Role of fluorodeoxyglucose-positron emission tomography in predicting the pathological response and prognosis after neoadjuvant chemoradiotherapy for locally advanced non-small-cell lung cancer

Abstract

Objectives The present study compared the utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and CT for predicting the pathological response and prognosis following neoadjuvant therapy for locally advanced NSCLC. Methods This retrospective analysis included 72 patients in whom adjacent structures showed involvement and/or cN2 NSCLC who received induction chemoradiotherapy (ICRT) and subsequent surgery at our hospital from 2008 to 2019. FDG-PET and CT were performed in all patients before and after ICRT using the same scanner with similar techniques. We calculated the reduction in the maximum standardized uptake value in FDG-PET (ΔSUVmax) and tumour size on CT (ΔCT-size) before and after ICRT and investigated the relationship between the pathological response and prognosis. Results The disease response was classified as a major pathological response in 43 patients, and a minor response in 29 patients. ΔSUVmax 60% and ΔCT-size 30% were identified as the optimal cut-off values for predicting a major pathological response. ΔSUVmax was superior to ΔCT-size in terms of sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, ΔSUVmax was superior to ΔCT-size for predicting the prognosis. Conclusions Based on the results of the present study, FDG-PET appeared to have greater utility than CT in predicting the pathological response following ICRT and the postoperative prognosis in patients with locally advanced NSCLC.

Evaluation of the efficacy of pretreatment chest CT markers in predicting response to neoadjuvant chemoradiotherapy in locally advanced non-small cell lung cancer (NSCLC)

“…There was no significant difference between the subgroups of nonsmall cell lung tumors in terms of response to neoadjuvant treatment or progression times. These results obtained in our study were consistent with the literature 12,13 . As a matter of fact, lung tumors are divided into two groups as small cell and non-small cell in terms of treatment protocol 8,13 .…”

“…These results obtained in our study were consistent with the literature 12,13 . As a matter of fact, lung tumors are divided into two groups as small cell and non-small cell in terms of treatment protocol 8,13 .…”

The combined tumor-nodal glycolytic entropy improves survival stratification in nonsmall cell lung cancer with locoregional disease

“…18 F-fluorodeoxyglucose PET ( 18 F-FDG PET) has been implemented in clinical practice as a pretreatment imaging tool for assessing the extent of disease in NSCLC [2]. Because 18 F-FDG PET reflects the tumor's glycolytic activity, which results from cancer's metabolic reprogramming, the imaging features of 18 F-FDG PET are useful for prognostic evaluation [9][10][11]. For example, the total lesion glycolysis (TLG) is a feature frequently used to predict the survival outcomes of NSCLC [12].…”

Genomic and Glycolytic Entropy Are Reliable Radiogenomic Heterogeneity Biomarkers for Non-Small Cell Lung Cancer

“…Higher 18 F-FDG PET-derived glycolytic activity and heterogeneity are associated with regional nodal metastasis and unfavorable survival outcomes. These features also reportedly predict pathological response after neoadjuvant chemoradiotherapy in patients with NSCLC [ 4 , 5 , 6 ]. The combination of gene tests and metabolic radiomics of 18 F-FDG PET (radiogenomics) has gained increasing attention in NSCLC research [ 7 , 8 ].…”