Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer

Richard Castillo, Ngoc Pham, Sobiya Ansari, Dmitriy Meshkov, Sarah Castillo, Min Li, Adenike Olanrewaju, Brian Hobbs, Edward Castillo, Thomas Guerrero

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background: A retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. Methods and Materials: We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV80 to SUV95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. Results: The study subjects were treated with 3D conformal RT (n = 23), intensity modulated RT (n = 64), and proton therapy (n = 13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V30 with SUV95 = 1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV95 = 0.5 of the same age and identical V30. Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI = 0.69 - 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. Conclusions: The pretreatment pulmonary FDG uptake, as quantified by the SUV95, predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.

Original languageEnglish (US)
Article number74
JournalRadiation Oncology
Issue number1
StatePublished - Mar 13 2014
Externally publishedYes


  • Imaging biomarker
  • PET/CT
  • Radiation pneumonitis
  • Standard uptake value
  • Thoracic radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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