Comparison of F-18-Fluoroerythronitroimidazole and F-18-Fluorodeoxyglucose Positron Emission Tomography and Prognostic Value in Locally Advanced Non-Small-Cell Lung Cancer

Introduction: The aim of this study was to compare glucose metabolism and hypoxia using F-18-fluorodeoxyglucose (F-18-FDG) and F-18-fluoroerythronitroimidazole (F-18-FETNIM) positron emission tomography (PET) and investigate their prognostic role on survival in patients with locally advanced non-small-cell lung cancer (NSCLC). Patients and Methods: Twenty-six patients with NSCLC were imaged with F-18-FETNIM PET/computed tomography (CT), and 11 cases also with F-18-FDG PET/CT imaging among those with significant F-18-FETNIM uptake, a few days before any chemo/adiation therapy. The maximum standardized uptake value (SUVmax) was used to depict F-18-FDG uptake, and hypoxic volume (HV) and tumor: blood ratio (T/B-max) were used to quantify hypoxia. Overall survival (OS) after treatment was selected as the endpoint of the study. Results: Twenty-two patients (84.6%) had significant F-18-FETNIM uptake in the primary tumor. The correlations between the overall tumor SUVmax of F-18-FDG and HV, T/B-max ratio of F-18-FENTIM in 11 patients were small and without significant difference. In univariate analyses, log-rank tests were used to compare Kaplan-Meier survival curves. F-18-FETNIM T/B-max ratio and HV were strong predictors for OS, and F-18-FDG uptake of the primary lesions did not have a significant relationship with survival. In multivariate survival analysis, only F-18-FETNIM T/B-max ratio was found to be an independent prognostic factor. Conclusion: Imaging using both F-18-FETNIM and F-18-FDG appears to be beneficial in the evaluation of solid tumors. F-18-FETNIM imaging provides us with a valuable method to detect tumor hypoxia and predict OS. These preliminary results warrant validation in larger trials.