Olarn Roengvoraphoj1, Chukwuka Eze2, Cherylina Wijaya3, Maurice Dantes2, Julian Taugner2, Amanda Tufman4, Rudolf Maria Huber4, Peter Bartenstein5, Claus Belka2, Farkhad Manapov2. 1. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. Olarn.Roengvoraphoj@med.uni-muenchen.de. 2. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. 3. Department of Pulmonology, Asklepios-Fachkliniken München-Gauting, Munich, Germany. 4. Respiratory Medicine and Thoracic Oncology, Internal Medicine V, Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Ziemssenstraße 1, 80336, Munich, Germany. 5. Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.
Abstract
PURPOSE: We analysed a correlation between pre- to post-treatment primary tumour metabolic volume (PT-MV) reduction on 18F-FDG-PET/CT and survival in non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy (CRT). METHODS: Sixty consecutive patients with NSCLC stage IIIA-B (UICC 7th edition), treated with chemoradiotherapy, who underwent 18F-FDG-PET/CT at the same institution before and 6 weeks after treatment, were analysed. Different metabolic response values were investigated on their correlation with survival parameters: complete response (100% PT-MV reduction); major response (80-99% PT-MV reduction); moderate response (50-79% PT-MV reduction); minor response (1-49% PT-MV reduction) and non-response (no change or increase in uptake). RESULTS: From 60 patients, 52 (87%) had repeat PET/CT scans 6 weeks after completion of CRT. Complete metabolic response (CR) was reached in ten (17%), whereas major and moderate metabolic responses occurred in 16 (27%) and 15 (25%) patients, respectively. Four patients (7%) had minor metabolic response. Non-response was documented in seven patients (12%). Median overall survival (MS) for the entire cohort was 17 months (95% CI: 11.9-22.1 months). MS according to the different metabolic response values was as follows: 34 months (95% CI: 0-84.1); 22 months (95% CI: 14.2-29.8); 12 months (95% CI: 0.4-23.6); 11 months (95% CI: 0.2-21.8) and 17 months in patients with complete, major, moderate, minor and non-response (95% CI: 6.7-27.3), respectively (p = 0.008). On multivariate analysis, significant predictors of survival included ECOG performance status (p = 0.035, HR 0.49, 95% CI: 0.25-0.95) as well as complete and major metabolic response as a continuous variable with PT-MV reduction of at least 80% (p = 0.021, HR 0.36, 95% CI: 0.15-0.86). Moderate metabolic response did not correlate with improved outcome (p = 0.522). CONCLUSIONS: In this homogeneous locally-advanced NSCLC single-centre patient cohort, a PT-MV reduction of at least 80% (complete and major metabolic response) following CRT was necessary to significantly improve patient outcome.
PURPOSE: We analysed a correlation between pre- to post-treatment primary tumour metabolic volume (PT-MV) reduction on 18F-FDG-PET/CT and survival in non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy (CRT). METHODS: Sixty consecutive patients with NSCLC stage IIIA-B (UICC 7th edition), treated with chemoradiotherapy, who underwent 18F-FDG-PET/CT at the same institution before and 6 weeks after treatment, were analysed. Different metabolic response values were investigated on their correlation with survival parameters: complete response (100% PT-MV reduction); major response (80-99% PT-MV reduction); moderate response (50-79% PT-MV reduction); minor response (1-49% PT-MV reduction) and non-response (no change or increase in uptake). RESULTS: From 60 patients, 52 (87%) had repeat PET/CT scans 6 weeks after completion of CRT. Complete metabolic response (CR) was reached in ten (17%), whereas major and moderate metabolic responses occurred in 16 (27%) and 15 (25%) patients, respectively. Four patients (7%) had minor metabolic response. Non-response was documented in seven patients (12%). Median overall survival (MS) for the entire cohort was 17 months (95% CI: 11.9-22.1 months). MS according to the different metabolic response values was as follows: 34 months (95% CI: 0-84.1); 22 months (95% CI: 14.2-29.8); 12 months (95% CI: 0.4-23.6); 11 months (95% CI: 0.2-21.8) and 17 months in patients with complete, major, moderate, minor and non-response (95% CI: 6.7-27.3), respectively (p = 0.008). On multivariate analysis, significant predictors of survival included ECOG performance status (p = 0.035, HR 0.49, 95% CI: 0.25-0.95) as well as complete and major metabolic response as a continuous variable with PT-MV reduction of at least 80% (p = 0.021, HR 0.36, 95% CI: 0.15-0.86). Moderate metabolic response did not correlate with improved outcome (p = 0.522). CONCLUSIONS: In this homogeneous locally-advanced NSCLC single-centre patient cohort, a PT-MV reduction of at least 80% (complete and major metabolic response) following CRT was necessary to significantly improve patient outcome.
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