Pre-treatment FDG-PET predicts the site of in-field progression following concurrent chemoradiotherapy for stage III non-small cell lung cancer

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Abstract

Purpose: Locoregional progression following definitive chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC) is common. In this study, we explore the utility of pre-treatment PET for predicting sites of disease progression following CRT. Methods: We identified patients treated at our institution with definitive, concurrent CRT for stage III NSCLC in the years 2007-2010 who underwent staging FDG-PET/CT. Using a semiautomatic gradient-based tool, visible thoracic hypermetabolic lesions were contoured on each patient's pre-treatment PET. Post-treatment imaging was reviewed to identify specific locations of disease progression. Patients' maximum SUV (SUVmax_pat) and metabolic tumor volume (MTV_pat) were evaluated as predictors of clinical outcomes using logrank testing. Competing risks analysis was performed to examine the relationship between lesion (tumor or lymph node) MTV (MTV_les) and the risk of local disease progression. Patient death and progression in other sites were treated as competing risks. Results: 28 patients with 82 hypermetabolic lesions (27 pulmonary tumors, 55 lymph nodes) met inclusion criteria. Median follow-up was 39.0 months for living patients. Median progression-free survival (PFS) was 12.4 months, and median overall survival (OS) was 31.8 months. Low MTV_pat was associated with improved PFS (median 14.3 months for MTV < 60. cc vs. 9.7 months for MTV > 60. cc, p=0.039). MTV_les was strongly associated with the risk of local disease progression. The 2-year cumulative incidence rate (CIR) for progression in lesions larger than 25. cc was 45%, compared to 5% for lesions under 25. cc (p<0.001). Conclusion: Pre-treatment PET can be used to identify specific lesions at high risk for treatment failure following definitive CRT for locally advanced NSCLC. Selective treatment intensification to high-risk lesions should be studied as a strategy to improve clinical outcomes in this patient population.

Original languageEnglish (US)
Pages (from-to)23-27
Number of pages5
JournalLung Cancer
Volume87
Issue number1
DOIs
StatePublished - 2015

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Chemoradiotherapy
Non-Small Cell Lung Carcinoma
Disease Progression
Therapeutics
Disease-Free Survival
Lymph Nodes
Tumor Burden
Treatment Failure
Neoplasms
Thorax
Lung
Survival
Incidence
Population

Keywords

  • Chemoradiotherapy
  • FDG-PET
  • Metabolic tumor volume
  • Non-small cell lung cancer
  • Patterns of failure
  • SUV

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

@article{20ad81fae94b495ca591cb1458e67419,
title = "Pre-treatment FDG-PET predicts the site of in-field progression following concurrent chemoradiotherapy for stage III non-small cell lung cancer",
abstract = "Purpose: Locoregional progression following definitive chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC) is common. In this study, we explore the utility of pre-treatment PET for predicting sites of disease progression following CRT. Methods: We identified patients treated at our institution with definitive, concurrent CRT for stage III NSCLC in the years 2007-2010 who underwent staging FDG-PET/CT. Using a semiautomatic gradient-based tool, visible thoracic hypermetabolic lesions were contoured on each patient's pre-treatment PET. Post-treatment imaging was reviewed to identify specific locations of disease progression. Patients' maximum SUV (SUVmax_pat) and metabolic tumor volume (MTV_pat) were evaluated as predictors of clinical outcomes using logrank testing. Competing risks analysis was performed to examine the relationship between lesion (tumor or lymph node) MTV (MTV_les) and the risk of local disease progression. Patient death and progression in other sites were treated as competing risks. Results: 28 patients with 82 hypermetabolic lesions (27 pulmonary tumors, 55 lymph nodes) met inclusion criteria. Median follow-up was 39.0 months for living patients. Median progression-free survival (PFS) was 12.4 months, and median overall survival (OS) was 31.8 months. Low MTV_pat was associated with improved PFS (median 14.3 months for MTV < 60. cc vs. 9.7 months for MTV > 60. cc, p=0.039). MTV_les was strongly associated with the risk of local disease progression. The 2-year cumulative incidence rate (CIR) for progression in lesions larger than 25. cc was 45{\%}, compared to 5{\%} for lesions under 25. cc (p<0.001). Conclusion: Pre-treatment PET can be used to identify specific lesions at high risk for treatment failure following definitive CRT for locally advanced NSCLC. Selective treatment intensification to high-risk lesions should be studied as a strategy to improve clinical outcomes in this patient population.",
keywords = "Chemoradiotherapy, FDG-PET, Metabolic tumor volume, Non-small cell lung cancer, Patterns of failure, SUV",
author = "Nitin Ohri and Bilal Piperdi and Garg, {Madhur K.} and Bodner, {William R.} and Gucalp, {Rasim A.} and Roman Perez-Soler and Keller, {Steven M.} and Chandan Guha",
year = "2015",
doi = "10.1016/j.lungcan.2014.10.016",
language = "English (US)",
volume = "87",
pages = "23--27",
journal = "Lung Cancer",
issn = "0169-5002",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Pre-treatment FDG-PET predicts the site of in-field progression following concurrent chemoradiotherapy for stage III non-small cell lung cancer

