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Journal of Clinical Oncology, Vol 23, No 33 (November 20), 2005: pp. 8362-8370
© 2005 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.01.1189
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Prognostic Relevance of Response Evaluation Using [18F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Patients With Locally Advanced Non–Small-Cell Lung Cancer

Corneline J. Hoekstra, Sigrid G. Stroobants, Egbert F. Smit, Johan Vansteenkiste, Harm van Tinteren, Pieter E. Postmus, Richard P. Golding, Bonne Biesma, Frans J.H.M. Schramel, Nico van Zandwijk, Adriaan A. Lammertsma, Otto S. Hoekstra

From the Departments of Nuclear Medicine and Positron Emission Tomography Research, Pulmonary Medicine, and Radiology, Vrije University Medical Center, Amsterdam; Department of Pulmonary Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch; Department of Pulmonary Medicine, St Antonius Hospital, Nieuwegein; Department of Thoracic Oncology, Cancer Institute/Antoni van Leeuwenhoek Hospital; Comprehensive Cancer Center, Amsterdam, the Netherlands; and Departments of Nuclear Medicine and Pulmonary Medicine, University Hospital Gasthuisberg, Leuven, Belgium

Address reprint requests to O.S. Hoekstra, MD, PhD, Department of Nuclear Medicine and PET Research, VU University Medical Center, PO Box 7057, Amsterdam, the Netherlands 1007 MB; e-mail: os.hoekstra{at}vumc.nl

PURPOSE: The objective of this study was to determine the accuracy of (early) response measurements using [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG PET) with respect to survival of patients with stage IIIA-N2 non–small-cell lung cancer (NSCLC) undergoing induction chemotherapy (IC), with a comparative analysis of PET methods.

PATIENTS AND METHODS: In a prospective multicenter study, PET was performed in patients before IC and after one and three cycles. Computed tomography (CT) was performed before and after IC. Glucose consumption (metabolic rate of glucose [MRglu]) was measured using Patlak graphical analysis and correlated with simplified methods. Mediastinal lymph node (MLN) status was assessed visually. Cox proportional hazards analysis was used to determine the prognostic relevance of CT and PET measures of response with respect to survival.

RESULTS: Complete PET data sets were available in 47 patients. Median survival was 21 months. MLN status after IC by PET predicted survival (hazard ratio [HR], 2.33; 95% CI, 1.04 to 5.22; P = .04) in contrast with CT (HR, 1.87; 95% CI, 0.81 to 4.30; P = .14). Residual MRglu after IC proved to be the best prognostic factor (HR, 1.95; 95% CI, 1.28 to 2.97; P = .002). Multivariate stepwise analysis showed that PET identified prognostically different strata in patients considered responsive according to CT. Residual MRglu after one cycle selected patients with different outcomes (HR, 2.04; 95% CI, 1.18 to 3.52; P = .01). Simplified quantitative 18FDG PET methods were correlated with Patlak graphical analysis during and after therapy (r ≥ 0.90).

CONCLUSION: 18FDG PET has additional value over CT in monitoring response to IC in patients with stage IIIA-N2 NSCLC, and it seems feasible to predict survival early during IC. Simple semiquantitative and complex PET methods perform equally well.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, June 5-8, 2004, New Orleans, LA.

Authors' disclosures of potential conflicts of interest are found at the end of this article.




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