In this Issue

The study evaluated changes in esophageal F-fluorodeoxyglucose (FDG) uptake during chemoradiotherapy (CRT) and its association with the onset and severity of radiation esophagitis (RE) in the treatment of patients with stage II-III non–small cell lung cancer (NSCLC). Serial four-dimensional computed tomography and PET scans were used during CRT (60-74Gy). The volume of esophagus receiving 50 Gy (V50) and volume of esophagus receiving 60 Gy (V60) were associated with the development of RE. Of the 27 patients analyzed, 74% developed RE, of which 22% were grade 3. Patients with RE showed significant increase in SUVpeak (esophagus peak standard uptake value) at week 4 (p1⁄40.01) and week 7 (p1⁄40.03); the significant increase was at week 2 (p1⁄40.01) and week 7 (p1⁄40.03) for grade 3 RE vs. < grade 3 RE. Patients with RE had significantly greater median V50 and V60 (46.3% and 33.4%, respectively). The C-statistic (area under the curve [AUC]) indicated that percentage change in SUVpeak at week 2, V50 and V60 could be of predictive values for grade 3 RE (AUC1⁄40.69, 0.67 and 0.66, respectively). Taken together, the findings from serial FDG-PET images during CRT demonstrated significant increases in SUVpeak for patients with RE, with changes at week 2 predictive of those at risk for developing grade 3 RE. This could guide adaptive planning and early intervention. (p. 213)