AU - Ohri, Nitin

AU - Piperdi, Bilal

AU - Garg, Madhur K.

AU - Bodner, William R.

AU - Gucalp, Rasim A.

AU - Perez-Soler, Roman

AU - Keller, Steven M.

AU - Guha, Chandan

PY - 2015

Y1 - 2015

N2 - Purpose: Locoregional progression following definitive chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC) is common. In this study, we explore the utility of pre-treatment PET for predicting sites of disease progression following CRT. Methods: We identified patients treated at our institution with definitive, concurrent CRT for stage III NSCLC in the years 2007-2010 who underwent staging FDG-PET/CT. Using a semiautomatic gradient-based tool, visible thoracic hypermetabolic lesions were contoured on each patient's pre-treatment PET. Post-treatment imaging was reviewed to identify specific locations of disease progression. Patients' maximum SUV (SUVmax_pat) and metabolic tumor volume (MTV_pat) were evaluated as predictors of clinical outcomes using logrank testing. Competing risks analysis was performed to examine the relationship between lesion (tumor or lymph node) MTV (MTV_les) and the risk of local disease progression. Patient death and progression in other sites were treated as competing risks. Results: 28 patients with 82 hypermetabolic lesions (27 pulmonary tumors, 55 lymph nodes) met inclusion criteria. Median follow-up was 39.0 months for living patients. Median progression-free survival (PFS) was 12.4 months, and median overall survival (OS) was 31.8 months. Low MTV_pat was associated with improved PFS (median 14.3 months for MTV < 60. cc vs. 9.7 months for MTV > 60. cc, p=0.039). MTV_les was strongly associated with the risk of local disease progression. The 2-year cumulative incidence rate (CIR) for progression in lesions larger than 25. cc was 45%, compared to 5% for lesions under 25. cc (p<0.001). Conclusion: Pre-treatment PET can be used to identify specific lesions at high risk for treatment failure following definitive CRT for locally advanced NSCLC. Selective treatment intensification to high-risk lesions should be studied as a strategy to improve clinical outcomes in this patient population.

AB - Purpose: Locoregional progression following definitive chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC) is common. In this study, we explore the utility of pre-treatment PET for predicting sites of disease progression following CRT. Methods: We identified patients treated at our institution with definitive, concurrent CRT for stage III NSCLC in the years 2007-2010 who underwent staging FDG-PET/CT. Using a semiautomatic gradient-based tool, visible thoracic hypermetabolic lesions were contoured on each patient's pre-treatment PET. Post-treatment imaging was reviewed to identify specific locations of disease progression. Patients' maximum SUV (SUVmax_pat) and metabolic tumor volume (MTV_pat) were evaluated as predictors of clinical outcomes using logrank testing. Competing risks analysis was performed to examine the relationship between lesion (tumor or lymph node) MTV (MTV_les) and the risk of local disease progression. Patient death and progression in other sites were treated as competing risks. Results: 28 patients with 82 hypermetabolic lesions (27 pulmonary tumors, 55 lymph nodes) met inclusion criteria. Median follow-up was 39.0 months for living patients. Median progression-free survival (PFS) was 12.4 months, and median overall survival (OS) was 31.8 months. Low MTV_pat was associated with improved PFS (median 14.3 months for MTV < 60. cc vs. 9.7 months for MTV > 60. cc, p=0.039). MTV_les was strongly associated with the risk of local disease progression. The 2-year cumulative incidence rate (CIR) for progression in lesions larger than 25. cc was 45%, compared to 5% for lesions under 25. cc (p<0.001). Conclusion: Pre-treatment PET can be used to identify specific lesions at high risk for treatment failure following definitive CRT for locally advanced NSCLC. Selective treatment intensification to high-risk lesions should be studied as a strategy to improve clinical outcomes in this patient population.

KW - Chemoradiotherapy

KW - FDG-PET

KW - Metabolic tumor volume

KW - Non-small cell lung cancer

KW - Patterns of failure

KW - SUV

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