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World J Radiol. Jul 28, 2014; 6(7): 392-398
Published online Jul 28, 2014. doi: 10.4329/wjr.v6.i7.392
FDG-PET/CT response evaluation during EGFR-TKI treatment in patients with NSCLC
Matthijs H van Gool, Tjeerd S Aukema, Koen J Hartemink, Renato A Valdés Olmos, Harm van Tinteren, Houke M Klomp
Matthijs H van Gool, Koen J Hartemink, Houke M Klomp, Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
Tjeerd S Aukema, Renato A Valdés Olmos, Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
Harm van Tinteren, Department of Biometrics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
Author contributions: All authors contributed equally on this manuscript in accordance with the standard proposed by the International Committee of Medical Journal Editors.
Correspondence to: Houke M Klomp, MD, PhD, Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. h.klomp@nki.nl
Telephone: +31-20-5122554 Fax: +31-20-5129111
Received: January 23, 2014
Revised: April 28, 2014
Accepted: May 16, 2014
Published online: July 28, 2014
Processing time: 188 Days and 16.5 Hours
Abstract

Over recent years, [18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography (FDG-PET/CT) has proven its role as a staging modality in patients with non-small cell lung cancer (NSCLC). The purpose of this review was to present the evidence to use FDG-PET/CT for response evaluation in patients with NSCLC, treated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI). All published articles from 1 November 2003 to 1 November 2013 reporting on 18F-FDG-PET response evaluation during EGFR-TKI treatment in patients with NSCLC were collected. In total 7 studies, including data of 210 patients were eligible for analyses. Our report shows that FDG-PET/CT response during EGFR-TKI therapy has potential in targeted treatment for NSCLC. FDG-PET/CT response is associated with clinical and radiologic response and with survival. Furthermore FDG-PET/CT response monitoring can be performed as early as 1-2 wk after initiation of EGFR-TKI treatment. Patients with substantial decrease of metabolic activity during EGFR-TKI treatment will probably benefit from continued treatment. If metabolic response does not occur within the first weeks of EGFR-TKI treatment, patients may be spared (further) unnecessary toxicity of ineffective treatment. Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.

Keywords: Non-small cell lung cancer; Epidermal growth factor receptor-tyrosine kinase inhibitors therapy; Positron emission tomography-computed tomography; Computed tomography; Response monitoring

Core tip: Our report shows that response monitoring using [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) acquired together with low dose computed tomography has potential in targeted treatment for non-small cell lung cancer and can be performed as early as 1-2 wk after initiation of treatment. Patients with substantial decrease of metabolic activity during epidermal growth factor receptor-tyrosine kinase inhibitors treatment will probably benefit from continued treatment. Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.