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Fluorodeoxyglucose Positron Emission Tomography as a Staging and Prognostic Tool in Non–Small-Cell Lung Cancer
r nb Rationale _______________________ • Most patients diagnosed with non– small-cell lung cancer (NSCLC) present with locoregionally advanced disease, and many will have metastatic disease.1 Despite advances in treatment regimens, many patients still relapse following local treatment, suggesting that, in many cases, initial staging underestimated the true extent of disease. Sensitive and specific methods of detection are necessary to ensure appropriate staging and to accurately assess response to treatment. • Positron emission tomography (PET) is a sensitive imaging method that works by detecting increased metabolic activity in tissue rather than simply mass. Conventional anatomical imaging methods, such as computed tomography (CT) and magnetic resonance imaging (MRI) generally work by detecting differences in tumor mass, density, or water content, which renders them unable, in some cases, to detect very small tumors and to distinguish an active tumor from scarring, infection, or other nonneoplastic variants in tissue anatomy. PET scanning with [18F]fluorodeoxyglucose (FDG) relies on the increased expression of glucose transporters and glycolytic enzymes in tumor cells, which facilitates the uptake of FDG into the tumor cells at a higher rate than normal surrounding tissue.1 • Several studies, including a metaanalysis of 15 studies in 1144 lung cancer patients, have determined FDG-PET staging to be superior to conventional staging techniques and a more accurate detector of distant metastases.2 This metaanalysis suggested that results from FDG-PET staging led to a change in therapeutic management in 18% of cases, and unexpected extrathoracic metastases were found in 12% of patients. In addition, a demonstration of Prepared by: Heather DeGrendele, PhD Reviewed by: Chandra P. Belani, MD, Ralph Naumann, MD, Charles White, MD
changes in the levels of glucose utilization in tumors during the course of chemotherapy has led to the investigation of FDGPET as a prognostic indicator of response to chemotherapy.3 The ability to detect nonresponsive tumors early in the course of therapy may avoid unnecessary treatmentrelated toxicity and allow early modification of therapy in the hopes of achieving tumor response.
The Utility of Fluorodeoxyglucose Positron Emission Tomography in Addition to Conventional Staging in Patients with Potentially Operable Non–Small-Cell Lung Cancer Approximately 20% of patients who undergo a curative resection for NSCLC have an early relapse, usually occurring at distant sites.4 Thus, improvement in the detection of distant lesions is needed. Generally, detection is based on clinical
findings and imaging tests such as CT, MRI, and bone scans. By adding imaging techniques such as FDG-PET to conventional staging procedures, sensitivity might be improved. Vansteenkiste and colleagues from Belgium undertook a study with the aim of answering 3 questions: (1) How many additional distant lesions can be detected by whole-body PET compared to conventional staging procedures? (2) To what extent does wholebody PET classify lesions found to be equivocal by conventional imaging? (3) Does the use of whole-body PET reduce the number of patients relapsing after curative surgery? The results of this study were reported at the 27th Meeting of the European Society of Medical Oncology (ESMO) in Nice, France.
