title: Prognostic implications of volume-based measurements on FDG PET/CT in stage III non-small-cell lung cancer after induction chemotherapy.
abstract: OBJECTIVE
  We sought to determine whether metabolic volume-based measurements on FDG PET/CT scans could provide additional information for predicting outcome in patients with stage III non-small-cell lung cancer (NSCLC) treated with induction chemotherapy.
  
  
  METHODS
  Included in the study were 32 patients with stage III NSCLC who were treated with induction platinum-based chemotherapy followed in 21 by surgery. All patients had an FDG PET/CT scan before and after the induction chemotherapy. Tumours were delineated using adaptive threshold methods. The SUVmax, SUVpeak, SUVmean, tumour volume (TV), total lesion glycolysis (TLG), and volume and largest diameter on the CT images (CTV and CTD, respectively) were calculated. Index ratios of the primary tumour were calculated by dividing the follow-up measurements by the baseline measurements. The prognostic value of each parameter for event-free survival (EFS) was determined using Cox regression models.
  
  
  RESULTS
  The median follow-up time was 19 months (range 6-43 months). Baseline PET and CT parameters were not significant prognostic factors. After induction therapy, only SUVmax, SUVpeak, SUVmean, TV, TLG and CTV were prognostic factors for EFS, in contrast to CTD. Of the index ratios, only TV and TLG ratios were prognostic factors for EFS. Patients with a TLG ratio <0.48 had a longer EFS than those with a TLG ratio >0.48 (13.9 vs. 9.2 months, p = 0.04). After adjustment for the effect of surgical treatment, all the parameters significantly correlated with EFS remained significant.
  
  
  CONCLUSIONS
  SUV, metabolic volume-based indices, and CTV after induction chemotherapy give independent prognostic information in stage III NSCLC. However, changes in metabolic TV and TLG under induction treatment provide more accurate prognostic information than SUV alone, and CTD and CTV.
authors.affiliation: University Paris 13, Sorbonne Paris Cité, Bobigny, France. michael.soussan@avc.aphp.fr
authors.forename: Michael
authors.initials: M
authors.lastname: Soussan
authors.forename: Kader
authors.initials: K
authors.lastname: Chouahnia
authors.forename: Jacques-Antoine
authors.initials: JA
authors.lastname: Maisonobe
authors.forename: Marouane
authors.initials: M
authors.lastname: Boubaya
authors.forename: Véronique
authors.initials: V
authors.lastname: Eder
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morère
authors.forename: Irène
authors.initials: I
authors.lastname: Buvat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D060828:Induction Chemotherapy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects*
chemical_list: D019788:Fluorodeoxyglucose F18