title: Compliance with PET acquisition protocols for therapeutic monitoring of erlotinib therapy in an international trial for patients with non-small cell lung cancer.
abstract: OBJECTIVE
  The Response Evaluation Criteria in Solid Tumors (RECIST) are widely used but have recognized limitations. Molecular imaging assessments, including changes in (18)F-deoxyglucose (FDG) or (18)F-deoxythymidine (FLT) uptake by positron emission tomography (PET), may provide earlier, more robust evaluation of treatment efficacy.
  
  
  METHODS
  A prospective trial evaluated on-treatment changes in FDG and FLT PET imaging among patients with relapsed or recurrent non-small cell lung cancer treated with erlotinib to assess the relationship between PET-evaluated response and clinical outcomes. We describe an audit of compliance with the study imaging charter, to establish the feasibility of achieving methodological consistency in a multicentre setting.
  
  
  RESULTS
  Patients underwent PET scans at baseline and approximately day 14 and day 56 of treatment (n = 73, 66 and 51 studies, and n = 73, 63 and 50 studies for FDG PET and FLT PET, respectively). Blood glucose levels were within the target range for all FDG PET scans. Charter-specified uptake times were achieved in 86% (63/73) and 89% (65/73) of baseline FDG and FLT scans, respectively. On-treatment scans were less consistent: 72% (84/117) and 68% (77/113), respectively, achieved the target of ±5 min of baseline uptake time. However, 96% (112/117) and 94% (106/113) of FDG and FLT PET studies, respectively, were within ±15 min. Bland-Altman analysis of intra-individual hepatic average standardized uptake value (SUV(ave)), to assess reproducibility, showed only a small difference in physiological uptake (-0.006 ± 0.224 in 118 follow-up FDG scans and 0.09 ± 0.81 in 111 follow-up FLT scans).
  
  
  CONCLUSIONS
  It is possible to achieve high reproducibility of scan acquisition methodology, provided that strict imaging compliance guidelines are mandated in the study protocol.
authors.affiliation: The Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Binns
authors.forename: Andrea
authors.initials: A
authors.lastname: Pirzkall
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: Jason
authors.initials: J
authors.lastname: Callahan
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.forename: Peter
authors.initials: P
authors.lastname: Conti
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Scott
authors.forename: David
authors.initials: D
authors.lastname: Macfarlane
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Fine
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
mesh_terms: D001692:Biological Transport; D001786:Blood Glucose / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D015224:Dideoxynucleosides / Q000378:metabolism; D000069347:Erlotinib Hydrochloride; D005240:Feasibility Studies; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008175:Lung Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards; D011786:Quality Control; D011799:Quinazolines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D015224:Dideoxynucleosides; D011799:Quinazolines; D019788:Fluorodeoxyglucose F18; D000069347:Erlotinib Hydrochloride; C002854:alovudine