Abstract
Purpose: With the increasing number of therapy options available for patients with lung cancer, early response evaluation is needed. We performed this pilot study to assess the feasibility of early, repeated Positron emission tomography-magnetic resonance (PET/MR), the impact of timing and the capability for response prediction in lung tumors during chemotherapy. Methods: Patients with stage IV non-small cell lung cancer referred for chemotherapy were prospectively recruited. Fluorine-18-Fluorodeoxyglucose(18F-FDG)-PET/MR scans were performed prior to, during and after the first or second cycle of chemotherapy. Primary tumors were defined on all scans and size, FDG-uptake and apparent diffusion coefficient (ADC) were measured. Early response was described over time and a Standard Linear Mixed Model was applied to analyze changes over time. Results: 45 FDG-PET/MR scans were performed in 11 patients. Whereas the overall changes measured by ADC did not change significantly, there was an overall significant decrease in FDG-uptake from pre to post treatment scans. There was no difference in the FDG-uptake measured 1 or 3 weeks after therapy, but uptake measured 2 weeks after therapy differed from measurements at week 3. Changes measured in patients scanned during the first treatment cycle appeared more pronounced than during the second cycle. Conclusions: This pilot study indicates that response evaluation shortly after initiation of chemotherapy appears concordant with later evaluation and probably more reliable than evaluation midway between cycles. Responses during or after the first cycle of chemotherapy rather than during subsequent cycles are likely to be more readily measured.
Highlights
Despite increased focus on early detection, most patients with non-small cell lung cancer (NSCLC)present with advanced disease, i.e., they are inoperable and a cure is extremely rare [1]
The study was performed in order to explore the technical feasibility of repeated Positron emission tomography-magnetic resonance (PET/MR) very early during chemotherapy and the existence of multi-parametric patterns, potentially enabling us to predict a response very early during therapy, with a special focus on the possible existence of flare potentially hampering the use of early response evaluation
The study proves that it is challenging to schedule five scans in three weeks during chemotherapy for patients newly diagnosed with a severe illness and with short life expectancy
Summary
Despite increased focus on early detection, most patients with non-small cell lung cancer (NSCLC)present with advanced disease, i.e., they are inoperable and a cure is extremely rare [1]. Despite increased focus on early detection, most patients with non-small cell lung cancer (NSCLC). As each treatment cycle usually lasts for three weeks, the first response evaluation is typically carried out eight to twelve weeks after the initiation of cytotoxic treatment. The median survival time for patients with advanced NSCLC is 3–4 months without treatment and about 10–11 months when receiving palliative chemotherapy [1]. Further improvement in survival for this group of patients will require new treatment strategies [3] and more efficient follow-up to make the right decisions about which patients would benefit from chemotherapy and who are unlikely to benefit and should be spared the side effects. Evaluation of treatment response enabling modification of ineffective treatment regimens is of great interest
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