[¹⁸F]fluorodeoxyglucose uptake patterns in lung before radiotherapy identify areas more susceptible to radiation-induced lung toxicity in non-small-cell lung cancer patients

Steven F Petit*, Wouter J C van Elmpt, Cary J G Oberije, Erik Vegt, Anne-Marie C Dingemans, Philippe Lambin, André L A J Dekker, Dirk De Ruysscher

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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PURPOSE: Our hypothesis was that pretreatment inflammation in the lung makes pulmonary tissue more susceptible to radiation damage. The relationship between pretreatment [(18)F]fluorodeoxyglucose ([(18)F]FDG) uptake in the lungs (as a surrogate for inflammation) and the delivered radiation dose and radiation-induced lung toxicity (RILT) was investigated.

METHODS AND MATERIALS: We retrospectively studied a prospectively obtained cohort of 101 non-small-cell lung cancer patients treated with (chemo)radiation therapy (RT). [(18)F]FDG-positron emission tomography-computed tomography (PET-CT) scans used for treatment planning were studied. Different parameters were used to describe [(18)F]FDG uptake patterns in the lungs, excluding clinical target volumes, and the interaction with radiation dose. An increase in the dyspnea grade of 1 (Common Terminology Criteria for Adverse Events version 3.0) or more points compared to the pre-RT score was used as an endpoint for analysis of RILT. The effect of [(18)F]FDG and CT-based variables, dose, and other patient or treatment characteristics that effected RILT was studied using logistic regression.

RESULTS: Increased lung density and pretreatment [(18)F]FDG uptake were related to RILT after RT with univariable logistic regression. The 95th percentile of the [(18)F]FDG uptake in the lungs remained significant in multivariable logistic regression (p = 0.016; odds ratio [OR] = 4.3), together with age (p = 0.029; OR = 1.06), and a pre-RT dyspnea score of ≥1 (p = 0.005; OR = 0.20). Significant interaction effects were demonstrated among the 80th, 90th, and 95th percentiles and the relative lung volume receiving more than 2 and 5 Gy.

CONCLUSIONS: The risk of RILT increased with the 95th percentile of the [(18)F]FDG uptake in the lungs, excluding clinical tumor volume (OR = 4.3). The effect became more pronounced as the fraction of the 5%, 10%, and 20% highest standardized uptake value voxels that received more than 2 Gy to 5 Gy increased. Therefore, the risk of RILT may be decreased by applying sophisticated radiotherapy techniques to avoid areas in the lung with high [(18)F]FDG uptake.

Original languageEnglish
Pages (from-to)698-705
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
Publication statusPublished - 1 Nov 2011


  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung
  • Chemoradiotherapy
  • Dyspnea
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Logistic Models
  • Lung
  • Lung Neoplasms
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Odds Ratio
  • Positron-Emission Tomography
  • Radiation Pneumonitis
  • Radiopharmaceuticals
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Journal Article
  • Research Support, Non-U.S. Gov't

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