title: The impact of time between staging PET/CT and definitive chemo-radiation on target volumes and survival in patients with non-small cell lung cancer.
abstract: OBJECTIVE
  To investigate the impact of treatment delays on radiation therapy (RT) target volumes and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) who underwent two baseline FDG PET/CT scans.
  
  
  METHODS
  Patients underwent a staging (PET1) and RT planning (PET2) FDG PET/CT scan. At PET1 all patients were eligible for radical chemo-RT. OS and progression-free survival (PFS) were compared for patients remaining eligible for radical RT and those treated palliatively because PET2 showed progression. RT target volumes were contoured using PET1 and PET2. Normal tissue doses were compared for patients remaining eligible for radical RT.
  
  
  RESULTS
  Eighty-two patients underwent PET2 scans between October 2004 and February 2007. Of these, 21 had a prior PET1 scan, median 23 days apart (range 8-176 days). Six patients (29%) were unsuitable for radical RT after PET2; five received palliative treatment and one received no treatment. Patients treated palliatively had significantly worse OS and PFS than patients treated radically p<0.001. Mean RT tumour volume increased from 105cc to 198cc (p<0.005) between scans.
  
  
  CONCLUSIONS
  Disease progression while awaiting initiation of curative RT in NSCLC is associated with larger treatment volumes and worse survival.
authors.affiliation: Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. sarah.everitt@petermac.org
authors.forename: Sarah
authors.initials: S
authors.lastname: Everitt
authors.forename: Nikki
authors.initials: N
authors.lastname: Plumridge
authors.forename: Alan
authors.initials: A
authors.lastname: Herschtal
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.forename: David
authors.initials: D
authors.lastname: Ball
authors.forename: Jason
authors.initials: J
authors.lastname: Callahan
authors.forename: Tomas
authors.initials: T
authors.lastname: Kron
authors.forename: Michal
authors.initials: M
authors.lastname: Schneider-Kolsky
authors.forename: David
authors.initials: D
authors.lastname: Binns
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.forename: Michael
authors.initials: M
authors.lastname: Mac Manus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden