An (18)F-FDG PET/CT and mean lung dose model to predict early radiation pneumonitis in stage III non-small cell lung cancer patients treated with chemoradiation and immunotherapy Journal Article
| Authors: | Thor, M.; Lee, C.; Sun, L.; Patel, P.; Apte, A.; Grkovski, M.; Shepherd, A. F.; Gelblum, D. Y.; Wu, A. J.; Simone, C. B. 2nd; Chaft, J. E.; Rimner, A.; Gomez, D. R.; Deasy, J. O.; Shaverdian, N. |
| Article Title: | An (18)F-FDG PET/CT and mean lung dose model to predict early radiation pneumonitis in stage III non-small cell lung cancer patients treated with chemoradiation and immunotherapy |
| Abstract: | Radiation pneumonitis (RP) that develops early (i.e., within 3mo) (RPEarly) after completion of concurrent chemoradiation (cCRT) leads to treatment discontinuation and poorer survival for patients with stage III non-small cell lung cancer. Since no RPEarly risk model exists, we explored whether published RP models and pretreatment 18FFDG PET/CT-derived features predict RPEarly. Methods: One hundred sixty patients with stage III non-small cell lung cancer treated with cCRT and consolidative immunotherapy were analyzed for RPEarly. Three published RP models that included the mean lung dose (MLD) and patient characteristics were examined. Pretreatment 18F-FDG PET/CT normal-lung SUV featured included the following: 10th percentile of SUV (SUVP10), 90th percentile of SUV (SUVP90), SUVmax, SUVmean, minimum SUV, and SD. Associations between models/ features and RPEarly were assessed using area under the receiveroperating characteristic curve (AUC), P values, and the Hosmer- Lemeshow test (pHL). The cohort was randomly split, with similar RPEarly rates, into a 70%/30% derivation/internal validation subset. Results: Twenty (13%) patients developed RPEarly. Predictors for RPEarly were MLD alone (AUC, 0.72; P = 0.02; pHL, 0.87), SUVP10, SUVP90, and SUVmean (AUC, 0.70-0.74; P = 0.003-0.006; pHL, 0.67- 0.70). The combined MLD and SUVP90 model generalized in the validation subset and was deemed the final RPEarly model (RPEarly risk 5 1/[11e(2x)]; x5 26.08 1 [0.17 3 MLD] 1 [1.63 3 SUVP90]). The final model refitted in the 160 patients indicated improvement over the published MLD-alone model (AUC, 0.77 vs. 0.72; P = 0.0001 vs. 0.02; pHL, 0.65 vs. 0.87). Conclusion: Patients at risk for RPEarly can be detected with high certainty by combining the normal lung's MLD and pretreatment 18F-FDG PET/CT SUVP90. This refined model can be used to identify patients at an elevated risk for premature immunotherapy discontinuation due to RPEarly and could allow for interventions to improve treatment outcomes. © 2024 by the Society of Nuclear Medicine andMolecular Imaging. |
| Keywords: | adult; controlled study; aged; retrospective studies; unclassified drug; major clinical study; area under the curve; treatment planning; validation process; cancer radiotherapy; radiation dose; cancer staging; antineoplastic agent; cancer immunotherapy; radiation; carcinoma, non-small-cell lung; lung neoplasms; cohort analysis; diagnostic imaging; radiation injury; retrospective study; prediction; risk; lung tumor; statistical significance; immunotherapy; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; lung; non-small cell lung cancer; radiation pneumonia; chemoradiotherapy; pet/ct; clinical assessment tool; pneumonitis; non small cell lung cancer; concurrent chemoradiation; clinical outcome; radiation pneumonitis; oncological parameters; very elderly; humans; human; male; female; article; internal validation; durvalumab; mean lung dose; positron emission tomography-computed tomography; positron emission tomography computed tomography; cisplatin plus etoposide; carboplatin plus paclitaxel; carboplatin plus pemetrexed; cisplatin plus pemetrexed; hosmer lemeshow test; standardized uptake value ratio |
| Journal Title: | Journal of Nuclear Medicine |
| Volume: | 65 |
| Issue: | 4 |
| ISSN: | 0161-5505 |
| Publisher: | Society of Nuclear Medicine |
| Date Published: | 2024-04-01 |
| Start Page: | 520 |
| End Page: | 526 |
| Language: | English |
| DOI: | 10.2967/jnumed.123.266965 |
| PUBMED: | 38485270 |
| PROVIDER: | scopus |
| PMCID: | PMC10995528 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Maria Thor -- Source: Scopus |
