Prediction of residual metabolic activity after treatment in NSCLC patients
Open Access
- 13 September 2010
- journal article
- research article
- Published by Taylor & Francis Ltd in Acta Oncologica
- Vol. 49 (7), 1033-1039
- https://doi.org/10.3109/0284186X.2010.498441
Abstract
Purpose. Metabolic response assessment is often used as a surrogate of local failure and survival. Early identification of patients with residual metabolic activity is essential as this enables selection of patients who could potentially benefit from additional therapy. We report on the development of a pre-treatment prediction model for metabolic response using patient, tumor and treatment factors. Methods. One hundred and one patients with inoperable NSCLC (stage I-IV), treated with 3D conformal radical (chemo)-radiotherapy were retrospectively included in this study. All patients received a pre and post-radiotherapy fluorodeoxyglucose positron emission tomography-computed tomography FDG-PET-CT scan. The electronic medical record system and the medical patient charts were reviewed to obtain demographic, clinical, tumor and treatment data. Primary outcome measure was examined using a metabolic response assessment on a postradiotherapy FDG-PET-CT scan. Radiotherapy was delivered in fractions of 1.8 Gy, twice a day, with a median prescribed dose of 60 Gy. Results. Overall survival was worse in patients with residual metabolic active areas compared with the patients with a complete metabolic response (p=0.0001). In univariate analysis, three variables were significantly associated with residual disease: larger primary gross tumor volume (GTV(primary), p=0.002), higher pre-treatment maximum standardized uptake value (SUVmax, p=0.0005) in the primary tumor and shorter overall treatment time (OTT, p=0.046). A multivariate model including GTV(primary), SUVmax, equivalent radiation dose at 2 Gy corrected for time (EQD(2, T))and OTT yielded an area under the curve assessed by the leave-one-out cross validation of 0.71 (95% CI, 0.65-0.76). Conclusion. Our results confirmed the validity of metabolic response assessment as a surrogate of survival. We developed a multivariate model that is able to identify patients at risk of residual disease. These patients may benefit from an individualized and more adequate therapeutic approach, thereby improving local control and survival.status: publisheKeywords
This publication has 32 references indexed in Scilit:
- Estimates of cancer incidence and mortality in Europe in 2008European Journal of Cancer, 2010
- Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy 18Fluorodeoxyglucose-PET-CT scanRadiotherapy and Oncology, 2009
- Complete metabolic tumour response, assessed by 18-fluorodeoxyglucose positron emission tomography (18FDG-PET), after induction chemotherapy predicts a favourable outcome in patients with locally advanced non-small cell lung cancer (NSCLC)Lung Cancer, 2008
- Prognostic Value of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography Imaging in Patients With Advanced-Stage Non–Small-Cell Lung CarcinomaJournal of Clinical Oncology, 2008
- Weighing Tumor Biology in Treatment Decisions for Patients with Non-small Cell Lung CancerJournal of Thoracic Oncology, 2007
- A prognostic model for advanced stage nonsmall cell lung cancerCancer, 2006
- Metabolic (FDG–PET) response after radical radiotherapy/chemoradiotherapy for non-small cell lung cancer correlates with patterns of failureLung Cancer, 2005
- Prognostic factors in non‐small cell lung cancerSeminars in Surgical Oncology, 2003
- Medical Imaging for Improved Tumour Characterization, Delineation and Treatment VerificationActa Oncologica, 2002
- Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trialRadiotherapy and Oncology, 1999