Abstract
Ziele: PET with both FDG and FLT using different quantitative parameters was evaluated with respect to accuracy of early prediction of outcome following erlotinib therapy in patients with untreated advanced non-small cell lung cancer. Methode: Data of 30 patients were used from a prospective trial involving patients with untreated stage IV non-small cell lung cancer. FDG PET and FLT PET were performed before, and one (early) and 6 (late) weeks after erlotinib treatment. Several quantitative standardized uptake values (SUV) using different definitions of VOI with varying isocontours and metabolically active volume measurements were obtained. Metabolic response was defined as a minimum reduction of 30% in each of the different SUV values and as a minimum reduction of 45% in metabolically active volume. Progression-free survival (PFS) was compared between patients with and without metabolic response measured with each of the different parameters, using Kaplan-Meier statistics and the log-rank test. Ergebnis: Patients with a metabolic response on early FDG PET and FLT PET in the hottest single tumor lesion as well in the sum of up to five lesions per scan had a significantly longer PFS, regardless of the method used to calculate SUV. However, the highest significance was obtained for SUVmax, SUV50, SUVA50 and SUVA41. Patients with a metabolic response measured by SUVmax and SUV3Dpeak on late FDG PET in the hottest single tumor lesion had a significantly longer PFS. Furthermore, Kaplan-Meier analyses showed a strong association between PFS and response seen by metabolic active volume, measured either in early FLT or in late FDG. Schlussfolgerung: Early metabolic response, measured using FDG PET and FLT PET can predict PFS whichever method is used for SUV calculation. Metabolically active volume measurement in early FLT PET and late FDG-PET may have an additional predictive value in monitoring response in patients with advanced non-small cell lung cancer treated with erlotinib.
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