title: FDG PET/CT texture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy.
abstract: BACKGROUND
  With (18)F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether (18)F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT).
  
  
  METHODS
  Sixty-three patients with NSCLC treated by SBRT underwent a (18)F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis.
  
  
  RESULTS
  The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the (18)F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01).
  
  
  CONCLUSIONS
  The textural feature dissimilarity measured on the baseline (18)F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization.
authors.affiliation: Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium. pierre.lovinfosse@chu.ulg.ac.be.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lovinfosse
authors.affiliation: Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium.
authors.forename: Zsolt Levente
authors.initials: ZL
authors.lastname: Janvary
authors.affiliation: Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Coucke
authors.affiliation: Department of Medical Physics, CHU of Liège, Liège, Belgium.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Jodogne
authors.affiliation: Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium.
authors.forename: Claire
authors.initials: C
authors.lastname: Bernard
authors.affiliation: LaTIM, INSERM UMR 1101, Brest, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Hatt
authors.affiliation: LaTIM, INSERM UMR 1101, Brest, France.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Visvikis
authors.affiliation: Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jansen
authors.affiliation: Division of Pulmonology, CHU Liège, Liège, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Duysinx
authors.affiliation: Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Hustinx
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; Heterogeneity; Non-small cell lung cancer; Prognostic factor; Stereotactic body radiation therapy; Textural analysis
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