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Publications

Journal Article Multicenter Study Randomized Controlled Trial Clinical Trial, Phase II Clinical Trial, Phase III Epublish

PubMed: 40015915 DOI: 10.2967/jnumed.124.268499

Prognostic Value of FDG PET Metabolic Parameters Before and After 42 Gy of Radiochemotherapy in Patients with Inoperable Stage III Nonsmall Cell Lung Cancer.

J Nucl Med 66(4):516-524

Authors: Pierre Vera, Philippe Giraud, Sébastien Hapdey, Pierrick Gouel, Orianne Jan, Paul Le Roux, Alexandra Langlais, Emilie Lévêque, Florence Le Tinier, Anaïs Olivier, Etienne Martin, Alina Berriolo-Riedinger, Nicolas Pourel, Jean Marc Broglia, Pierre Boisselier, Sophie Guillemard, Naji Salem, Isabelle Brenot-Rossi, Camilo Garcia, Céline Berthold, Etienne Giroux-Leprieur, Damien Moreau, Sophie Guillerm, Khadija Benali, Laurent Tessonnier, Clarisse Audigier-Valette, Delphine Lerouge, Elske Quak, Carole Massabeau, Frédéric Courbon, Maxime Loo, Anne Larrouy, Nadia Ghazzar, Philippe Chaumet-Riffaud, Elodie Amour, Gérard Zalcman, Romain Modzelewski, Sébastien Thureau

Affiliations

  • Nuclear Medicine, QuantIF-LITIS (EA4108), Centre Henri Becquerel, Rouen, France;.
  • Radiotherapy, Université Paris Cité, European Hospital Georges-Pompidou, AP-HP, Paris, France.
  • Nuclear Medicine, Centre Henri Becquerel, Rouen, France.
  • Clinical Research, IFCT, Paris, France.
  • Clinical Research, Centre Henri Becquerel, Rouen, France.
  • Radiotherapy, Centre Oscar Lambret, Lille, France.
  • Nuclear Medicine, Centre Oscar Lambret, Lille, France.
  • Radiotherapy, Centre Georges-Françsois Leclerc, Dijon, France.
  • Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
  • Oncologie-thoracique, Institut du Cancer, Avignon, France.
  • Nuclear Medicine, Institut Sainte-Catherine, Avignon, France.
  • Radiotherapy, Institut du Cancer de Montpellier, Montpellier, France.
  • Nuclear Medicine, Institut du Cancer de Montpellier, Montpellier, France.
  • Radiotherapy, Institut Paoli-Calmettes, Marseille, France.
  • Nuclear Medicine, Institut Paoli-Calmettes, Marseille, France.
  • Nuclear Medicine Department, Gustave Roussy, Villejuif, France.
  • Radiation Oncology Department, Gustave Roussy, Villejuif, France.
  • Department of Thoracic Oncology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France.
  • Radiotherapy, European Hospital Georges-Pompidou, AP-HP, Paris, France.
  • Radiotherapy, Saint-Louis Hospital, AP-HP, Paris, France.
  • Nuclear Medicine, Bichat-Claude Bernard, AP-HP Nord, Paris, France.
  • Nuclear Medicine, CHITS Toulon Sainte-Musse, Toulon, France.
  • Pneumology, CHITS Toulon Sainte-Musse, Toulon, France.
  • Radiotherapy, Centre Francois Baclesse, Caen, France.
  • Nuclear Medicine, Centre Francois Baclesse, Caen, France.
  • Radiotherapy, IUCTOncopole, Toulouse, France.
  • Nuclear Medicine, IUCTOncopole, Toulouse, France.
  • Radiotherapy, Hopital René Huguenin, Institut Curie, Saint-Cloud, France.
  • Radiotherapy, Centre de Cancerologie Paris Nord, Sarcelles, France.
  • Nuclear Medicine, Université Paris Cité, European Hospital Georges-Pompidou, AP-HP, Paris, France.
  • Clinical Research, Hôpital National 15-20, Paris, France.
  • Thoracic Oncology Department, Université Paris Cité, CIC INSERM 1425, Hôpital Bichat-Claude Bernard, AP-HP Nord, Paris, France; and.
  • Radiotherapy, Centre Henri Becquerel, Rouen, France.

Abstract

The purpose of this study was to assess the prognostic value of 18F-FDG PET parameter variation between baseline and 42 Gy (PET2) of radiochemotherapy at 6 mo and 1 y of evaluation in patients with stage III inoperable nonsmall cell lung cancer based on RECIST 1.1. Methods: In total, 158 patients in a prospective multicenter phase II/III study were analyzed. Patients were randomized into 2 groups: an experimental arm (group A) and a standard arm (group B). Patients from group A with residual metabolism on PET2 (group A+) at 42 Gy received a radiation boost (74 Gy). Patients without residual uptake on 18F-FDG PET at 42 Gy (group A-) and patients in group B received a standard radiotherapy dose (66 Gy). We compared group A with group B. The 18F-FDG PET parameters SUV max, SUV mean, SUV peak, peak SUV normalized on lean body mass, mean SUV normalized on lean body mass, total lesion glycolysis, total metabolic tumor volume (MTV) (tumor and nodes), and tumor MTV were measured. All patients were evaluated with RECIST 1.1 using CT at 6 mo and 1 y after radiochemotherapy. Progression-free survival and overall survival were evaluated. Results: Except for the radiotherapy dose (P < 0.001), patient demographic characteristics were similar between the 2 groups (A vs. B). All 18F-FDG PET uptake and volume parameter measurements were correlated. Therefore, only the change in SUV max (ΔSUV max) and total MTV were selected for the analysis. There was no significant difference in any variable between the 2 groups. In the multivariate analysis, ΔSUV max appeared to be the most important prognostic factor for overall survival, and SUV max of PET2 appeared to be the most important prognostic factor for progression-free survival. Conclusion: 18F-FDG PET at 42 Gy can be used to identify good responders to radiochemotherapy in patients with inoperable stage III nonsmall cell lung cancer. The SUV max of PET2 and ΔSUV max are independent prognostic factors.

MeSH

Radiotherapy, Cells, Lung, Neoplasms, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms, Chemoradiotherapy, Nuclear Medicine