Effects of chemoradiotherapy on the cardiac and aortic glucose metabolism in patients with advanced non-small cell lung cancer

Abstract Background Cardiovascular side-effects of chemoradiotherapy for non-small cell lung cancer (NSCLC) remain a major concern. Insights into vascular changes in atherosclerotic burden and overall disease activity secondary to chemoradiotherapy are useful to predict cardiovascular risk. Computed tomography (CT) calcium score is a biomarker of atherosclerosis while [18F] Fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging can evaluate cardiovascular inflammation. Purpose In patients with advanced NSCLC undergoing repeated [18F] FDG PET/CT imaging, we investigated the effects of chemoradiotherapy on aortic atherosclerotic burden assessed by aortic calcium score, and atherosclerotic disease activity with [18F] FDG uptake. Methods All available oncology PET-CT scans of patients with stage 3B NSCLC from the American College of Radiology Imaging Network (ACRIN 6668) trial were retrieved from the Cancer Imaging Archive and a retrospective analysis was performed. Pre- and post-treatment scans were performed approximately 14 weeks apart. Volumes of interest for the left ventricle, aorta and major non-cardiac organs were manually delineated on all PET-CT scans. Average standard uptake values (SUV), target-to-background ratios (TBR) to aortic blood pool and calcium score were quantified. Aortic PET uptake was analysed for both calcified and non-calcified areas and comparisons before and after treatment scans were performed. Results A total of 26 patients (mean 60±9 years, body-mass index 25±5 kg/m2) met the inclusion criteria. After chemoradiotherapy, calcium score increased by 10% in calcified aortic plaques (p