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EJNMMI Research
Published in: EJNMMI Research 1/2017

Open Access 01-12-2017 | Original research

A comparison of FLT to FDG PET/CT in the early assessment of chemotherapy response in stages IB–IIIA resectable NSCLC

Authors: John P. Crandall, Abdel K. Tahari, Rosalyn A. Juergens, Julie R. Brahmer, Charles M. Rudin, Giuseppe Esposito, Deepa S. Subramaniam, Michael V. Knopp, Nathan C. Hall, Prateek Gajwani, Jeffrey P. Leal, Martin A. Lodge, Joo H. O., Edward W. Gabrielson, Lalitha K. Shankar, Richard L. Wahl

Published in: EJNMMI Research | Issue 1/2017

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Abstract

Background

The aim of this study was to compare the percentage change in 18F-fluorothymidine (FLT) standard uptake value (SUV) between baseline and after one cycle of chemotherapy in patients categorized by RECIST 1.1 computed tomography (CT) as responders or non-responders after two cycles of therapy. Change in 18F-fluorodeoxyglucose (FDG) uptake was also compared between these time points.
Nine patients with newly diagnosed, operable, non-small cell lung cancer (NSCLC) were imaged with FDG positron emission tomography/CT (PET), FLT PET/CT, and CT at baseline, following one cycle of neoadjuvant therapy (75 mg/m2 docetaxel + 75 mg/m2 cisplatin), and again after the second cycle of therapy. All patients had a biopsy prior to enrollment and underwent surgical resection within 4 weeks of post-cycle 2 imaging.

Results

Between baseline and post-cycle 1, non-responders had mean SULmax (maximum standard uptake value adjusted for lean body mass) increases of 7.0 and 3.4% for FDG and FLT, respectively. Responders had mean decreases of 44.8 and 32.0% in FDG and FLT SULmax, respectively, between baseline and post-cycle 1 imaging. On post-cycle 1 imaging, primary tumor FDG SUL values were significantly lower in responders than in non-responders (P = 0.016). Primary tumor FLT SUL values did not differ significantly between these groups. Using the change from baseline to post-cycle 1, receiver-operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.94 for FDG and 0.78 for FLT in predicting anatomic tumor response after the second cycle of therapy.

Conclusions

Fractional decrease in FDG SULmax from baseline to post-cycle 1 imaging was significantly different between anatomic responders and non-responders, while percentage changes in FLT SULmax were not significantly different between these groups over the same period of time.
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Metadata
Title
A comparison of FLT to FDG PET/CT in the early assessment of chemotherapy response in stages IB–IIIA resectable NSCLC
Authors
John P. Crandall
Abdel K. Tahari
Rosalyn A. Juergens
Julie R. Brahmer
Charles M. Rudin
Giuseppe Esposito
Deepa S. Subramaniam
Michael V. Knopp
Nathan C. Hall
Prateek Gajwani
Jeffrey P. Leal
Martin A. Lodge
Joo H. O.
Edward W. Gabrielson
Lalitha K. Shankar
Richard L. Wahl
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2017
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-017-0258-3

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