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FDG PET/CT for assessing the resectability of NSCLC patients with N2 disease after neoadjuvant therapy

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Abstract

Objective

Neoadjuvant chemoradiotherapy (CMRT) is the most effective treatment of stage III non-small-cell lung cancer (NSCLC). The present study aimed at assessing FDG PET/CT for defining the response of N2 disease to neoadjuvant CMRT, as surgical resection after such therapy significantly improves 5-year survival in responding N2 disease.

Methods

Forty-five patients with locally advanced NSCLC underwent both pre-neoadjuvant therapy FDG PET/CT and post-neoadjuvant therapy FDG PET/CT followed by anatomical resection of lung and ipsilateral mediastinal lymph nodes (LN). Seventeen of these patients who had PET/CT studies in our institution and were operated after CMRT were retrospectively included in the study group (12 males, ages 43–78 years; stage IIIA: 14 patients, stage IIIB: 3 patients). PET/CT response in N2 was visually scored per-lymph node station and per patient. Quantitative N2 response was evaluated by SUVmax and total lesion glycolysis (TLG) measurements after therapy alone and in comparison with pre-therapy values. PET/CT N2 response was confirmed at surgery.

Results

Seventeen NSCLC patients with 29 metastatic N2 lymph nodes (LN) were assessed. Histopathology confirmed 14 responders and 3 non-responders, and was available in 20/29 metastatic LN, showing complete response in 17 and residual disease in 3 LN. LN-based visual analysis of N2 response on PET/CT defined 3 TP, 16 TN and 1 FP, for sensitivity, specificity, accuracy, negative and positive predictive values (NPV and PPV) of 100, 94, 95, 100 and 75 %, respectively. Patient-based visual analysis defined 3 TP, 13 TN and 1 FP study, for sensitivity, specificity, accuracy, NPV and PPV of 100, 93, 94, 100 and 75 %, respectively. Nodal-based quantitative analysis of FDG uptake in N2 nodes revealed a significant difference between responding and non-responding LN only of SUVmax post-therapy (2.5 ± 1.21 vs. 3.5 ± 2.36, P = 0.04).

Conclusion

FDG PET/CT after neoadjuvant therapy accurately defined response in metastatic N2 nodes of NSCLC patients, presenting very high sensitivity and NPV for detecting responding nodes. PET/CT may enable selection of candidates for curative resection of stage III NSCLC. Mediastinoscopy may not be mandatory in patients with a negative PET/CT after neoadjuvant therapy.

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References

  1. Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, et al. Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention. J Nat Cancer Ins. 2003;95(17):1276–9.

    Article  Google Scholar 

  2. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin. 2003;53:5–26.

    Article  PubMed  Google Scholar 

  3. Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer. 1993;54:594–606.

    Article  CAS  PubMed  Google Scholar 

  4. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med. 2004;3550:379–92.

    Google Scholar 

  5. Kobrinsky NL, Klug MG, Hokanson PJ, Sjolander DE, Burd L. Impact of smoking on cancer stage and diagnosis. J Clin Oncol. 2003;21:907.

    Article  PubMed  Google Scholar 

  6. Shields T. General thoracic surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  7. Poettgen C, Theegarten D, Eberhardt W, Levegruen S, Gauler T, Krbek T, et al. Correlation of PET/CT findings and histopathology after neoadjuvant therapy in non-small cell lung cancer. Oncology. 2007;73:316–23.

    Article  CAS  PubMed  Google Scholar 

  8. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groups in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:706.

    Article  PubMed  Google Scholar 

  9. Weber WA, Petersen V, Schmidt B, Tyndale-Hines L, Link T, Peschel C, et al. Positron emission tomography in non-small-cell lung cancer: prediction of response to chemotherapy by quantitative assessment of glucose use. J Clin Oncol. 2003;21(14):2651–7.

    Article  CAS  PubMed  Google Scholar 

  10. Pisters KM, Ginsberg RJ, Giroux DJ, Putnam JB Jr, Kris MG, Johnson DH, et al. Induction chemotherapy before surgery for early-stage lung cancer: a novel approach. Bimodality Lung Oncology Team. J Thorac Cardiovasc Surg. 2000;119(3):429–39.

