Prognostic Value of Postinduction Chemotherapy Volumetric PET/CT Parameters for Stage IIIA or IIIB Non–Small Cell Lung Cancer Patients Receiving Definitive Chemoradiotherapy

Abstract

The aim of this follow-up analysis of the ESPATUE phase-3 trial was to explore the prognostic value of post-induction chemotherapy PET metrics in patients with stage III non-small cell lung cancer (NSCLC) who were assigned to receive definitive chemoradiotherapy.Materials/Methods: All eligible patients stage IIIA (cN2) and stage IIIB of the trial received induction chemotherapy consisting of 3 cycles of cisplatin/paclitaxel and chemoradiotherapy up to 45 Gy/1.5 Gy per fraction twice-a-day, followed by a radiation-boost with 2 Gy once per day with concurrent cisplatin/vinorelbine. The protocol definition prescribed a total dose of 65-71 Gy. 18 F-FDG-PET/CT (PETpre) was performed at study entry and before concurrent chemoradiotherapy (interim-PET; PETpost). Interim PETpost metrics and known prognostic clinical parameters were correlated in uni-and multivariable survival analyses. Leave-one-out cross-validation was used to show internal validity.Results: Ninety-two patients who underwent 18 F-FDG-PET/CT after induction chemotherapy were enrolled.Median MTVpost value was 5.9 ml. Altogether 85 patients completed the whole chemoradiation with the planned total dose of 60-71 Gy. In univariable proportional hazard analysis, each of the parameters MTVpost, SUVmax(post) and TLGmax(post) was associated with overall survival (p < 0.05). Multivariable survival analysis, including clinical and post-induction PET parameters, found TLGmax(post) (hazard ratio: 1.032 (95%-CI: 1.013-1.052) per 100 ml increase) and total radiation dose (hazard ratio: 0.930 (0.902-0.959) per Gray increase) significantly related with overall survival in the whole group of patients, and also in patients receiving a total dose ≥ 60 Gy. The best leave-one-out cross-validated 2-parameter classifier contained TLGmax(post) and total radiation dose. TLGmax(post) was associated with time to distant metastases (p = 0.0018), and SUVmax(post) with time to loco-regional relapse (p = 0.039) in multivariable analysis of patients receiving a total dose ≥ 60 Gy. Conclusion:Post-induction chemotherapy PET parameters demonstrated prognostic significance.Therefore, an interim 18 F-FDG-PET/CT is a promising diagnostic modality for guiding individualized treatment intensification.

C-reactive protein as robust laboratory value associated with prognosis in patients with stage III non-small cell lung cancer (NSCLC) treated with definitive radiochemotherapy

“…In addition, study results found the association and interaction between decreased albumin levels, liver function and immunotherapy effect 47,65 . To date, elevated blood parameters have not significantly influenced clinical treatment decisions for radiochemotherapy 27,[66][67][68][69] . Among the various blood parameters analyzed, the CRP value at the end of radiotherapy was determined to be a promising biomarker.…”

“…Three patients with large cell neuroendocrine tumors received a modified chemotherapy protocol, and because induction chemotherapy began with cisplatin and etoposide, these patients continued with the same medications. Radiotherapy was administered with either a fractionated dose of 1.5 Gy/F twice daily, with a minimum of 6 h between fractions, to a total dose of 45 Gy, followed by conventional fractionation to 61-65 Gy analog the ESPATUE Trial [26][27][28] , or a fractionated dose of 2 Gy/F once daily, 5 days a week 4 .…”

Respiration-controlled radiotherapy in lung cancer: Systematic evaluation of the optimal application practice

“…The majority of patients with lung cancer receive induction chemotherapy at the West German Cancer Centre. [11] The only exclusion criterion was inability to maintain a calm, reproducible and steady respiratory phase. All patients received planning CTs during defined breathing exercises, following professional guidance how to maintain a reproducible deep inspiratory breath-hold state or a regular, serene and reproducible breathing cycle: A fast spiral CT during deep voluntary inspiration breath-hold (DIBH) in the venous phase after intravenous contrast, and A prospectively gated sequential mode CT in expiration during shallow breathing (FB-EH), sequential mode acquires images without CT couch motion and image volume is defined by collimator width.…”

[68Ga]FAPI-PET/CT for radiation therapy planning in biliary tract, pancreatic ductal adeno-, and adenoidcystic carcinomas

“…Metabolic shrinkage may be greater than plain anatomic changes 5 . Thus, it can represent a valid prognostic parameter of interim [ 18 F]FDG-PET/CT-imaging as supported by a large retrospective study examining post-induction chemotherapy, interim PET-parameters 8 . Interim [ 18 F]FDG-PET/CT-imaging is reported to have a significant progonstic impact and to represent a valuable tool for guiding individualized treatment intensification 8 .…”