title: Rapid disease progression with delay in treatment of non-small-cell lung cancer.
abstract: OBJECTIVE
  To assess rate of disease progression from diagnosis to initiation of treatment for Stage I-IIIB non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Forty patients with NSCLC underwent at least two sets of computed tomography (CT) and 18-fluorodeoxyglucose positron emission tomography (PET) scans at various time intervals before treatment. Progression was defined as development of any new lymph node involvement, site of disease, or stage change.
  
  
  RESULTS
  Median time interval between first and second CT scans was 13.4 weeks, and between first and second PET scans was 9.0 weeks. Median initial primary maximum tumor dimension (MTD) was 3.5 cm (0.6-8.5 cm) with a median standardized uptake value (SUV) of 13.0 (1.7-38.5). The median MTD increased by a median of 1.0 cm (mean, 1.6 cm) between scans for a median relative MTD increase of 35% (mean, 59%). Nineteen patients (48%) progressed between scans. Rate of any progression was 13%, 31%, and 46% at 4, 8, and 16 weeks, respectively. Upstaging occurred in 3%, 13%, and 21% at these intervals. Distant metastasis became evident in 3%, 13%, and 13% after 4, 8, and 16 weeks, respectively. T and N stage were associated with progression, whereas histology, grade, sex, age, and maximum SUV were not. At 3 years, overall survival for Stage III patients with vs. without progression was 18% vs. 67%, p = 0.05.
  
  
  CONCLUSIONS
  With NSCLC, treatment delay can lead to disease progression. Diagnosis, staging, and treatment initiation should be expedited. After 4-8 weeks of delay, complete restaging should be strongly considered.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
authors.forename: Nasiruddin
authors.initials: N
authors.lastname: Mohammed
authors.forename: Larry Llyn
authors.initials: LL
authors.lastname: Kestin
authors.forename: Inga Siiner
authors.initials: IS
authors.lastname: Grills
authors.forename: Madhu
authors.initials: M
authors.lastname: Battu
authors.forename: Dwight Lamar
authors.initials: DL
authors.lastname: Fitch
authors.forename: Ching-Yee Oliver
authors.initials: CY
authors.lastname: Wong
authors.forename: Jeffrey Harold
authors.initials: JH
authors.lastname: Margolis
authors.forename: Gary William
authors.initials: GW
authors.lastname: Chmielewski
authors.forename: Robert James
authors.initials: RJ
authors.lastname: Welsh
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden