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Impact of staging with 18F-FDG-PET on outcome of patients with stage III non-small cell lung cancer: PET identifies potential survivors.

Eschmann SM, Friedel G, Paulsen F, Reimold M, Hehr T, Scheiderbauer J, Budach W, Kotzerke J, Bares R - Eur. J. Nucl. Med. Mol. Imaging (2006)

Bottom Line: Overall survival and disease-free survival were used as parameters of therapeutic success and analysed statistically.Another significant factor for survival was complete tumour resection (p=0.02).Gender, histological tumour type, tumour grade and UICC stage had no significant influence.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University of Tübingen, Otfried-Mueller-Strasse 14, 72076, Tübingen, Germany. susanne-martina.eschmann@med.uni-tuebingen.de

ABSTRACT

Purpose: The aim of this study was to analyse the impact of FDG-PET staging on treatment results of neo-adjuvant radiochemotherapy in patients with advanced non-small cell lung cancer (NSCLC). We compared prospectively the outcome of two patient groups with stage III NSCLC undergoing the same neo-adjuvant radio-chemotherapy (NARCT). In one group, FDG-PET was part of the pretherapeutic staging, whereas in the other group, no PET scans were performed.

Methods: One hundred and eighty-eight patients with advanced stage III NSCLC were selected for a phase II trial of NARCT. The first 115 patients underwent conventional workup (CWU) and FDG-PET before inclusion (group I); the remaining 73 patients underwent CWU only (group II). All patients were followed up according to a standardised protocol for at least 11 months (up to 64 months). Overall survival and disease-free survival were used as parameters of therapeutic success and analysed statistically.

Results: After staging, 157/188 patients were included in the clinical trial. Thirty-one were excluded owing to the results of FDG-PET, in most cases because of the detection of previously unknown distant metastases. Overall survival and metastasis-free survival were significantly longer in patients of group I stratified by FDG-PET than in group II (p=0.006 and 0.02 respectively). Another significant factor for survival was complete tumour resection (p=0.02). Gender, histological tumour type, tumour grade and UICC stage had no significant influence.

Conclusion: Pretherapeutic staging by FDG-PET significantly influences the results of NARCT and subsequent surgery by identifying patients not eligible for curative treatment.

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Related in: MedlinePlus

Kaplan-Meier analysis: time interval until onset of distant metastases. Patients are grouped according to whether they underwent PET and conventional workup (CWU) (group I, n=84) or CWU only (group II, n=73). The time interval to onset of metastases was significantly longer in group I (p=0.02)
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Fig3: Kaplan-Meier analysis: time interval until onset of distant metastases. Patients are grouped according to whether they underwent PET and conventional workup (CWU) (group I, n=84) or CWU only (group II, n=73). The time interval to onset of metastases was significantly longer in group I (p=0.02)

Mentions: Follow-up data were available for all 157 patients. One hundred and three patients had died. Of the remaining 54 patients, 40 are alive at present (November 2005). No recent follow-up data are available in 14 patients owing to refusal of further follow-up (n=8) or the patient moving away from the area (n=6). The median overall survival of the whole patient group was 14.2 months (group I, 22.3 months vs group II, 11.3 months). The median follow-up of the 40 patients who are still alive is 35.3 months [16–50.6 months (25–75% quantiles)] in group I and 16.4 (8.4–22.4) in group II. Univariate outcome analysis was performed concerning the following criteria: staging by PET, complete tumour resection, UICC stage, N stage, T stage, histological tumour type, age and gender. Outcome in terms of overall survival (Fig. 2, p=0.006) or time interval until onset of distant metastases (Fig. 3, p=0.02) was significantly better in patients of group I. Distant metastases occurred in 61 patients during follow-up: 22 patients developed brain metastases, 17 bone metastases, seven liver metastases, six lung metastases, four adrenal metastases, three abdominal metastases and two cervical metastases.Fig. 2


Impact of staging with 18F-FDG-PET on outcome of patients with stage III non-small cell lung cancer: PET identifies potential survivors.

