News | PET-CT | July 14, 2017

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

News | Women's Health

October 11, 2021 — Electrical engineering professor Magda El-Shenawee’s effort to develop a more accurate and less ...

Time October 11, 2021
arrow
News | Quality Assurance (QA)

October 11, 2021 — To maintain safety in radiation therapy (RT), every machine performance and patient delivery ...

Time October 11, 2021
arrow
News | Radiation Therapy

October 7, 2021 — NANOBIOTIX, a late-stage clinical biotechnology company pioneering physics-based approaches to expand ...

Time October 07, 2021
arrow
Feature | Cardiac Imaging

October 6, 2021 – A new study published in Radiology: Cardiothoracic Imaging on cardiac imaging trends over a decade ...

Time October 06, 2021
arrow
Feature | Radiation Therapy | By Dave Fornell

To maintain safety in radiation therapy (RT), every machine performance and patient delivery measurement must be as ...

Time October 05, 2021
arrow
Feature | Radiation Therapy

September 28, 2021 — New research from Washington University School of Medicine in St. Louis suggests that radiation ...

Time September 28, 2021
arrow
News | Radiation Oncology

September 28, 2021 — The global radiotherapy devices market is expected to grow from $5.44 billion in 2020 to $5.848 ...

Time September 28, 2021
arrow
News | Prostate Cancer

September 24, 2021 — Scientists have identified two subtypes of metastatic prostate cancer that respond differently to ...

Time September 24, 2021
arrow
News | Radiation Therapy

September 24, 2021 — The "Global Surface Guided Radiation Therapy (SGRT) Devices Market, By Device Type (Portable v/s ...

Time September 24, 2021
arrow
News | Lung Imaging

September 23, 2021 — The National Cancer Institute announced that Virginia Commonwealth University Massey Cancer Center ...

Time September 23, 2021
arrow
Subscribe Now