Early detection of disease progression after palliative chemotherapy in NSCLC patients by ¹⁸F-FDG-PET

Summary

Aim: We investigated whether ¹⁸F-fluorodeo- xyglucose positron emission tomography (FDG-PET) is capable of detecting renewed disease progression earlier than computed tomography (CT) in patients with inoperable non-small cell lung cancer (NSCLC) who have undergone chemotherapy as part of a palliative treatment plan. Patients, methods: 18 patients were studied retrospectively. Three FDG-PET/CT scans for initial and follow-up diagnostic purposes were evaluated. Palliative chemotherapy was administered between the first FDG-PET/CT scan (t₀) and the second (t₁), followed by a treatment-free interval between the second FDG-PET/CT scan (t₁) and the third (t₂). Maximum standardized uptake values (SUV_max) and largest diameters of lesions were determined for PET scans and the corresponding CTs. Lesion-based and patient-based assessments were performed, as were assessments according to RECIST/PER- CIST. Results: 82 lesions were identified in 18 patients. In interval t₁-t₂, the increase in diameter in the lesion-based evaluation was 5.0% (non-significant), while the patient based evaluation showed a non-significant reduction of 2.8%. Considering PET, both the lesion-based and patient-based evaluations found a significant increase in SUV_max by a median of 30.4 % and 45.8 %, respectively. PERCIST criteria at time point t₂ identified ten more patients with progression than did REC- IST. Conclusion: In patients with NSCLC, renewed progression during the treatment-free interval after palliative chemotherapy can be detected earlier with PET than with CT. Thus, FDG-PET appears to be a useful diagnostic imaging procedure regarding this aspect. Its clinical relevance should be investigated in further studies.

Zusammenfassung

Ziel dieser Studie ist es, zu untersuchen, ob die ¹⁸F-Fluorodesoxyglukose-Positronenemissi- onstomographie (FDG-PET) bei Patienten mit nicht kleinzelligem Lungenkarzinom (NSCLC) nach einer palliativen Chemotherapie einen Progress früher erkennen kann, als die Computertomographie (CT). Patienten, Methoden: 18 Patienten wurden retrospektiv untersucht und drei PET/CT für die Erst- und Verlaufsuntersuchungen pro Patient ausgewertet. Die palliative Chemotherapie fand zwischen der ersten (t₀) und der zweiten PET/CT (t₁) statt. Es folgte ein therapiefreies Intervall zwischen der zweiten (t₁) und der dritten PET/CT(t₂). Die größten Durchmesser und die maximalen Standardized Uptake Values (SUV_max) aller Läsionen wurden in den CT- und zugehörigen PET-Untersuchungen ermittelt. Im Anschluss fand eine Läsions- und Patienten-basierte Auswertung sowie eine Auswertung nach RECIST/ PERCIST statt. Ergebnisse: 82 Läsionen wurden in den 18 Patienten gefunden. Im Intervall t₁-t₂ der Läsions-basierten Auswertung fand eine nicht signifikante Vergrößerung der Durchmesser um 5,0% statt, wohingegen sich in der Patienten-basierten Auswertung eine nicht signifikante Reduktion um 2,8% zeigte. In der PET zeigte sich in der Läsions-basierten und Patienten-basierten Auswertung ein signifikanter Anstieg von median 30,4% bzw. 45,8%. Nach PERCIST- Kriterien wurden zum Zeitpunkt t₂ 10 zusätzliche Patienten mit Progress identifiziert, als nach RECIST-Kriterien. Schlussfolgerung: Bei NSCLC-Patienten im therapiefreien Intervall nach einer palliativen Chemotherapie kann ein erneuter Progress mit der PET früher als mit der CT erkannt werden. Die FDG-PET scheint daher in dieser Fragestellung ein nützliches bildgebendes Verfahren zu sein. Die klinische Relevanz sollte in künftigen Studien überprüft werden.

Keywords

¹⁸F-FDG-PET - palliative chemotherapy - NSCLC - disease progression - early detection - PERCIST

Schlüsselwörter

¹⁸F-FDG-PET - Palliative Chemotherapie - NSCLC - Progress - frühzeitige Erkennung - PERCIST

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