Prognostic Value of FDG PET Metabolic Parameters Before and After 42 Gy of Radiochemotherapy in Patients with Inoperable Stage III Nonsmall Cell Lung Cancer

The Journal of Nuclear Medicine Pub Date : 2025-02-27 DOI:10.2967/jnumed.124.268499

Pierre Vera, Philippe Giraud, Sébastien Hapdey, Pierrick Gouel, Orianne Jan, Paul Le Roux, Alexandra Langlais, Emilie Lévêque, Florence Le Tinier, Anaïs Olivier, Etienne Martin, Alina Berriolo-Riedinger, Nicolas Pourel, Jean Marc Broglia, Pierre Boisselier, Sophie Guillemard, Naji Salem, Isabelle Brenot-Rossi, Camilo Garcia, Céline Berthold, Etienne Giroux-Leprieur, Damien Moreau, Sophie Guillerm, Khadija Benali, Laurent Tessonnier, Clarisse Audigier-Valette, Delphine Lerouge, Elske Quak, Carole Massabeau, Frédéric Courbon, Maxime Loo, Anne Larrouy, Nadia Ghazzar, Philippe Chaumet-Riffaud, Elodie Amour, Gérard Zalcman, Romain Modzelewski, Sébastien Thureau

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Abstract

The purpose of this study was to assess the prognostic value of ¹⁸F-FDG PET parameter variation between baseline and 42 Gy (PET2) of radiochemotherapy at 6 mo and 1 y of evaluation in patients with stage III inoperable nonsmall cell lung cancer based on RECIST 1.1. Methods: In total, 158 patients in a prospective multicenter phase II/III study were analyzed. Patients were randomized into 2 groups: an experimental arm (group A) and a standard arm (group B). Patients from group A with residual metabolism on PET2 (group A+) at 42 Gy received a radiation boost (74 Gy). Patients without residual uptake on ¹⁸F-FDG PET at 42 Gy (group A−) and patients in group B received a standard radiotherapy dose (66 Gy). We compared group A with group B. The ¹⁸F-FDG PET parameters SUV_max, SUV_mean, SUV_peak, peak SUV normalized on lean body mass, mean SUV normalized on lean body mass, total lesion glycolysis, total metabolic tumor volume (MTV) (tumor and nodes), and tumor MTV were measured. All patients were evaluated with RECIST 1.1 using CT at 6 mo and 1 y after radiochemotherapy. Progression-free survival and overall survival were evaluated. Results: Except for the radiotherapy dose (P < 0.001), patient demographic characteristics were similar between the 2 groups (A vs. B). All ¹⁸F-FDG PET uptake and volume parameter measurements were correlated. Therefore, only the change in SUV_max (ΔSUV_max) and total MTV were selected for the analysis. There was no significant difference in any variable between the 2 groups. In the multivariate analysis, ΔSUV_max appeared to be the most important prognostic factor for overall survival, and SUV_max of PET2 appeared to be the most important prognostic factor for progression-free survival. Conclusion: ¹⁸F-FDG PET at 42 Gy can be used to identify good responders to radiochemotherapy in patients with inoperable stage III nonsmall cell lung cancer. The SUV_max of PET2 and ΔSUV_max are independent prognostic factors.

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42 Gy放化疗前后FDG - PET代谢参数对不能手术III期非小细胞肺癌患者的预后价值

本研究的目的是基于RECIST 1.1评估不能手术的III期非小细胞肺癌患者在6个月和1个月时放化疗基线和42 Gy （PET2）之间的18F-FDG PET参数变化的预后价值。方法：在一项前瞻性多中心II/III期研究中，共分析了158例患者。患者被随机分为两组：实验组（A组）和标准组（B组）。A组PET2残余代谢（A+组）在42 Gy下接受74 Gy的辐射增强。18F-FDG PET在42 Gy下无残留摄取的患者（A -组）和B组患者接受标准放疗剂量（66 Gy）。比较A组和b组的18F-FDG PET参数SUVmax、SUVmean、SUVpeak、峰值SUV归一化瘦体质量、平均SUV归一化瘦体质量、总病变糖酵解、总代谢肿瘤体积（MTV）（肿瘤和淋巴结）、肿瘤MTV。所有患者在放化疗后6个月和1年用CT评估RECIST 1.1。评估无进展生存期和总生存期。结果：除放疗剂量(P <；0.001)，两组患者的人口学特征相似（A组与B组）。所有18F-FDG PET摄取和体积参数测量均相关。因此，我们只选取SUVmax （ΔSUVmax）和总MTV的变化进行分析。两组间各项指标均无显著差异。在多变量分析中，ΔSUVmax似乎是总生存期最重要的预后因素，PET2的SUVmax似乎是无进展生存期最重要的预后因素。结论：42 Gy的18F-FDG PET可用于鉴别不能手术的III期非小细胞肺癌放化疗反应良好的患者。PET2的SUVmax和ΔSUVmax是独立的预后因素。

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The Journal of Nuclear Medicine

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