Complete metabolic tumour response, assessed by 18-fluorodeoxyglucose positron emission tomography (18FDG-PET), after induction chemotherapy predicts a favourable outcome in patients with locally advanced non-small cell lung cancer (NSCLC)

Decoster, L.; Schallier, D.; Everaert, H.; Nieboer, K.; Meysman, M.; Neyns, B.; De Mey, J.; De Grève, J.

doi:10.1016/j.lungcan.2008.02.015

« Previous Next »Lung Cancer
Volume 62, Issue 1 , Pages 55-61, October 2008

Complete metabolic tumour response, assessed by 18-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET), after induction chemotherapy predicts a favourable outcome in patients with locally advanced non-small cell lung cancer (NSCLC)

L. Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
D. Schallier
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
H. Everaert
- Department of Nuclear Medecine, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
K. Nieboer
- Department of Radiology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
M. Meysman
- Department of Pneumology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
B. Neyns
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
J. De Mey
- Department of Radiology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
J. De Grève
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
- Corresponding author. Tel.: +32 2 477 64 15; fax: +32 2 477 62 10.

Received 17 September 2007; received in revised form 29 January 2008; accepted 5 February 2008. published online 07 April 2008.

Summary

Background

¹⁸FDG-PET and multislice computerized axial tomography (CT) scan are used for diagnosis, staging and response evaluation in NSCLC patients. The correlation between the response assessment by both imaging techniques and survival was assessed in patients with unresectable stage III NSCLC treated with induction chemotherapy followed by consolidation radiotherapy.

Methods

Thirty-one patients, enrolled in a phase II study evaluating the efficacy and toxicity of a novel triplet induction chemotherapy (paclitaxel, carboplatin and gemcitabine) (PACCAGE) before consolidation radiotherapy, were evaluated by CT and ¹⁸FDG-PET at baseline and after three cycles of chemotherapy. The correlation between CT and ¹⁸FDG-PET response and time to progression and overall survival was analyzed using the Kaplan–Meier estimates of survival and the log rank test.

Results

Ten patients with a complete response (CR) on ¹⁸FDG-PET had a significantly longer time to progression and overall survival than patients with a non-CR (median 19.9 months versus 9.8 months, p=0.026, and median >49 months versus 14.4 months, p=0.004, respectively). Twenty patients with a partial CT response (PR) had a significantly longer time to progression (median 15 months versus 9.4 months, p=0.001) than patients with a non-PR but the difference in overall survival only showed a trend (23.3 months versus 14.4 months, p=0.093).

Conclusions

A CR on ¹⁸FDG-PET following induction chemotherapy for locally advanced, unresectable NSCLC seems to be a more powerful prognostic marker for survival compared to PR on CT.

Keywords: Non-small cell lung cancer, Stage III unresectable, ¹⁸FDG-PET, CT scan, Response evaluation, Survival, Prognosis