DOI: 10.1186/s13550-017-0258-3Pages: 1-10

A comparison of FLT to FDG PET/CT in the early assessment of chemotherapy response in stages IB–IIIA resectable NSCLC

1. Washington University School of Medicine, Mallinckrodt Institute of Radiology

2. King Fahad Specialist Hospital, Medical Imaging Department

3. McMaster University, Juravinski Cancer Centre

4. Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center

5. Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine

6. Georgetown University Hospital, Department of Radiology

7. Georgetown University Hospital, Department of Medicine

8. Wexner Medical Center, Department of Radiology, The Ohio State University

9. University of Pennsylvania, Department of Radiology, Perelman School of Medicine

10. Johns Hopkins University School of Medicine, The Johns Hopkins Wilmer Eye Institute

11. Johns Hopkins University School of Medicine, The Russell H. Morgan Department of Radiology

12. Catholic Medical Center, Department of Nuclear Medicine, Seoul St. Mary’s Hospital

13. Johns Hopkins University School of Medicine, Department of Pathology

14. National Cancer Institute

Correspondence to:
Richard L. Wahl
Tel: (314) 362-7100




The aim of this study was to compare the percentage change in 18F-fluorothymidine (FLT) standard uptake value (SUV) between baseline and after one cycle of chemotherapy in patients categorized by RECIST 1.1 computed tomography (CT) as responders or non-responders after two cycles of therapy. Change in 18F-fluorodeoxyglucose (FDG) uptake was also compared between these time points.

Nine patients with newly diagnosed, operable, non-small cell lung cancer (NSCLC) were imaged with FDG positron emission tomography/CT (PET), FLT PET/CT, and CT at baseline, following one cycle of neoadjuvant therapy (75 mg/m2 docetaxel + 75 mg/m2 cisplatin), and again after the second cycle of therapy. All patients had a biopsy prior to enrollment and underwent surgical resection within 4 weeks of post-cycle 2 imaging.


Between baseline and post-cycle 1, non-responders had mean SULmax (maximum standard uptake value adjusted for lean body mass) increases of 7.0 and 3.4% for FDG and FLT, respectively. Responders had mean decreases of 44.8 and 32.0% in FDG and FLT SULmax, respectively, between baseline and post-cycle 1 imaging. On post-cycle 1 imaging, primary tumor FDG SUL values were significantly lower in responders than in non-responders (P = 0.016). Primary tumor FLT SUL values did not differ significantly between these groups. Using the change from baseline to post-cycle 1, receiver-operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.94 for FDG and 0.78 for FLT in predicting anatomic tumor response after the second cycle of therapy.


Fractional decrease in FDG SULmax from baseline to post-cycle 1 imaging was significantly different between anatomic responders and non-responders, while percentage changes in FLT SULmax were not significantly different between these groups over the same period of time.

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  • Accepted: Jan 6, 2017
  • Online: Jan 19, 2017

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