Prediction of response by FDG PET early during concurrent chemoradiotherapy for locally advanced non-small cell lung cancer

PURPOSE: To evaluate the predictive value of the early response of (18)F-flurodeoxyglucose positron emission tomography (FDG PET) during concurrent chemoradiotherapy (CCRT) for locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: FDG PET was performed before and during CCRT for 13 NSCLC patients. Maximum standardized uptake value (SUV(max)), mean standardized uptake value (SUV(mean)), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured and the changes were calculated. These early metabolic changes were compared with the standard tumor response by computed tomograms (CT) one month after CCRT. RESULTS: One month after the completion of CCRT, 9 patients had partial response (PR) of tumor and 4 patients had stable disease. The percent changes of SUV(max) (%ΔSUV(max)) were larger in responder group than in non-responder group (55.7% ± 15.6% vs. 23.1% ± 19.0%, p = 0.01). The percent changes of SUV(mean) (%ΔSUV(mean)) were also larger in responder group than in non-responder group (54.4% ± 15.9% vs. 22.3% ± 23.0%, p = 0.01). The percent changes of MTV (%ΔMTV) or TLG (%ΔTLG) had no correlation with the tumor response after treatment. All the 7 patients (100%) with %ΔSUV(max) ≥ 50% had PR, but only 2 out of 6 patients (33%) with %ΔSUV(max) < 50% had PR after CCRT (p = 0.009). Likewise, all the 6 patients (100%) with %ΔSUV(mean) ≥ 50% had PR, but only 3 out of 7 patients (43%) with %ΔSUV(mean) < 50% had PR after CCRT (p = 0.026). CONCLUSION: The degree of metabolic changes measured by PET-CT during CCRT was predictive for NSCLC tumor response after CCRT.