Non–Small Cell Lung Cancer Treated with Erlotinib: Heterogeneity of 18F-FDG Uptake at PET—Association with Treatment Response and Prognosis

Gary J R Cook; Mary E. O'Brien; Muhammad Siddique; Sugama Chicklore; Hoi Y. Loi; Bhupinder Sharma; Ravi Punwani; Paul Bassett; Vicky Goh; Sue Chua; Sugama Chicklore

doi:10.1148/radiol.2015141309

Non–Small Cell Lung Cancer Treated with Erlotinib: Heterogeneity of 18F-FDG Uptake at PET—Association with Treatment Response and Prognosis

Gary J R Cook^*, Mary E. O'Brien, Muhammad Siddique, Sugama Chicklore, Hoi Y. Loi, Bhupinder Sharma, Ravi Punwani, Paul Bassett, Vicky Goh, Sue Chua, Sugama Chicklore

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

147 Citations (Scopus)

Abstract

Purpose

To determine if first-order and high-order textural features on fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) images of non–small cell lung cancer (NSCLC) (a) at baseline, (b) at 6 weeks, or (c) the percentage change between baseline and 6 weeks can predict response or survival in patients treated with erlotinib.

Materials and Methods

Institutional review board approval was obtained for post hoc analysis of data from a prospective single-center study for which informed consent was obtained. The study included 47 patients with NSCLC who underwent 18F-FDG PET/computed tomography (CT) at baseline (n = 47) and 6 weeks (n = 40) after commencing treatment with erlotinib. First-order and high-order primary tumor texture features reflecting image heterogeneity, standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured for all 18F-FDG PET studies. Response to erlotinib was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) on CT images obtained at 12 weeks (n = 32). Associations between PET parameters, overall survival (OS), and RECIST-based treatment response were tested by Cox and logistic regression analyses, respectively.

Results

Median OS was 14.1 months. According to CT RECIST at 12 weeks, there were 21 nonresponders and 11 responders. Response to erlotinib was associated with reduced heterogeneity (first-order standard deviation, P = .01; entropy, P = .001; uniformity, P = .001). At multivariable analysis, high-order contrast at 6 weeks (P = .002) and percentage change in first-order entropy (P = .03) were independently associated with survival. Percentage change in first-order entropy was also independently associated with treatment response (P = .01).

Conclusion

Response to erlotinib is associated with reduced heterogeneity at 18F-FDG PET. Changes in first-order entropy are independently associated with OS and treatment response.

Original language	English
Pages (from-to)	883-893
Number of pages	11
Journal	Radiology
Volume	276
Issue number	3
Early online date	17 Aug 2015
DOIs	https://doi.org/10.1148/radiol.2015141309
Publication status	Published - 1 Sept 2015

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1148/radiol.2015141309

Cite this

@article{56ee7e3de02d4dc797bdd38caf3877aa,

title = "Non–Small Cell Lung Cancer Treated with Erlotinib: Heterogeneity of 18F-FDG Uptake at PET—Association with Treatment Response and Prognosis",

abstract = "PurposeTo determine if first-order and high-order textural features on fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) images of non–small cell lung cancer (NSCLC) (a) at baseline, (b) at 6 weeks, or (c) the percentage change between baseline and 6 weeks can predict response or survival in patients treated with erlotinib.Materials and MethodsInstitutional review board approval was obtained for post hoc analysis of data from a prospective single-center study for which informed consent was obtained. The study included 47 patients with NSCLC who underwent 18F-FDG PET/computed tomography (CT) at baseline (n = 47) and 6 weeks (n = 40) after commencing treatment with erlotinib. First-order and high-order primary tumor texture features reflecting image heterogeneity, standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured for all 18F-FDG PET studies. Response to erlotinib was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) on CT images obtained at 12 weeks (n = 32). Associations between PET parameters, overall survival (OS), and RECIST-based treatment response were tested by Cox and logistic regression analyses, respectively.ResultsMedian OS was 14.1 months. According to CT RECIST at 12 weeks, there were 21 nonresponders and 11 responders. Response to erlotinib was associated with reduced heterogeneity (first-order standard deviation, P = .01; entropy, P = .001; uniformity, P = .001). At multivariable analysis, high-order contrast at 6 weeks (P = .002) and percentage change in first-order entropy (P = .03) were independently associated with survival. Percentage change in first-order entropy was also independently associated with treatment response (P = .01).ConclusionResponse to erlotinib is associated with reduced heterogeneity at 18F-FDG PET. Changes in first-order entropy are independently associated with OS and treatment response.",

author = "Cook, {Gary J R} and O'Brien, {Mary E.} and Muhammad Siddique and Sugama Chicklore and Loi, {Hoi Y.} and Bhupinder Sharma and Ravi Punwani and Paul Bassett and Vicky Goh and Sue Chua and Sugama Chicklore",

year = "2015",

month = sep,

day = "1",

doi = "10.1148/radiol.2015141309",

language = "English",

volume = "276",

pages = "883--893",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America",

number = "3",

}

TY - JOUR

T1 - Non–Small Cell Lung Cancer Treated with Erlotinib

T2 - Heterogeneity of 18F-FDG Uptake at PET—Association with Treatment Response and Prognosis

AU - Cook, Gary J R

AU - O'Brien, Mary E.

