News | PET-CT | July 14, 2017

PET/CT Tracer Identifies Vulnerable Lesions in Non-Small Cell Lung Cancer Patients

Tracer identifies hypoxic areas where increased radiotherapy dose proves beneficial to outcomes

PET/CT Tracer Identifies Vulnerable Lesions in Non-Small Cell Lung Cancer Patients

Example of a patient with an upper left lung NSCLC: A: FDG; B: FDG PET/CT; C: Planning radiotherapy based on FDG (66Gy) with BTVm (GTV), CTV and PTV; D: PET FMISO E: FMISO PET/CT; F: boost based on the FMISO PET (76Gy) with BTVh (biological hypoxic target volume) and PTV boost. Credit: QuantIF – LITIS EA 4108 – FR CNRS 3638, Henri Becquerel Cancer Center, Rouen, France

July 14, 2017 — Fluorine-18 (18F)-fluoromisonidazole (FMISO) is a positron emission tomography (PET) radiotracer that is widely used to diagnose hypoxia and non-small cell lung cancer (NSCLC) patients with FMISO uptake are known to face a poor prognosis. A multicenter French Phase II study featured in the July issue of The Journal of Nuclear Medicine (JNM) investigated whether a selective radiotherapy (RT) dose increase to tumor areas with significant FMISO uptake in NSCLC patients could improve outcomes.

The study, conducted by 15 academic PET facilities across France, evaluated 54 patients with localized, advanced non-small cell cancers, who were undergoing chemoradiotherapy. For each patient, two FDG-PET/CT (computed tomography) and two FMISO-PET/CT scans were performed using the same machine and under the identical operational conditions. Quality control was centrally supervised to secure homogeneity in the image quality in all participating centers. In 24 of the patients, the radiotherapy dose could be increased up to 86 Gy on hypoxic areas identified on FMISO PET/CT. Unfortunately, this dose increase did not improve patient outcomes.

On the bright side, Pierre Vera, M.D., Ph.D., of the Henri Becquerel Cancer Center and Rouen University Hospital in Rouen, France, noted, "We demonstrate that this approach of radiotherapy boost based on hypoxia PET is feasible in a multicenter setting. Regarding the clinical aspect, a recent randomized trial (Bradley Lancet Oncol 2015) failed to demonstrate the benefit of escalated radiotherapy dose in large target volumes. Our data show that smaller volumes, identified on their functional characteristics using hypoxia PET/CT, can be adequately targeted. In addition, no significant toxicity has been observed in patients receiving radiotherapy boost."

In an invited perspective, also published in the July JNM, Rodney J. Hicks, M.D., FRACP, FAHMS, of the Peter MacCallum Cancer Centre and the University of Melbourne in Melbourne, Australia, points out that negative results are instructive. He stated, "Clearly, hypoxia remains an evil foe in our battle to achieve better outcomes in non-small cell cancer. But by demonstrating its importance, Vera and colleagues pose us the challenge to design new combination therapies. ...[For example,] there may be synergy between radiation and check-point immunotherapy."

For more information: www.jnm.snmjournals.org

Related Content

Novel Technique May Significantly Reduce Breast Biopsies
News | Breast Biopsy Systems | January 17, 2019
A novel technique that uses mammography to determine the biological tissue composition of a tumor could help reduce...
Digital Mammography Increases Breast Cancer Detection
News | Mammography | January 16, 2019
The shift from film to digital mammography increased the detection of breast cancer by 14 percent overall in the United...
MIM Software Inc. Receives FDA 510(k) Clearance for Molecular Radiotherapy Dosimetry
Technology | Nuclear Imaging | January 16, 2019
MIM Software Inc. received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for molecular radiotherapy...
Artificial Intelligence Used in Clinical Practice to Measure Breast Density
News | Artificial Intelligence | January 15, 2019
An artificial intelligence (AI) algorithm measures breast density at the level of an experienced mammographer,...
Machine Learning Uncovers New Insights Into Human Brain Through fMRI
News | Neuro Imaging | January 11, 2019
An interdisciplinary research team led by scientists from the National University of Singapore (NUS) has successfully...
Mobile App Data Collection Shows Promise for Population Health Surveys
News | Population Health | January 10, 2019
Mobile app data collection can bring access to more potential clinical study participants, reduce clinical study...
Hypertension With Progressive Cerebral Small Vessel Disease Increases Cognitive Impairment Risk
News | Magnetic Resonance Imaging (MRI) | January 08, 2019
Patients with high blood pressure and progression of periventricular white matter hyperintensities showed signs of...
Artificial Intelligence Pinpoints Nine Different Abnormalities in Head Scans

A brain scan (left) showing an intraparenchymal hemorrhage in left frontal region and a scan (right) of a subarachnoid hemorrhage in the left parietal region. Both conditions were accurately detected by the Qure.ai tool. Image courtesy of Nature Medicine.

News | Artificial Intelligence | January 07, 2019
The rise in the use of computed tomography (CT) scans in U.S. emergency rooms has been a well-documented trend1 in...
Electronic Brachytherapy Effective in Long-Term Study of 1,000 Early-Stage Breast Cancers
News | Brachytherapy Systems, Women's Healthcare | January 07, 2019
Breast cancer recurrence rates of patients treated with intraoperative radiation therapy (IORT) using the Xoft Axxent...
Brachytherapy Alone Superior Treatment for Intermediate-Risk Prostate Cancer
News | Brachytherapy Systems | January 04, 2019
Patient-reported outcomes (PROs) indicated a significantly different clinician and patient-reported late toxicity...