TY - JOUR
T1 - What 18 F-FDG PET response-assessment method best predicts survival after curative-intent chemoradiation in non–small cell lung cancer
T2 - EORTC, PERCIST, Peter Mac criteria, or Deauville criteria?
AU - Turgeon, Guy Anne
AU - Iravani, Amir
AU - Akhurst, Tim
AU - Beaulieu, Alexis
AU - Callahan, Jason W.
AU - Bressel, Mathias
AU - Cole, Aidan J.
AU - Everitt, Sarah J.
AU - Siva, Shankar
AU - Hicks, Rodney J.
AU - Ball, David L.
AU - Mac Manus, Michael P.
N1 - Funding Information:
The 18F-FLT/18F-FDG study (ACTRN12611001283965) was supported by the National Health and Medical Research Council (APP1003895) and the Victorian Cancer Agency. The 68Ga-ventilation/ perfusion PET study (U1111-1138-4421) was supported by the National Health and Medical Research Council (APP1038399) and the Cancer Australia Priority–driven Collaborative Cancer Research Scheme (project 1060919). David L. Ball has an advisory role for Pfizer Australia. Rodney J. Hicks has ownership interest in Telix Radiopharmaceuticals. Shankar Siva has an advisory role for Astellas and Janssen, receives research funding and is on the speakers’ bureau of Varian Medical Systems and Merck, Sharp, and Dohme, and receives travel and accommodations expenses from Bristol-Meyer-Squibb. No other potential conflict of interest relevant to this article was reported.
Publisher Copyright:
Copyright © 2019 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - The optimal methodology for defining response with 18 F-FDG PET after curative-intent chemoradiation for non–small cell lung cancer (NSCLC) is unknown. We compared survival outcomes according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC), PERCIST 1.0, the Peter Mac metabolic visual criteria, and the Deauville criteria, respectively. Methods: Three prospective trials of chemoradiation for NSCLC, involving baseline and posttreatment 18 F-FDG PET/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-hazards models and log-rank tests assessed the impact of each response on overall survival (OS). Results: Eighty-seven patients underwent 18 F-FDG PET/CT before and after radical chemoradiation for NSCLC. Follow-up 18 F-FDG PET/CT scans were performed at a median of 89 d (interquartile range, 79–93 d) after radiotherapy. Median follow-up and OS after PET response imaging were 49 and 28 mo, respectively. Interobserver agreements for EORTC, PERCIST, Peter Mac, and Deauville had k values of 0.76, 0.76, 0.87, and 0.84, respectively. All 4 response criteria were significantly associated with OS. Peter Mac and Deauville showed better fit than EORTC and PERCIST and distinguished better between CMR and non-CMR. Conclusion: All 4 response criteria were highly predictive of OS, but visual criteria showed greater interobserver 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.
AB - The optimal methodology for defining response with 18 F-FDG PET after curative-intent chemoradiation for non–small cell lung cancer (NSCLC) is unknown. We compared survival outcomes according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC), PERCIST 1.0, the Peter Mac metabolic visual criteria, and the Deauville criteria, respectively. Methods: Three prospective trials of chemoradiation for NSCLC, involving baseline and posttreatment 18 F-FDG PET/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-hazards models and log-rank tests assessed the impact of each response on overall survival (OS). Results: Eighty-seven patients underwent 18 F-FDG PET/CT before and after radical chemoradiation for NSCLC. Follow-up 18 F-FDG PET/CT scans were performed at a median of 89 d (interquartile range, 79–93 d) after radiotherapy. Median follow-up and OS after PET response imaging were 49 and 28 mo, respectively. Interobserver agreements for EORTC, PERCIST, Peter Mac, and Deauville had k values of 0.76, 0.76, 0.87, and 0.84, respectively. All 4 response criteria were significantly associated with OS. Peter Mac and Deauville showed better fit than EORTC and PERCIST and distinguished better between CMR and non-CMR. Conclusion: All 4 response criteria were highly predictive of OS, but visual criteria showed greater interobserver 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.
KW - Deauville criteria
KW - EORTC
KW - FDG PET/CT
KW - NSCLC
KW - PERCIST
KW - Peter Mac
UR - http://www.scopus.com/inward/record.url?scp=85063321281&partnerID=8YFLogxK
U2 - 10.2967/jnumed.118.214148
DO - 10.2967/jnumed.118.214148
M3 - Article
C2 - 30030343
AN - SCOPUS:85063321281
SN - 0161-5505
VL - 60
SP - 328
EP - 334
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 3
ER -