title: Is ¹⁸F-fluorodeoxyglucose positron emission tomography-based metabolic response superior to Response Evaluation Criteria In Solid Tumors-based response after two cycles of platinum-based chemotherapy in predicting clinical outcome of untreated patients with advanced non-small cell lung cancer?
abstract: OBJECTIVE
  This prospective observational study aimed to compare ¹⁸F-fluorodeoxyglucose positron emission tomography-based metabolic response with Response Evaluation Criteria In Solid Tumors (RECIST)-based response after two cycles of platinum-based chemotherapy in predicting clinical outcome of patients with advanced non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Untreated patients with advanced NSCLC scheduled to receive platinum-based chemotherapy were enrolled for this study. They underwent spiral computed tomography and ¹⁸F-fluorodeoxyglucose positron emission tomography concurrently before and after two cycles of chemotherapy. An optimal maximum standardized uptake value reduction of primary lesion was investigated retrospectively for a metabolic response.
  
  
  RESULTS
  A total of 43 patients were eligible for final analysis from August 2003 to May 2007. Objective response rate (ORR) was significantly higher in RECIST-based responders compared with RECIST-based nonresponders after two cycles of platinum-based chemotherapy [85.0% (17/20) vs. 4.3% (1/23), respectively; P=0.000], but median progression-free survival (PFS) and median overall survival (OS) were similar [5.8 95% confidence interval (CI): 3.6-8.0) vs. 5.0 (95% CI: 3.3-6.7) months, respectively, P=0.761; 13.7 (95% CI: 7.3-20.1) vs. 15.5 (95% CI: 3.8-27.2) months, respectively, P=0.356]. At the optimal cut-off value (maximum standardized uptake value reduction of primary lesion by 31%) for a metabolic response after two cycles of chemotherapy, metabolic responders had a significantly higher ORR [66.7% (16/24) vs. 10.5% (2/19), P=0.000] and a longer median PFS [6.5 (95% CI: 5.2-7.8) vs. 4.8 (95% CI: 2.9-6.7) months, P=0.041]; median OS was 17.7 months (95% CI: 9.2-26.2) in metabolic responders and 12.0 months (95% CI: 3.3-20.7) in metabolic nonresponders (P=0.799).
  
  
  CONCLUSIONS
  Metabolic response could be superior to RECIST-based response after two cycles of platinum-based chemotherapy in predicting PFS of untreated patients with advanced NSCLC. Both of them could be predictive for ORR, but neither of them could predict OS.
authors.affiliation: Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Jin-Ji
authors.initials: JJ
authors.lastname: Yang
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Wang
authors.forename: Wen-Zhao
authors.initials: WZ
authors.lastname: Zhong
authors.forename: Chong-Rui
authors.initials: CR
authors.lastname: Xu
authors.forename: Hong-Hong
authors.initials: HH
authors.lastname: Yan
authors.forename: Yi-Long
authors.initials: YL
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C053989:nedaplatin; D016190:Carboplatin; D002945:Cisplatin