ABSTRACT
Lung cancers are the most common tumors with low survival despite significant advances in both diagnostic and therapeutic approaches. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the most accurate method for detecting primary, nodal and metastatic areas for lung cancer staging. Depending on the stage of the disease, treatment options such as surgery, chemotherapy, radiotherapy, targeted therapies, immunotherapy and radiofrequency ablation are available. Post-treatment imaging is important for determining the efficacy of treatment, correct use of treatment options, early recognition of potentially salvageable recurrence and predicting prognosis. Anatomical imaging such as Thorax CT has limited accuracy in distinguishing viable tumor from post-treatment changes (cavitation, inflammation, consolidation, fibrosis). It is known that FDG PET/CT can change patient management by detecting residual/relapsing disease earlier and more accurately. However, the guidelines do not recommend the use of FDG PET/CT in the routine follow-up of lung cancers. It is preferred to perform when CT is non-diagnostic or disease recurrence is suspected. In this article, the role of FDG PET/CT in evaluating treatment response in lung cancers is discussed.
References
1Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7-30.
2Ettinger DS, Wood DE, Aisner DL, et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 2.2021. J Natl Compr Canc Netw 2021;19:254-266.
3Kalemkerian GP, Loo BW, Akerley W, et al. NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018. J Natl Compr Canc Netw 2018;16:1171-1182.
4Heineman DJ, Daniels JM, Schreurs WH. Clinical staging of NSCLC: current evidence and implications for adjuvant chemotherapy. Ther Adv Med Oncol 2017;9:599-609.
5Yılmaz Ü. Akciğer Kanserlerinde Tedavi Yaklaşımları. Nucl Med Semin 2018;4:32-38.
6National Comprehensive Cancer Network (NCCN) Guidelines. Non-small cell lung cancer, version 4.2021. www.nccn.org/guidelines
7Mirili C, Guney IB, Paydas S, et al. Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC). Int J Clin Oncol 2019;24:168-178.
8National Comprehensive Cancer Network (NCCN) Guidelines. Small cell lung cancer, version 3.2021. www.nccn.org/guidelines
9Treglia G, Castaldi P, Rindi G, Giordano A, Rufini V. Diagnostic performance of Gallium-68 somatostatin receptor PET and PET/CT in patients with thoracic and gastroenteropancreatic neuroendocrine tumours: a meta-analysis. Endocrine 2012;42:80-87.
10Selçuk NA, Demirci E, Kabasakal L, et al. Nöroendokrin Tümörlerde Ga-68 DOTA Bağlı Somatostatin Reseptör Hedefli Peptitler ile PET/BT Uygulama Kılavuzu. Nucl Med Semin 2020;6:397-405.
11Surveillance, Epidemiology, and End Results Program. SEER cancer statistics review, 1975–2012,lung cancer. National Cancer Institute website. seer. cancer.gov/archive/csr/1975_2012/.
12Sheikhbahaei S, Verde F, Hales RK, Rowe SP, Solnes LB. Imaging in Therapy Response Assessment and Surveillance of Lung Cancer: Evidenced-based Review With Focus on the Utility of 18F-FDG PET/CT. Clin Lung Cancer 2020;21:485-497.
13Turgeon GA, Iravani A, Akhurst T, et al. What 18F-FDG PET Response-Assessment Method Best Predicts Survival After Curative-Intent Chemoradiation in Non-Small Cell Lung Cancer: EORTC, PERCIST, Peter Mac Criteria, or Deauville Criteria? J Nucl Med 2019;60:328-334.
14Mielgo-Rubio X, Uribelarrea EA, Cortés LQ, Moyano MS. Immunotherapy in non-small cell lung cancer: Update and new insights. J Clin Transl Res 2021;7:1-21.
15Paz-Ares L, Dvorkin M, Chen Y, et al. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 2019;394:1929-1939.
16Ready NE, Ott PA, Hellmann MD, et al. Nivolumab Monotherapy and Nivolumab Plus Ipilimumab in Recurrent Small Cell Lung Cancer: Results From the CheckMate 032 Randomized Cohort. J Thorac Oncol 2020;15:426-435.
17Evangelista L, Sepulcri M, Pasello G. PET/CT and the Response to Immunotherapy in Lung Cancer. Curr Radiopharm 2020;13:177-184.
18Beer L, Hochmair M, Prosch H. Pitfalls in the radiological response assessment of immunotherapy. Memo 2018;11:138-143.
19Decazes P, Bohn P. Immunotherapy by Immune Checkpoint Inhibitors and Nuclear Medicine Imaging: Current and Future Applications. Cancers (Basel) 2020;12:371.
20Kwak JJ, Tirumani SH, Van den Abbeele AD, Koo PJ, Jacene HA. Cancer immunotherapy: imaging assessment of novel treatment response patterns and immune-related adverse events. Radiographics 2015;35:424-437.
21Westeel V, Choma D, Clément F, et al. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg 2000;70:1185-1190.
22Dane B, Grechushkin V, Plank A, Moore W, Bilfinger T. PET/CT vs. non-contrast CT alone for surveillance 1-year post lobectomy for stage I non-small-cell lung cancer. Am J Nucl Med Mol Imaging 2013;3:408-416.
