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Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer

Analyse des metabolischen Primärtumorvolumens im Verlauf der Radiochemotherapie bei lokal fortgeschrittenem nichtkleinzelligem Lungenkarzinom

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A Correction to this article was published on 14 March 2018

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Abstract

Purpose

Positron emission tomography with 2‑deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) has an established role in the initial diagnosis and staging of lung cancer. However, a prognostic value of PET/CT during multimodality treatment has not yet been fully clarified. This study evaluated the role of primary tumor metabolic volume (PT-MV) changes on PET/CT before, during, and after chemoradiotherapy (CRT).

Methods

A total of 65 patients with non-small-cell lung cancer (NSCLC) UICC stage IIIA/B (TNM 7th Edition) were treated with definitive chemoradiotherapy (sequential or concurrent setting). PET/CT was acquired before the start, at the end of the third week, and 6 weeks following CRT.

Results

Median overall survival (OS) for the entire cohort was 16 months (95% confidence interval [CI]: 12–20). In all, 60 (92.3%) patients were eligible for pre-treatment (pre-PT-MV), 28 (43%) for mid-treatment (mid-PT-MV), and 53 (81.5%) for post-treatment (post-PT-MV) volume analysis. Patients with pre-PT-MV >63 cm3 had worse OS (p < 0.0001). A reduction from mid-PT-MV to post-PT-MV of >15% improved OS (p = 0.001). In addition, patients with post-PT-MV > 25 cm3 had significantly worse outcome (p = 0.001). On multivariate analysis, performance status (p = 0.002, hazard ratio [HR] 0.007; 95% CI 0.00–0.158), pre-PT-MV1 < 63 cm3 (p = 0.027, HR 3.98; 95% CI 1.17–13.49), post-PT-MV < 25 cm3 (p = 0.013, HR 11.90; 95% CI 1.70–83.27), and a reduction from mid-PT-MV to post-PT-MV > 15% (p = 0.004, HR 0.25; 95% CI 0.02–0.31) correlated with improved OS.

Conclusions

Our results demonstrated that pre- and post-treatment PT-MV, as well as an at least 15% reduction in mid- to post-PT-MV, significantly correlates with OS in patients with inoperable locally advanced NSCLC.

Zusammenfassung

Zielsetzung

Die kombinierte Positronenemissionstomographie (PET) mit 18F-2-Fluor-2-desoxy-D-Glukose und Computertomographie (18F-FDG-PET/CT) hat sich in der initialen Diagnostik und im Staging des Lungenkarzinoms bewährt. Jedoch wurde der prognostische Wert der PET/CT-Untersuchung während der multimodalen Therapie noch nicht vollständig aufgeklärt. In dieser Studie wurde die Rolle der Änderung des metabolischen Primärtumorvolumens („primary tumor metabolic volume“ [PT-MV]) in der PET/CT vor, während und nach der definitiven Radiochemotherapie untersucht.

Methoden

Insgesamt 65 Patienten mit nichtkleinzelligem Lungenkarzinom (NSCLC) des UICC-Stadiums IIIA/B (TNM, 7. Version) wurden mit definitiver Radiochemotherapie behandelt (sequenziell oder gleichzeitig). Eine PET/CT wurde vor dem Start, am Ende der dritten Behandlungswoche und 6 Wochen nach dem Abschluss der Radiochemotherapie durchgeführt.

Ergebnisse

Das mediane Gesamtüberleben der Kohorte betrug 16 Monate (95 %-Konfidenzintervall [KI]: 12–20 Monate). Insgesamt 60 (92,3 %) Patienten waren in die Volumenanalyse vor der Behandlung („pre-PT-MV“), 28 (43 %) in die Volumenanalyse während der Behandlung („mid-PT-MV“) und 53 (81,5 %) in die Volumenanalyse nach abgeschlossener Behandlung („post-PT-MV“) eingeschlossen. Patienten mit „pre-PT-MV“ > 63 cm3 hatten ein signifikant schlechteres Gesamtüberleben (p < 0,0001). Eine Reduktion von „mid-PT-MV“ zu „post-PT-MV“ um >15 % verbesserte das Gesamtüberleben signifikant (p = 0,001). Außerdem zeigten Patienten mit einem „post-PT-MV“ > 25 cm3 eine signifikant schlechtere Überlebensrate (p = 0,001). In der multivariaten Analyse korrelierten der Performance-Status (p = 0,002, Hazard Ratio [HR] 0,007; 95 %-KI 0,00–0,158), ein „pre-PT-MV“ < 63 cm3 (p = 0,027, HR 3,98; 95 %-KI 1,17–13,49), ein „post-PT-MV“ < 25 cm3 (p = 0,013, HR 11,90; 95 %-KI 1,70–83,27) und eine Abnahme von „mid-PT-MV“ zu „post-PT-MV“ um >15 % (p = 0,004, HR 0,25; 95 %-KI 0,02–0,31) signifikant mit einem verbesserten Gesamtüberleben.

Schlussfolgerung

Unsere Ergebnisse zeigen, dass die pre-PT-MV- und post-PT-MV-Werte sowie eine Abnahme des PT-MV zwischen der dritten Behandlungswoche und 6 Wochen nach der Radiochemotherapie um mindestens 15 % signifikant mit dem Gesamtüberleben von Patienten mit inoperablem, lokal fortgeschrittenem NSCLC korrelieren.

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Change history

  • 14 March 2018

    Correction to:

    Strahlenther Onkol 2017

    https://doi.org/10.1007/s00066-017-1229-3

    Unfortunately, an incorrect reference was provided in Table 4.

    The corrected version of Table 4 can be found in the Correction article.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Olarn Roengvoraphoj MD, Chukwuka Eze MD, Minglun Li, Maurice Dantes MD, Julian Taugner, Claus Belka MD PhD & Farkhad Manapov MD

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

    Cherylina Wijaya MD

  3. Respiratory Medicine and Thoracic Oncology, Internal Medicine V, Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Ziemssenstraße 1, 80336, Munich, Germany

    Amanda Tufman MD & Rudolf Maria Huber MD PhD

  4. members of the German Centre for Lung Research (DZL CPC-M), -, Germany

    Amanda Tufman MD, Rudolf Maria Huber MD PhD, Claus Belka MD PhD & Farkhad Manapov MD

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  1. Olarn Roengvoraphoj MD
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  2. Cherylina Wijaya MD
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  10. Farkhad Manapov MD
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Correspondence to Olarn Roengvoraphoj MD.

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Conflict of interest

O. Roengvoraphoj, C. Wijaya, C. Eze, M. Li, M. Dantes, J. Taugner, A. Tufman, R.M. Huber, C. Belka, and F. Manapov declare that they have no competing interests.

Additional information

Presented in part as a poster at the European Lung Cancer Conference (ELCC) 2016, Geneva, Switzerland, 13–16 April 2016: https://www.ncbi.nlm.nih.gov/pubmed/27198263

Olarn Roengvoraphoj and Cherylina Wijaya contributed equally to this work

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Roengvoraphoj, O., Wijaya, C., Eze, C. et al. Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer. Strahlenther Onkol 194, 107–115 (2018). https://doi.org/10.1007/s00066-017-1229-3

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