How much primary tumor metabolic volume reduction is required to improve outcome in stage III NSCLC after chemoradiotherapy? A single-centre experience
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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).
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).
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).
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.
KeywordsChemoradiotherapy Metabolic response NSCLC Primary tumour metabolic volume Overall survival
Presented in part as a poster discussion at the European Lung Cancer Conference (ELCC) 2017, Geneva, Switzerland, 05–08 May 2017.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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