Invited Commentary

Abstract

The treatment and survival of patients with early-stage lung cancer has remained relatively unchanged for the past 20 years. Despite attempts to improve survival rates in this population, few studies have shown any survival advantage for adjuvant chemotherapy in these patients. The studies that have shown a benefit have shown only modest results [1Strauss G, Herndon II J, Maddaus M, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 26:5043–51.Google Scholar]. Okada and colleagues’ study attempts to use maximum standardized uptake values (SUVmax) on positron emission tomography (PET) scans to differentiate patients with stage I lung cancer who will benefit from adjuvant chemotherapy from those who will not [2Sasada S. Miyata Y. Tsubokawa N. Mimae T. Yoshiya T. Okada M. Role of positron emission tomography/computed tomography findings for adjuvant chemotherapy indications in stage T1b-2aN0M0 Lung Adenocarcinoma.Ann Thorac Surg. 2014; 98: 417-423Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. The study’s limitations are pointed out by the authors and include a nonrandomized study design, small sample size, and subjective use of adjuvant chemotherapy based on surgeon discretion. Nevertheless, the study shows an impressive survival advantage for patients with T1a tumors (> 2 cm) and those with T1b tumors who received adjuvant chemotherapy. When the groups were evaluated further, the survival advantage seemed to be limited to patients with a SUVmax greater than 2.6. Other studies have suggested that PET imaging may have prognostic value in patients with early-stage lung cancer. Shiono and colleagues [3Shiono S. Abiko M. Sato T. Positron emission tomography/computed tomography and lymphovascular invasion predict local recurrence in stage i lung cancer.J Thorac Oncol. 2011; 6: 43-47Crossref PubMed Scopus (61) Google Scholar] showed that patients with SUVmax greater than 4.7 and lymphovascular invasion had greater recurrence rates and worse disease-free survival. Likewise, Uehara and colleagues [4Uehara H. Tsutani Y. Okumura S. et al.Prognostic role of positron emission tomography and high-resolution computed tomography in clinical stage IA lung adenocarcinoma.Ann Thorac Surg. 2013; 96: 1958-1965Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] found that SUVmax was able to predict nodal metastases, early recurrence, and survival in patients with stage I lung cancer. The role of PET imaging and adjuvant chemotherapy for stage I lung cancer remains unclear. Studies like the one by Okada and colleagues suggest that this technology could potentially be used to direct additional therapy for patients with completely resected early-stage lung cancer and improve survival. The current studies in the literature are all limited by small sample size, nonrandomized study design, and modest survival improvements; however, the data are intriguing enough to warrant a prospective trial to better evaluate the true benefit of this therapeutic approach. Role of Positron Emission Tomography/Computed Tomography Findings for Adjuvant Chemotherapy Indications in Stage T1b-2aN0M0 Lung AdenocarcinomaThe Annals of Thoracic SurgeryVol. 98Issue 2PreviewThis study aimed to determine the significance of the maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) images on postoperative adjuvant chemotherapy for lung adenocarcinoma. Full-Text PDF