[18F]Fdg Pet Radiomics and Its Application in Lung Cancer Radiotherapy: A Systematic Review Publisher



Abedifirouzjah R ; Mahdavi SR ; Ay MR ; Ghaffari H ; Faghanieskandarkolaei P ; Abbaspour S
Source: Journal of Radioanalytical and Nuclear Chemistry Published:2026

Abstract

Radiomics on positron emission tomography using 2-deoxy-2-[fluorine-18]fluoro- D-glucose ([18F]FDG PET) has been suggested as a potential method to describe the biology of tumors and enhance the prognosis of lung cancer patients receiving radiotherapy (RT). Its clinical preparedness is however not clear. The objective of this study was to conduct a systematic review that would assess the quality of methodology, predictive accuracy, and reproducibility of PET radiomics models developed for RT-related outcomes in lung cancer. A systematic search of PubMed, Scopus, Web of Science, and Google Scholar found original articles (20,152,025) that employed radiomics to either pre-, mid-, or post-treatment PET scans of patients undergoing RT of lung cancer. Eight articles met the inclusion criteria. Data were extracted on the imaging protocols, radiomics pipelines, modeling strategies, validation methodologies, and clinical outcome. PET radiomics has demonstrated to be superior to conventional PET parameters in local recurrence, distant metastasis, overall survival and treatment response. Harmonization-based multicenter studies and external validation also had the most consistent performance. Nonetheless, reproducibility and generalizability differed because there was a significant heterogeneity in acquisition procedures, segmentation, feature extraction, and validation procedures. Overall, [18F]FDG PET radiomics shows promising potential as a prognostic and predictive tool in lung cancer RT. However, to achieve widespread clinical use, uniform workflows, stringent reproducibility evaluation, and prospective validation multicenter validation is needed to create strong and general radiomic biomarkers. © Akademiai Kiado Zrt 2026.