Effect of FDG PET-CT for Staging and Radiotherapy Planning – A Comparison of Cohorts From Two Randomized Trials of Thoracic Radiotherapy in Limited-Stage SCLC

IF 3 Q2 ONCOLOGY
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Abstract

Introduction

18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) is recommended for staging and defining target volume in limited-stage SCLC, though the impact on outcomes compared with CT staging and elective nodal irradiation (ENI) is not well documented. We analyzed patients receiving 45 Gy/30 fractions in two randomized trials of thoracic radiotherapy (TRT) in limited-stage SCLC (HAST and THORA trials) to evaluate whether PET-CT for staging and radiotherapy planning reduces radiotoxicity and improves survival.

Methods

Patients in HAST were staged with CT of the thorax and upper abdomen and brain magnetic resonance imaging of the brain. Patients in THORA were staged with PET-CT in addition. All patients were to receive four courses of platinum/etoposide chemotherapy and concurrent TRT starting three to four weeks after the first chemotherapy course. In HAST, target volumes included pathological lesions on CT plus ENI of lymph node stations 4–7 (bilateral). In THORA, target volumes were limited to PET-CT-positive lesions (selective nodal irradiation [SNI]).

Results

A total of 149 patients were included (PET-CT/SNI: n = 76, CT/ENI: n=73); the median age was 64 years, 56% were women, 85% had PS 0 to 1, and 81% had stage III disease. The PET-CT/SNI group experienced less grade 3-4 esophagitis (18% versus 33%, p = 0.043), less grade >=1 pneumonitis (5% versus 16%, p = 0.028), and less dysphagia after TRT (mean scores on European Organisation for Research and Treatment of Cancer 13-item lung cancer module: 45 versus 72). There was no difference in median overall survival (24 versus 25 mo, p = 0.59) or progression-free survival (11 versus 11 mo, p = 0.23).

Conclusions

Using PET-CT for staging and target volume definition of TRT reduces acute radiotoxicity but does not improve overall or progression-free survival in limited-stage SCLC.

FDG PET-CT 对分期和放疗计划的影响--两项胸腔放疗随机试验中局限期 SCLC 队列的比较
导言18F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描(PET-CT)被推荐用于局限期SCLC的分期和靶体积的确定,但与CT分期和选择性结节照射(ENI)相比,PET-CT对疗效的影响尚无充分的文献记载。我们分析了两项胸腔放疗(TRT)随机试验(HAST 试验和 THORA 试验)中接受 45 Gy/30 分次放疗的局限期 SCLC 患者,以评估 PET-CT 用于分期和放疗计划是否能降低放射性毒性并提高生存率。THORA的患者还需进行PET-CT分期。所有患者都将接受四个疗程的铂/依托泊苷化疗,并在第一个化疗疗程后三到四周开始同时接受TRT治疗。在HAST中,目标体积包括CT上的病理病灶和4-7淋巴结站(双侧)的ENI。结果 共纳入 149 例患者(PET-CT/SNI:n = 76,CT/ENI:n = 73);中位年龄为 64 岁,56% 为女性,85% 为 PS 0 至 1,81% 为 III 期疾病。PET-CT/SNI 组的 3-4 级食管炎较少(18% 对 33%,P = 0.043),1 级肺炎较少(5% 对 16%,P = 0.028),TRT 后吞咽困难较少(欧洲癌症研究和治疗组织 13 项肺癌模块平均得分:45 对 72):45对72)。中位总生存期(24 个月对 25 个月,p = 0.59)或无进展生存期(11 个月对 11 个月,p = 0.23)均无差异。结论使用 PET-CT 对 TRT 进行分期和靶体积定义可降低急性放射性毒性,但不会改善局限期 SCLC 的总生存期或无进展生存期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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