• Rosario Mazzola, Alba Fiorentino, Gioacchino Di Paola, Giaj LevraNiccolòNRadiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy., Francesco Ricchetti, Sergio Fersino, Umberto Tebano, Stefano Pasetto, Ruggero Ruggieri, Matteo Salgarello, and Filippo Alongi.
• Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy. Electronic address: rosariomazzola@hotmail.il.
• J Thorac Oncol. 2017 Mar 1; 12 (3): 547-555.

ObjectivesThe objective of this study was to investigate fludeoxyglucose F 18 positron emission tomography/computed tomography (18FDG-PET/CT) parameters as predictive of response after stereotactic ablative radiotherapy (SABR) for lung oligometastases.MethodsThe inclusion criteria of the current retrospective study were as follows: (1) lung oligometastases treated by SABR, (2) presence of 18FDG-PET/CT before and after SABR for at least two subsequent evaluations, (3) Karnofsky performance status higher than 80, and (4) life expectancy longer than 6 months. All patients were treated with a biologically equivalent dose of at least 100 Gy with an alpha/beta ratio of 10. The following metabolic parameters were semiquantitatively defined: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume, and total lesion glycolysis.ResultsA total of 50 patients met the inclusion criteria, for a total of 70 lung metastases. The pre-SABR median SUVmax was 6.5 (range 4-17), the median SUVmean was 3.7 (range 2.5-6.5), and the median metabolic tumor volume was 2.3 cm3 (0.2-31 cm3). The following metabolic parameters were significantly related to complete response at 6 months: SUVmax less than 5 (p < 0.001) and SUVmean less than 3.5 (p = 0.03). ΔSUVmax at 3 to 6 months was +126% for lesions with in-field progression versus -26% for the remaining lesions (p = 0.002). ΔSUVmean at 3 to 6 months was +15% for lesions with in-field progression versus -26% for the remaining metastases (p = 0.008).ConclusionsIn the current analysis, complete response from lung metastasis at 6 months after stereotactic body radiation therapy was significantly associated with both the maximum and mean values of pre-SABR 18FDG-PET/CT SUV. Longer-term trials are strongly advocated to improve the personalization of the monitoring of tumor response in patients with lung oligometastases and, consequently, monitoring of the cost-effectiveness of the health care.Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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