Is ¹⁸F-FDG-PET/CT a Valid Non-Invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?

Natalie Desiree Klass, Richard P. Baum, Michael Schmuecking, Norbert Presselt, Klaus-Michael Mueller, Thomas G. Wendt, Reiner Bonnet

Department of Nuclear Medicine, Zentralklinik Bad Berka, Bad Berka, Germany.
Department of Pneumology, Zentralklinik Bad Berka, Bad Berka, Germany.
Department of Radiation Oncology, University of Jena, Jena, Germany.
Department of Radiation-Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Department of Thoracic Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
Institute of Pathology, University of Münster, Münster, Germany.

DOI: 10.4236/jct.2014.56061                

Abstract

Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of ¹⁸F-FDG-PET after neoadjuvant chemoradiation as a valid, non-invasive predictor for early therapy response and its effect on survival as compared to histopathologic tumor response, data of 32 of 210 randomized patients with NSCLC stage IIIA/IIIB, who were treated in a prospective randomized controlled multicenter trial (LUCAS- MD), were re-evaluated. Material and Methods: For 32 patients with NSCLC stage IIIA (44%) IIIB (56%) neoadjuvant treatment consisted of two to three cycles of chemotherapy (225 mg/m² paclitaxel and carboplatin AUC 6 d1q22) and concomitant chemoradiation (50 mg/m² paclitaxel and carboplatin AUC 2 d1, d8, d15; 1.5 Gy b.i.d. up to 45 Gy). Documentation of involved lymph node stations as detected by ¹⁸F-FDG-PET/CT and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with ¹⁸F-FDG-PET/CT for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests. Results: Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation plus chemotherapy: complete vs. incomplete metabolic remission prior to surgery after 60 months: 40% vs. 24% (p = 0.018). RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p = 0.006). 18/32 (56%) patients had RG III/IIb, 8/32 (25%) patients had regression grade III. 1/8 pts. with RG III were in the ¹⁸F-FDG- PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the ¹⁸F-FDG-PET/CT false negative. One patient with RG IIa was in the ¹⁸F-FDG-PET/CT false negative. Hence, the cut-off level in detecting vital tumor cells by ¹⁸F-FDG-PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Conclusion: Histological regression grading correlates well with metabolic remission as detected by ¹⁸F-FDG-PET. Thus, ¹⁸F-FDG-PET precedes CT in measuring the tumor response and may predict long-term therapeutic outcome in patients with stage III NSCLC. Invasive staging procedures may be avoided and patients who will not profit from resection due to insufficient downstaging after neoadjuvant treatment will be easily detected by using ¹⁸F-FDG-PET as standard imaging in workup and evaluation of treatment response.

Keywords

NSCLC, ¹⁸18F-FDG-PET, Neoadjuvant Treatment, Non-Invasive Predictor

Conflicts of Interest

The authors declare no conflicts of interest.

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