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Value of ¹⁸F-Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography/Computed Tomography in Non–Small-Cell Lung Cancer for Prediction of Pathologic Response and Times to Relapse after Neoadjuvant Chemoradiotherapy

Authors' Affiliations: Departments of ¹ Radiotherapy, ² Nuclear Medicine, ³ Internal Medicine/Cancer Research, and ⁴ Diagnostic and Interventional Radiology, University of Duisburg-Essen Medical School; ⁵ Department of Thoracic Surgery, Ruhrlandklinik, Essen, Germany; and ⁶ Institute of Pathology, Ruhr University Bochum, Bochum, Germany

Requests for reprints: Martin Stuschke, Department of Radiotherapy, University of Duisburg-Essen Medical School, Hufelandstrasse 55, D-45122 Essen, Germany. Phone: 49-201-723-2321; Fax: 49-201-723-5640; E-mail: martin.stuschke{at}medizin.uni-essen.de.

Purpose: To determine the value of combined positron emission tomography/computed tomography (PET/CT) during induction chemotherapy (CTx) followed by chemoradiotherapy (CTx/RTx) for non–small-cell lung cancer to predict histopathologic response in primary tumor and mediastinum and prognosis of the patient.

Experimental Design: Fifty consecutive patients with locally advanced non–small-cell lung cancer received induction therapy and, if considered resectable, proceeded to surgery (37 of 50 patients). Patients had at least two repeated ¹⁸F-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT scans either before treatment (t₀) or after induction CTx (t₁) or CTx/RTx (t₂). Variables from the PET/CT studies [e.g., lesion volume and corrected maximum standardized glucose uptake values (SUV_max,corr)] were correlated with histopathologic response (graded as 3, 2b, or 2a: 0%, >0-10%, or >10% residual tumor cells) and times to failure.

Results: Primary tumors showed a percentage decrease in SUV_max,corr during induction significantly larger in grade 2b/3 than in grade 2a responding tumors (67% versus 34% at t₁, 73% versus 49% at t₂; both P < 0.005). SUV_max,corr at t₂ was significantly correlated with histopathologic response in tumors smaller than the median volume (7.5 cm³; r = –0.54, P = 0.02). In the mediastinal lymph nodes, SUV_max,corr values at t₂ predicted an ypN₀ status with a sensitivity and specificity of 73% and 89%, respectively (SUV_max,corr threshold of 4.1, r = –0.54, P = 0.0005). Freedom from extracerebral relapse was significantly better in grade 2b/3 patients (86% at 16 months versus 20% in 2a responders; P = 0.003) and in patients with a greater percentage decrease in SUV_max,corr in the primary tumor at t₂ in relation to t₀ than in patients with lesser response (83% at 16 months versus 43%; P = 0.03 for cutoff points between 0.45 and 0.55).

Conclusions: SUV_max,corr values from two serial PET/CT scans, before and after three chemotherapy cycles or later, allow prediction of histopathologic response in the primary tumor and mediastinal lymph nodes and have prognostic value.

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