title: FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer.
abstract: OBJECTIVE
  Glucose metabolic activity measured by [(18)F]-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) has shown prognostic value in multiple malignancies, but results are often confounded by the inclusion of patients with various disease stages and undergoing various therapies. This study was designed to evaluate the prognostic value of tumor FDG uptake quantified by maximum standardized uptake value (SUVmax) in a large group of early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) using consistent treatment techniques.
  
  
  METHODS
  Two hundred nineteen lesions in 211 patients treated with definitive SBRT for stage I NSCLC were analyzed after a median follow-up of 25.2 months. Cox regression was used to determine associations between SUVmax and overall survival (OS), disease-specific survival (DSS), and freedom from local recurrence (FFLR) or distant metastasis (FFDM).
  
  
  RESULTS
  SUVmax >3.0 was associated with worse OS (p<0.001), FFLR (p=0.003) and FFDM (p=0.003). On multivariate analysis, OS was associated with SUVmax (HR 1.89, p=0.03), gross tumor volume (GTV) (HR 1.94, p=0.005) and Karnofsky performance status (KPS) (HR 0.51, p=0.008). DSS was associated only with SUVmax (HR 2.58, p=0.04). Both LR (HR 11.47, p=0.02) and DM (HR 3.75, p=0.006) were also associated with higher SUVmax.
  
  
  CONCLUSIONS
  In a large patient population, SUVmax >3.0 was associated with worse survival and a greater propensity for local recurrence and distant metastasis after SBRT for NSCLC.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Kohutek
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Amanda
authors.initials: A
authors.lastname: Foster
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Shaun U
authors.initials: SU
authors.lastname: Din
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Yorke
authors.affiliation: Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Downey
authors.affiliation: Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY, United States.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
authors.affiliation: Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States. Electronic address: rimnera@mskcc.org.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rimner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000379:methods; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Non-small cell lung cancer; PET; Stereotactic body radiation therapy