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Original Articles
- Predictive Role of Baseline Peripheral Lung SUVmax on PET/CT for Immune-Related Pneumonitis and Adverse Events in Lung Cancer Patients Treated with Immune Checkpoint Inhibitors
- Kun Ho Kim, Seong Min Kim, Jeong Eun Lee, Song Soo Kim, Da Hyun Kang, Chaeuk Chung
- Received May 22, 2025 Accepted October 22, 2025 Published online October 28, 2025
- DOI: https://doi.org/10.4143/crt.2025.548 [Epub ahead of print]
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Abstract
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Supplementary Material
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ePub - Purpose
Immune checkpoint inhibitors (ICIs) offer durable responses in lung cancer patients lacking actionable mutations or with resistance to prior therapies. However, predicting their efficacy and associated immune-related adverse events (irAEs), such as severe pneumonitis, remains a clinical challenge. This study investigated the predictive value of positron emission tomography/computed tomography (PET/CT)–derived metabolic parameters for pneumonitis and other irAEs in lung cancer patients treated with ICIs.
Materials and Methods
We retrospectively analyzed 151 patients with advanced non–small cell lung cancer (NSCLC) who received ICIs as first-line treatment, either as monotherapy or in combination. Pre-treatment PET/CT was used to measure maximum standardized uptake value (SUVmax) at the primary tumor, tumor-uninvolved peripheral lung, and metastatic sites. Pneumonitis and irAEs were assessed using clinical and radiological findings.
Results
Pneumonitis, severe pneumonitis (grade ≥ 3), and irAEs occurred in 26.5%, 19.9%, and 37.1% of patients, respectively. A peripheral SUVmax cutoff of > 1.1 significantly predicted pneumonitis (area under the curve, 0.720; p < 0.001). High peripheral SUVmax was associated with higher rates of pneumonitis (42.9% vs. 12.3%, p < 0.001), severe pneumonitis (31.4% vs. 9.9%, p=0.001), and irAEs (46.4% vs. 29.5%, p=0.038). In multivariate analysis, high peripheral SUVmax independently predicted pneumonitis (odds ratio [OR], 4.621; 95% confidence interval [CI], 1.868 to 11.431; p=0.001), severe pneumonitis (OR, 2.848; 95% CI, 1.043 to 7.779; p=0.041), and irAEs (OR, 2.509; 95% CI, 1.114 to 5.504; p=0.022).
Conclusion
Baseline peripheral SUVmax on PET/CT may serve as a noninvasive biomarker for predicting immune-related pneumonitis and other irAEs in NSCLC patients receiving ICIs, supporting early risk identification. -
Citations
Citations to this article as recorded by
- Baseline immune-organ 18F-FDG PET/CT metabolism is associated with immune-related adverse events in anti-PD-1-treated non-small cell lung cancer
Haixu Zhu, Renhua Na, Xiaolong Yao, Jureti Azhati, Liming Chai, Canwen Sun, Bing Liu, Zeqiang Dai, Yan Xing
Frontiers in Medicine.2026;[Epub] CrossRef
- Baseline immune-organ 18F-FDG PET/CT metabolism is associated with immune-related adverse events in anti-PD-1-treated non-small cell lung cancer
- 2,446 View
- 89 Download
- 1 Crossref
- Gynecologic cancer
- Early Assessment of Response to Neoadjuvant Chemotherapy with 18F-FDG-PET/CT in Patients with Advanced-Stage Ovarian Cancer
- Young Shin Chung, Hyun-Soo Kim, Jung-Yun Lee, Won Jun Kang, Eun Ji Nam, Sunghoon Kim, Sang Wun Kim, Young Tae Kim
- Cancer Res Treat. 2020;52(4):1211-1218. Published online April 28, 2020
- DOI: https://doi.org/10.4143/crt.2019.506
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Abstract
PDFSupplementary MaterialPubReaderePub
- Purpose
The aim of this study was to evaluate the ability of sequential 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) after one cycle of neoadjuvant chemotherapy (NAC) to predict chemotherapy response before interval debulking surgery (IDS) in advanced-stage ovarian cancer patients.
