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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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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

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).

Methods

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).

Results

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).

Conclusions

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.

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Acknowledgments

Presented in part as a poster discussion at the European Lung Cancer Conference (ELCC) 2017, Geneva, Switzerland, 05–08 May 2017.

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Author notes

  1. Olarn Roengvoraphoj and Chukwuka Eze contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Olarn Roengvoraphoj, Chukwuka Eze, Maurice Dantes, Julian Taugner, Claus Belka & Farkhad Manapov

  2. Department of Pulmonology, Asklepios-Fachkliniken München-Gauting, Munich, Germany

    Cherylina Wijaya

  3. Respiratory Medicine and Thoracic Oncology, Internal Medicine V, Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Ziemssenstraße 1, 80336, Munich, Germany

    Amanda Tufman & Rudolf Maria Huber

  4. Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

    Peter Bartenstein

Authors
  1. Olarn Roengvoraphoj
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  2. Chukwuka Eze
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  7. Rudolf Maria Huber
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  9. Claus Belka
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Corresponding author

Correspondence to Olarn Roengvoraphoj.

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The authors declare no conflict of interest.

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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.

Additional information

Rudolf Maria Huber, Claus Belka and Farkhad Manapov are members of the German Centre for Lung Research (DZL CPC-M)

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Roengvoraphoj, O., Eze, C., Wijaya, C. et al. How much primary tumor metabolic volume reduction is required to improve outcome in stage III NSCLC after chemoradiotherapy? A single-centre experience. Eur J Nucl Med Mol Imaging 45, 2103–2109 (2018). https://doi.org/10.1007/s00259-018-4063-7

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