Cancer Res Treat.  2020 Jan;52(1):85-97. 10.4143/crt.2019.007.

SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer

• Kwak YK
• Park HH
• Choi KH
• Park EY
• Sung SY
• Lee SW
• Hong JH
• Lee HC
• Yoo IR
• Kim YS

• KMID: 2501204
• DOI: http://doi.org/10.4143/crt.2019.007

Abstract

Purpose
Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC.
Materials and Methods
Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%).
Results
Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5).
Conclusion
Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.

Keyword

Radiosurgery; Non-small-cell lung carcinoma; Positron emission tomography computed tomography; Prognostic factor

Figure

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  Fig. 1. Patterns of failure after stereotactic ablative radiotherapy.

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  Fig. 2. Treatment outcomes depicted in Kaplan-Meier survival curve. (A) Local control rate. (B) Regional progression-free survival rate. (C) Distant progression-free survival rate. (D) Overall survival rate. (E) Cause-specific survival rate.

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  Fig. 3. Comparison of survival curves regarding pretreatment maximal standardized uptake value (SUVmax) level. (A) Local control rate. (B) Regional progression-free survival rate. (C) Distant progression-free survival rate. (D) Overall survival rate.

Reference

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