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Prognostic implications of volume-based measurements on FDG PET/CT in stage III non-small-cell lung cancer after induction chemotherapy

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Abstract

Purpose

We sought to determine whether metabolic volume-based measurements on FDG PET/CT scans could provide additional information for predicting outcome in patients with stage III non-small-cell lung cancer (NSCLC) treated with induction chemotherapy.

Methods

Included in the study were 32 patients with stage III NSCLC who were treated with induction platinum-based chemotherapy followed in 21 by surgery. All patients had an FDG PET/CT scan before and after the induction chemotherapy. Tumours were delineated using adaptive threshold methods. The SUVmax, SUVpeak, SUVmean, tumour volume (TV), total lesion glycolysis (TLG), and volume and largest diameter on the CT images (CTV and CTD, respectively) were calculated. Index ratios of the primary tumour were calculated by dividing the follow-up measurements by the baseline measurements. The prognostic value of each parameter for event-free survival (EFS) was determined using Cox regression models.

Results

The median follow-up time was 19 months (range 6–43 months). Baseline PET and CT parameters were not significant prognostic factors. After induction therapy, only SUVmax, SUVpeak, SUVmean, TV, TLG and CTV were prognostic factors for EFS, in contrast to CTD. Of the index ratios, only TV and TLG ratios were prognostic factors for EFS. Patients with a TLG ratio <0.48 had a longer EFS than those with a TLG ratio >0.48 (13.9 vs. 9.2 months, p = 0.04). After adjustment for the effect of surgical treatment, all the parameters significantly correlated with EFS remained significant.

Conclusion

SUV, metabolic volume-based indices, and CTV after induction chemotherapy give independent prognostic information in stage III NSCLC. However, changes in metabolic TV and TLG under induction treatment provide more accurate prognostic information than SUV alone, and CTD and CTV.

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Acknowledgments

We are indebted to Dr. Michel Cymbalista (Department of Radiology, Monfermeil Hospital, France) for his help in using the lung analysis software package, and to Dr. Sébastien Vauclin (DOSIsoft, France) for his help in using the DOSIsoft software.

Conflicts of interest

None.

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Authors and Affiliations

  1. University Paris 13, Sorbonne Paris Cité, Bobigny, France

    Michael Soussan, Véronique Eder & Jean-François Morère

  2. Department of Nuclear Medicine, AP-HP, Avicenne University Hospital, 125 rue de Stalingrad, 93000, Bobigny, France

    Michael Soussan & Véronique Eder

  3. IMNC - UMR 8165 CNRS—Paris 7 and Paris 11 Universities, Orsay, France

    Michael Soussan, Jacques-Antoine Maisonobe & Irène Buvat

  4. Department of Oncology, AP-HP, Avicenne University Hospital, Bobigny, France

    Kader Chouahnia & Jean-François Morère

  5. Clinical Research Unit, AP-HP, Avicenne University Hospital, Bobigny, France

    Marouane Boubaya

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  1. Michael Soussan
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Correspondence to Michael Soussan.

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Soussan, M., Chouahnia, K., Maisonobe, JA. et al. Prognostic implications of volume-based measurements on FDG PET/CT in stage III non-small-cell lung cancer after induction chemotherapy. Eur J Nucl Med Mol Imaging 40, 668–676 (2013). https://doi.org/10.1007/s00259-012-2321-7

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  • DOI: https://doi.org/10.1007/s00259-012-2321-7

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