title: Correlation of (18)F-FDG avid volumes on pre-radiation therapy and post-radiation therapy FDG PET scans in recurrent lung cancer.
abstract: OBJECTIVE
  To investigate the spatial correlation between high uptake regions of 2-deoxy-2-[(18)F]-fluoro-D-glucose positron emission tomography ((18)F-FDG PET) before and after therapy in recurrent lung cancer.
  
  
  METHODS
  We enrolled 106 patients with inoperable lung cancer into a prospective study whose primary objectives were to determine first, the earliest time point when the maximum decrease in FDG uptake representing the maximum metabolic response (MMR) is attainable and second, the optimum cutoff value of MMR based on its predicted tumor control probability, sensitivity, and specificity. Of those patients, 61 completed the required 4 serial (18)F-FDG PET examinations after therapy. Nineteen of 61 patients experienced local recurrence at the primary tumor and underwent analysis. The volumes of interest (VOI) on pretherapy FDG-PET were defined by use of an isocontour at ≥50% of maximum standard uptake value (SUVmax) (≥50% of SUVmax) with correction for heterogeneity. The VOI on posttherapy images were defined at ≥80% of SUVmax. The VOI of pretherapy and posttherapy (18)F-FDG PET images were correlated for the extent of overlap.
  
  
  RESULTS
  The size of VOI at pretherapy images was on average 25.7% (range, 8.8%-56.3%) of the pretherapy primary gross tumor volume (GTV), and their overlap fractions were 0.8 (95% confidence interval [CI]: 0.7-0.9), 0.63 (95% CI: 0.49-0.77), and 0.38 (95% CI: 0.19-0.57) of VOI of posttherapy FDG PET images at 10 days, 3 months, and 6 months, respectively. The residual uptake originated from the pretherapy VOI in 15 of 17 cases.
  
  
  CONCLUSIONS
  VOI defined by the SUVmax-≥50% isocontour may be a biological target volume for escalated radiation dose.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: nshusharina@partners.org.
authors.forename: Nadya
authors.initials: N
authors.lastname: Shusharina
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Sharp
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Noah C
authors.initials: NC
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy; D017239:Paclitaxel / Q000008:administration & dosage; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D020266:Radiotherapy, Conformal / Q000379:methods; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D016190:Carboplatin; D005947:Glucose; D017239:Paclitaxel
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