Computed Tomography Hounsfield Unit Values As a Treatment Response Indicator for Spinal Metastatic Lesions in Patients with Non-small-cell Lung Cancer: a Retrospective Study in Japan

Overview

Journal Asian Spine J

Date 2025 Jan 20

PMID 39829178

Authors

Hiroshi Taniwaki

Sho Dohzono

Ryuichi Sasaoka

Kiyohito Takamatsu

Masatoshi Hoshino

Hiroaki Nakamura

Affiliations

Soon will be listed here.

Abstract

Study Design: A retrospective study.

Purpose: This study aimed to determine the impact of increased Hounsfield unit (HU) values for metastatic spinal lesions measured via computed tomography on the overall survival of patients with non-small-cell lung cancer (NSCLC) and identify factors associated with increased HU values in metastatic spinal lesions.

Overview Of Literature: Previous studies have underscored the utility of the HU as a marker of treatment response in metastatic bone lesions. However, no prior studies have explored the relationship between HU changes in response to treatment and overall survival in patients with NSCLC.

Methods: This study included a total of 85 patients between 2016 and 2021. Nonsurgical treatments were provided by the respiratory medicine department. HU values for metastatic spinal lesions were evaluated upon diagnosis of spinal metastasis (baseline) and at 3, 6, and 12 months thereafter. Patients were then divided into two groups based on the median HU increase from baseline to 3 months. Overall survival was assessed using the Kaplan-Meier method.

Results: Based on the median change in HU value (124), 42 and 43 patients were categorized into the HU responder and non-responder groups, respectively. The median overall survival was significantly longer in the HU responder group than in the HU non-responder group (13.7 months vs. 6.4 months, p <0.001). Multiple linear regression analysis revealed that the use of antiresorptive agents and molecularly targeted therapies were factors significantly associated with an increase in HU.

Conclusions: An increase in HU values for metastatic spinal lesions after 3 months of treatment was correlated with a significantly longer overall survival in patients with NSCLC. Thus, HU measurements may not only serve as an easy and quantitative approach for evaluating treatment response in metastatic spinal lesions but also predict overall survival.

Citing Articles

Analysis of Early Post-Radiation Surgical Management of Metastatic Spinal Tumors.

Seok S, Cho J, Lee H, Park J, Park J, Lee D J Clin Med. 2025; 14(3).

PMID: 39941700 PMC: 11818097. DOI: 10.3390/jcm14031032.

References

Hu Y, Ren H, Yang L, Jin C, Wei Y . Effect of molecular targeted therapy combined with radiotherapy on the expression and prognostic value of COX-2 and VEGF in bone metastasis of lung cancer. J BUON. 2020; 25(2):811-820. View

Al Husaini H, Wheatley-Price P, Clemons M, Shepherd F . Prevention and management of bone metastases in lung cancer: a review. J Thorac Oncol. 2009; 4(2):251-9. DOI: 10.1097/JTO.0b013e31819518fc. View

Schreiber J, Anderson P, Rosas H, Buchholz A, Au A . Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011; 93(11):1057-63. DOI: 10.2106/JBJS.J.00160. View

Ahern D, McDonnell J, Riffault M, Evans S, Wagner S, Vaccaro A . A meta-analysis of the diagnostic accuracy of Hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population. Spine J. 2021; 21(10):1738-1749. DOI: 10.1016/j.spinee.2021.03.008. View

Kouloulias V, Liakouli Z, Zygogianni A, Mystakidou K, Kouvaris J . Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data. Int J Mol Sci. 2016; 17(9). PMC: 5037671. DOI: 10.3390/ijms17091391. View

Wang Q, Sun B, Meng X, Liu C, Cong Y, Wu S . Density of bone metastatic lesions increases after radiotherapy in patients with breast cancer. J Radiat Res. 2019; 60(3):394-400. PMC: 6530615. DOI: 10.1093/jrr/rry098. View

