Top

Published in:

Open Access 01-12-2015 | Research

Textural features in pre-treatment [F18]-FDG-PET/CT are correlated with risk of local recurrence and disease-specific survival in early stage NSCLC patients receiving primary stereotactic radiation therapy

Authors: Thomas Pyka, Ralph A Bundschuh, Nicolaus Andratschke, Benedikt Mayer, Hanno M Specht, Laszló Papp, Norbert Zsótér, Markus Essler

Published in: Radiation Oncology | Issue 1/2015

Abstract

Background

Textural features in FDG-PET have been shown to provide prognostic information in a variety of tumor entities. Here we evaluate their predictive value for recurrence and prognosis in NSCLC patients receiving primary stereotactic radiation therapy (SBRT).

Methods

45 patients with early stage NSCLC (T1 or T2 tumor, no lymph node or distant metastases) were included in this retrospective study and followed over a median of 21.4 months (range 3.1–71.1). All patients were considered non-operable due to concomitant disease and referred to SBRT as the primary treatment modality. Pre-treatment FDG-PET/CT scans were obtained from all patients. SUV and volume-based analysis as well as extraction of textural features based on neighborhood gray-tone difference matrices (NGTDM) and gray-level co-occurence matrices (GLCM) were performed using InterView Fusion™ (Mediso Inc., Budapest). The ability to predict local recurrence (LR), lymph node (LN) and distant metastases (DM) was measured using the receiver operating characteristic (ROC). Univariate and multivariate analysis of overall and disease-specific survival were executed.

Results

7 out of 45 patients (16%) experienced LR, 11 (24%) LN and 11 (24%) DM. ROC revealed a significant correlation of several textural parameters with LR with an AUC value for entropy of 0.872. While there was also a significant correlation of LR with tumor size in the overall cohort, only texture was predictive when examining T1 (tumor diameter < = 3 cm) and T2 (>3 cm) subgroups. No correlation of the examined PET parameters with LN or DM was shown.

In univariate survival analysis, both heterogeneity and tumor size were predictive for disease-specific survival, but only texture determined by entropy was determined as an independent factor in multivariate analysis (hazard ratio 7.48, p = .016). Overall survival was not significantly correlated to any examined parameter, most likely due to the high comorbidity in our cohort.

Conclusions

Our study adds to the growing evidence that tumor heterogeneity as described by FDG-PET texture is associated with response to radiation therapy in NSCLC. The results may be helpful into identifying patients who might profit from an intensified treatment regime, but need to be verified in a prospective patient cohort before being incorporated into routine clinical practice.

Guckenberger M, Allgauer M, Appold S, Dieckmann K, Ernst I, Ganswindt U, et al. Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol. 2013;8(8):1050–8.PubMedCrossRef

Senthi S, Lagerwaard FJ, Haasbeek CJ, Slotman BJ, Senan S. Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol. 2012;13(8):802–9.PubMedCrossRef

Taremi M, Hope A, Dahele M, Pearson S, Fung S, Purdie T, et al. Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys. 2012;82(2):967–73.PubMedCrossRef

Vahdat S, Oermann EK, Collins SP, Yu X, Abedalthagafi M, Debrito P, et al. CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18 F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment. J Hematol Oncol. 2010;3:6.PubMedCentralPubMedCrossRef

Wiegman EM, Pruim J, Ubbels JF, Groen HJ, Langendijk JA, Widder J. 18 F-FDG PET during stereotactic body radiotherapy for stage I lung tumours cannot predict outcome: a pilot study. Eur J Nucl Med Mol Imaging. 2011;38(6):1059–63.PubMedCrossRef

Nakajima N, Sugawara Y, Kataoka M, Hamamoto Y, Ochi T, Sakai S, et al. Differentiation of tumor recurrence from radiation-induced pulmonary fibrosis after stereotactic ablative radiotherapy for lung cancer: characterization of 18 F-FDG PET/CT findings. Ann Nucl Med. 2013;27(3):261–70.PubMedCrossRef

Essler M, Wantke J, Mayer B, Scheidhauer K, Bundschuh RA, Haller B, et al. Positron-emission tomography CT to identify local recurrence in stage I lung cancer patients 1 year after stereotactic body radiation therapy. Strahlenther Onkol. 2013;189(6):495–501.PubMedCrossRef