23Cho S, Lee EB. A follow-up of integrated positron emission tomography/computed tomography after curative resection of non-small-cell lung cancer in asymptomatic patients. J Thorac Cardiovasc Surg 2010;139:1447-1451.
24Choi SH, Kim YT, Kim SK, et al. Positron emission tomography-computed tomography for postoperative surveillance in non-small cell lung cancer. Ann Thorac Surg 2011;92:1826-1832; discussion 1832.
25Toba H, Kawakita N, Takashima M, et al. Diagnosis of recurrence and follow-up using FDG-PET/CT for postoperative non-small-cell lung cancer patients. Gen Thorac Cardiovasc Surg 2021;69:311-317.
26Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017;47:579-594.
27William WN Jr, Pataer A, Kalhor N, et al. Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non-small-cell lung cancer after neoadjuvant chemotherapy. J Thorac Oncol 2013;8:222-228.
28Sheikhbahaei S, Mena E, Yanamadala A, et al. The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer. AJR Am J Roentgenol 2017;208:420-433.
29Palmero R, Vilariño N, Navarro-Martín A, Nadal E. Induction treatment in patients with stage III non-small cell lung cancer. Transl Lung Cancer Res 2021;10:539-554.
30Chung JH, Kang SY, Wu HG, et al. Risk stratification of symptomatic brain metastases by clinical and FDG PET parameters for selective use of prophylactic cranial irradiation in patients with extensive disease of small cell lung cancer. Radiother Oncol 2020;143:81-87.
31Jeremic B, Shibamoto Y, Nikolic N, et al. Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study. J Clin Oncol 1999;17:2092-2099.
32Özmen Ö. Torasik Tümörlerde Nükleer Tıp Uygulamaları. Yılmaz Ü. Editör.Torasik Tümörler. Gögüs Hastalıkları Kitabı, Türkiye Solunum Araştırmaları Derneği TÜSAD Eğitim Kitapları Serisi-22 Yayın Tarihi 2019. p. J108-J128.ISBN numarası 978- 605-89519-4-5 Yayın Evi: Türkiye Solunum Araştırmaları Derneği
33Christensen TN, Andersen PK, Langer SW, Fischer BMB. Prognostic Value of 18F-FDG-PET Parameters in Patients with Small Cell Lung Cancer: A Meta-Analysis and Review of Current Literature. Diagnostics (Basel) 2021;11:174.
34Blum R, MacManus MP, Rischin D, Michael M, Ball D, Hicks RJ. Impact of positron emission tomography on the management of patients with small-cell lung cancer: preliminary experience. Am J Clin Oncol 2004;27:164-171.
35Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015;42:328-354.
36Evangelista L, Cuppari L, Menis J, et al. 18F-FDG PET/CT in non-small-cell lung cancer patients: a potential predictive biomarker of response to immunotherapy. Nucl Med Commun 2019;40:802-807.
37Kaira K, Higuchi T, Naruse I, et al. Metabolic activity by 18F-FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC. Eur J Nucl Med Mol Imaging 2018;45:56-66.
38Tao X, Li N, Wu N, et al. The efficiency of 18F-FDG PET-CT for predicting the major pathologic response to the neoadjuvant PD-1 blockade in resectable non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2020;47:1209-1219.
39Rossi G, Bauckneht M, Genova C, et al. Comparison Between 18F-FDG PET-Based and CT-Based Criteria in Non-Small Cell Lung Cancer Patients Treated with Nivolumab. J Nucl Med 2020;61:990-998.
40Aide N, Hicks RJ, Le Tourneau C, Lheureux S, Fanti S, Lopci E. FDG PET/CT for assessing tumour response to immunotherapy: Report on the EANM symposium on immune modulation and recent review of the literature. Eur J Nucl Med Mol Imaging 2019;46:238-250.
41Na F, Wang J, Li C, Deng L, Xue J, Lu Y. Primary tumor standardized uptake value measured on F18-Fluorodeoxyglucose positron emission tomography is of prediction value for survival and local control in non-small-cell lung cancer receiving radiotherapy: meta-analysis. J Thorac Oncol 2014;9:834-842.
42Hoopes DJ, Tann M, Fletcher JW, et al. FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. Lung Cancer 2007;56:229-234.
43Binkley MS, Koenig JL, Kashyap M, et al. Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume. Radiat Oncol 2020;15:114.
44Ohri N, Bodner WR, Halmos B, et al. 18F-Fluorodeoxyglucose/Positron Emission Tomography Predicts Patterns of Failure After Definitive Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017;97:372-380.
45Kong FM, Ten Haken RK, Schipper M, et al. Effect of Midtreatment PET/CT-Adapted Radiation Therapy With Concurrent Chemotherapy in Patients With Locally Advanced Non-Small-Cell Lung Cancer: A Phase 2 Clinical Trial. JAMA Oncol 2017;3:1358-1365.
46Higuchi M, Suzuki H, Gotoh M. Role of PET/Computed Tomography in Radiofrequency Ablation for Malignant Pulmonary Tumors. PET Clin 2016;11:47-55.
47He YQ, Gong HL, Deng YF, Li WM. Diagnostic efficacy of PET and PET/CT for recurrent lung cancer: a meta-analysis. Acta Radiol 2014;55:309-317.
