Department of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Dr MC 5847, Stanford, CA, 94305, USA.
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
Radiat Oncol. 2020 May 19;15(1):114. doi: 10.1186/s13014-020-01546-y.
We evaluated whether pre- and mid-treatment metabolic tumor volume (MTV) predicts per lesion local recurrence (LR) in patients treated with definitive radiation therapy (RT, dose≥60 Gy) for locally advanced non-small cell lung cancer (NSCLC).
We retrospectively reviewed records of patients with stage III NSCLC treated from 2006 to 2018 with pre- and mid-RT PET-CT. We measured the MTV of treated lesions on the pre-RT (MTV) and mid-RT (MTV) PET-CT. LR was defined per lesion as recurrence within the planning target volume. Receiver operating characteristic (ROC) curves, cumulative incidence rates, and uni- and multivariable (MVA) competing risk regressions were used to evaluate the association between MTV and LR.
We identified 111 patients with 387 lesions (112 lung tumors and 275 lymph nodes). Median age was 68 years, 69.4% were male, 46.8% had adenocarcinoma, 39.6% had squamous cell carcinoma, and 95.5% received concurrent chemotherapy. Median follow-up was 38.7 months. 3-year overall survival was 42.3%. 3-year cumulative incidence of LR was 26.8% per patient and 11.9% per lesion. Both MTV and MTV were predictive of LR by ROC (AUC = 0.71 and 0.76, respectively) and were significantly associated with LR on MVA (P = 0.004 and P = 7.1e-5, respectively). Among lesions at lower risk of LR based on MTV, higher MTV was associated with LR (P = 0.001).
Per-lesion, larger MTV and MTV predicted for increased risk of LR. MTV was more highly predictive of LR than MTV and if validated may allow for further discrimination of high-risk lesions at mid-RT informing dose painting strategies.
我们评估了在接受根治性放疗（剂量≥60Gy）治疗局部晚期非小细胞肺癌（NSCLC）的患者中，治疗前和中期代谢肿瘤体积（MTV）是否可以预测每处病变的局部复发（LR）。
我们回顾性分析了 2006 年至 2018 年接受局部晚期 NSCLC 根治性放疗的患者的 PET-CT 记录。我们在治疗前（MTV）和中期（MTV）PET-CT 上测量了治疗病变的 MTV。根据计划靶区的复发定义为病变内的局部复发。使用受试者工作特征（ROC）曲线、累积发生率以及单变量和多变量（MVA）竞争风险回归来评估 MTV 与 LR 之间的关系。
我们确定了 111 例患者的 387 处病变（112 个肺肿瘤和 275 个淋巴结）。中位年龄为 68 岁，69.4%为男性，46.8%为腺癌，39.6%为鳞癌，95.5%接受了同步化疗。中位随访时间为 38.7 个月。3 年总生存率为 42.3%。3 年患者的 LR 累积发生率为 26.8%，病变的 LR 累积发生率为 11.9%。MTV 和 MTV 通过 ROC 均具有预测 LR 的能力（AUC 分别为 0.71 和 0.76），并且在 MVA 中与 LR 显著相关（P=0.004 和 P=7.1e-5）。在基于 MTV 病变 LR 风险较低的情况下，较高的 MTV 与 LR 相关（P=0.001）。
每处病变较大的 MTV 和 MTV 预测 LR 风险增加。MTV 比 MTV 更能预测 LR，如果得到验证，可能会进一步区分中期 RT 时高风险病变，为剂量绘画策略提供信息。