Takeda A, Yokosuka N, Ohashi T, Kunieda E, Fujii H, Aoki Y, et al. The maximum standardized uptake value (SUVmax) on FDG-PET is a strong predictor of local recurrence for localized non-small-cell lung cancer after stereotactic body radiotherapy (SBRT). Radiother Oncol. 2011;101(2):291–7.PubMedCrossRef

Horne ZD, Clump DA, Vargo JA, Shah S, Beriwal S, Burton SA, et al. Pretreatment SUVmax predicts progression-free survival in early-stage non-small cell lung cancer treated with stereotactic body radiation therapy. Radiat Oncol. 2014;9:41.PubMedCentralPubMedCrossRef

10.

Clarke K, Taremi M, Dahele M, Freeman M, Fung S, Franks K, et al. Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC): is FDG-PET a predictor of outcome? Radiother Oncol. 2012;104(1):62–6.PubMedCrossRef

11.

Burdick MJ, Stephans KL, Reddy CA, Djemil T, Srinivas SM, Videtic GM. Maximum standardized uptake value from staging FDG-PET/CT does not predict treatment outcome for early-stage non-small-cell lung cancer treated with stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(4):1033–9.PubMedCrossRef

12.

Hoopes DJ, Tann M, Fletcher JW, Forquer JA, Lin PF, Lo SS, et al. FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. Lung Cancer. 2007;56(2):229–34.PubMedCrossRef

13.

Eary JF, O’Sullivan F, O’Sullivan J, Conrad EU. Spatial heterogeneity in sarcoma 18 F-FDG uptake as a predictor of patient outcome. J Nucl Med. 2008;49(12):1973–9.PubMedCentralPubMedCrossRef

14.

Cheng NM, Fang YH, Chang JT, Huang CG, Tsan DL, Ng SH, et al. Textural features of pretreatment 18 F-FDG PET/CT images: prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma. J Nucl Med. 2013;54(10):1703–9.PubMedCrossRef

15.

Tixier F, Le Rest CC, Hatt M, Albarghach N, Pradier O, Metges JP, et al. Intratumor heterogeneity characterized by textural features on baseline 18 F-FDG PET images predicts response to concomitant radiochemotherapy in esophageal cancer. J Nucl Med. 2011;52(3):369–78.PubMedCentralPubMedCrossRef

16.

van Velden FH, Cheebsumon P, Yaqub M, Smit EF, Hoekstra OS, Lammertsma AA, et al. Evaluation of a cumulative SUV-volume histogram method for parameterizing heterogeneous intratumoural FDG uptake in non-small cell lung cancer PET studies. Eur J Nucl Med Mol Imaging. 2011;38(9):1636–47.PubMedCentralPubMedCrossRef

17.

Tixier F, Hatt M, Valla C, Fleury V, Lamour C, Ezzouhri S, et al. Visual versus quantitative assessment of intratumor 18 F-FDG PET uptake heterogeneity: prognostic value in Non-small cell lung cancer. J Nucl Med. 2014;55(8):1235–41.PubMedCrossRef

18.

Cook GJ, Yip C, Siddique M, Goh V, Chicklore S, Roy A, et al. Are pretreatment 18 F-FDG PET tumor textural features in non-small cell lung cancer associated with response and survival after chemoradiotherapy? J Nucl Med. 2013;54(1):19–26.PubMedCrossRef

19.

Chicklore S, Goh V, Siddique M, Roy A, Marsden PK, Cook GJ. Quantifying tumour heterogeneity in 18 F-FDG PET/CT imaging by texture analysis. Eur J Nucl Med Mol Imaging. 2013;40(1):133–40.PubMedCrossRef

20.

Martinez MJ, Bercier Y, Schwaiger M, Ziegler SI. PET/CT Biograph Sensation 16. Performance improvement using faster electronics. Nuklearmedizin. 2006;45(3):126–33.PubMed

21.

