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  • Review Article
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PET in the management of locally advanced and metastatic NSCLC

Nature Reviews Clinical Oncology volume 12, pages 395–407 (2015)Cite this article

Subjects

Key Points

  • Disease-specific survival of patients with advanced-stage non-small-cell lung cancer remains poor; combined and intensified treatments have failed to substantially improve patient outcome

  • Specific patient groups can benefit considerably from certain treatment approaches, emphasizing the requirement to adapt treatment to the individual

  • PET can be used to characterize the biological landscape of the tumour and identify possible resistance to specific treatments, and thus facilitate clinical decision-making

  • Quantification of tumour glucose metabolism, hypoxia, and cellular proliferation has the potential to provide valuable information for treatment selection, adaptation and response assessment in this patient group

  • Ongoing development of novel PET radiotracers will further extend the opportunities to non-invasively quantify other factors relevant to treatment resistance, which could ultimately be used to personalize treatment

Abstract

Despite considerable improvements in the treatment options for advanced-stage non-small-cell lung cancer (NSCLC), disease-specific survival remains poor. With the aim of improving patient outcome, the treatment paradigm of locally advanced NSCLC has shifted from solely radiotherapy towards combined and intensified treatment approaches. Also, treatment for patients with stage IV (oligo)metastatic NSCLC has evolved rapidly, with therapeutic options that include a number of targeted agents, surgery, and stereotactic ablative radiotherapy. However, personalizing treatment to the individual patient remains difficult and requires monitoring of biological parameters responsible for treatment resistance to facilitate treatment selection, guidance, and adaptation. PET is a well-established molecular imaging platform that enables non-invasive quantification of many biological parameters that are relevant to both local and systemic therapy. With increasing clinical evidence, PET has gradually evolved from a purely diagnostic tool to a multifunctional imaging modality that can be utilized for treatment selection, adaptation, early response monitoring, and follow up in patients with NSCLC. Herein, we provide a comprehensive overview of the available clinical data on the use of this modality in this setting, and discuss future perspectives of PET imaging for the clinical management of patients with locally advanced and metastatic NSCLC.

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Figure 1: The application of PET imaging for dose-painting radiotherapy in a patient with NSCLC.
Figure 2: Adaptive radiotherapy planning using serial FDG-PET–CT imaging in a patient with stage IIIB NSCLC.
Figure 3: Sequential FDG-PET and low-dose CT imaging for treatment response monitoring in two patients with stage III NSCLC treated with concomitant chemoradiotherapy.

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Acknowledgements

W.G. is the recipient of an educational grant from Siemens Healthcare, The Hague, Netherlands. The authors would like to thank Aniek Even and Lucas Persoon from the Department of Radiation Oncology (MAASTRO clinic), Maastricht University Medical Centre, for providing the radiotherapy dose painting and adaptive radiotherapy images shown in Figure 1 and Figure 2, respectively.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands

    Willem Grootjans, Eric P. Visser & Wim J. G. Oyen

  2. Department of Radiation Oncology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands

    Johan Bussink

  3. Department of Radiology and Nuclear Medicine, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands

    Lioe-Fee de Geus-Oei

  4. Department of Radiation Oncology (MAASTRO) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, Netherlands

    Esther G. C. Troost

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  1. Willem Grootjans
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Contributions

W.G., L.-F.d.G.-O., and E.G.C.T. researched the data for the article. W.G., L.-F.d.G.-O., E.G.C.T., W.J.G.O., and J.B. made substantial contributions to discussions of content. W.G. wrote the article and all authors reviewed/edited the manuscript before submission.

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Correspondence to Willem Grootjans.

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Grootjans, W., de Geus-Oei, LF., Troost, E. et al. PET in the management of locally advanced and metastatic NSCLC. Nat Rev Clin Oncol 12, 395–407 (2015). https://doi.org/10.1038/nrclinonc.2015.75

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