A pilot study of [¹⁸F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non-small-cell lung cancer

Purpose: To study whether changes of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) during treatment correlate with post-treatment responses in tumor and normal lung in patients with non-small-cell lung cancer (NSCLC). Patients and Methods: Patients with stage I to III NSCLC requiring a definitive dose of fractionated radiation therapy (RT) were eligible. FDG-PET/computed tomography scans were acquired before, during, and after RT. Tumor and lung metabolic responses were assessed qualitatively by physicians and quantitatively by normalized peak FDG activity (the ratio of the maximum FDG activity divided by the mean of the aortic arch background). Results: The study reached the goal of recruiting 15 patients between February 2004 and August 2005. Of these, 11 patients had partial metabolic response, two patients had complete metabolic response, and two patients had stable disease at approximately 45 Gy during RT. The mean peak tumor FDG activity was 5.2 (95% CI, 4.0 to 6.4), 2.5 (95% CI, 2.0 to 3.0), and 1.7 (95% CI, 1.3 to 2.0) on pre-, during, and post-RT scans, respectively. None of the patients had appreciable changes in the lung during RT. The peak FDG activity of the lung was 0.47 (95% CI, 0.36 to 0.59), 0.52 (95% CI, 0.40 to 0.64), and 1.29 (95% CI, 0.82 to 1.76), on pre-, during-, and post-RT scans, respectively. The qualitative response during RT correlated with the overall response post-RT (P = .03); the peak tumor FDG activity during RT correlated with those 3 months post-RT (R² = 0.7; P < .001). Conclusion: This pilot study suggests a significant correlation in tumor metabolic response and no association in lung FDG activity between during RT scans and 3 months post-RT scans in patients with NSCLC. Additional study with a large number of patients is needed to validate these findings.