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Quantification of global lung inflammation using volumetric 18F-FDG PET/CT parameters in locally advanced non-small-cell lung cancer patients treated with concurrent chemoradiotherapy: a comparison of photon and proton radiation therapy.

AbstractINTRODUCTION:
Radiation pneumonitis is a major dose-limiting complication in thoracic radiation therapy (RT) and presents clinically in the first few months after RT. We evaluated the feasibility of quantifying pulmonary parenchymal glycolysis (PG) as a surrogate of global lung inflammation and radiation-induced pulmonary toxicity using a novel semiautomatic lung segmentation technique in non-small-cell lung cancer (NSCLC) patients and compared PG in patients treated with photon or proton RT.
PATIENTS AND METHODS:
We evaluated 18 consecutive locally advanced NSCLC patients who underwent pretreatment and post-treatment F-FDG PET/CT treated with definitive (median: 66.6 Gy; 1.8 Gy fractions) photon or proton RT between 2010 and 2014. Lung volume segmentation was conducted using 3D Slicer by performing simple thresholding. Pulmonary PG was calculated by summing F-FDG uptake in the whole lung.
RESULTS:
In nine patients treated with photon RT, significant increases in PG in both ipsilateral (mean difference: 1400±510; P=0.02) and contralateral (mean difference: 1200±450; P=0.03) lungs were noted. In nine patients treated with proton therapy, no increase in pulmonary PG was observed in either the ipsilateral (P=0.30) or contralateral lung (P=0.98).
CONCLUSION:
We observed a significant increase in global lung inflammation bilaterally as measured by quantification of PG. However, no significant change in global lung inflammation was noted after proton therapy. Future larger studies are needed to determine whether this difference correlates with lower risks of radiation pneumonitis in NSCLC patients treated with proton therapy.
AuthorsStephanie R Rice, Babak Saboury, Sina Houshmand, Ali Salavati, Anusha Kalbasi, Chelain R Goodman, Thomas J Werner, Zeljko Vujaskovic, Charles B Simone 2nd, Abass Alavi
JournalNuclear medicine communications (Nucl Med Commun) Vol. 40 Issue 6 Pg. 618-625 (Jun 2019) ISSN: 1473-5628 [Electronic] England
PMID31095527 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Fluorodeoxyglucose F18
Topics
  • Aged
  • Carcinoma, Non-Small-Cell Lung (pathology, therapy)
  • Chemoradiotherapy (adverse effects)
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms (pathology, therapy)
  • Male
  • Middle Aged
  • Photons (adverse effects, therapeutic use)
  • Pneumonia (diagnostic imaging, etiology)
  • Positron Emission Tomography Computed Tomography
  • Proton Therapy (adverse effects)
  • Radiation Injuries (diagnostic imaging, etiology)
  • Retrospective Studies

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