research in brief
Fluorodeoxyglucose Positron Emission Tomography as a Staging and Prognostic Tool in Non–Small-Cell Lung Cancer
Study Design This study enrolled 144 patients in whom conventional staging was negative
Table 1: Staging and Outcome as a Result of Fluorodeoxyglucose Positron Emission Tomography Scan in Addition to Conventional Staging Number of Patients Additional Lesion Positive by PET
11
True positive
7
False positive
4
Lesions Equivocal by CS
21
True negative by PET*
17
False negative by PET†
2
False positive by PET
2
Disease Outcome in Patients M0 by FDG-PET
(n = 86)
Disease free after mean follow-up of 51 months
56 (65%)
Recurrent disease at local site
9 (10%)
Recurrent disease at distant site
16 (19%)
*24 lesions. †19 lesions. Abbreviations: CS = conventional staging; FDG = 2-[18F]fluorodeoxyglucose; PET = positron emission tomography
Clinical Lung Cancer January 2003
213
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Table 2: Fluorodeoxyglucose Positron Emission Tomography as a Predictor of Response to Platinum-Based Chemotherapy (n = 49) Responders*
Nonresponders*
P Value
9.27 ± 5.1
9.56 ± 5.46
NS
-43.7% ± 18
-11.2% ± 22
< 0.0001
PET Responders†
PET Nonresponders†
P Value
Median PFS (Days)
163
85
0.01
Median OS (Days)
249
151
0.007
1-Year Survival
41%
18%
–
Baseline SUV SUV Decrease at 3 Weeks
*Responders = patients achieving a complete or partial response; nonresponders = patients with no change or progressive disease. †PET responders ≥ 20% reduction in standardized uptake value of FDG; PET nonresponders < 20% reduction in standardized uptake value of FDG. Abbreviations: FDG = 2-[18F]fluorodeoxyglucose; NS = not significant; OS = overall survival PET = positron emission tomography; PFS = progression-free survival; SUV = standardized uptake value
or equivocal for metastases. Conventional staging included contrast-enhanced CT of the thorax and upper abdomen examination with ultrasound or CT with additional MRI for equivocal lesions. Patients with neurological symptoms or nonsquamous histology received an additional brain CT. Bone scintigraphy was performed for patients with bone pain or elevated alkaline phosphatase or serum calcium levels; additional bone radiography, CT, or MRI was performed in cases of equivocal findings. Final stage was decided by either surgical biopsy of suspicious lesions or additional imaging or follow-up of at least 18 months. Results The addition of FDG-PET to conventional staging techniques resulted in detection of previously undetected lesions in 11 patients (Table 1). Five of these lesions were determined to be true positives for distant metastases: 3 in bone, 1 in the lymph nodes, and 1 in the contralateral lung. Two additional lesions were also true positives, although for asymptomatic colorectal cancer. Four of the additionally detected lesions were false positives. Of the 24 lesions in 21 patients that were equivocal after thorough conventional staging, PET was able to correctly exclude metastasis in 19 lesions (17 patients). Two falsepositive lesions and 2 false-negative le-
214
Clinical Lung Cancer January 2003
sions were also detected by PET scan. A complete resection was performed in 86 patients determined to be free of metastatic disease by PET (M0). Among these, 56 patients (65%) remain disease free after a mean follow-up of 51 months (Table 1). However, 25 patients developed recurrent disease, with 9 local relapses and 16 distant relapses. In this study, the combination of thorough conventional staging techniques and FDG-PET still failed to diagnose occult metastatic disease in 19% of patients.
Fluorodeoxyglucose Positron Emission Tomography Results Can Serve as a Predictor of Disease Response in Patients with Advanced Non–Small-Cell Lung Cancer Undergoing Platinum-Based Chemotherapy Studies have shown that levels of tumor glucose utilization decrease early during the course of chemotherapy, while these levels remain high in untreated tumors.3 These data suggest that FDG-PET scanning could potentially be used to evaluate the effectiveness of chemotherapy, thus allowing the early elimination of ineffective treatments. In order to test this hypothesis, Petersen and colleagues from Germany initiated a study to evaluate the prognostic value of FDG-PET for response to chemotherapy as well as survival in patients undergoing plat-
