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Prognostic value of post-induction chemotherapy 18F-FDG PET-CT in stage II/III non-small cell lung cancer before (chemo-) radiation


Autoři: Julien Ganem aff001;  Sebastien Thureau aff001;  Pierrick Gouel aff001;  Bernard Dubray aff002;  Mathieu Salaun aff003;  Edgar Texte aff001;  Pierre Vera aff001
Působiště autorů: Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France aff001;  Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France aff002;  QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France aff003;  Department of Pneumology, Rouen University Hospital, Rouen, France aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222885

Souhrn

Introduction

The purpose of our present study was to assess the prognostic impact of FDG PET-CT after induction chemotherapy for patients with inoperable non-small-cell lung cancer (NSCLC).

Material and methods

This retrospective study included 50 patients with inoperable stage II/III NSCLC from January 2012 to July 2015. They were treated for curative intent with induction chemotherapy, followed by concomitant chemoradiation therapy or sequential radiation therapy. FDG PET-CT scans were acquired at initial staging (PET1) and after the last cycle of induction therapy (PET2). Five parameters were evaluated on both scans: SUVmax, SUVpeak, SUVmean, TLG, MTV, and their respective deltas. The prognostic value of each parameter for overall survival (OS) and progression-free survival (PFS) was evaluated with Cox proportional-hazards regression models.

Results

Median follow-up was 19 months. PET1 parameters, clinical and histopathological data were not predictive of the outcome. TLG2 and ΔTLG were prognostic factors for OS. TLG2 was the only prognostic factor for PFS. For OS, log-rank test showed that there was a better prognosis for patients with TLG2< 69g (HR = 7.1, 95%CI 2.8–18, p = 0.002) and for patients with ΔTLG< -81% after induction therapy (HR = 3.8, 95%CI 1.5–9.6, p = 0.02). After 2 years, the survival rate was 89% for the patients with low TLG2 vs 52% for the others. We also evaluated a composite parameter considering both MTV2 and ΔSUVmax. Patients with MTV2> 23cc and ΔSUVmax> -55% had significantly shorter OS than the other patients (HR = 5.7, 95%CI 2.1–15.4, p< 0.01).

Conclusion

Post-induction FDG PET might be an added value to assess the patients’ prognosis in inoperable stage II/III NSCLC. TLG, ΔTLG as well as the association of MTV and ΔSUVmax seemed to be valuable parameters, more accurate than clinical, pathological or pretherapeutic imaging data.

Klíčová slova:

Cancer chemotherapy – Cancer treatment – Lesions – Non-small cell lung cancer – Prognosis – Radiation therapy – Chemoradiotherapy


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