title: Endobronchial/Endoesophageal Ultrasound (EBUS/EUS) Guided Fine Needle Aspiration (FNA) and 18F-FDG PET/CT Scanning in Restaging of Locally Advanced Non-small Cell Lung Cancer (NSCLC) Treated with Chemo-radiotherapy: A Mono-institutional Pilot Experience.
abstract: Chemo-radiotherapy is standard treatment of stage IIIA-N2 bulky or IIIB non-small cell lung cancer (NSCLC). Surgical resection of residual disease in downstaged patients may improve overall survival. In this setting, restaging disease is still a challenge. 18F-FDG PET/CT represents the gold standard although accuracy results are disappointing. Endoscopic bronchial/ esophageal ultrasound (EBUS/EUS)-guided fine needle aspiration (FNA) may confirm lymph node (LN) involvement. We analyzed 16 patients with stage IIIA-N2 bulky or IIIB NSCLC treated with chemo-radiotherapy. At restaging, all patients performed EBUS/EUS with FNA and PET/CT scan and results were compared. Patients underwent PET/CT scan 43 days (range: 24-89) and EBUS/EUS 42 days (range: 14-71) after therapy. Overall, 7 EBUS and 9 EUS procedures were performed: no complications resulting from the procedure occurred. In 6 patients EBUS/EUS did not reveal any suspicious lesions; in 2 the exam showed enlarged mediastinal LN that were biopsied, but with no evidence of tumor cells; in 2 the sample was not considered diagnostic; 6 had persistent mediastinal LN involvement. PET/CT scan showed 4 cases of complete metabolic response, 9 partial metabolic response, 2 stable metabolic disease and one progressive metabolic disease. Notably, all 7 patients with .80% decrease in SUV with respect to basal value showed a pathological complete response or negative EBUS/EUS. EBUS/EUS could be used to complement PET/CT scanning to verify mediastinal LN clearance. Further prospective trials are warranted to confirm the utility of EBUS/EUS together with PET/CT in restaging locally advanced NSCLC.
authors.affiliation: Department of Medical Oncology, AUSL Rimini, "Cervesi" Hospital, Cattolica, Italy ggenestreti@libero.it.
authors.forename: Giovenzio
authors.initials: G
authors.lastname: Genestreti
authors.affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Marco Angelo
authors.initials: MA
authors.lastname: Burgio
authors.affiliation: Diagnostic Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Department of Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.affiliation: Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
authors.affiliation: Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Monti
authors.affiliation: Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Bucchi
authors.affiliation: Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Parisi
authors.affiliation: Department of Pneumology, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Crociani
authors.affiliation: Department of Pneumology, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gurioli
authors.affiliation: Department of Pneumology, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
authors.affiliation: Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Gavelli
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Induction therapy; Mediastinum; Nodal restaging; Transbronchial needle aspiration