title: Maximum standardized uptake value on FDG-PET is a strong predictor of overall and disease-free survival for non-small-cell lung cancer patients after stereotactic body radiotherapy.
abstract: BACKGROUND
  The maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose positron emission tomography is a predictor for overall survival (OS) in non-small-cell lung cancer (NSCLC) after resection. We investigated the association between SUVmax and outcomes in NSCLC after stereotactic body radiotherapy.
  
  
  METHODS
  Between 2005 and 2012, 283 patients with early NSCLC (T1a-2N0M0) were treated with stereotactic body radiotherapy; the total doses were 40 to 60 Gy in five fractions. Patients who underwent staging F-fluorodeoxyglucose positron emission tomography scans by a single scanner and were followed up for more than or who died within 6 months were eligible. The optimal threshold SUVmax was calculated for each outcome. Outcomes were analyzed using the Kaplan-Meier method and log-rank test. Prognostic significance was assessed by univariate and multivariate analyses.
  
  
  RESULTS
  One hundred fifty-two patients were eligible. Median follow-up was 25.3 (range, 1.3-77.4) months. Local, regional, and distant recurrences, cancer-specific deaths, and deaths from other reasons occurred in 14, 11, 27, 21, and 31 patients, respectively. The optimal threshold SUVmax for local, regional, and distant recurrences, and disease-free survival (DFS), cancer-specific survival, and OS were 2.47 to 3.64. Outcomes of patients with SUVmax lower than each threshold were significantly better than those with higher SUVmax (all p<0.005): 3-year DFS rates were 93.0% versus 58.3% (p<0.001) and 3-year OS rates were 86.5% versus 42.2% (p<0.001), respectively. By multivariate analysis, higher SUVmax was a significantly worse predictor for DFS (p<0.01) and OS (p=0.04).
  
  
  CONCLUSIONS
  SUVmax was a predictor for DFS and OS. A high SUVmax may be considered for intensive treatment to improve outcomes.
authors.affiliation: *Department of Radiology, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan; †Division of Functional Imaging, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan; ‡Department of Radiology, Yuai Clinic, Yokohama, Japan; and §Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Takeda
authors.forename: Naoko
authors.initials: N
authors.lastname: Sanuki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Fujii
authors.forename: Noriko
authors.initials: N
authors.lastname: Yokosuka
authors.forename: Shuichi
authors.initials: S
authors.lastname: Nishimura
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Aoki
authors.forename: Yohei
authors.initials: Y
authors.lastname: Oku
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Etsuo
authors.initials: E
authors.lastname: Kunieda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D016634:Radiosurgery; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18