Value of combined interpretation of computed tomography response and positron emission tomography response for prediction of prognosis after neoadjuvant chemotherapy in non-small cell lung cancer

Ho Yun Lee, Hyun Ju Lee, Young Tae Kim, Chang Hyun Kang, Bo Gun Jang, Doo Hyun Chung, Jin Mo Goo, Chang Min Park, Chang Hyun Lee, Keon Wook Kang
Journal of Thoracic Oncology 2010, 5 (4): 497-503

INTRODUCTION: The purpose of this study was to assess the value of tumor response evaluation using combined interpretation of [18F] fluorodeoxyglucose positron emission tomography (PET) and computed tomography (CT) for the prediction of clinical outcome and pathologic response in patients with stage III non-small cell lung cancer who underwent neoadjuvant chemotherapy followed by surgery.

METHODS: This study was approved by the Institutional Review Board with a waiver of informed consent. Forty-four consecutive patients (M:F = 32:12; mean age, 60.7 years) with locally advanced non-small cell lung cancer received neoadjuvant chemotherapy followed by curative surgery. Time to recurrence (TTR) was stratified by radiologic, metabolic, and radiologic-metabolic response using the Kaplan-Meier method. The accuracy of radiologic, metabolic, and radiologic-metabolic response criteria for the prediction of pathologic response was evaluated.

RESULTS: Radiologic-metabolic responders had a longer TTR than nonresponders (mean TTR, 58.7 months versus 22.3 months, p = 0.001 with criteria of >or=30% reduction of size and >or=50% reduction of [maximum standardized uptake value] SUVmax and mean TTR, 49.4 months versus 23.5 months, p = 0.022 with criteria of >or=30% reduction of size and >or=25% reduction of SUVmax, respectively). The TTR of radiologic responders (criteria of >or=30% reduction of size) and metabolic responders (criteria of >or=25% reduction of SUVmax) was not different from the TTR of nonresponders (p > 0.05). The accuracy for the prediction of pathologic response was 70% in radiologic responders, 52 to 75% in metabolic responders, and 73 to 82% in radiologic-metabolic responders.

CONCLUSIONS: Tumor response evaluation using combined interpretation of [18F] fluorodeoxyglucose-PET and CT was more effective than single interpretation of CT response or PET response alone for the prediction of tumor recurrence and pathologic response.

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