageal cancer at high risk for radiation pneumonitis. Radiology, 275(3), 822-831. https://doi.org/10.1148/radiol.14140457