Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: A multicenter study

Li, Xin; Zhang, Huaqi; Xing, Ligang; Hollywood, MA; Xie, Peng; Zhang, Lin; Xu, Xiangdong; Yue, Jinbo; Sun, Xia; Hu, Xudong; Chen, Ming; Xu, Wengui; Chen, Lusheng; Yu, Jinming

doi:10.1016/j.radonc.2011.10.016

Cited by 60 publications

(22 citation statements)

References 29 publications

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“…Therefore, regional lymph node evaluation is needed to determine whether patients are appropriate candidates for SBRT. 18 F-fludeoxyglucose–PET (FDG-PET) has been shown to have excellent diagnostic accuracy, with a negative predictive value of 91%—an improvement compared with computed tomography (CT) alone 18 . Many patients also undergo histologic evaluation of lymph nodes with mediastinoscopy or, more commonly, endobronchial ultrasonography (EBUS).…”

mentioning

confidence: 99%

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Hobbs

Paryani

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non–small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes.Patients and MethodsWe retrospectively reviewed the cases of consecutive patients with FDG-PET–staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models.ResultsAmong 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02).ConclusionDisease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.

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confidence: 99%

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Hobbs

Paryani

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…[26] FDG PET-CT is reported to have a higher diagnostic accuracy than either CT or Pet alone. [27] A recent multicenter study has shown that FDG PET-CT has very high negative predictive value (91%) and specificity (83%), but limited positive predictive value (29%);[28] similar results were seen in a recent meta-analysis. [29] With respect to nodal size, the sensitivity of FDG PET-CT to detect malignant involvement was 32.4% in nodes <10 mm, and 85.3% in nodes ≥10 mm.…”

Section: Introductionmentioning

confidence: 57%

Positron emission tomography-computed tomography in the management of lung cancer: An update

Sharma¹,

Singh²,

Basu³

et al. 2013

South Asian J Cancer

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This communication presents an update on the current role of positron emission tomography-computed tomography (PET-CT) in the various clinical decision-making steps in lung carcinoma. The modality has been reported to be useful in characterizing solitary pulmonary nodules, improving lung cancer staging, especially for the detection of nodal and metastatic site involvement, guiding therapy, monitoring treatment response, and predicting outcome in non-small cell lung carcinoma (NSCLC). Its role has been more extensively evaluated in NSCLC than small cell lung carcinoma (SCLC). Limitations in FDG PET-CT are encountered in cases of tumor histotypes characterized by low glucose uptake (mucinous forms, bronchioalveolar carcinoma, neuroendocrine tumors), in the assessment of brain metastases (high physiologic 18F-FDG uptake in the brain) and in cases presenting with associated inflammation. The future potentials of newer PET tracers beyond FDG are enumerated. An evolving area is PET-guided assessment of targeted therapy (e.g., EGFR and EGFR tyrosine kinase overexpression) in tumors which have significant potential for drug development.

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“…Patients can be operated if there is no lymph node involvement (N0) or if there is only hilar lymph node involvement (N1) in NSCLC. SBRT provides good local control in non-operable patients with T1-2 tumor and without lymph node metastasis (N0) (80 Gray in 6-8 fractions; 30-60 Gy in 3-5 fractions) (17). For this reason, the highly accurate mediastinal staging provided by FDG-PET/CT is critical for early stage NSCLC patients who are candidates for SBRT.…”

Section: Stagingmentioning

confidence: 99%

“…For this reason, the highly accurate mediastinal staging provided by FDG-PET/CT is critical for early stage NSCLC patients who are candidates for SBRT. Li et al (17) evaluated 200 patients by FDG-PET/CT before the operation in their multi-centered study. They compared PET and the histopathologic results of surgery specimens.…”

Section: Stagingmentioning

confidence: 99%

Use of Positron Emission Tomography/Computed Tomography in Radiation Treatment Planning for Lung Cancer

Berberoğlu¹

2016

Mirt

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Radiotherapy (RT) plays an important role in the treatment of lung cancer. Accurate diagnosis and staging are crucial in the delivery of RT with curative intent. Target miss can be prevented by accurate determination of tumor contours during RT planning. Currently, tumor contours are determined manually by computed tomography (CT) during RT planning. This method leads to differences in delineation of tumor volume between users. Given the change in RT tools and methods due to rapidly developing technology, it is now more significant to accurately delineate the tumor tissue. F18 fluorodeoxyglucose positron emission tomography/CT (F18 FDG PET/CT) has been established as an accurate method in correctly staging and detecting tumor dissemination in lung cancer. Since it provides both anatomic and biologic information, F18 FDG PET decreases inter-user variability in tumor delineation. For instance, tumor volumes may be decreased as atelectasis and malignant tissue can be more accurately differentiated, as well as better evaluation of benign and malignant lymph nodes given the difference in FDG uptake. Using F18 FDG PET/CT, the radiation dose can be escalated without serious adverse effects in lung cancer. In this study, we evaluated the contribution of F18 FDG PET/CT for RT planning in lung cancer.

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Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: A multicenter study

Cited by 60 publications

References 29 publications

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Positron emission tomography-computed tomography in the management of lung cancer: An update

Use of Positron Emission Tomography/Computed Tomography in Radiation Treatment Planning for Lung Cancer

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