Predicting tumor responses and patient survival in chemoradiotherapy-treated patients with non-small-cell lung cancer using dynamic contrast-enhanced integrated magnetic resonance–positron-emission tomography [Vorhersage von Tumoransprechen und Patienten?berleben bei den mit Chemoradiotherapie behandelten Patienten mit nicht-kleinzelligem Lungenkrebs mittels dynamischer kontrastverst?rkter integrierter Magnetresonanz-Positronenemissionstomographie]
Journal
Strahlentherapie und Onkologie
Journal Volume
195
Journal Issue
8
Pages
707-718
Date Issued
2019
Abstract
Purpose: We investigated whether radiologic parameters by dynamic contrast-enhanced (DCE) integrated magnetic resonance–positron-emission tomography (MR-PET) predicts tumor response to treatment and survival in non-metastatic non-small-cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT). Methods: Patients underwent DCE integrated MR-PET imaging 1?week before CRT. The following parameters were analyzed: primary tumor size, gross tumor volume, maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG), apparent?diffusion coefficient (ADC), volume transfer constant (Ktrans), reverse reflux rate constant (kep), extracellular extravascular volume fraction (ve), blood plasma volume fraction (vp), and initial area under the time-concentration curve defined over the first 60?s post-enhancement (iAUC60). CRT responses were defined using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version?1.1). Results: Thirty patients were included. Non-responders demonstrated higher baseline TLG (p?= 0.012), and lower baseline Ktrans (p?= 0.020) and iAUC60 (p?= 0.016) compared to responders, indicating the usefulness of DCE integrated MR-PET to predict treatment responses. Receiver operating characteristic?curve indicated that TLG has the best differentiation capability to predict responders. By setting the threshold of TLG to 277, the sensitivity, specificity, and accuracy were 66.7%, 83.3%, and 75.0%, respectively, with an area under the curve of 0.776. The median follow-up time was 19.6 (range 7.8–32.0) months. In univariate analyses, baseline TLG >277 (p?= 0.005) and baseline Kt rans <254 (10?3?min?1; p?= 0.015) correlated with poor survival after CRT. In multivariate analysis, baseline TLG >277 remained the significant factor in predicting progression (p?= 0.012) and death (p?= 0.031). Conclusions: The radiologic parameters derived from DCE integrated MR-PET scans are useful for predicting treatment response in NSCLC patients treated with CRT; furthermore, these parameters are correlated with clinical and survival outcomes including tumor progression and death. ? 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Other Subjects
accuracy; adult; aged; apparent diffusion coefficient; area under the curve; area under the time concentration curve; Article; blood plasma volume fraction; cancer prognosis; cancer survival; chemoradiotherapy; clinical article; clinical outcome; controlled study; death; dynamic contrast-enhanced magnetic resonance imaging; extracellular extravascular volume fraction; female; follow up; glycolysis; human; male; maximum standardized uptake value; non small cell lung cancer; positron emission tomography; practice guideline; prospective study; radiological parameters; receiver operating characteristic; response evaluation criteria in solid tumors; reverse reflux rate constant; sensitivity and specificity; total lesion glycolysis; treatment response; tumor growth; tumor volume; very elderly; volume transfer constant; cancer staging; chemoradiotherapy; diagnostic imaging; drug effect; image enhancement; lung tumor; middle aged; mortality; non small cell lung cancer; nuclear magnetic resonance imaging; pathology; positron emission tomography; predictive value; procedures; prognosis; radiation response; survival rate; treatment outcome; contrast medium; Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy; Contrast Media; Female; Humans; Image Enhancement; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Prospective Studies; Survival Rate; Treatment Outcome; Tumor Burden
Type
journal article