Eschmann SM, Friedel G, Paulsen F, Reimold M, Hehr T, Scheiderbauer J, Budach W, Kotzerke J, Bares R - Eur. J. Nucl. Med. Mol. Imaging (2006)

Kaplan-Meier analysis: time interval until onset of distant metastases. Patients are grouped according to whether they underwent PET and conventional workup (CWU) (group I, n=84) or CWU only (group II, n=73). The time interval to onset of metastases was significantly longer in group I (p=0.02)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2562439&req=5

Fig3: Kaplan-Meier analysis: time interval until onset of distant metastases. Patients are grouped according to whether they underwent PET and conventional workup (CWU) (group I, n=84) or CWU only (group II, n=73). The time interval to onset of metastases was significantly longer in group I (p=0.02)
Mentions: Follow-up data were available for all 157 patients. One hundred and three patients had died. Of the remaining 54 patients, 40 are alive at present (November 2005). No recent follow-up data are available in 14 patients owing to refusal of further follow-up (n=8) or the patient moving away from the area (n=6). The median overall survival of the whole patient group was 14.2 months (group I, 22.3 months vs group II, 11.3 months). The median follow-up of the 40 patients who are still alive is 35.3 months [16–50.6 months (25–75% quantiles)] in group I and 16.4 (8.4–22.4) in group II. Univariate outcome analysis was performed concerning the following criteria: staging by PET, complete tumour resection, UICC stage, N stage, T stage, histological tumour type, age and gender. Outcome in terms of overall survival (Fig. 2, p=0.006) or time interval until onset of distant metastases (Fig. 3, p=0.02) was significantly better in patients of group I. Distant metastases occurred in 61 patients during follow-up: 22 patients developed brain metastases, 17 bone metastases, seven liver metastases, six lung metastases, four adrenal metastases, three abdominal metastases and two cervical metastases.Fig. 2

Bottom Line: Overall survival and disease-free survival were used as parameters of therapeutic success and analysed statistically.Another significant factor for survival was complete tumour resection (p=0.02).Gender, histological tumour type, tumour grade and UICC stage had no significant influence.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University of Tübingen, Otfried-Mueller-Strasse 14, 72076, Tübingen, Germany. susanne-martina.eschmann@med.uni-tuebingen.de

ABSTRACT

Purpose: The aim of this study was to analyse the impact of FDG-PET staging on treatment results of neo-adjuvant radiochemotherapy in patients with advanced non-small cell lung cancer (NSCLC). We compared prospectively the outcome of two patient groups with stage III NSCLC undergoing the same neo-adjuvant radio-chemotherapy (NARCT). In one group, FDG-PET was part of the pretherapeutic staging, whereas in the other group, no PET scans were performed.

Methods: One hundred and eighty-eight patients with advanced stage III NSCLC were selected for a phase II trial of NARCT. The first 115 patients underwent conventional workup (CWU) and FDG-PET before inclusion (group I); the remaining 73 patients underwent CWU only (group II). All patients were followed up according to a standardised protocol for at least 11 months (up to 64 months). Overall survival and disease-free survival were used as parameters of therapeutic success and analysed statistically.

Results: After staging, 157/188 patients were included in the clinical trial. Thirty-one were excluded owing to the results of FDG-PET, in most cases because of the detection of previously unknown distant metastases. Overall survival and metastasis-free survival were significantly longer in patients of group I stratified by FDG-PET than in group II (p=0.006 and 0.02 respectively). Another significant factor for survival was complete tumour resection (p=0.02). Gender, histological tumour type, tumour grade and UICC stage had no significant influence.

Conclusion: Pretherapeutic staging by FDG-PET significantly influences the results of NARCT and subsequent surgery by identifying patients not eligible for curative treatment.

Show MeSH
Related in: MedlinePlus