• Tumor Response in Patients With Advanced Non-Small Cell Lung Cancer: Perfusion CT Evaluation of Chemotherapy and Radiation Therapy

    AJR:193, October2009

    Jianwei Wang, Ning Wu, Matthew D. Cham, Ying Song

    OBJECTIVE. The objectives of this study were to prospectively evaluate changes in tu­mor perfusion after chemoradiation therapy and to investigate the feasibility of perfusion CT for prediction of early tumor response and prognosis of non-small cell lung cancer.


    SUBJECTS AND METHODS. Perfusion CT was performed on an MDCT scanner with 50 mL of iodinated contrast material injected at 4 mL/s. The quality of each functional map was rated from 0 to 3 for 123 patients with confirmed lung cancer. A subset of images was in­dependently reviewed by two radiologists to measure interobserver and intraobserver variabil­ity. Perfusion parameters and tumor response were assessed for 35 patients with non-small cell lung cancer who underwent chemoradiation therapy. Progression-free survival and overall sur­vival were analyzed for 22 patients who underwent repeated perfusion CT after therapy.


    RESULTS. Image quality was graded 2 (moderate) or 3 (good) in 68.2% of cases. High interobserver and intraobserver correlations of perfusion parameters were found on quali­fied images. The patients who responded to chemoradiation therapy had significantly great­er blood flow (p = 0.023) than patients who did not respond. The median progression-free survival period of the patients with an increased permeability-surface area product was 4.7 months, significantly lower than the median progression-free survival period of 19.0 months among patients with a decreased permeability-surface area product (p < 0.001). The median overall survival period was 10.6 months for the group with an increased permeability-surface area product, significantly lower than the 19.3 months for the group with a decreased perme­ability-surface area product (p = 0.004).


    CONCLUSION. Non-small cell lung cancer with higher perfusion is more sensitive to chemoradiation therapy than that with lower perfusion. After chemoradiation therapy, find­ings at perfusion CT are a significant predictor of early tumor response and overall survival among patients with non-small cell lung cancer.