    Article  CAS  PubMed  Google Scholar 

  11. Roth JA, Atkinson EN, Fossella F, Komaki R, Bernadette Ryan M, Putnam JB Jr, Lee JS, Dhingra H, De Caro L, Chasen M, Hong WK. Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. Lung Cancer. 1998;21:1–6.

    Article  CAS  PubMed  Google Scholar 

  12. Felip E, Rosell R. Is the evidence in favour of neoadjuvant chemotherapy in stage IIIA (N2) non-small cell lung cancer solid enough? Monaldi Arch Chest Dis. 2000;55:305–10.

    CAS  PubMed  Google Scholar 

  13. Betticher DC, Hsu Schmitz SF, Tötsch M, Hansen E, Joss C, von Briel C, Schmid RA, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial. J Clin Oncol. 2003;21(9):1752–9.

    Article  CAS  PubMed  Google Scholar 

  14. Cerfolio RJ, Bryant AS, Winokur TS, Ohja B, Bartolucci AA. Repeat FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. Ann Thorac Surg. 2004;78:1903–9.

    Article  PubMed  Google Scholar 

  15. Therasse P, Eisenhauer EA, Verweij J. RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer. 2006;42:1031–9.

    Article  CAS  PubMed  Google Scholar 

  16. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981;47:207–14.

    Article  CAS  PubMed  Google Scholar 

  17. Mac Manus MP, Hicks RJ, Matthews JP, McKenzie A, Rischin D, Salminen EK, et al. Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol. 2003;21:1285–92.

    Article  PubMed  Google Scholar 

  18. Vansteenkiste J, Fischer BM, Dooms C, Mortensen J. Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review. Lancet Oncol. 2004;5:531–40.

    Article  PubMed  Google Scholar 

  19. deGeus-Oei LF, van der Heijden HF, Corstens FH, Oven WJ. Predictive and prognostic value of FDG-PET in nonsmall-cell lung cancer: a systematic review. Cancer. 2007;110:1654–64.

    Article  Google Scholar 

  20. Akhurst T, Downey RJ, Ginsberg MS, Gonen M, Bains M, Korst R, et al. An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer. Ann Thorac Surg. 2002;73:259–66.

    Article  PubMed  Google Scholar 

  21. Cerfolio RJ, Ojha B, Mukherjee S, Pask AH, Bass CS, Katholi CR. Positron emission tomography scanning with 2-fluoro-2-deoxy-d-glucose as a predictor of response of neoadjuvant treatment for non-small cell carcinoma. J Thorac Cardiovasc Surg. 2003;125(4):938–44.

    Article  PubMed  Google Scholar 

  22. Yamamoto Y, Nishiyama Y, Monden T, Sasakawa Y, Ohkawa M, Gotoh M, et al. Correlation of FDG-PET findings with histopathology in the assessment of response to induction chemoradiotherapy in non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2006;33:140–7.

    Article  PubMed  Google Scholar 

  23. Ryu JS, Choi NC, Fischman AJ, Lynch TJ, Mathisen DJ. FDG-PET in staging and restaging non-small cell lung cancer after neoadjuvant chemoradiotherapy: correlation with histopathology. Lung Cancer. 2002;35:179–87.

    Article  PubMed  Google Scholar 

  24. Hicks Rodney J. Role of 18F-FDG PET in assessment of response in non-small cell lung cancer. J Nucl Med. 2009;50:31S–42S.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel

    Ran Kremer, Yury Peysakhovich, Levy-Faber Dan & Rony-Reuven Nir

  2. Department of Diagnostic Radiology, Rambam Health Care Campus, Haifa, Israel

    Ludmila Guralnik

  3. Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel

    Olga Kagna & Rachel Bar-Shalom

  4. Department of Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Israel

    Rachel Bar-Shalom

Authors
  1. Ran Kremer
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  2. Yury Peysakhovich
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  3. Levy-Faber Dan
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  4. Ludmila Guralnik
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  5. Olga Kagna
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  6. Rony-Reuven Nir
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  7. Rachel Bar-Shalom
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Correspondence to Ran Kremer.

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Kremer, R., Peysakhovich, Y., Dan, LF. et al. FDG PET/CT for assessing the resectability of NSCLC patients with N2 disease after neoadjuvant therapy. Ann Nucl Med 30, 114–121 (2016). https://doi.org/10.1007/s12149-015-1038-7

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  • DOI: https://doi.org/10.1007/s12149-015-1038-7

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