Prediction of Survival by [18F]Fluorodeoxyglucose Positron Emission Tomography in Patients With Locally Advanced Non–Small-Cell Lung Cancer Undergoing Definitive Chemoradiation Therapy: Results of the ACRIN 6668/RTOG 0235 Trial

• Published in: Journal of clinical oncology Vol. 31; no. 30; pp. 3823 - 3830
• Main Authors: MACHTAY, Mitchell, FENGHAI DUAN, SHERWIN, Nancy, KWAN HO CHO, KIM, Seok-Ki, VIDETIC, Gregory, NEUMANN, Donald R, KOMAKI, Ritsuko, MACAPINLAC, Homer, BRADLEY, Jeffrey D, ALAVI, Abass, SIEGEL, Barry A, SNYDER, Bradley S, GORELICK, Jeremy J, REDDIN, Janet S, MUNDEN, Reginald, JOHNSON, Douglas W, WILF, Larry H, DENITTIS, Albert
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20.10.2013
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carboplatin - administration & dosage; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy; Cisplatin - administration & dosage; Etoposide - administration & dosage; Female; Fluorodeoxyglucose F18; Humans; Kaplan-Meier Estimate; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; ORIGINAL REPORTS; Paclitaxel - administration & dosage; Pneumology; Positron-Emission Tomography - methods; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Radiopharmaceuticals; Radiotherapy Dosage; Radn; Treatment Outcome; Tumors; Tumors of the respiratory system and mediastinum; Radionuclide study; Human; Lung disease; 2-deoxy-2-fluoroglucose; Respiratory disease; Lung cancer; Prediction; Malignant tumor; non-small cell lung carcinoma; Chemoradiotherapy; Survival; Cancerology; Bronchus disease; Clinical trial; Locally advanced stage; Predictive factor; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2012.47.5947

In this prospective National Cancer Institute-funded American College of Radiology Imaging Network/Radiation Therapy Oncology Group cooperative group trial, we hypothesized that standardized uptake value (SUV) on post-treatment [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) correlates with survival in stage III non-small-cell lung cancer (NSCLC). Patients received conventional concurrent platinum-based chemoradiotherapy without surgery; postradiotherapy consolidation chemotherapy was allowed. Post-treatment FDG-PET was performed at approximately 14 weeks after radiotherapy. SUVs were analyzed both as peak SUV (SUVpeak) and maximum SUV (SUVmax; both institutional and central review readings), with institutional SUVpeak as the primary end point. Relationships between the continuous and categorical (cutoff) SUVs and survival were analyzed using Cox proportional hazards multivariate models. Of 250 enrolled patients (226 were evaluable for pretreatment SUV), 173 patients were evaluable for post-treatment SUV analyses. The 2-year survival rate for the entire population was 42.5%. Pretreatment SUVpeak and SUVmax (mean, 10.3 and 13.1, respectively) were not associated with survival. Mean post-treatment SUVpeak and SUVmax were 3.2 and 4.0, respectively. Post-treatment SUVpeak was associated with survival in a continuous variable model (hazard ratio, 1.087; 95% CI, 1.014 to 1.166; P = .020). When analyzed as a prespecified binary value (≤ v > 3.5), there was no association with survival. However, in exploratory analyses, significant results for survival were found using an SUVpeak cutoff of 5.0 (P = .041) or 7.0 (P < .001). All results were similar when SUVmax was used in univariate and multivariate models in place of SUVpeak. Higher post-treatment tumor SUV (SUVpeak or SUVmax) is associated with worse survival in stage III NSCLC, although a clear cutoff value for routine clinical use as a prognostic factor is uncertain at this time.