inum-based chemotherapy for NSCLC.5 Results were reported at the 27th ESMO Meeting. Study Design This trial enrolled patients scheduled to undergo treatment with cisplatin/vinorelbine, carboplatin/tamoxifen, cisplatin/ docetaxel, or cisplatin/etoposide as firstline therapy for locally advanced or metastatic NSCLC. Patients with prior chemotherapy or radiotherapy of the thorax were excluded. Patients were given spiral CT of the thorax to measure tumor response along with FDG-PET prior to start of chemotherapy. FDG-PET was repeated following the first cycle of chemotherapy (3 weeks), and spiral CT was repeated following the second cycle (6 weeks). Patients A total of 52 patients were enrolled, with a mean age of 60 years. Forty-eight percent of patients had a World Health Organization (WHO) performance status (PS) of 0, and 48% had a WHO PS of 1. Most of the patients (77%) had stage IV disease with adenocarcinoma (50%) and squamous cell carcinoma (29%) being the most common histological types. Results Forty-nine patients were evaluable for response correlation to FDG uptake. Patients who achieved a partial response (PR, 41%) were classified as responders. No patients achieved a complete response (CR). Nonresponders consisted of patients who experienced no change in tumor burden (33%) or progressive disease (26%). Baseline metabolic activity as determined by FDG uptake was not significantly different between responders (9.27 ± 5.1) and nonresponders (9.56 ± 5.46). There was a significantly greater decrease in FDG uptake among patients in the responder group (-43.7% ± 18) compared to the nonresponder group (-11.2% ± 22; P < 0.0001). This study found that FDG uptake could be used as a predictor of disease response to chemotherapy (Table 2). Using a cutoff value of 20% reduction in FDG
Study Design Patients with stage IIIA or IIIB, mediastinoscopically proven pN2/3 NSCLC were enrolled. Treatment consisted of docetaxel 100 mg/m2 on day 1 followed by carboplatin at an area under the curve of 7.5 on day 2, every 21 days for a total of 4 cycles. All patients also received adjuvant radiotherapy, prophylactic erythropoietin, and granulocyte colonystimulating factor. FDG-PET was performed prior to chemotherapy and again following the completion of 4 cycles of therapy. Patients The median age was 62 years (range, 37-76 years) for the 56 patients enrolled. Most of the patients (96%) had a Karnofsky PS of 70%-99%, and 87% had stage IIIA disease. Results All 56 patients were evaluable for response by CT scan (Table 3). This study resulted in an overall response rate of 63% with 1 CR (2%) and 34 PRs (61%). Of the 37 patients evaluable for metabolic response by FDG-PET scan, 38% achieved a metabolic CR as defined by a standardized uptake value for FDG of < 2.5. Subgroup analysis of the responders by CT scan demonstrated a 60% 2-year diseasefree survival rate for patients who
Table 3: Fluorodeoxyglucose Positron Emission Tomography as a Predictor of Survival in Non–Small-Cell Lung Cancer Patients Undergoing Docetaxel/Carboplatin Chemotherapy Number of Patients Response by CT (n = 56) Overall response Complete response
35 (63%) 1 (2%)
Partial response
34 (61%)
Stable disease
9 (16%)
Progressive disease
10 (18%)
Not evaluated
research in brief
uptake, patient response could be predicted with a sensitivity of 90% and 76% specificity with a positive predictive value of 72% and a negative predictive value of 92%. Patients predicted to be responders by PET were found to have a median progression-free survival (PFS) of 163 days, while median PFS was only 85 days for predicted nonresponders (P = 0.01). Furthermore, 1-year survival was significantly greater among PET responders (41%) compared to PET nonresponders (18%). A similar study was conducted in patients with stage III NSCLC undergoing chemotherapy with docetaxel/carboplatin by Griesinger and colleagues from Germany.6 The results of this study were also reported at the 27th ESMO Meeting.
2 (4%)
Metabolic Response (n = 37) Complete response*
14 (38%)
Partial response,† SD, or PD
23 (62%)
2-Year DFS (CT Responders) Metabolic CR by FDG-PET
60%
Metabolic nonresponse by FDG-PET‡
35%
*Standardized uptake value of FDG < 2.5. †Metabolic partial response = FDG standardized uptake value of < 50% of start value. ‡P = 0.025. Abbreviations: CR = complete response; CT = computed tomography; DFS = disease-free survival, FDG = 2-[18F]fluorodeoxyglucose; PD = progressive disease; PET = positron emission tomography; SD = stable disease
achieved a metabolic CR, while only 35% of the nonresponders remained disease free at 2 years (Table 3).