Materials and Methods
Forty consecutive patients underwent 18F-FDG-PET/CT at baseline and after one cycle of NAC. Metabolic responses were assessed by quantitative decrease in the maximum standardized uptake value (SUVmax) with PET/CT. Decreases in SUVmax were compared with cancer antigen 125 (CA-125) level before IDS, response rate by Response Evaluation Criteria in Solid Tumors criteria before IDS, residual tumor at IDS, and I chemotherapy response score (CRS) at IDS.
Results
A 40% cut-off for the decrease in SUVmax provided the best performance to predict CRS 3 (compete or near-complete pathologic response), with sensitivity, specificity, and accuracy of 81.8%, 72.4%, and 72.4%, respectively. According to this 40% cut-off, there were 17 (42.5%) metabolic responders (≥ 40%) and 23 (57.5%) metabolic non-responders (< 40%). Metabolic responders had higher rate of CRS 3 (52.9% vs. 8.7%, p=0.003), CA-125 normalization (< 35 U/mL) before IDS (76.5% vs. 39.1%, p=0.019), and no residual tumor at IDS (70.6% vs. 31.8%, p=0.025) compared with metabolic non-responders. There were significant associations with progression-free survival (p=0.021) between metabolic responders and non-responders, but not overall survival (p=0.335).
Conclusion
Early assessment with 18F-FDG-PET/CT after one cycle of NAC can be useful to predic response to chemotherapy before IDS in patients with advanced-stage ovarian cancer. -
Citations
Citations to this article as recorded by- Effect of neoadjuvant chemotherapy on [68Ga]Ga-FAPI-46 PET/CT in peritoneal carcinomatosis: a prospective translational exploratory sub-cohort analysis
Ayça Arçay Öztürk, Gabriel Liberale, Jean Christophe Noël, Wendy Delbart, Anne-Leen Deleu, Erwin Woff, Raluca Poenaru, Laura Polastro, Laurent Theunissen, Paulus Kristanto, Sigrid Vercauteren, Clementine Marin, Loubna Taraji, Patrick Flamen
European Journal of Nuclear Medicine and Molecular Imaging.2026;[Epub] CrossRef - Positron Emission Tomography/Computed Tomography in Ovarian Cancer: Current Status and Future Potential
Caiyun Xu, Jing Peng, Jinyan Chen, Lixia Zhang, Jing Wang
iRADIOLOGY.2025; 3(5): 337. CrossRef - The Evaluation Value of CT in the Efficacy of Neoadjuvant Chemotherapy in Ovarian Cancer Patients
Daying Mou, Shengyan Xie, Pingyuan Li, Mohammad Farukh Hashmi
Contrast Media & Molecular Imaging.2022;[Epub] CrossRef - Radiomics Analysis of PET and CT Components of 18F-FDG PET/CT Imaging for Prediction of Progression-Free Survival in Advanced High-Grade Serous Ovarian Cancer
Xihai Wang, Zaiming Lu
Frontiers in Oncology.2021;[Epub] CrossRef
- Effect of neoadjuvant chemotherapy on [68Ga]Ga-FAPI-46 PET/CT in peritoneal carcinomatosis: a prospective translational exploratory sub-cohort analysis
- 11,948 View
- 154 Download
- 10 Web of Science
- 4 Crossref
- SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer
- Yoo-Kang Kwak, Hee Hyun Park, Kyu Hye Choi, Eun Young Park, Soo Yoon Sung, Sea-Won Lee, Ji Hyun Hong, Hyo Chun Lee, Ie Ryung Yoo, Yeon Sil Kim
- Cancer Res Treat. 2020;52(1):85-97. Published online May 17, 2019
- DOI: https://doi.org/10.4143/crt.2019.007
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Abstract
PDFPubReaderePub
- Purpose
Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC.
Materials and Methods
Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%).
Results
Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5).