AU - Siddique, Muhammad

AU - Chicklore, Sugama

AU - Loi, Hoi Y.

AU - Sharma, Bhupinder

AU - Punwani, Ravi

AU - Bassett, Paul

AU - Goh, Vicky

AU - Chua, Sue

AU - Chicklore, Sugama

PY - 2015/9/1

Y1 - 2015/9/1

N2 - PurposeTo determine if first-order and high-order textural features on fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) images of non–small cell lung cancer (NSCLC) (a) at baseline, (b) at 6 weeks, or (c) the percentage change between baseline and 6 weeks can predict response or survival in patients treated with erlotinib.Materials and MethodsInstitutional review board approval was obtained for post hoc analysis of data from a prospective single-center study for which informed consent was obtained. The study included 47 patients with NSCLC who underwent 18F-FDG PET/computed tomography (CT) at baseline (n = 47) and 6 weeks (n = 40) after commencing treatment with erlotinib. First-order and high-order primary tumor texture features reflecting image heterogeneity, standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured for all 18F-FDG PET studies. Response to erlotinib was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) on CT images obtained at 12 weeks (n = 32). Associations between PET parameters, overall survival (OS), and RECIST-based treatment response were tested by Cox and logistic regression analyses, respectively.ResultsMedian OS was 14.1 months. According to CT RECIST at 12 weeks, there were 21 nonresponders and 11 responders. Response to erlotinib was associated with reduced heterogeneity (first-order standard deviation, P = .01; entropy, P = .001; uniformity, P = .001). At multivariable analysis, high-order contrast at 6 weeks (P = .002) and percentage change in first-order entropy (P = .03) were independently associated with survival. Percentage change in first-order entropy was also independently associated with treatment response (P = .01).ConclusionResponse to erlotinib is associated with reduced heterogeneity at 18F-FDG PET. Changes in first-order entropy are independently associated with OS and treatment response.

AB - PurposeTo determine if first-order and high-order textural features on fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) images of non–small cell lung cancer (NSCLC) (a) at baseline, (b) at 6 weeks, or (c) the percentage change between baseline and 6 weeks can predict response or survival in patients treated with erlotinib.Materials and MethodsInstitutional review board approval was obtained for post hoc analysis of data from a prospective single-center study for which informed consent was obtained. The study included 47 patients with NSCLC who underwent 18F-FDG PET/computed tomography (CT) at baseline (n = 47) and 6 weeks (n = 40) after commencing treatment with erlotinib. First-order and high-order primary tumor texture features reflecting image heterogeneity, standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured for all 18F-FDG PET studies. Response to erlotinib was assessed by using the Response Evaluation Criteria in Solid Tumors (RECIST) on CT images obtained at 12 weeks (n = 32). Associations between PET parameters, overall survival (OS), and RECIST-based treatment response were tested by Cox and logistic regression analyses, respectively.ResultsMedian OS was 14.1 months. According to CT RECIST at 12 weeks, there were 21 nonresponders and 11 responders. Response to erlotinib was associated with reduced heterogeneity (first-order standard deviation, P = .01; entropy, P = .001; uniformity, P = .001). At multivariable analysis, high-order contrast at 6 weeks (P = .002) and percentage change in first-order entropy (P = .03) were independently associated with survival. Percentage change in first-order entropy was also independently associated with treatment response (P = .01).ConclusionResponse to erlotinib is associated with reduced heterogeneity at 18F-FDG PET. Changes in first-order entropy are independently associated with OS and treatment response.

UR - http://www.scopus.com/inward/record.url?scp=84940869624&partnerID=8YFLogxK

UR - https://pubs.rsna.org/doi/suppl/10.1148/radiol.2015141309/suppl_file/ry141309suppa1.pdf

U2 - 10.1148/radiol.2015141309

DO - 10.1148/radiol.2015141309

M3 - Article

AN - SCOPUS:84940869624

SN - 0033-8419

VL - 276

SP - 883

EP - 893

JO - Radiology

JF - Radiology

IS - 3

ER -

Non–Small Cell Lung Cancer Treated with Erlotinib: Heterogeneity of 18F-FDG Uptake at PET—Association with Treatment Response and Prognosis

Abstract

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this