Measurement of perfusion in stage IIIA-N2 non-small cell lung cancer using H₂¹⁵O and positron emission tomography

Purpose: As the interest in antiangiogenesis therapy in oncology is rising, the need for in vivo techniques to monitor such therapy is obvious. Measurement of tumor perfusion using positron emission tomography and H₂¹⁵O potentially is such a technique. The objective of the present study was to assess whether it is feasible to measure perfusion in vivo in non-small cell lung cancer (NSCLC) using H₂¹⁵O and positron emission tomography. Experimental Design: Fifteen dynamic H₂¹⁵O and [¹⁸F]2-fluoro-2-deoxy-D-glucose (¹⁸FDG) studies were performed in 10 patients with stage IIIA-N2 NSCLC. Blood flow (BF) data were correlated with simplified methods of analysis (tumor:normal tissue ratio and standardized uptake value) and with glucose metabolism (MR_glu). Results: ¹⁸FDG data were required for accurate definition of tumor and mediastinal lymph node metastases. There was large intertumor variation in BF. Correlation of simplified methods of analysis with quantitative BF was poor. In addition, BF and MR_glu were not correlated. Conclusion: Measurement of BF in NSCLC using H₂¹⁵O and ¹⁸FDG is feasible. Simple uptake analysis, however, cannot be used as an indicator of perfusion. Whether BF can be used for response monitoring needs to be evaluated in a large patient study, where results can be compared with outcome.