Conclusion The low survival rate of patients with advanced NSCLC due to the inability to accurately detect distant metastases suggests that new screening tools are needed. FDGPET technology provides a sensitive and noninvasive method of screening. A metaanalysis of previous studies has reported that the use of FDG-PET imaging detected unknown lesions in 12% of cases and altered therapeutic management in approximately 18% of cases of NSCLC.2 Data presented by Vansteenkiste and colleagues only reported detection of unknown distant metastases in 5% of patients.4 However, the investigators suggest that this discrepancy may be due to differences in imaging methods used. The more modern imaging techniques used by the
Vansteenkiste study may be superior to the staging techniques used in many previous studies, many of which relied on CT alone. While FDG-PET did appear to detect metastases missed by conventional staging techniques, it is important to note that 19% of patients staged as M0 by FDGPET still had systemic relapse 3-24 months following a complete resection. Another promising role for FDG-PET was suggested by the studies by Petersen et al5 and Griesinger et al,6 in which this screening tool was able to accurately predict response and survival to platinumbased chemotherapy. By utilizing the fact that tumors responding to chemotherapy decrease their rates of glucose metabolism and thus decrease FDG uptake, nonresponsive tumors can be identified early in the course of therapy. Significant correlation between changes in FDG uptake and overall response to chemotherapy as well as a positive predictive value of 72% and a
Clinical Lung Cancer January 2003
215
research in brief 216
negative predictive value of 92% were seen. FDG-PET appears to be a useful addition to our diagnostic armamentarium for staging lung cancer and possibly predicting disease outcome.
References ______________________ 1.
Salminen E, Mac Manus M. FDG-PET imaging in the management of non-small-cell lung cancer. Ann
Clinical Lung Cancer January 2003
2.
3.
4.
Oncol 2002; 13:357-360. Hellwig D, Ukena D, Paulsen F, et al. [Meta-analysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose in lung tumors. Basis for discussion of the German Consensus Conference on PET in Oncology 2000]. Pneumologie 2001; 55:367377. Weber WA, Ziegler SI, Thodtmann R, et al. Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 1999; 40:17711777. Vansteenkiste J, Stroobants S, Dooms C, et al. Additional value of whole-body FDG-PET in the detec-
5.
6.
tion of distant metastases in patients with potentially operable non-small cell lung cancer. Ann Oncol 2002; 13:128 (Abstract #471PD). Petersen V, Weber W, Schmidt B, et al. Prognostic value of FDG-PET in patients with inoperable NSCLC during platin based chemotherapy. Ann Oncol 2002; 13:128 (Abstract #472PD). Griesinger F, Lahmann F, Leugering J, et al. FDGPET after induction chemotherapy in NSCLC IIIA and IIIB is highly predictive for disease-free survival in the group of CT-responders. Ann Oncol 2002; 13:129 (Abstract #475PD).
changes in the levels of glucose utilization in tumors during the course of chemotherapy has led to the investigation of FDGPET as a prognostic indicator of response to chemotherapy.3 The ability to detect nonresponsive tumors early in the course of therapy may avoid unnecessary treatmentrelated toxicity and allow early modification of therapy in the hopes of achieving tumor response.
The Utility of Fluorodeoxyglucose Positron Emission Tomography in Addition to Conventional Staging in Patients with Potentially Operable Non–Small-Cell Lung Cancer Approximately 20% of patients who undergo a curative resection for NSCLC have an early relapse, usually occurring at distant sites.4 Thus, improvement in the detection of distant lesions is needed. Generally, detection is based on clinical
findings and imaging tests such as CT, MRI, and bone scans. By adding imaging techniques such as FDG-PET to conventional staging procedures, sensitivity might be improved. Vansteenkiste and colleagues from Belgium undertook a study with the aim of answering 3 questions: (1) How many additional distant lesions can be detected by whole-body PET compared to conventional staging procedures? (2) To what extent does wholebody PET classify lesions found to be equivocal by conventional imaging? (3) Does the use of whole-body PET reduce the number of patients relapsing after curative surgery? The results of this study were reported at the 27th Meeting of the European Society of Medical Oncology (ESMO) in Nice, France.
