Abstract
BackgroundTo evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1).MethodsFifty-three patients with a histological diagnosis of NSCLC prospectively underwent PCT of the whole tumour, before/after CCT or before/after CCT and RT. Blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) were compared before and after treatment and with the response as defined by RECIST-1.1. The relationship between changes in the perfusion parameters and in tumour size was also evaluated.ResultsPCT parameters decreased after treatment, significantly for BV (p = 0.002) and MTT (p = 0.027). The 30 patients with partial response had a significant decrease of 21% for BV (p = 0.006) and 17% for MTT (p = 0.031). A non-significant decrease in all perfusion parameters was found in patients with stable disease (p > 0.137). In patients with progressive disease, MTT decreased by 10% (p = 0.465) and the other parameters did not significantly vary (p > 0.809). No significant correlation was found between changes in size and PCT parameters (p > 0.145).ConclusionsTreatment of NSCLC with platinum derivatives, with or without RT, induces changes in PCT parameters. Partial response is associated with a significant decrease in BV and MTT, attributable to the effect of the treatment on tumour vascularisation.
Highlights
To evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1)
Partial response is associated with a significant decrease in blood volume (BV) and mean transit time (MTT), attributable to the effect of the treatment on tumour vascularisation
Partial response was associated with a significant decrease in blood volume and mean transit time
Summary
To evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1). Several genomic mutations have been identified, such as those regarding the endothelial growth factor receptor and anaplastic lymphoma kinase that are associated with response to tyrosine kinase inhibitors and crizotinib, respectively, with a marked improvement in response rates and survival [4, 5] In this setting, the assessment of response to treatment based on tumour size using the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1) guidelines [6] presents some disadvantages, such as disregarding any asymmetric growth of the tumour that does not involve changes in the maximum diameter or the presence of cavitation, necrosis, or haemorrhage that increase the size of the tumour. Perfusion computed tomography (PCT) is an imaging tool that has attracted increasing attention because the parameters obtained can be an indirect reflection of the vascularisation and vascular physiology of the tumour [8,9,10,11,12,13,14,15,16,17,18,19,20,21], and it can be incorporated into routine monitoring protocols for lung cancer [22]
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