What FDG-PET response-assessment method best predicts survival after curative-intent chemoradiation in non-small cell lung cancer (NSCLC) EORTC, PERCIST, Peter Mac or Deauville criteria?

Guy-Anne Turgeon, Amir Iravani, Tim Akhurst, Alexis Beaulieu, Jason W Callahan, Mathias Bressel, Aidan J Cole, Sarah Everitt, Shankar Siva, Rodney J Hicks, David L Ball, Michael P Mac Manus

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Abstract

The optimal methodology for defining response with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) after curative-intent chemoradiation for non-small cell lung cancer (NSCLC) is unknown. We compared survival outcomes according to European Organization for Research and Treatment of Cancer (EORTC), Positron Emission tomography Response Criteria In Solid Tumors 1.0 (PERCIST), Peter Mac Metabolic Visual and Deauville criteria respectively. Methods: Three prospective trials of chemoradiation for NSCLC, involving baseline and post-treatment FDG-PET/Computer Tomography (CT) imaging, were conducted between 2004 and 2016. Responses were categorized as complete metabolic response (CMR), partial metabolic response, stable metabolic disease or progressive metabolic disease. Cox proportional hazard models and logrank tests assessed the impact of each response on overall survival (OS). Results: Eighty-seven patients underwent FDG-PET/CT before and after radical chemoradiation for NSCLC. Follow-up FDG-PET/CT scans were performed at a median of 89 days (IQR 79-93 days) after radiotherapy. Median follow-up and OS after PET response imaging were 49 months and 28 months respectively. Inter-observer agreements for EORTC, PERCIST, Peter Mac and Deauville were kappa 0.76, 0.76, 0.87 and 0.84, respectively. All four response criteria were significantly associated with OS. Peter Mac and Deauville showed better fit compared to EORTC and PERCIST, and distinguished better between CMR and non-CMR. Conclusion: All four response criteria were highly predictive of overall survival, but visual criteria showed greater inter-observer agreement and stronger discrimination between CMR and non-CMR, highlighting the importance of visual assessment to recognize radiation pneumonitis, changes in lung configuration and patterns of response.

Original languageEnglish
Pages (from-to)1-42
JournalThe Journal of Nuclear Medicine
Early online date20 Jul 2018
DOIs
Publication statusEarly online date - 20 Jul 2018
Externally publishedYes

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