Annals of Surgical Oncology

, Volume 21, Issue 9, pp 2831–2837 | Cite as

18F-Fluorodeoxyglucose Positron Emission Tomography versus Computed Tomography in Predicting Histopathological Response to Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Treatment in Resectable Non-Small Cell Lung Cancer

  • Matthijs H. van Gool
  • Tjeerd S. Aukema
  • Eva E. Schaake
  • Herman Rijna
  • Henk E. Codrington
  • Renato A. Valdés Olmos
  • Hendrik J. Teertstra
  • Renee van Pel
  • Sjaak A. Burgers
  • Harm van Tinteren
  • Houke M. Klomp
Thoracic Oncology



To prospectively evaluate diagnostic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for identification of histopathologic response to neoadjuvant erlotinib, an epidermal growth factor receptor–tyrosine kinase inhibitor in patients with resectable non-small cell lung cancer (NSCLC).


This study was designed as an open-label phase 2 trial, performed in four hospitals in the Netherlands. Patients received preoperative erlotinib 150 mg once daily for 3 weeks. CT and FDG-PET/CT were performed at baseline and after 3 weeks of treatment. CT was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. FDG-PET/CT, tumor FDG uptake, and changes were measured by standardized uptake values (SUV). Radiologic and metabolic responses were compared to the histopathological response.


Sixty patients were enrolled onto this study. In 53 patients (22 men, 31 women), the combination of CT, FDG-PET/CT, and histopathological evaluation was available for analysis. Three patients (6 %) had radiologic response. According to European Organisation for Research and Treatment of Cancer (EORTC) criteria, 15 patients (28 %) showed metabolic response. In 11 patients, histopathologic response (≥50 % necrosis) was seen. In predicting histopathologic response, relative FDG change in SUVmax showed more SUVmax decrease in the histopathologic response group (−32 %) versus the group with no pathologic response (−4 %) (p = 0.0132). Relative change in tumor size on diagnostic CT was similar in these groups with means close to 0.


FDG-PET/CT has an advantage over CT as a predictive tool to identify histopathologic response after 3 weeks of EGFR–TKI treatment in NSCLC patients.


Epidermal Growth Factor Receptor Erlotinib Epidermal Growth Factor Receptor Mutation Histopathologic Response Diagnostic Compute Tomography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This phase 2 study is an investigator-initiated study, supported by an unrestricted educational grant from Roche, the Netherlands. We thank the data center of the Netherlands Cancer Institute for their data management and logistic support.


The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Matthijs H. van Gool
    • 1
  • Tjeerd S. Aukema
    • 1
    • 2
    • 3
  • Eva E. Schaake
    • 2
  • Herman Rijna
    • 7
  • Henk E. Codrington
    • 8
  • Renato A. Valdés Olmos
    • 3
  • Hendrik J. Teertstra
    • 4
  • Renee van Pel
    • 5
  • Sjaak A. Burgers
    • 2
  • Harm van Tinteren
    • 6
  • Houke M. Klomp
    • 1
  1. 1.Department of Surgical OncologyThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Thoracic OncologyThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of Nuclear MedicineThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  4. 4.Department of RadiologyThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  5. 5.Department of PathologyThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  6. 6.Department of BiometricsThe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  7. 7.Department of SurgeryKennemer GasthuisHaarlemThe Netherlands
  8. 8.Department of PulmonologyHaga HospitalThe HagueThe Netherlands

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