Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Radiother Oncol. 2020 Feb;143:30-36. doi: 10.1016/j.radonc.2019.10.008. Epub 2019 Nov 22.
To investigate associations of early post-treatment Fluorodeoxyglucose-positron-emission-tomography (FDG-PET)-scans with local (LF), regional (RF), distant failure (DF) and overall survival (OS) in locally advanced non-small cell lung cancer (LA-NSCLC)-patients treated with concurrent chemoradiotherapy.
Forty-seven stage IIIA-B NSCLC-patients included in a randomized phase II-trial (NTR2230) received 66 Gy (24x2.75 Gy) with low dose Cisplatin +/- Cetuximab. FDG-PET-scans were performed at baseline and 4 weeks post-treatment (range, 1.6-10.1). SUV, SUV, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and gross tumor volume were calculated separately for the primary tumor and the involved lymph nodes to generate baseline, post-treatment, and relative response metrics defined as (metric-metric)/metric. Univariable cox regression analyses were performed to investigate associations between PET-metrics and outcomes.
Metrics resulted from the post-treatment scan and relative response were associated with outcome, but baseline metrics were not. Primary tumor metrics were stronger associated with all outcomes than lymph node metrics. Both the volumetric (TLG/MTV) and intensity (SUV/SUV) PET-metrics were associated with OS. The intensity metrics were associated with LF, while the volumetric PET-metrics were associated with RF/DF. This was in contrast to the nodal metrics, demonstrating only an association between RF and the relative response of TLG/MTV. No preference was found between PET volumetric and intensity metrics associated with outcome.
Early post-treatment PET-metrics are associated with treatment outcome in LA-NSCLC patients treated with chemoradiotherapy. Both volumetric and intensity PET-metrics are useful, but more for the primary tumor than for lymph nodes.
本研究旨在探讨局部晚期非小细胞肺癌（LA-NSCLC）患者同步放化疗后早期氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）与局部（LF）、区域（RF）、远处失败（DF）和总生存（OS）的相关性。
47 例 IIIA-B 期 NSCLC 患者入组一项随机 II 期试验（NTR2230），接受 66Gy（24x2.75Gy）低剂量顺铂+/-西妥昔单抗治疗。FDG-PET 扫描在基线和治疗后 4 周（范围 1.6-10.1）进行。对原发肿瘤和受累淋巴结分别计算 SUV、SUV、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）和大体肿瘤体积，以生成基线、治疗后和相对反应指标，定义为（指标-指标）/指标。采用单变量 Cox 回归分析探讨 PET 指标与结局的相关性。
治疗后扫描的指标和相对反应与结局相关，但基线指标与结局无关。原发肿瘤指标与所有结局的相关性均强于淋巴结指标。体积（TLG/MTV）和强度（SUV/SUV）PET 指标均与 OS 相关。强度指标与 LF 相关，而体积 PET 指标与 RF/DF 相关。这与淋巴结指标相反，仅显示 TLG/MTV 相对反应与 RF 相关。在与结局相关的 PET 体积和强度指标之间，未发现偏好。
在接受放化疗的 LA-NSCLC 患者中，治疗后早期 PET 指标与治疗结局相关。体积和强度 PET 指标均有用，但对原发肿瘤的作用大于淋巴结。
