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Role of interim 18F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review

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Abstract

Background

Non-Small Cell Lung Cancer (NSCLC) is characterized by aggressiveness and includes the majority of thorax malignancies. The possibility of early stratification of patients as responsive and non-responsive to radiotherapy with a non-invasive method is extremely appealing. The distribution of the Fluorodeoxyglucose (18F–FDG) in tumours, provided by Positron-Emission-Tomography (PET) images, has been proved to be useful to assess the initial staging of the disease, recurrence, and response to chemotherapy and chemo-radiotherapy (CRT).

Objectives

In the last years, particular efforts have been focused on the possibility of using ad interim 18F–FDG PET (FDGint) to evaluate response already in the course of radiotherapy. However, controversial findings have been reported for various malignancies, although several results would support the use of FDGint for individual therapeutic decisions, at least in some pathologies. The objective of the present review is to assemble comprehensively the literature concerning NSCLC, to evaluate where and whether FDGint may offer predictive potential.

Methods

Several searches were completed on Medline and the Embase database, combining different keywords. Original papers published in the English language from 2005 to 2016 with studies involving FDGint in patients affected by NSCLC and treated with radiation therapy or chemo-radiotherapy only were chosen.

Results

Twenty-one studies out of 970 in Pubmed and 1256 in Embase were selected, reporting on 627 patients.

Conclusion

Certainly, the lack of univocal PET parameters was identified as a major drawback, while standardization would be required for best practice. In any case, all these papers denoted FDGint as promising and a challenging examination for early assessment of outcomes during CRT, sustaining its predictivity in lung cancer.

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Acknowledgements

The authors gratefully acknowledge Dr. Maria Dolors Del Hoyo Pastor for her kind support and constructive discussions.

Author information

Author notes

  1. Cristina Garibaldi and Roberto Orecchia contributed equally to this work and should be considered as co-last authors.

Authors and Affiliations

  1. Radiation Research Unit, European Institute of Oncology, Milano, Italy

    Marta Cremonesi & Cristina Garibaldi

  2. Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy

    Laura Gilardi, Laura Lavinia Travaini & Chiara Maria Grana

  3. Medical Physics Unit, European Institute of Oncology, Milano, Italy

    Mahila Esmeralda Ferrari & Francesca Botta

  4. Division of Radiation Oncology, European Institute of Oncology, Milano, Italy

    Gaia Piperno, Sara Ronchi, Delia Ciardo & Barbara Alicja Jereczek-Fossa

  5. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Robert Timmerman

  6. Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milano, Italy

    Guido Baroni

  7. Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy

    Barbara Alicja Jereczek-Fossa & Roberto Orecchia

  8. Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milano, Italy

    Roberto Orecchia

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  1. Marta Cremonesi
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Correspondence to Marta Cremonesi.

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Cremonesi, M., Gilardi, L., Ferrari, M.E. et al. Role of interim 18F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review. Eur J Nucl Med Mol Imaging 44, 1915–1927 (2017). https://doi.org/10.1007/s00259-017-3762-9

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