Abstract
Objective: Progression-free and overall survival are better correlated with metabolically active tumor volume (MTV) and total lesion glycolysis (TLG), as compared to the maximum standardized uptake value (SUVmax) in NSCLC patients. In this study, we aimed to evaluate the correlation between the PET-CT parameters and histopathologic tumor regression score in non-small cell lung cancer(NSCLC) patients after treatment with neoadjuvant chemotherapy.(1) Methods: This retrospective study evaluated stage III lung cancer patients who were treated with neoadjuvant chemotherapy followed by surgical resection at a single institution between 2014 and 2018. The 3-dimensional volumes of interest were drawn in primary tumor and largest lymph node on the pretreatment examination and corresponding location on the post-treatment examination to obtain a pre- and post-treatment SUVmax, SUVmean, MTV and TLG. All hematoxylin- and eosin-stained surgery specimens were assessed based on a 4-tiered scale. Results: Patients who had lower than 10% histologic response established higher values of SUVmax, in tumor as compared to good responders in basal PET CT assessment (p:0.014). Patients who established higher than 10% pathologic response showed higher reduction rates in terms of SUVmax (p:0.002), mean tumor volume (p:0.024), and total lesion glycolysis (p:0.009). The overall survival for patients with <10% histologic response was 15.26 months while the patients with good histologic response had 35.36 months and the difference was statistical significance (p<0.001). Due to univariate analysis, the higher SUVmax, TLG and MTV reduction have been found in association with better overall survival. Conclusion: PET CT parameters may be useful to predict histopathologic response for NSCLC patients who received neoadjuvant chemotherapy
Highlights
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide [1]
This retrospective study evaluated stage III lung cancer patients who were treated with neoadjuvant chemotherapy followed by surgical resection at a single institution between 2014 and 2018
Patients who established higher than 10% pathologic response showed higher reduction rates in terms of SUVmax (p:0.002), mean tumor volume (p:0.024), and total lesion glycolysis (p:0.009). (Figure 1)
Summary
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide [1]. Assessment of response to induction chemotherapy is critical to evaluate surgical eligibility and prognosis. As the pathologic ypN2 nodes may be a predictor of decreased overall survival, 18Ffluorodeoxyglucose-positron emission tomography (18FFDG-PET) utility in N2 nodes and its association with histopathologic response is important. The relationship between SUVmax and histopathologic tumor regression after induction chemotherapy has been shown in non–small cell lung cancer (NSCLC) patients [3]. Elevated macrophage infiltration may result in a falsely elevated SUVmax and a bulky lesion which still contains residual vital tumor may show a false negative complete metabolic response according to SUVmax [4]. 18F-FDG PET with a complete metabolic response has advantages as compared with computed tomography (CT) volume assessment for evaluating histopath ologic response [5]
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