Research

CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment

Saloomeh Vahdat¹ , Eric K Oermann¹ , Sean P Collins¹ , Xia Yu¹ , Malak Abedalthagafi² , Pedro DeBrito² , Simeng Suy¹ , Shadi Yousefi⁵ , Constanza J Gutierrez⁵ , Thomas Chang⁶ , Filip Banovac⁶ , Eric D Anderson³ , Giuseppe Esposito⁴ and Brian T Collins¹

¹  Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA

²  Department of Pathology, Georgetown University Hospital, Washington, DC, USA

³  Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Hospital, Washington, DC, USA

⁴  Department of Nuclear Medicine, Georgetown University Hospital, Washington, DC, USA

⁵  Department of Radiology, Georgetown University Hospital, Washington, DC, USA

⁶  Division of Vascular & Interventional Radiology, Georgetown University Hospital, Washington, DC, USA

author email corresponding author email

Journal of Hematology & Oncology 2010, 3:6doi:10.1186/1756-8722-3-6

Published:	4 February 2010

Abstract

Objective

To report serial 18F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) tumor response following CyberKnife radiosurgery for stage IA non-small cell lung cancer (NSCLC).

Methods

Patients with biopsy-proven inoperable stage IA NSCLC were enrolled into this IRB-approved study. Targeting was based on 3-5 gold fiducial markers implanted in or near tumors. Gross tumor volumes (GTVs) were contoured using lung windows; margins were expanded by 5 mm to establish the planning treatment volumes (PTVs). Doses ranged from 42-60 Gy in 3 equal fractions. ¹⁸F-FDG PET/CT was performed prior to and at 3-6-month, 9-15 months and 18-24 months following treatment. The tumor maximum standardized uptake value (SUV_max) was recorded for each time point.

Results

Twenty patients with an average maximum tumor diameter of 2.2 cm were treated over a 3-year period. A mean dose of 51 Gy was delivered to the PTV in 3 to 11 days (mean, 7 days). The 30-Gy isodose contour extended an average of 2 cm from the GTV. At a median follow-up of 43 months, the 2-year Kaplan-Meier overall survival estimate was 90% and the local control estimate was 95%. Mean tumor SUV_max before treatment was 6.2 (range, 2.0 to 10.7). During early follow-up the mean tumor SUV_max remained at 2.3 (range, 1.0 to 5.7), despite transient elevations in individual tumor SUV_max levels attributed to peritumoral radiation-induced pneumonitis visible on CT imaging. At 18-24 months the mean tumor SUV_max for controlled tumors was 2.0, with

a narrow range of values (range, 1.5 to 2.8). A single local failure was confirmed at 24 months in a patient with an elevated tumor SUV_max of 8.4.

Conclusion

Local control and survival following CyberKnife radiosurgery for stage IA NSCLC is exceptional. Early transient increases in tumor SUV_max are likely related to radiation-induced pneumonitis. Tumor SUV_maxvalues return to background levels at 18-24 months, enhancing ¹⁸F-FDG PET/CT detection of local failure. The value of ¹⁸F-FDG PET/CT imaging for surveillance following lung SBRT deserves further study.