title: Performance of automatic image segmentation algorithms for calculating total lesion glycolysis for early response monitoring in non-small cell lung cancer patients during concomitant chemoradiotherapy.
abstract: This study evaluated the use of total lesion glycolysis (TLG) determined by different automatic segmentation algorithms, for early response monitoring in non-small cell lung cancer (NSCLC) patients during concomitant chemoradiotherapy.
  
  
  
  Twenty-seven patients with locally advanced NSCLC treated with concomitant chemoradiotherapy underwent (18)F-fluorodeoxyglucose (FDG) PET/CT imaging before and in the second week of treatment. Segmentation of the primary tumours and lymph nodes was performed using fixed threshold segmentation at (i) 40% SUVmax (T40), (ii) 50% SUVmax (T50), (iii) relative-threshold-level (RTL), (iv) signal-to-background ratio (SBR), and (v) fuzzy locally adaptive Bayesian (FLAB) segmentation. Association of primary tumour TLG (TLGT), lymph node TLG (TLGLN), summed TLG (TLGS=TLGT+TLGLN), and relative TLG decrease (ΔTLG) with overall-survival (OS) and progression-free survival (PFS) was determined using univariate Cox regression models.
  
  
  
  Pretreatment TLGT was predictive for PFS and OS, irrespective of the segmentation method used. Inclusion of TLGLN improved disease and early response assessment, with pretreatment TLGS more strongly associated with PFS and OS than TLGT for all segmentation algorithms. This was also the case for ΔTLGS, which was significantly associated with PFS and OS, with the exception of RTL and T40.
  
  
  
  ΔTLGS was significantly associated with PFS and OS, except for RTL and T40. Inclusion of TLGLN improves early treatment response monitoring during concomitant chemoradiotherapy with FDG-PET.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: W.Grootjans@lumc.nl.
authors.forename: Willem
authors.initials: W
authors.lastname: Grootjans
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Usmanij
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Wim J G
authors.initials: WJ
authors.lastname: Oyen
authors.affiliation: Department of Pulmonary Medicine, Radboud University Medical Center, The Netherlands.
authors.forename: Erik H F M
authors.initials: EH
authors.lastname: van der Heijden
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Visser
authors.affiliation: INSERM, UMR 1101 Laboratoire de Traitement de l'information Médicale (LaTIM), Brest, France.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Visvikis
authors.affiliation: INSERM, UMR 1101 Laboratoire de Traitement de l'information Médicale (LaTIM), Brest, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Hatt
authors.affiliation: Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Bussink
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, The Netherlands.
authors.forename: Lioe-Fee
authors.initials: LF
authors.lastname: de Geus-Oei
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001499:Bayes Theorem; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D016016:Proportional Hazards Models
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: (18)F-FDG PET/CT; Automatic image segmentation; Concomitant chemoradiochemotherapy; Early response monitoring; Non-small cell lung cancer; Total lesion glycolysis