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High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose-positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer†
Article first published online: 9 JUL 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 21, pages 5030–5037, 1 November 2010
How to Cite
Everitt, S., Herschtal, A., Callahan, J., Plumridge, N., Ball, D., Kron, T., Schneider-Kolsky, M., Binns, D., Hicks, R. J. and MacManus, M. (2010), High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose-positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer. Cancer, 116: 5030–5037. doi: 10.1002/cncr.25392
Presented in part at the 13th World Conference on Lung Cancer, San Francisco, California, July 31-August 4, 2009.
- Issue published online: 9 JUL 2010
- Article first published online: 9 JUL 2010
- Manuscript Accepted: 16 MAR 2010
- Manuscript Revised: 15 MAR 2010
- Manuscript Received: 10 JAN 2010
- disease progression;
- lung cancer;
- waiting time;
- tumor volume doubling time;
- fluorodeoxyglucose positron emission tomography/computed tomography
The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo-RT.
Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG-PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent.
Eighty-two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8-176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%-49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P = .022), 16% in average SUV (P = .004), and 116% in percentage injected dose (P = .002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51-95 days).
Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG-PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy. Cancer 2010. © 2010 American Cancer Society.