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Prognostic value of pre-treatment 18F-FDG-PET uptake in small-cell lung cancer

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Abstract

Purpose

Small-cell lung cancer (SCLC) is an aggressive disease, despite an initially favorable response to treatment, and its prognosis is still poor. Multiple parameters have been studied as possible prognostic factors, but none of them are reliable enough to change the treatment approach. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is a novel imaging technique for staging of SCLC. The aim of this study was to evaluate the prognostic value of pre-treatment FDG-PET parameters on clinical outcome in limited stage (LS) SCLC patients treated with curative thoracic radiotherapy (RT) and chemotherapy.

Methods

Clinical records of 46 LS-SCLC patients with pre-treatment FDG-PET imaging were retrospectively reviewed. Patients were treated with definitive RT for a total dose of 50–60 Gy and chemotherapy. The clinical endpoints were progression-free survival (PFS) and overall survival (OS).

Results

The median age was 59 (range 30–82) years, and median follow-up time was 23.2 months (range 5–82.8 months). Median OS was 30.9 months for pre-treatment tumor maximum standardized uptake value (SUVmax) <9.3 and 20.6 months for SUVmax ≥9.3 (p = 0.027) and PFS was 55.6 months for SUVmax <9.3 and 38.6 months for SUVmax ≥9.3 (p = 0.16). Median OS was 73 months for pre-treatment lymph node SUVmax <5.8 and 21 months for ≥5.8 (p = 0.01) and PFS was 38.6 months (range 6.8–70.3 months) for SUVmax-LN ≥5.8; all patients with SUVmax-LN <5.8 were alive (p = 0.07). Median survival time was 28.2 months (range 21.7–34.7 months) for patients younger than 65 and 8.7 months (range 5.7–11.8 months) for those ≥65 years (p = 0.00).

Conclusions

Pre-treatment FDG-PET uptake may be a valuable tool to evaluate prognosis in SCLC patients. Patients with a higher pre-treatment FDG uptake may be considered at increased risk of failure and may benefit from more aggressive treatment approaches.

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Authors and Affiliations

  1. Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey

    Meryem Aktan, Mehmet Koc, Gul Kanyilmaz & Berrin Benli Yavuz

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  1. Meryem Aktan
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Correspondence to Meryem Aktan.

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Author Meryem AKTAN declares that she has no conflict of interest. Author Mehmet KOC declares that he has no conflict of interest. Author Gul KANYILMAZ declares that she has no conflict of interest. Author Berrin BENLI YAVUZ declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Aktan, M., Koc, M., Kanyilmaz, G. et al. Prognostic value of pre-treatment 18F-FDG-PET uptake in small-cell lung cancer. Ann Nucl Med 31, 462–468 (2017). https://doi.org/10.1007/s12149-017-1178-z

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  • DOI: https://doi.org/10.1007/s12149-017-1178-z

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