Conclusion
Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes. -
Citations
Citations to this article as recorded by- Pretreatment SUVmax Stratifies the Benefit of Consecutive Daily SBRT in Early-Stage Non-Small Cell Lung Cancer
Yupeng Di, Haifeng Pang, Xuan Wang, Lingling Meng
Clinical Lung Cancer.2026; 27(6): 75. CrossRef - Enhanced NSCLC subtyping and staging through attention-augmented multi-task deep learning: A novel diagnostic tool
Runhuang Yang, Weiming Li, Siqi Yu, Zhiyuan Wu, Haiping Zhang, Xiangtong Liu, Lixin Tao, Xia Li, Jian Huang, Xiuhua Guo
International Journal of Medical Informatics.2025; 193: 105694. CrossRef - The utility of [18F]FDG PET in discriminating between local recurrence and inflammatory changes following SABR in primary lung cancer patients
Maria Fala, Eleni Josephides, Sweni Shah, Hemal Ariyaratne, Anant Patel, Gary J. R. Cook, Sugama Chicklore, Thomas Wagner
European Journal of Nuclear Medicine and Molecular Imaging.2025; 53(1): 181. CrossRef - Quantitative Imaging Biomarkers in Lung Cancer: Current Trends and Future Directions
Joice Prodigios, Ronak Kundalia, Amanda Acevedo, Jean Bontemps, David Pfaehler, Md Mahfuz Al Hasan, Kyle B. See, Nupur Verma, Daniela Hochhegger, Alysson Roncally Silva Carvalho, Tan-Lucien Mohammed, Bruno Hochhegger
Seminars in Roentgenology.2025; 60(4): 439. CrossRef - Invasive Nodal Staging via Endobronchial Ultrasound and Outcome in Patients Treated with Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer – Results from a Single Institution Study
Benjamin George, Atallah Baydoun, Samar Bhat, Lauryn Bailey, Theodore Arsenault, Yilun Sun, Yuxia Zhang, Yiran Zheng, Prashant Vempati, Tarun Podder, Tithi Biswas
Clinical Lung Cancer.2024; 25(4): e181. CrossRef - Prognostic value of consolidation-to-tumor ratio on computed tomography in NSCLC: a meta-analysis
Yongming Wu, Wenpeng Song, Denian Wang, Junke Chang, Yan Wang, Jie Tian, Sicheng Zhou, Yingxian Dong, Jing Zhou, Jue Li, Ziyi Zhao, Guowei Che
World Journal of Surgical Oncology.2023;[Epub] CrossRef - Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer
Pengfei Zhang, Wei Chen, Kewei Zhao, Xiaowen Qiu, Tao Li, Xingzhuang Zhu, Peng Sun, Chunsheng Wang, Yipeng Song
BMC Medical Imaging.2023;[Epub] CrossRef - Evaluation of response to stereotactic body radiation therapy for nonsmall cell lung cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors
Jixia Han, Qi Song, Feng Guo, Rui Du, Henghu Fang, Jingbo Kang, Zejun Lu
Nuclear Medicine Communications.2022; 43(6): 717. CrossRef - Assessing tumor angiogenesis using dynamic contrast-enhanced integrated magnetic resonance-positron emission tomography in patients with non-small-cell lung cancer
Yu-Sen Huang, Jenny Ling-Yu Chen, Hsin-Ming Chen, Li-Hao Yeh, Jin-Yuan Shih, Ruoh-Fang Yen, Yeun-Chung Chang
BMC Cancer.2021;[Epub] CrossRef - Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review
Giulia Riva, Sara Imparato, Giovanni Savietto, Mattia Pecorilla, Alberto Iannalfi, Amelia Barcellini, Sara Ronchi, Maria Rosaria Fiore, Chiara Paganelli, Giulia Buizza, Mario Ciocca, Guido Baroni, Lorenzo Preda, Ester Orlandi
The British Journal of Radiology.2021;[Epub] CrossRef - Prognostic value of metabolic signature on 18F-FDG uptake in breast cancer patients after radiotherapy
Jin Meng, Emmanuel Deshayes, Li Zhang, Wei Shi, Xiaomeng Zhang, Xingxing Chen, Xin Mei, Jinli Ma, Yizhou Jiang, Jiong Wu, Zhimin Shao, Xiaoli Yu, Zhaozhi Yang, Xiaomao Guo
Molecular Therapy Oncolytics.2021; 23: 412. CrossRef - Parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos en el cáncer de pulmón localizado e inoperable
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M. Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular.2020; 39(6): 353. CrossRef - 18F-FDG PET/CT quantitative parameters as prognostic factors in localized and inoperable lung cancer
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition).2020; 39(6): 353. CrossRef
- Pretreatment SUVmax Stratifies the Benefit of Consecutive Daily SBRT in Early-Stage Non-Small Cell Lung Cancer
- 10,351 View
- 135 Download
- 12 Web of Science
- 13 Crossref
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