title: Interpretation and Prognostic Value of Positron Emission Tomography-Computed Tomography After Induction Chemotherapy With or Without Radiation in IIIA-N2 Non-small Cell Lung Cancer Patients Who Receive Curative Surgery.
abstract: We evaluate the correlation of clinical staging on positron emission tomography-computed tomography (PET-CT) and pathologic staging and the prognostic value of PET-CT after induction chemotherapy in patients with locally advanced nonsmall cell lung cancer (NSCLC). We analyzed 42 cases of clinical stage IIIA-N2 NSCLC who receive 2 to 4 cycles of preoperative chemotherapy with or without radiation followed by curative resection. The maximum standard uptake value (SUVmax) of the suspected lesion on PET-CT was recorded. PET-CT findings after induction chemotherapy were compared with those of initial PET-CT and pathology after surgery. The accuracy of PET-CT in restaging of the primary tumor after induction chemotherapy was 50.0%. Eighteen (42.8%) of 42 patients were underestimated ycT stage, and 3 (7.1%) of 42 patients was overestimated ycT stage by PET-CT scan. The accuracy of PET-CT in restaging of the nodal disease was 71.4%. Six (14.3%) of 42 patients were underestimated ycN stage, and 6 (14.3%) of 42 patients were overestimated ycN stage as compared with pathologic staging. The 2-year overall survival (OS) and relapse-free survival (RFS) rate were 68.5% and 40.9%, respectively. Complete responders (ycT0N0M0) on PET-CT after induction chemotherapy had a significantly longer RFS time than did incomplete responders (28.3 vs 9.1 months, P = 0.021). Complete response on PET-CT after induction chemotherapy with or without radiation was a good prognosticator for RFS in stage IIIA-N2 NSCLC patients who received surgery. However, response evaluation on PET-CT after induction chemotherapy should be interpreted with caution due to its unacceptable accuracy.
authors.affiliation: From the Department of Radiation Oncology (SHK, JHL, SMJ, YKK); Internal Medicine (HKK); Thoracic Surgery (DGC); Nuclear Medicine (YHP), St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea and Radiation Oncology (MNY, SCY); Internal Medicine (GJL), Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Guk Jin
authors.initials: GJ
authors.lastname: Lee
authors.forename: Songmi
authors.initials: S
authors.lastname: Jeong
authors.forename: Yoo-Kang
authors.initials: YK
authors.lastname: Kwak
authors.forename: Hoon-Kyo
authors.initials: HK
authors.lastname: Kim
authors.forename: Deog Gon
authors.initials: DG
authors.lastname: Cho
authors.forename: Young Ha
authors.initials: YH
authors.lastname: Park
authors.forename: Mina
authors.initials: M
authors.lastname: Yu
authors.forename: Sei Chul
authors.initials: SC
authors.lastname: Yoon
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18