Abstract
BackgroundLung cancer is the most common among all kinds of cancers. It still constitutes the leading cause of cancer-related deaths worldwide, even with major advancements in prevention and treatments available. More than 85% of the cases are of non-small cell lung cancer (NSCLC), while less than 15% are of small cell lung cancers (SCLCs).Patients and methodsThis is a prospective study of 20 patients confirmed histopathologically to have bronchogenic carcinoma, who came for assessment of therapeutic response. All patients underwent positron emission tomography/computed tomography (PET/CT) before and after therapy. Semiquantitative assessment was used to determine maximum standardized uptake value (SUVmax). Treatment response evaluation was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.ResultsComparison of the pre- and post-treatment SUVmax in the responder and non-responder groups revealed that the post-treatment SUV was significantly lower than the baseline SUV in the responder group (P = 0.008). The responder post-treatment SUV and ∆ SUV were significantly lower than the non-responder values (P = 0.014 and 0.0004 respectively). The optimum threshold values of post-treatment SUV and ∆ SUV threshold defined by the receiver operating characteristic (ROC) curve analysis were ≤ 8 and ≤ −48.3 respectively. The sensitivity, specificity, PPV, NPV, and AUC of post-treatment SUV for predicting tumor response were 100%, 66.67%, 66.7%, 100%, and 0.833 respectively. The sensitivity, specificity, PPV, NPV, and AUC of ∆ SUV for predicting tumor response were 100%, 91.67%, 88.9%, 100%, and 0.979% respectively.ConclusionPET/CT proved itself as useful, efficient, and reliable tool in follow-up of lung cancer patients as it gives an early and accurate metabolic response assessment before any CT changes, leading to early modification of therapy or confirmation of its efficiency.
Highlights
Lung cancer is the most common among all kinds of cancers
When responder and non-responder groups were compared, no significant difference was found between the pre-treatment Standardized uptake value (SUV) of both groups; the responder post-treatment SUV and Δ SUV were significantly lower than the non-responder values (Table 3)
We found out that comparison of the pre- and post-treatment SUV in the responder and nonresponder groups revealed that the post-treatment SUV was significantly lower than the baseline SUV in the responder group (P = 0.008) while no significant difference existed between post-treatment and baseline values in the non-responder group, and this is almost close to the results found by Bahce et al and Yamamoto et al who studied the ability of post-therapeutic tumor SUV uptake to predict pathological response in patients with non-small cell lung cancer (NSCLC) and compared the results with the histopathology
Summary
Lung cancer is the most common among all kinds of cancers. It still constitutes the leading cause of cancer-related deaths worldwide, even with major advancements in prevention and treatments available. There is a need for a multidisciplinary methodology to include the advanced imaging techniques for the purpose of early accurate staging of lung cancer and administrating the treatment in order to avoid ineffective treatments to improve the chances of overall survival. This in turn will be reflected on the patient’s quality of life [2]. Because of the strong positive relationship between tracer uptake and the number of viable cancer cells, PET response criteria in solid tumors (PERCIST) were proposed in 2009 not to replace RECIST criteria but to complement them. It depends on standardized uptake value (SUV uptake) changes by the tumoral mass and has a unique advantage of predicting response by assessing the change in tumor metabolism [8]
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