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Published in: Annals of Nuclear Medicine 5/2022

01-05-2022 | NSCLC | Original Article

Prediction of cardiac events following concurrent chemoradiation therapy for non-small-cell lung cancer using FDG PET

Authors: Sang-Geon Cho, Yong-Hyub Kim, Hyukjin Park, Ki Seong Park, Jahae Kim, Sung-Ja Ahn, Hee-Seung Bom

Published in: Annals of Nuclear Medicine | Issue 5/2022

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Abstract

Objective

No imaging biomarkers are available for the prediction of cardiac events following concurrent chemoradiation therapy (CCRT) for non-small-cell lung cancer (NSCLC). We evaluated whether F-18 fluorodeoxyglucose positron emission tomography (FDG PET) early after CCRT, in addition to cardiac dosimetry, could predict late cardiac events in NSCLC.

Methods

We retrospectively enrolled 133 consecutive patients with locally advanced, unresectable stage III NSCLC, who underwent FDG PET early after CCRT and survived at least 6 months. The primary endpoint was cardiac event ≥ grade 2 according to the Common Terminology Criteria for Adverse Events (version 5.0). Myocardial FDG uptake was measured and its association with the risk of cardiac events was evaluated.

Results

FDG PET was performed after a median interval of 11 days of completing CCRT. Overall, 42 (32%) patients experienced cardiac events during a median follow-up of 45 months. The mean heart dose, maximum left ventricular (LV) standardized uptake value (SUV), changes in maximum and mean LV SUV, right ventricular uptake, tumor stage, white blood cell count, and diabetes were associated with cardiac events in univariable analysis. In multivariable analysis, maximum LV SUV (cutoff > 12.84; hazard ratio [95% confidence interval] = 2.140 [1.140–4.016]; p = 0.018) was an independent predictor of cardiac events along with the mean heart dose (> 11.1 Gy; 3.646 [1.792–7.417]; p < 0.001) and tumor stage (IIIB; 1.986 [1.056–3.734]; p = 0.033). It remained predictive of cardiac events in those with higher mean heart dose but not in those with lower mean heart dose.

Conclusions

Early FDG PET after CCRT for NSCLC could aid in predicting late cardiac events, especially in patients with higher mean heart dose.
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Metadata
Title
Prediction of cardiac events following concurrent chemoradiation therapy for non-small-cell lung cancer using FDG PET
Authors
Sang-Geon Cho
Yong-Hyub Kim
Hyukjin Park
Ki Seong Park
Jahae Kim
Sung-Ja Ahn
Hee-Seung Bom
Publication date
01-05-2022
Publisher
Springer Nature Singapore
Published in
Annals of Nuclear Medicine / Issue 5/2022
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-022-01724-w

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