Purpose: The relationship between thoracic radiation to the heart and overall survival (OS) has been recently demonstrated in non-small cell lung cancer (NSCLC) patients. Functional imaging, and in particular PET/CT, has been used to provide an early predictor for clinical outcomes. The purpose of this study was to use a large, co-operative group clinical trial (ACRIN 6668) data-set to evaluate whether PET-CT changes in the heart are predictive of OS.
Methods: We retrospectively evaluated data for 239 patients enrolled on the ACRIN 6668 study which evaluated the prognostic value of pre-treatment tumor PET-CT information for stage 2-3 NSCLC patients treated with chemo-radiation. 77 Eligible patients for the current analysis included patients for whom pre and post-treatment PET/CT data was acquired. The heart was contoured for each patient’s PET-CT scan and the mean Standard Uptake Value (SUVmean) was calculated for each heart contour. The SUVmean cardiac change was calculated as post-treatment SUVmean minus pre-treatment SUVmean. The ability of cardiac SUVmean change to predict for OS was assessed using multivariable Cox modeling (controlling for cofactors of age and stage) and by comparing OS for patients with positive or negative cardiac SUVmean change.
Results: The median OS was 469 days (range 144-1640 days). SUVmean cardiac change from pre to post-treatment was predictive of OS on multivariate analysis (p=0.016, Hazard ratio=0.81, 95% confidence interval=[0.68-0.96]). Median survival for patients with a negative SUVmean change (i.e. a post-treatment decrease in cardiac SUV) was 413 days while patients with a positive SUVmean change had a median OS of 585 days (p<0.01).
Conclusion: The data demonstrates that cardiac SUV changes are significantly associated with OS in NSCLC patients. If validated in a prospective cohort, our data show the potential for cardiac metabolic changes to be an early predictor for clinical outcomes.
Funding Support, Disclosures, and Conflict of Interest: NCI grant: RO1CA236857