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  • 1.
    Lazzeroni, Marta
    et al.
    Medical Radiation Physics, Department of Oncology and Pathology, Karolinska Institutet, Sweden.
    Uhrdin, Johan
    RaySearch Laboratories AB, Stockholm, Sweden.
    Carvalho, Sara
    Department of Radiation Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
    van Elmpt, Wouter
    Department of Radiation Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
    Lambin, Philippe
    Department of Radiation Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
    Dasu, Alexandru
    The Skandion Clinic, Uppsala, Sweden.
    Wersäll, Peter
    Medical Radiation Physics, Department of Oncology and Pathology, Karolinska Institutet, Sweden; Medical Radiation Physics, Department of Physics, Stockholm University, Sweden.
    Toma-Dasu, Iuliana
    Medical Radiation Physics, Department of Oncology and Pathology, Karolinska Institutet, Sweden; Medical Radiation Physics, Department of Physics, Stockholm University, Sweden.
    Evaluation of third treatment week as temporal window for assessing responsiveness on repeated FDG-PET scans in Non-Small Cell Lung Cancer patients2018Inngår i: Physica medica (Testo stampato), ISSN 1120-1797, E-ISSN 1724-191X, Vol. 46, s. 45-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    Early assessment of tumour response to treatment with repeated FDG-PET-CT imaging has potential for treatment adaptation but it is unclear what the optimal time window for this evaluation is. Previous studies indicate that changes in SUVmean and the effective radiosensitivity (αeff, accounting for uptake variations and accumulated dose until the second FDG-PET-CT scan) are predictive of 2-year overall survival (OS) when imaging is performed before radiotherapy and during the second week. This study aims to investigate if multiple FDG-PET-derived quantities determined during the third treatment week have stronger predictive power.

    Methods

    Twenty-eight lung cancer patients were imaged with FDG-PET-CT before radiotherapy (PET1) and during the third week (PET2). SUVmean, SUVmax, SUVpeak, MTV41%–50% (Metabolic Tumour Volume), TLG41%–50% (Total Lesion Glycolysis) in PET1 and PET2 and their change (), as well as average αeff (α¯eff) and the negative fraction of αeff values (fαeff<0) were determined. Correlations were sought between FDG-PET-derived quantities and OS with ROC analysis.

    Results

    Neither SUVmean, SUVmax, SUVpeak in PET1 and PET2 (AUC = 0.5–0.6), nor their changes (AUC = 0.5–0.6) were significant for outcome prediction purposes. Lack of correlation with OS was also found for α¯eff (AUC = 0.5) and fαeff<0 (AUC = 0.5). Threshold-based quantities (MTV41%–50%, TLG41%–50%) and their changes had AUC = 0.5–0.7.

    P-values were in all cases ≫0.05.

    Conclusions

    The poor OS predictive power of the quantities determined from repeated FDG-PET-CT images indicates that the third week of treatment might not be suitable for treatment response assessment. Comparatively, the second week during the treatment appears to be a better time window.

  • 2.
    Toma-Dasu, Iuliana
    et al.
    Stockholm University and Karolinska Institutet.
    Uhrdin, Johan
    RaySearch Laboratories AB.
    Lazzeroni, Marta
    Karolinska Institutet.
    Carvalho, Sara
    Maastricht University Medical Center, Maastricht, The Netherlands.
    van Elmpt, Wouter
    Maastricht University Medical Center, Maastricht, The Netherlands.
    Lambin, Philippe
    Maastricht University Medical Center, Maastricht, The Netherlands.
    Dasu, Alexandru
    Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper.
    Evaluating tumor response of non-small cell lung cancer patients with 18F-fludeoxyglucose positron emission tomography: potential for treatment individualization2015Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 91, nr 2, s. 376-384Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess early tumor responsiveness and the corresponding effective radiosensitivity for individual patients with non-small cell lung cancer (NSCLC) based on 2 successive 18F-fludeoxyglucose positron emission tomography (FDG-PET) scans.

    Methods and Materials: Twenty-six NSCLC patients treated in Maastricht were included in the study. Fifteen patients underwent sequential chemoradiation therapy, and 11 patients received concomitant chemoradiation therapy. All patients were imaged with FDG before the start and during the second week of radiation therapy. The sequential images were analyzed in relation to the dose delivered until the second image. An operational quantity, effective radiosensitivity, αeff, was determined at the voxel level. Correlations were sought between the average αeff or the fraction of negative αeff values and the overall survival at 2 years. Separate analyses were performed for the primary gross target volume (GTV), the lymph node GTV, and the clinical target volumes (CTVs).

    Results: Patients receiving sequential treatment could be divided into responders and nonresponders, using a threshold for the average αeff of 0.003 Gy-1 in the primary GTV, with a sensitivity of 75% and a specificity of 100% (P<.0001). Choosing the fraction of negative αeff as a criterion, the threshold 0.3 also had a sensitivity of 75% and a specificity of 100% (P<.0001). Good prognostic potential was maintained for patients receiving concurrent chemotherapy. For lymph node GTV, the correlation had low statistical significance. A cross-validation analysis confirmed the potential of the method.

    Conclusions: Evaluation of the early response in NSCLC patients showed that it is feasible to determine a threshold value for effective radiosensitivity corresponding to good response. It also showed that a threshold value for the fraction of negative αeff could also be correlated with poor response. The proposed method, therefore, has potential to identify candidates for more aggressive strategies to increase the rate of local control and also avoid exposing to unnecessary aggressive therapies the majority of patients responding to standard treatment.

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