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

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

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.

Figures

Figure 1
Figure 1
Value of textural and standard PET parameters for prediction of local recurrence. ROC curves for prediction of local recurrence through different PET parameters. Coarseness is the same curve as busyness.
Figure 2
Figure 2
Survival curves for OS and DSS stratified to different PET parameters. Overall and disease-specific survival of subgroups determined by SUVmax(A andE), MTV (B andF), busyness (C andG) and entropy (D andH) are shown.
Figure 3
Figure 3
Influence of tumor segmentation. Correlation between entropy values calculated on SUV 2.0 and SUV 2.5 isocontour VOIs.

References

    1. 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. doi: 10.1097/JTO.0b013e318293dc45.
    1. 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. doi: 10.1016/S1470-2045(12)70242-5.
    1. 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. doi: 10.1016/j.ijrobp.2010.12.039.
    1. 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. doi: 10.1186/1756-8722-3-6.
    1. 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. doi: 10.1007/s00259-010-1706-8.
    1. 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. doi: 10.1007/s12149-012-0682-4.
    1. 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. doi: 10.1007/s00066-013-0310-9.
    1. 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. doi: 10.1016/j.radonc.2011.08.008.
    1. 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. doi: 10.1186/1748-717X-9-41.
    1. 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. doi: 10.1016/j.radonc.2012.04.019.
    1. 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. doi: 10.1016/j.ijrobp.2009.09.081.
    1. 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. doi: 10.1016/j.lungcan.2006.12.009.
    1. 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. doi: 10.2967/jnumed.108.053397.
    1. 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. doi: 10.2967/jnumed.112.119289.
    1. 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. doi: 10.2967/jnumed.110.082404.
    1. 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. doi: 10.1007/s00259-011-1845-6.
    1. 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. doi: 10.2967/jnumed.113.133389.
    1. 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. doi: 10.2967/jnumed.112.107375.
    1. 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. doi: 10.1007/s00259-012-2247-0.
    1. Martinez MJ, Bercier Y, Schwaiger M, Ziegler SI. PET/CT Biograph Sensation 16. Performance improvement using faster electronics. Nuklearmedizin. 2006;45(3):126–33.
    1. 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. doi: 10.1016/j.radonc.2011.06.009.
    1. 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. doi: 10.1097/JTO.0000000000000031.
    1. 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. doi: 10.2967/jnumed.112.116715.
    1. Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48(6):932–45. doi: 10.2967/jnumed.106.035774.
    1. 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. doi: 10.2967/jnumed.113.129858.
    1. 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. doi: 10.1016/j.ijrobp.2014.08.008.
    1. 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. doi: 10.1016/j.ijrobp.2012.04.040.
    1. 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. doi: 10.1148/radiol.12112428.
    1. 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. doi: 10.1118/1.4866219.
    1. 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. doi: 10.2967/jnumed.111.099127.
    1. 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. doi: 10.1371/journal.pone.0115510.
    1. 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. doi: 10.1007/s12149-010-0442-2.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다