Relating acute esophagitis to radiotherapy dose using FDG-PET in concurrent chemo-radiotherapy for locally advanced non-small cell lung cancer

PURPOSE: To correlate radiotherapy (RT) dose to acute esophagitis (AE) by means of FDG-PET scans acquired after concurrent chemo-radiotherapy (cCRT) for locally advanced non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS: Patients treated with 24 × 2.75 Gy were selected on presence of a post-RT PET (PET(post)) scan acquired within 3 months after cCRT. The value of PET(post) in relation to AE was evaluated by comparing the mean esophageal SUV of the highest 50% (mathematical left angle bracket SUV(50%) mathematical right angle bracket) between gr < 2 and gr ≥ 2AE. The local dose on the esophagus wall was correlated to the SUV and modeled using a power-law fit. The Lyman-Kutcher-Burman (LKB) model was used to predict gr ≥ 2AE. The local dose-response relation was used in the LKB model to calculate the EUD. Resulting prediction accuracy was compared to D(mean), V(35), V(55) and V(60).

RESULTS: Eighty-two patients were included (gr < 2 = 25, gr ≥ 2=57). The mathematical left angle bracket SUV(50%) mathematical right angle bracket ≥ was significantly higher for gr ≥ 2AE (2.2 vs. 2.6, p < 0.01). The LKB parameters (95% CI) were n = 0.130 (0.120-0.141), m = 0.25 (0.13-0.85) and TD(50) = 50.4 Gy (37.5-55.4), which resulted in improved predictability of AE compared to other predictors.

CONCLUSION: Esophageal uptake of FDG post-cCRT reflects AE severity. Predictability of grade ≥ 2AE was improved by using the local dose-SUV response model, with narrow confidence intervals for the optimized LKB parameters.