Distribution of Stage I Lung Cancer Growth Rates Determined with Serial Volumetric CT Measurements

Jennings, S. Gregory; Winer-Muram, Helen T.; Tann, Mark; Ying, Jun; Dowdeswell, Ian

doi:10.1148/radiol.2412051185

Cited by 75 publications

(70 citation statements)

References 27 publications

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“…The fact that lung cancers may become smaller prior to treatment has been reported, 7,9 and in our study, four lung cancers became smaller. The fact that cancers have been documented to decreased in size at some point in their development should 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 Volume ( have raised questions previously about the utility of equations that assume the exponential growth of lung cancers in order to determine whether a nodule is benign or malignant.…”

Section: Discussionsupporting

confidence: 72%

5-Year Lung Cancer Screening Experience

Lindell

Hartman

Swensen

et al. 2009

Chest

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Background: Although no study has prospectively documented the rate at which lung cancers grow, many have assumed exponential growth. The purpose of this study was to document the growth of lung cancers detected in high-risk participants receiving annual screening chest CT scans. Methods: Eighteen lung cancers were evaluated by at least four serial CT scans (4 men, 14 women; age range, 53 to 79 years; mean age, 66 years). CT scans were retrospectively reviewed for appearance, size, and volume (volume [v] ‫؍‬ /6[ab

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Section: Discussionsupporting

confidence: 72%

5-Year Lung Cancer Screening Experience

Lindell

Hartman

Swensen

et al. 2009

Chest

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“…Other studies have looked at DTs in lung cancer (6)(7)(8)(9)(10). Several studies have compared DT in squamous cell carcinoma (SCC) and AC, showing significantly shorter DT in SCC than in AC (6-8).…”

Section: Discussionmentioning

confidence: 99%

Doubling Times and CT Screen–Detected Lung Cancers in the Pittsburgh Lung Screening Study

Wilson¹,

Ryan

Fuhrman

et al. 2012

Am J Respir Crit Care Med

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Rationale: As computed tomography (CT) screening for lung cancer becomes more widespread, volumetric analyses, including doubling times, of CT-screen detected lung nodules and lung cancers may provide useful information in the follow-up and management of CT-detected lung nodules and cancers. Objectives: To analyze doubling times in CT screen detected lung cancers and compare prevalent and nonprevalent cancers and different cell types on non small cell lung cancer. Methods: We performed volumetric and doubling time analysis on 63 non-small cell lung cancers detected as part of the Pittsburgh Lung Screening Study using a commercially available VITREA 2 workstation and VITREA VITAL nodule segmentation software. Measurements and Main Results: Doubling times (DT) were divided into three groups: rapid (DT , 183 d), typical (DT 183-365 d), and slow (DT . 365 d). Adenocarcinoma/bronchioloalveolar carcinoma comprised 86.7% of the slow DT group compared with 20% of the rapid DT group. Conversely, squamous cell cancer comprised 60% of the rapid DT group compared with 3.3% of the slow DT group. Twenty-eight of 42 (67%) prevalent and 2 of 21 (10%) nonprevalent cancers were in the slow DT group (P , 0.0001; Fisher's exact test). Twenty-four of 32 (75%) prevalent and 1 of 11 (9%) nonprevalent adenocarcinomas were in the slow DT group (P , 0.0002; Fisher's exact test). Conclusions: Volumetric analysis of CT-detected lung cancers is particularly useful in AC/BAC. Prevalent cancers have a significantly slower DT than nonprevalent cancers and a higher percentage of adenocarcinoma/bronchioloalveolar carcinoma. These results should affect the management of indeterminant lung nodules detected on screening CT scans.Keywords: lung cancer; doubling times; lung cancer screening Computed tomography (CT) screening for lung cancer has been under study for over a decade. With the publication of results from the National Lung Screening Trial (NLST) (1), CT screening for lung cancer may become widespread. We have accumulated over 150 lung cancers as part of the Pittsburgh Lung Screening Study (PLuSS), which started enrolling subjects in 2002 (2). Although there have been several studies of volumetric evaluation of lung nodule doubling times (DTs) for differentiating benign versus malignant pulmonary nodules (3-5), there is less information about DTs in screening-detected lung cancers. We present software volumetric evaluation of DTs in 63 non-small cell lung cancers (NSCLCs) from PLuSS and compare the doubling times in prevalent and nonprevalent cancers. METHODSPLuSS involved 3,642 subjects and was approved by the Institutional Review Board of the University of Pittsburgh. Written informed consent was obtained from all participants, and the study was compliant with the Health Insurance Portability and Accountability Act. At the time of this study, 148 lung cancers had been diagnosed; 63 were suitable for volumetric nodule analysis. CT Imaging and Nodule Classification ProtocolCT scans evaluated for volumetric analysis included lung cancer scre...

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“…Previous studies reported DTs of untreated lung cancers of between 90 and 207 days. 6,11,21 More recently, Eastham and colleagues compared serial FDG-PET scans (not PET/CT) for 11 patients with NSCLC, and reported tumor volume DTs of 6.5 weeks (45 days) in 4 patients. 2 Experimental solid tumors often show early exponential initial growth with later slowing as they enlarge (Gompertzian growth pattern).…”

Section: Discussionmentioning

confidence: 99%

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

Everitt

Herschtal

Callahan

et al. 2010

Cancer

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BACKGROUND:The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo-RT. METHODS: Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG-PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent. RESULTS: Eighty-two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8-176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%-49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P ¼ .022), 16% in average SUV (P ¼ .004), and 116% in percentage injected dose (P ¼ .002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51-95 days). CONCLUSIONS: Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG-PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy. Cancer 2010;116:5030-7.

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Distribution of Stage I Lung Cancer Growth Rates Determined with Serial Volumetric CT Measurements

Abstract: At serial volumetric CT measurements, there was wide variability in growth rates. Some biopsy-proved cancers decreased in volume between examinations.

Cited by 75 publications

References 27 publications

5-Year Lung Cancer Screening Experience

5-Year Lung Cancer Screening Experience

Doubling Times and CT Screen–Detected Lung Cancers in the Pittsburgh Lung Screening Study

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

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