PROGNOSTIC VALUE OF POST-INDUCTION CHEMOTHERAPY VOLUMETRIC PET/CT PARAMETERS FOR STAGE IIIA/B NON-SMALL CELL LUNG CANCER PATIENTS RECEIVING DEFINITIVE CHEMORADIOTHERAPY.
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- Record sourced from PubMed, PMID 34016730.
- Also identified by DOI 10.2967/jnumed.120.260646 and PMC identifier 8612197.
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Abstract
<b>Purpose/Objective(s):</b> The aim of this follow-up analysis of the ESPATUE phase-3 trial was to explore the prognostic value of post-induction chemotherapy PET metrics in patients with stage III non-small cell lung cancer (NSCLC) who were assigned to receive definitive chemoradiotherapy. <b>Materials/Methods:</b> All eligible patients stage IIIA (cN2) and stage IIIB of the trial received induction chemotherapy consisting of 3 cycles of cisplatin/paclitaxel and chemoradiotherapy up to 45 Gy/1.5 Gy per fraction twice-a-day, followed by a radiation-boost with 2 Gy once per day with concurrent cisplatin/vinorelbine. The protocol definition prescribed a total dose of 65-71 Gy. <sup>18</sup>F-FDG-PET/CT (PETpre) was performed at study entry and before concurrent chemoradiotherapy (interim-PET; PETpost). Interim PETpost metrics and known prognostic clinical parameters were correlated in uni- and multivariable survival analyses. Leave-one-out cross-validation was used to show internal validity. <b>Results:</b> Ninety-two patients who underwent <sup>18</sup>F-FDG-PET/CT after induction chemotherapy were enrolled. Median MTVpost value was 5.9 ml. Altogether 85 patients completed the whole chemoradiation with the planned total dose of 60-71 Gy. In univariable proportional hazard analysis, each of the parameters MTVpost, SUV<sub>max</sub>(post) and TLGmax(post) was associated with overall survival (<i>P</i> < 0.05). Multivariable survival analysis, including clinical and post-induction PET parameters, found TLGmax(post) (hazard ratio: 1.032 (95%-CI: 1.013-1.052) per 100 ml increase) and total radiation dose (hazard ratio: 0.930 (0.902-0.959) per Gray increase) significantly related with overall survival in the whole group of patients, and also in patients receiving a total dose ≥ 60 Gy. The best leave-one-out cross-validated 2 parameter classifier contained TLGmax(post) and total radiation dose. TLGmax(post) was associated with time to distant metastases (<i>P</i> = 0.0018), and SUV<sub>max</sub>(post) with time to loco-regional relapse (<i>P</i> = 0.039) in multivariable analysis of patients receiving a total dose ≥ 60 Gy. <b>Conclusion:</b> Post-induction chemotherapy PET parameters demonstrated prognostic significance. Therefore, an interim <sup>18</sup>F-FDG-PET/CT is a promising diagnostic modality for guiding individualized treatment intensification.