RT Journal Article
SR Electronic
T1 Prognostic Value of Postinduction Chemotherapy Volumetric PET/CT Parameters for Stage IIIA or IIIB Non–Small Cell Lung Cancer Patients Receiving Definitive Chemoradiotherapy
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1684
OP 1691
DO 10.2967/jnumed.120.260646
VO 62
IS 12
A1 Maja Guberina
A1 Christoph Pöttgen
A1 Martin Metzenmacher
A1 Marcel Wiesweg
A1 Martin Schuler
A1 Clemens Aigner
A1 Till Ploenes
A1 Lale Umutlu
A1 Thomas Gauler
A1 Kaid Darwiche
A1 Georgios Stamatis
A1 Dirk Theegarten
A1 Hubertus Hautzel
A1 Walter Jentzen
A1 Nika Guberina
A1 Ken Herrmann
A1 Wilfried E.E. Eberhardt
A1 Martin Stuschke
YR 2021
UL http://jnm.snmjournals.org/content/62/12/1684.abstract
AB The aim of this follow-up analysis of the ESPATUE phase 3 trial was to explore the prognostic value of postinduction chemotherapy PET metrics in patients with stage III non–small cell lung cancer who were assigned to receive definitive chemoradiotherapy. Methods: All eligible stage IIIA (cN2) and stage IIIB patients in the trial received an induction doublet chemotherapy consisting of 3 cycles with cisplatin and paclitaxel, and subsequent combined chemoradiotherapy with a cumulative dose of up to 45 Gy (1.5 Gy per fraction twice a day), followed by a radiation boost (2 Gy once per day) with concurrent continuation of doublet chemotherapy with cisplatin and vinorelbine. The protocol definition prescribed a total dose of 65–71 Gy. 18F-FDG PET/CT was performed at study entry and before concurrent chemoradiotherapy. Interim PET metrics and known prognostic clinical parameters were correlated in uni- and multivariable survival analyses. Leave-one-out cross-validation was used to show internal validity. Results: Ninety-two patients who underwent 18F-FDG PET/CT after induction chemotherapy were enrolled. Median posttreatment MTV was 5.9 cm3. Altogether, 85 patients completed the whole chemoradiation with the planned total dose of 60–71 Gy. In univariable proportional-hazards analysis, each of 3 parameters—posttreatment MTV, posttreatment SUVmax, and posttreatment maximum total lesion glycolysis (TLGmax(post))—was associated with overall survival (P < 0.05). Multivariable survival analysis, including clinical and postinduction PET parameters, found TLGmax(post) (hazard ratio, 1.032 [95% CI, 1.013–1.052] per 100 cm3 increase) and total radiation dose (hazard ratio, 0.930 [95% CI, 0.902–0.959] per 1 Gy increase) was significantly related to overall survival in the whole group of patients and in patients receiving a total dose of at least 60 Gy. The best leave-one-out cross-validated 2-parameter classifier was TLGmax(post) and total radiation dose. TLGmax(post) was associated with time to distant metastases (P = 0.0018), and posttreatment SUVmax was associated with time to locoregional relapse (P = 0.039), in multivariable analysis of patients receiving a total dose of at least 60 Gy. Conclusion: Postinduction chemotherapy PET parameters demonstrated prognostic significance. Therefore, interim 18F-FDG PET/CT is a promising diagnostic modality for guiding individualized treatment intensification.