Abstract
PurposeTo study whether esophageal FDG activity changes by time of mid-course of fractionated radiotherapy (RT), and whether these changes are associated with radiation esophagitis in patients with non-small cell lung cancer (NSCLC).MethodsFifty patients with stage I-III NSCLC were enrolled prospectively and, all received ≥60 Gy RT. FDG-PET/CT scans were acquired prior to, and during-RT after delivery of 45 Gy. Normalized standardized uptake values (NSUV), defined by the esophageal maximum SUV relative to intravascular background level in the aortic arch, were sampled in the esophagus at the level of the primary tumor, sternal notch, aortic arch, carina, and gastro-esophageal junction. Symptomatic radiation esophagitis was defined as an event.ResultsCompared to baseline, esophageal NSUV increased significantly during-RT at the level of the primary tumor (1.09 ± 0.05 vs.1.28 ± 0.06, p = 0.001), but did not change at other levels in the esophagus. 16 patients had radiation esophagitis events and these patients had significantly higher during-RT to baseline NSUV ratios than those without esophagitis (1.46 ± 0.12, 95% CI 1.20-1.71; vs. 1.11 ± 0.05, 95% CI 1.01-1.21, p = 0.002). Maximum esophageal dose (p = 0.029), concurrent chemotherapy (p = 0.022) and esophageal FDG PET NSUV ratio (during-RT to baseline, p = 0.007), were independent factors associated with esophagitis and area under curves (AUC) were 0.76, 0.70 and 0.78, respectively. Combining esophageal maximum dose and FDG PET NSUV Ratio at the tumor level increased AUC to 0.85 (p = 0.016).ConclusionFDG uptake increased in esophagus during-RT and this increase may predict radiation esphagitis during later course of treatment.
Highlights
Esophagitis is a common complication of patients who undergo thoracic radiation therapy (RT) for non–small cell lung cancer (NSCLC) and a source of considerable morbidity [1,2]
Concurrent chemotherapy and esophageal radiation dose were correlated with the clinical severity of esophagitis, in some reports [7,8]. 18Fluorodeoxyglucose-positron emission tomography (FDG-PET) can show the functional status of a tumor through the visualization of its metabolic activity gauged by FDG uptake, and it can provide additional information to aid in the understanding of radiation induced-esophagitis
The purpose of this study was to examine whether esophageal FDG activity changes by mid-course of fractionated RT, and whether these changes in esophageal FDG uptake are associated with radiation induced-esophagitis late during course of treatment in patients with NSCLC
Summary
Esophagitis is a common complication of patients who undergo thoracic radiation therapy (RT) for non–small cell lung cancer (NSCLC) and a source of considerable morbidity [1,2]. Concurrent chemotherapy and esophageal radiation dose were correlated with the clinical severity of esophagitis, in some reports [7,8]. Some investigators have reported esophageal FDG uptake after radiation therapy [9,10,11,12,13,14]. The correlation of esophageal FDG uptake and clinical signs and symptoms of radiation induced-esophagitis were not well studied. The purpose of this study was to examine whether esophageal FDG activity changes by mid-course of fractionated RT, and whether these changes in esophageal FDG uptake are associated with radiation induced-esophagitis late during course of treatment in patients with NSCLC
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