research in brief
Fluorodeoxyglucose Positron Emission Tomography as a Staging and Prognostic Tool in Non–Small-Cell Lung Cancer
Study Design This study enrolled 144 patients in whom conventional staging was negative
Table 1: Staging and Outcome as a Result of Fluorodeoxyglucose Positron Emission Tomography Scan in Addition to Conventional Staging Number of Patients Additional Lesion Positive by PET
11
True positive
7
False positive
4
Lesions Equivocal by CS
21
True negative by PET*
17
False negative by PET†
2
False positive by PET
2
Disease Outcome in Patients M0 by FDG-PET
(n = 86)
Disease free after mean follow-up of 51 months
56 (65%)
Recurrent disease at local site
9 (10%)
Recurrent disease at distant site
16 (19%)
*24 lesions. †19 lesions. Abbreviations: CS = conventional staging; FDG = 2-[18F]fluorodeoxyglucose; PET = positron emission tomography
Clinical Lung Cancer January 2003
213
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Table 2: Fluorodeoxyglucose Positron Emission Tomography as a Predictor of Response to Platinum-Based Chemotherapy (n = 49) Responders*
Nonresponders*
P Value
9.27 ± 5.1
9.56 ± 5.46
NS
-43.7% ± 18
-11.2% ± 22
< 0.0001
PET Responders†
PET Nonresponders†
P Value
Median PFS (Days)
163
85
0.01
Median OS (Days)
249
151
0.007
1-Year Survival
41%
18%
–
Baseline SUV SUV Decrease at 3 Weeks
*Responders = patients achieving a complete or partial response; nonresponders = patients with no change or progressive disease. †PET responders ≥ 20% reduction in standardized uptake value of FDG; PET nonresponders < 20% reduction in standardized uptake value of FDG. Abbreviations: FDG = 2-[18F]fluorodeoxyglucose; NS = not significant; OS = overall survival PET = positron emission tomography; PFS = progression-free survival; SUV = standardized uptake value
or equivocal for metastases. Conventional staging included contrast-enhanced CT of the thorax and upper abdomen examination with ultrasound or CT with additional MRI for equivocal lesions. Patients with neurological symptoms or nonsquamous histology received an additional brain CT. Bone scintigraphy was performed for patients with bone pain or elevated alkaline phosphatase or serum calcium levels; additional bone radiography, CT, or MRI was performed in cases of equivocal findings. Final stage was decided by either surgical biopsy of suspicious lesions or additional imaging or follow-up of at least 18 months. Results The addition of FDG-PET to conventional staging techniques resulted in detection of previously undetected lesions in 11 patients (Table 1). Five of these lesions were determined to be true positives for distant metastases: 3 in bone, 1 in the lymph nodes, and 1 in the contralateral lung. Two additional lesions were also true positives, although for asymptomatic colorectal cancer. Four of the additionally detected lesions were false positives. Of the 24 lesions in 21 patients that were equivocal after thorough conventional staging, PET was able to correctly exclude metastasis in 19 lesions (17 patients). Two falsepositive lesions and 2 false-negative le-
214
Clinical Lung Cancer January 2003
sions were also detected by PET scan. A complete resection was performed in 86 patients determined to be free of metastatic disease by PET (M0). Among these, 56 patients (65%) remain disease free after a mean follow-up of 51 months (Table 1). However, 25 patients developed recurrent disease, with 9 local relapses and 16 distant relapses. In this study, the combination of thorough conventional staging techniques and FDG-PET still failed to diagnose occult metastatic disease in 19% of patients.
