Impact of staging with 18F-FDG-PET on outcome of patients with stage III non-small cell lung cancer: PET identifies potential survivors

The aim of this study was to analyse the impact of FDG-PET staging on treatment results of neo-adjuvant radiochemotherapy in patients with advanced non-small cell lung cancer (NSCLC). We compared prospectively the outcome of two patient groups with stage III NSCLC undergoing the same neo-adjuvant ra...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2007-01, Vol.34 (1), p.54-59
Main Authors: Eschmann, S M, Friedel, G, Paulsen, F, Reimold, M, Hehr, T, Scheiderbauer, J, Budach, W, Kotzerke, J, Bares, R
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma, Non-Small-Cell Lung - diagnostic imaging
Carcinoma, Non-Small-Cell Lung - mortality
Carcinoma, Non-Small-Cell Lung - therapy
Chemotherapy
Clinical outcomes
Female
Fluorodeoxyglucose F18
Humans
Incidence
Lung cancer
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - mortality
Lung Neoplasms - therapy
Male
Medical treatment
Middle Aged
Neoplasm Staging
Original
Outcome Assessment (Health Care) - methods
Positron-Emission Tomography - statistics & numerical data
Prognosis
Radiopharmaceuticals
Reproducibility of Results
Risk Assessment - methods
Risk Factors
Sensitivity and Specificity
Survival Rate
Treatment Outcome
Tumors
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Summary:The aim of this study was to analyse the impact of FDG-PET staging on treatment results of neo-adjuvant radiochemotherapy in patients with advanced non-small cell lung cancer (NSCLC). We compared prospectively the outcome of two patient groups with stage III NSCLC undergoing the same neo-adjuvant radio-chemotherapy (NARCT). In one group, FDG-PET was part of the pretherapeutic staging, whereas in the other group, no PET scans were performed. One hundred and eighty-eight patients with advanced stage III NSCLC were selected for a phase II trial of NARCT. The first 115 patients underwent conventional workup (CWU) and FDG-PET before inclusion (group I); the remaining 73 patients underwent CWU only (group II). All patients were followed up according to a standardised protocol for at least 11 months (up to 64 months). Overall survival and disease-free survival were used as parameters of therapeutic success and analysed statistically. After staging, 157/188 patients were included in the clinical trial. Thirty-one were excluded owing to the results of FDG-PET, in most cases because of the detection of previously unknown distant metastases. Overall survival and metastasis-free survival were significantly longer in patients of group I stratified by FDG-PET than in group II (p=0.006 and 0.02 respectively). Another significant factor for survival was complete tumour resection (p=0.02). Gender, histological tumour type, tumour grade and UICC stage had no significant influence. Pretherapeutic staging by FDG-PET significantly influences the results of NARCT and subsequent surgery by identifying patients not eligible for curative treatment.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-006-0197-0