Andratschke N, Zimmermann F, Boehm E, Schill S, Schoenknecht C, Thamm R, et al. Stereotactic radiotherapy of histologically proven inoperable stage I non-small cell lung cancer: patterns of failure. Radiother Oncol. 2011;101(2):245–9.PubMedCrossRef

22.

Takeda A, Sanuki N, Fujii H, Yokosuka N, Nishimura S, Aoki Y, et al. Maximum standardized uptake value on FDG-PET is a strong predictor of overall and disease-free survival for non-small-cell lung cancer patients after stereotactic body radiotherapy. J Thorac Oncol. 2014;9(1):65–73.PubMedCrossRef

23.

Brooks FJ, Grigsby PW. The effect of small tumor volumes on studies of intratumoral heterogeneity of tracer uptake. J Nucl Med. 2014;55(1):37–42.PubMedCentralPubMedCrossRef

24.

Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48(6):932–45.PubMedCrossRef

25.

Orlhac F, Soussan M, Maisonobe JA, Garcia CA, Vanderlinden B, Buvat I. Tumor texture analysis in 18 F-FDG PET: relationships between texture parameters, histogram indices, standardized uptake values, metabolic volumes, and total lesion glycolysis. J Nucl Med. 2014;55(3):414–22.PubMedCrossRef

26.

Modh A, Rimner A, Williams E, Foster A, Shah M, Shi W, et al. Local control and toxicity in a large cohort of central lung tumors treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2014;90(5):1168–76.PubMedCrossRef

27.

Ohri N, Werner-Wasik M, Grills IS, Belderbos J, Hope A, Yan D, et al. Modeling local control after hypofractionated stereotactic body radiation therapy for stage I non-small cell lung cancer: a report from the elekta collaborative lung research group. Int J Radiat Oncol Biol Phys. 2012;84(3):e379–84.PubMedCrossRef

28.

Ganeshan B, Goh V, Mandeville HC, Ng QS, Hoskin PJ, Miles KA. Non-small cell lung cancer: histopathologic correlates for texture parameters at CT. Radiology. 2013;266(1):326–36.PubMedCrossRef

29.

Mattonen SA, Palma DA, Haasbeek CJ, Senan S, Ward AD. Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer. Med Phys. 2014;41(3):033502.PubMedCrossRef

30.

Tixier F, Hatt M, Le Rest CC, Le Pogam A, Corcos L, Visvikis D. Reproducibility of tumor uptake heterogeneity characterization through textural feature analysis in 18 F-FDG PET. J Nucl Med. 2012;53(5):693–700.PubMedCentralPubMedCrossRef

31.

Yip S, McCall K, Aristophanous M, Chen AB, Aerts HJ, Berbeco R. Comparison of texture features derived from static and respiratory-gated PET images in Non-small cell lung cancer. PLoS One. 2014;9(12):e115510.PubMedCentralPubMedCrossRef

32.

Kawano T, Ohtake E, Inoue T. Deep-inspiration breath-hold PET/CT versus free breathing PET/CT and respiratory gating PET for reference: evaluation in 95 patients with lung cancer. Ann Nucl Med. 2011;25(2):109–16.PubMedCrossRef

Title: Textural features in pre-treatment [F18]-FDG-PET/CT are correlated with risk of local recurrence and disease-specific survival in early stage NSCLC patients receiving primary stereotactic radiation therapy
Authors: Thomas Pyka
Ralph A Bundschuh
Nicolaus Andratschke
Benedikt Mayer
Hanno M Specht
Laszló Papp
Norbert Zsótér
Markus Essler
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-015-0407-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Textural features in pre-treatment [F18]-FDG-PET/CT are correlated with risk of local recurrence and disease-specific survival in early stage NSCLC patients receiving primary stereotactic radiation therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Lymph node ratio as a prognostic factor in head and neck cancer patients

Role of membrane Hsp70 in radiation sensitivity of tumor cells

Double-arc volumetric modulated therapy improves dose distribution compared to static gantry IMRT and 3D conformal radiotherapy for adjuvant therapy of gastric cancer

Acute adaptive immune response correlates with late radiation-induced pulmonary fibrosis in mice

Characteristics of non-coplanar IMRT in the presence of target-embedded organs at risk

Assessment and topographic characterization of locoregional recurrences in head and neck tumours