Metabolic Tumor Volume is an Independent Prognostic Factor in Patients Treated Definitively for Non-Small-Cell Lung Cancer
ABSTRACT Fluorine-18 flurodeoxyglucose positron emission tomography (FDG-PET) imaging has rapidly become the standard of care for staging patients with lung cancer. We evaluated the prognostic value of metabolic tumor volume (MTV), a measure of tumor burden on FDG-PET imaging, in patients with non-small-cell lung cancer (NSCLC) treated definitively.
A retrospective review identified 61 patients with NSCLC who underwent FDG-PET imaging for pretreatment staging. Metabolically active tumor regions were segmented on the PET scans semiautomatically to calculate the total body MTV. We determined the relationship of overall survival (OS) and progression-free survival (PFS) with MTV in the entire cohort, and in the subgroup treated definitively.
The estimated median PFS and OS for the entire cohort were 11.1 months and 18.9 months. Higher MTV was significantly associated with worse OS (P = 0.00075) and PFS (P = 0.00077). For definitively treated patients, when MTV was analyzed as a binary value above or below the median value, 2-year PFS was 60% versus 39.7% (median PFS 34.9 vs. 11.9 months) and 2-year OS was 79.7% versus 33.3% (median OS 41.9 vs. 18.9 months), respectively (log-rank P = 0.12 for PFS and P = 0.066 for OS). When MTV was analyzed as a continuous variable, multivariate Cox proportional hazards analysis demonstrated a trend to worse PFS (hazard ratio [HR] = 1.31; P = 0.12) and significantly worse OS (HR = 1.53; P = 0.018) with increasing MTV after controlling for known prognostic variables.
Tumor burden as assessed by MTV yields prognostic information on survival beyond that of established prognostic factors in patients with NSCLC treated definitively.
[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to investigate the value of standardized uptake values (SUVs) and metabolic tumor volume (MTV) in F-18-FDG PET/CT to predict the survival of patients with locally advanced non small cell lung cancer during the early stage of concurrent chemoradiotherapy. Methods: A total of 53 patients were included in the prospective study. All patients were evaluated by F-18-FDG PET before and after 40 Gy of radiotherapy with a concurrent cisplatin-based chemotherapy regimen. Semiquantitative assessment was used to determine the maximum and mean SUVs (SUVmax and SUVmean, respectively) and MTV of the primary tumor. The cutoffs for changes in SUVmax SUVmean, and MTV (37.2%, 41.7%, and 29.7%, respectively) determined in a previous study were used with Kaplan-Meier curves to separate the groups. The prognostic significance of PET/CT parameters and other clinical variables was assessed using Cox regression analysis. Results: Overall survival (OS) at 1 and 2 y was 83.0% (46/53) and 52.8% (28/53), respectively. Survival curves for SUVmean and MTW were significantly different using the cutoffs. However, Cox regression analysis showed that the only prognostic factor for OS was a decrease in MTV. Conclusion: The use of repeated F-18-FDG PET to assess survival early during concurrent chemoradiotherapy is possible in patients with locally advanced non small cell lung cancer. A decrease in MW according to (1)8F-FDG uptake by the primary tumor correlates with higher long-term OS.Journal of Nuclear Medicine 09/2014; 55(10). DOI:10.2967/jnumed.114.142919 · 5.56 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background To investigate a prognostic role of gross tumor volume (GTV) changes on survival outcomes following concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) patients.Methods We enrolled 191 patients with stage III NSCLC from 2001 to 2009 undergoing definitive CCRT. The GTV of 157 patients was delineated at the planning CT prior to CCRT and with a follow-up CT 1 month after CCRT. We assessed the volumetric parameters of pre-treatment GTV (GTVpre) post-treatment GTV (GTVpost), and volume reduction ratio of GTV (VRR). The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and locoregional progression-free survival (LRPFS). The best cut-off value was defined as that which exhibited the maximum difference between the two groups.ResultsThe median follow-up duration was 52.7 months in surviving patients. Median survival, 3-year OS, PFS and LRPFS rates were 25.5 months, 36.4%, 23.0%, and 45.0%, respectively. The selected cut-off values were 50 cm3 for GTVpre , 20 cm3 for GTVpost , and 50% for VRR. The smaller GTVpre and GTVpost values were associated with better OS (p¿<¿0.001 and p¿=¿0.015) and PFS (p¿=¿0.001 and p¿=¿0.004), respectively, upon univariate analysis. The higher VRR of¿>¿50% was associated with a trend toward poorer OS (p¿=¿0.004) and PFS (p¿=¿0.054). Upon multivariate analysis, smaller GTVpre indicated significantly improved OS (p¿=¿0.001), PFS (p¿=¿0.013) and LRPFS (p¿=¿0.002), while smaller GTVpost was marginally significant for PFS (p¿=¿0.086). Higher VRR was associated with a trend toward poorer OS (p¿=¿0.075).Conclusions In patients with stage III NSCLC undergoing definitive CCRT, GTVpre was an independent prognostic factor of survival. Notably, improved outcome was not correlated with higher VRR after short-term follow-up with CT alone.Radiation Oncology 12/2014; 9(1):283. DOI:10.1186/s13014-014-0283-6 · 2.36 Impact Factor
American Journal of Respiratory and Critical Care Medicine 07/2013; 188(2):157-166. DOI:10.1164/rccm.201304-0716UP · 11.99 Impact Factor