DOI: 10.1007/s00259-018-4063-7Pages: 2103-2109

How much primary tumor metabolic volume reduction is required to improve outcome in stage III NSCLC after chemoradiotherapy? A single-centre experience

1. University Hospital, LMU Munich, Department of Radiation Oncology

2. Asklepios-Fachkliniken München-Gauting, Department of Pulmonology

3. Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Respiratory Medicine and Thoracic Oncology, Internal Medicine V

4. University Hospital, LMU Munich, Department of Nuclear Medicine

Correspondence to:
Olarn Roengvoraphoj
Tel: +49/89-4400-57566
Email: Olarn.Roengvoraphoj@med.uni-muenchen.de

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Abstract

Purpose

We analysed a correlation between pre- to post-treatment primary tumour metabolic volume (PT-MV) reduction on 18F-FDG-PET/CT and survival in non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy (CRT).

Methods

Sixty consecutive patients with NSCLC stage IIIA-B (UICC 7th edition), treated with chemoradiotherapy, who underwent 18F-FDG-PET/CT at the same institution before and 6 weeks after treatment, were analysed. Different metabolic response values were investigated on their correlation with survival parameters: complete response (100% PT-MV reduction); major response (80–99% PT-MV reduction); moderate response (50–79% PT-MV reduction); minor response (1–49% PT-MV reduction) and non-response (no change or increase in uptake).

Results

From 60 patients, 52 (87%) had repeat PET/CT scans 6 weeks after completion of CRT. Complete metabolic response (CR) was reached in ten (17%), whereas major and moderate metabolic responses occurred in 16 (27%) and 15 (25%) patients, respectively. Four patients (7%) had minor metabolic response. Non-response was documented in seven patients (12%). Median overall survival (MS) for the entire cohort was 17 months (95% CI: 11.9–22.1 months). MS according to the different metabolic response values was as follows: 34 months (95% CI: 0–84.1); 22 months (95% CI: 14.2–29.8); 12 months (95% CI: 0.4–23.6); 11 months (95% CI: 0.2–21.8) and 17 months in patients with complete, major, moderate, minor and non-response (95% CI: 6.7–27.3), respectively (p = 0.008).

On multivariate analysis, significant predictors of survival included ECOG performance status (p = 0.035, HR 0.49, 95% CI: 0.25–0.95) as well as complete and major metabolic response as a continuous variable with PT-MV reduction of at least 80% (p = 0.021, HR 0.36, 95% CI: 0.15–0.86). Moderate metabolic response did not correlate with improved outcome (p = 0.522).

Conclusions

In this homogeneous locally-advanced NSCLC single-centre patient cohort, a PT-MV reduction of at least 80% (complete and major metabolic response) following CRT was necessary to significantly improve patient outcome.

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  • Accepted: May 27, 2018
  • Online: Jun 6, 2018

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