Pre-treatment non-target lung FDG-PET uptake predicts symptomatic radiation pneumonitis following Stereotactic Ablative Radiotherapy (SABR)Pre-treatment non-target lung FDG-PET uptake predicts radiation pneumonitis after SABR

Aadel A. Chaudhuri, Michael S. Binkley, Joseph Rigdon, Justin N. Carter, Sonya Aggarwal, Sara A. Dudley, Yushen Qian, Kiran A. Kumar, Wendy Y. Hara, Michael Gensheimer, Viswam S. Nair, Peter G. Maxim, David B. Shultz, Karl Bush, Nicholas Trakul, Quynh Thu Le, Maximilian Diehn, Billy W. Loo, Haiwei Henry Guo

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose To determine if pre-treatment non-target lung FDG-PET uptake predicts for symptomatic radiation pneumonitis (RP) following lung stereotactic ablative radiotherapy (SABR). Methods We reviewed a 258 patient database from our institution to identify 28 patients who experienced symptomatic (grade ⩾ 2) RP after SABR, and compared them to 57 controls who did not develop symptomatic RP. We compared clinical, dosimetric and functional imaging characteristics between the 2 cohorts including pre-treatment non-target lung FDG-PET uptake. Results Median follow-up time was 26.9 months. Patients who experienced symptomatic RP had significantly higher non-target lung FDG-PET uptake as measured by mean SUV (p < 0.0001) than controls. ROC analysis for symptomatic RP revealed area under the curve (AUC) of 0.74, with sensitivity 82.1% and specificity 57.9% with cutoff mean non-target lung SUV > 0.56. Predictive value increased (AUC of 0.82) when mean non-target lung SUV was combined with mean lung dose (MLD). We developed a 0–2 point model using these 2 variables, 1 point each for SUV > 0.56 or MLD > 5.88 Gy equivalent dose in 2 Gy per fraction (EQD2), predictive for symptomatic RP in our cohort with hazard ratio 10.01 for score 2 versus 0 (p < 0.001). Conclusions Patients with elevated pre-SABR non-target lung FDG-PET uptake are at increased risk of symptomatic RP after lung SABR. Our predictive model suggests patients with mean non-target lung SUV > 0.56 and MLD > 5.88 Gy EQD2 are at highest risk. Our predictive model should be validated in an external cohort before clinical implementation.

Original languageEnglish (US)
Pages (from-to)454-460
Number of pages7
JournalRadiotherapy and Oncology
Volume119
Issue number3
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Keywords

  • Fluorodeoxyglucose positron emission tomography (FDG-PET)
  • Lung cancer
  • Mean lung dose
  • Mean non-target lung SUV
  • Radiation pneumonitis
  • Stereotactic ablative radiotherapy (SABR)

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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