Cui Y, Lei M, Pan Y, Lin Y, Shi X . Scoring Algorithms for Predicting Survival Prognosis in Patients With Metastatic Spinal Disease: The Current Status and Future Directions. Clin Spine Surg. 2020; 33(8):296-306. DOI: 10.1097/BSD.0000000000001031. View

Socinski M, Obasaju C, Gandara D, Hirsch F, Bonomi P, Bunn Jr P . Current and Emergent Therapy Options for Advanced Squamous Cell Lung Cancer. J Thorac Oncol. 2017; 13(2):165-183. DOI: 10.1016/j.jtho.2017.11.111. View

Vassiliou V, Kalogeropoulou C, Christopoulos C, Solomou E, Leotsinides M, Kardamakis D . Combination ibandronate and radiotherapy for the treatment of bone metastases: clinical evaluation and radiologic assessment. Int J Radiat Oncol Biol Phys. 2006; 67(1):264-72. DOI: 10.1016/j.ijrobp.2006.08.022. View

10.

Vassiliou V, Kalogeropoulou C, Giannopoulou E, Leotsinidis M, Tsota I, Kardamakis D . A novel study investigating the therapeutic outcome of patients with lytic, mixed and sclerotic bone metastases treated with combined radiotherapy and ibandronate. Clin Exp Metastasis. 2007; 24(3):169-78. DOI: 10.1007/s10585-007-9066-x. View

11.

Rosen L, Gordon D, Kaminski M, Howell A, Belch A, Mackey J . Long-term efficacy and safety of zoledronic acid compared with pamidronate disodium in the treatment of skeletal complications in patients with advanced multiple myeloma or breast carcinoma: a randomized, double-blind, multicenter, comparative trial. Cancer. 2003; 98(8):1735-44. DOI: 10.1002/cncr.11701. View

12.

Cadieux B, Coleman R, Jafarinasabian P, Lipton A, Orlowski R, Saad F . Experience with denosumab (XGEVA®) for prevention of skeletal-related events in the 10 years after approval. J Bone Oncol. 2022; 33:100416. PMC: 8857591. DOI: 10.1016/j.jbo.2022.100416. View

13.

Katagiri H, Okada R, Takagi T, Takahashi M, Murata H, Harada H . New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med. 2014; 3(5):1359-67. PMC: 4302686. DOI: 10.1002/cam4.292. View

14.

Arbour K, Riely G . Systemic Therapy for Locally Advanced and Metastatic Non-Small Cell Lung Cancer: A Review. JAMA. 2019; 322(8):764-774. DOI: 10.1001/jama.2019.11058. View

15.

Pinto E, Neves J, Teixeira A, Frada R, Atilano P, Oliveira F . Efficacy of Hounsfield Units Measured by Lumbar Computer Tomography on Bone Density Assessment: A Systematic Review. Spine (Phila Pa 1976). 2021; 47(9):702-710. DOI: 10.1097/BRS.0000000000004211. View

16.

Hirsch F, Suda K, Wiens J, Bunn Jr P . New and emerging targeted treatments in advanced non-small-cell lung cancer. Lancet. 2016; 388(10048):1012-24. DOI: 10.1016/S0140-6736(16)31473-8. View

17.

Lustberg M, Reinbolt R, Shapiro C . Bone health in adult cancer survivorship. J Clin Oncol. 2012; 30(30):3665-74. DOI: 10.1200/JCO.2012.42.2097. View

18.

Nakata E, Sugihara S, Sugawara Y, Kozuki T, Harada D, Nogami N . Early response of bone metastases can predict tumor response in patients with non-small-cell lung cancer with bone metastases in the treatment with nivolumab. Oncol Lett. 2020; 20(3):2977-2986. PMC: 7401004. DOI: 10.3892/ol.2020.11856. View

19.

Brodowicz T, OByrne K, Manegold C . Bone matters in lung cancer. Ann Oncol. 2012; 23(9):2215-2222. PMC: 3425370. DOI: 10.1093/annonc/mds009. View

20.

Coleman R, Hadji P, Body J, Santini D, Chow E, Terpos E . Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2020; 31(12):1650-1663. DOI: 10.1016/j.annonc.2020.07.019. View