Cardiac metabolic changes on 18F‐positron emission tomography after thoracic radiotherapy predict for overall survival in esophageal cancer patients

• Type of Material: Article
• Authors: Sara J. Zakem, University of Washington; Bernard Jones, University of Colorado School of Medicine; Richard Castillo, Emory University; Edward Castillo, Beaumont Health; Moyed Miften, University of Colorado School of Medicine; Karyn A. Goodman, Mount Sinai; Tracey Schefter, University of Colorado School of Medicine; Jeffrey Olsen, University of Colorado School of Medicine; Yevgeniy Vinogradskiy, Thomas Jefferson University
• Language: English
• Date: 2022-03-04
• Publisher: Wiley Periodicals, LLC.
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1002%2Facm2.13552
• Title of Journal or Parent Work: Journal of Applied Clinical Medical Physics
• Volume: 24
• Issue: 9
• Start Page: e13552
• Grant/Funding Information: This work was partially funded by grant R01CA236857 and research partnership with MIM Software.
• Keywords: radiation; esophageal; PET; functional imaging; cancer; heart dose
• Research Categories: Health Sciences, Oncology

Abstract

Purpose Heart doses have been shown to be predictive of cardiac toxicity and overall survival (OS) for esophageal cancer patients. There is potential for functional imaging to provide valuable cardiac information. The purpose of this study was to evaluate the cardiac metabolic dose–response using 18F‐deoxyglucose (FDG)–PET and to assess whether standard uptake value (SUV) changes in the heart were predictive of OS. Methods Fifty‐one patients with esophageal cancer treated with radiation who underwent pre‐ and post‐treatment FDG–PET scans were retrospectively evaluated. Pre‐ and post‐treatment PET‐scans were rigidly registered to the planning CT for each patient. Pre‐treatment to post‐treatment absolute mean SUV (SUVmean) changes in the heart were calculated to assess dose–response. A dose–response curve was generated by binning each voxel in the heart into 10 Gy dose‐bins and analyzing the SUVmean changes in each dose‐bin. Multivariate cox proportional hazard models were used to assess whether pre‐to‐post treatment cardiac SUVmean changes predicted for OS. Results The cardiac dose–response curve demonstrated a trend of increasing cardiac SUV changes as a function of dose with an average increase of 0.044 SUV for every 10 Gy dose bin. In multivariate analysis, disease stage and SUVmean change in the heart were predictive (p < 0.05) for OS. Conclusions Changes in pre‐ to post‐treatment cardiac SUV were predictive of OS with patients having a higher pre‐ to post‐treatment cardiac SUV change surviving longer.