CT scan prior to radiotherapy in unresectable, locally advanced, non-small cell carcinoma of the lung: is it always necessary?
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There is broad consensus regarding evaluating response to chemotherapy (CHT) by means of computerized tomography (CT) in patients with localized or locally advanced non-small cell lung carcinoma (NSCLC). We present a study comparing the usefulness of CT versus chest X-ray (XR) and clinical findings when indicating radiotherapy (RT) following CHT.
Ninety-eight of 150 subjects with unresectable locally advanced NSCLC were blindly and independently evaluated by XR and CT, with pairs of chest XR and CT (before and after CHT). A null hypothesis (H0) was established of the conditioned probability of detecting progression by CT and not by XR of 10 % or more, with a statistical power of 80 %.
Sensitivity, specificity, positive and negative predictive value of XR versus CT were 98, 89, 99, and 80 % respectively. A 4 % (p = 0.0451) probability of improvement of CT versus XR was calculated, enabling the H0 to be ruled out.
The CT failed to prove to be significantly superior to the chest XR + clinical picture in indicating a change in treatment approach in patients with unresectable locally advanced NSCLC after CHT.
KeywordsNon-small cell carcinoma of the lung Lung cancer Lung cancer staging Chest X-ray Computerized tomography RECIST
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The current study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.
Informed consent was obtained from all individual participants included in the study.
- 1.Tsao AS, Scagliotti GV, Bunn PA Jr, Carbone DP, Warren GW, Bai C, et al. Scientific advances in lung cancer 2015. J Thorac Oncol. 2016 (p ii: S1556-0864(16)30022-3, Epub ahead of print ).Google Scholar
- 5.Garrido P, de Castro J, Concha Á, Felip E, Isla D, López-Ríos F, et al. Guidelines for biomarker testing in advanced non-small-cell lung cancer. A national consensus of the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP). Clin Transl Oncol. 2012;14:338–49.CrossRefPubMedGoogle Scholar
- 13.Edge SB, Byrd DR, Compton CC. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
- 16.Sculier JP, Chansky K, Crowley JJ, Van Meerbeeck J, Goldstraw P. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th edition of the TNM classification of malignant tumors and the proposals for the 7th edition. J Thorac Oncol. 2008;3:457–66.CrossRefPubMedGoogle Scholar
- 19.O’Rourke N, Roqué I, Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small-cell lung cancer. Cochrane Database Syst Rev. 2010:cd002140.Google Scholar
- 21.Esteban E, De Sande JL, Villanueva N, Corral N, Muñiz I, Vieitez JM, et al. Cisplatin plus gemcitabine with or without vinorelbine as induction chemotherapy prior to radical locoregional treatment for patients with stage III non-small-cell lung cancer (NSCLC): results of a prospective randomised study. E. Lung Cancer. 2007;55:173–80.CrossRefGoogle Scholar
- 22.European guidelines on quality criteria for diagnostic radiographic images. Report EUR 16260. 1996.Google Scholar
- 24.Shao J, editor. Mathematical statistics. New York: Springer; 2003.Google Scholar
- 25.Shao J, Tu D, editors. The jackknife and bootstrap. New York: Springer; 1995.Google Scholar
- 27.Le Chevalier T, Arriagada R, Quoix E, Ruffie P, de Cremoux H, Douillard JY, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in unresectable non-small-cell lung carcinoma: first analysis of to randomized trial in 353 patients. J Natl Cancer Inst. 1991;83:417–23.CrossRefPubMedGoogle Scholar
- 32.Yamamoto N, Nakagawa K, Nishimura Y, Tsujino K, Satouchi M, Kudo S, et al. Phase III study comparing second- and third-generation regimens with concurrent thoracic radiotherapy in patients with unresectable stage III non-small-cell lung cancer: west Japan Thoracic Oncology Group WJTOG0105. J Clin Oncol. 2010;28(23):3739–45.CrossRefPubMedGoogle Scholar