Fluorodeoxyglucose Positron Emission Tomography Results Can Serve as a Predictor of Disease Response in Patients with Advanced Non–Small-Cell Lung Cancer Undergoing Platinum-Based Chemotherapy Studies have shown that levels of tumor glucose utilization decrease early during the course of chemotherapy, while these levels remain high in untreated tumors.3 These data suggest that FDG-PET scanning could potentially be used to evaluate the effectiveness of chemotherapy, thus allowing the early elimination of ineffective treatments. In order to test this hypothesis, Petersen and colleagues from Germany initiated a study to evaluate the prognostic value of FDG-PET for response to chemotherapy as well as survival in patients undergoing plat-
inum-based chemotherapy for NSCLC.5 Results were reported at the 27th ESMO Meeting. Study Design This trial enrolled patients scheduled to undergo treatment with cisplatin/vinorelbine, carboplatin/tamoxifen, cisplatin/ docetaxel, or cisplatin/etoposide as firstline therapy for locally advanced or metastatic NSCLC. Patients with prior chemotherapy or radiotherapy of the thorax were excluded. Patients were given spiral CT of the thorax to measure tumor response along with FDG-PET prior to start of chemotherapy. FDG-PET was repeated following the first cycle of chemotherapy (3 weeks), and spiral CT was repeated following the second cycle (6 weeks). Patients A total of 52 patients were enrolled, with a mean age of 60 years. Forty-eight percent of patients had a World Health Organization (WHO) performance status (PS) of 0, and 48% had a WHO PS of 1. Most of the patients (77%) had stage IV disease with adenocarcinoma (50%) and squamous cell carcinoma (29%) being the most common histological types. Results Forty-nine patients were evaluable for response correlation to FDG uptake. Patients who achieved a partial response (PR, 41%) were classified as responders. No patients achieved a complete response (CR). Nonresponders consisted of patients who experienced no change in tumor burden (33%) or progressive disease (26%). Baseline metabolic activity as determined by FDG uptake was not significantly different between responders (9.27 ± 5.1) and nonresponders (9.56 ± 5.46). There was a significantly greater decrease in FDG uptake among patients in the responder group (-43.7% ± 18) compared to the nonresponder group (-11.2% ± 22; P < 0.0001). This study found that FDG uptake could be used as a predictor of disease response to chemotherapy (Table 2). Using a cutoff value of 20% reduction in FDG
Study Design Patients with stage IIIA or IIIB, mediastinoscopically proven pN2/3 NSCLC were enrolled. Treatment consisted of docetaxel 100 mg/m2 on day 1 followed by carboplatin at an area under the curve of 7.5 on day 2, every 21 days for a total of 4 cycles. All patients also received adjuvant radiotherapy, prophylactic erythropoietin, and granulocyte colonystimulating factor. FDG-PET was performed prior to chemotherapy and again following the completion of 4 cycles of therapy. Patients The median age was 62 years (range, 37-76 years) for the 56 patients enrolled. Most of the patients (96%) had a Karnofsky PS of 70%-99%, and 87% had stage IIIA disease. Results All 56 patients were evaluable for response by CT scan (Table 3). This study resulted in an overall response rate of 63% with 1 CR (2%) and 34 PRs (61%). Of the 37 patients evaluable for metabolic response by FDG-PET scan, 38% achieved a metabolic CR as defined by a standardized uptake value for FDG of < 2.5. Subgroup analysis of the responders by CT scan demonstrated a 60% 2-year diseasefree survival rate for patients who
Table 3: Fluorodeoxyglucose Positron Emission Tomography as a Predictor of Survival in Non–Small-Cell Lung Cancer Patients Undergoing Docetaxel/Carboplatin Chemotherapy Number of Patients Response by CT (n = 56) Overall response Complete response
35 (63%) 1 (2%)
Partial response
34 (61%)
Stable disease
9 (16%)
Progressive disease
10 (18%)
Not evaluated
research in brief
uptake, patient response could be predicted with a sensitivity of 90% and 76% specificity with a positive predictive value of 72% and a negative predictive value of 92%. Patients predicted to be responders by PET were found to have a median progression-free survival (PFS) of 163 days, while median PFS was only 85 days for predicted nonresponders (P = 0.01). Furthermore, 1-year survival was significantly greater among PET responders (41%) compared to PET nonresponders (18%). A similar study was conducted in patients with stage III NSCLC undergoing chemotherapy with docetaxel/carboplatin by Griesinger and colleagues from Germany.6 The results of this study were also reported at the 27th ESMO Meeting.
2 (4%)
Metabolic Response (n = 37) Complete response*
14 (38%)
Partial response,† SD, or PD
23 (62%)
2-Year DFS (CT Responders) Metabolic CR by FDG-PET
60%
Metabolic nonresponse by FDG-PET‡
35%
*Standardized uptake value of FDG < 2.5. †Metabolic partial response = FDG standardized uptake value of < 50% of start value. ‡P = 0.025. Abbreviations: CR = complete response; CT = computed tomography; DFS = disease-free survival, FDG = 2-[18F]fluorodeoxyglucose; PD = progressive disease; PET = positron emission tomography; SD = stable disease
achieved a metabolic CR, while only 35% of the nonresponders remained disease free at 2 years (Table 3).
Conclusion The low survival rate of patients with advanced NSCLC due to the inability to accurately detect distant metastases suggests that new screening tools are needed. FDGPET technology provides a sensitive and noninvasive method of screening. A metaanalysis of previous studies has reported that the use of FDG-PET imaging detected unknown lesions in 12% of cases and altered therapeutic management in approximately 18% of cases of NSCLC.2 Data presented by Vansteenkiste and colleagues only reported detection of unknown distant metastases in 5% of patients.4 However, the investigators suggest that this discrepancy may be due to differences in imaging methods used. The more modern imaging techniques used by the
Vansteenkiste study may be superior to the staging techniques used in many previous studies, many of which relied on CT alone. While FDG-PET did appear to detect metastases missed by conventional staging techniques, it is important to note that 19% of patients staged as M0 by FDGPET still had systemic relapse 3-24 months following a complete resection. Another promising role for FDG-PET was suggested by the studies by Petersen et al5 and Griesinger et al,6 in which this screening tool was able to accurately predict response and survival to platinumbased chemotherapy. By utilizing the fact that tumors responding to chemotherapy decrease their rates of glucose metabolism and thus decrease FDG uptake, nonresponsive tumors can be identified early in the course of therapy. Significant correlation between changes in FDG uptake and overall response to chemotherapy as well as a positive predictive value of 72% and a
Clinical Lung Cancer January 2003
215
research in brief 216
negative predictive value of 92% were seen. FDG-PET appears to be a useful addition to our diagnostic armamentarium for staging lung cancer and possibly predicting disease outcome.
References ______________________ 1.
Salminen E, Mac Manus M. FDG-PET imaging in the management of non-small-cell lung cancer. Ann
Clinical Lung Cancer January 2003
2.
3.
4.
Oncol 2002; 13:357-360. Hellwig D, Ukena D, Paulsen F, et al. [Meta-analysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose in lung tumors. Basis for discussion of the German Consensus Conference on PET in Oncology 2000]. Pneumologie 2001; 55:367377. Weber WA, Ziegler SI, Thodtmann R, et al. Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 1999; 40:17711777. Vansteenkiste J, Stroobants S, Dooms C, et al. Additional value of whole-body FDG-PET in the detec-
5.
6.
tion of distant metastases in patients with potentially operable non-small cell lung cancer. Ann Oncol 2002; 13:128 (Abstract #471PD). Petersen V, Weber W, Schmidt B, et al. Prognostic value of FDG-PET in patients with inoperable NSCLC during platin based chemotherapy. Ann Oncol 2002; 13:128 (Abstract #472PD). Griesinger F, Lahmann F, Leugering J, et al. FDGPET after induction chemotherapy in NSCLC IIIA and IIIB is highly predictive for disease-free survival in the group of CT-responders. Ann Oncol 2002; 13:129 (Abstract #475PD).