scholarly journals Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and 18F-FDG PET/CT for radiotherapy target volume definition

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maja Guberina ◽  
Kaid Darwiche ◽  
Hubertus Hautzel ◽  
Christoph Pöttgen ◽  
Nika Guberina ◽  
...  
Keyword(s):  
Lymph Node ◽  
Fdg Pet ◽  
Target Volume ◽  
Stage Iii ◽  
Target Volume Definition ◽  
Symmetry Test ◽  
Pet Ct ◽  
Exact Symmetry ◽  
Stage Iii Nsclc ◽  
Fdg Pet Ct

Abstract Purpose The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by 18F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in stage III NSCLC. Methods This is a single-center study based on our preceding investigation, including all consecutive patients with initial diagnosis of stage IIIA-C NSCLC, receiving concurrent radiochemotherapy (12/2011–06/2018). Inclusion criteria were curative treatment intent, 18F-FDG PET/CT and EBUS-TBNA prior to start of treatment. The lymphatic drainage was classified into echelon-1 (ipsilateral hilum), echelon-2 (ipsilateral LN-stations 4 and 7) and echelon-3 (rest of the mediastinum, contralateral hilum). The pattern of spread was classified according to all permutations of echelon-1, echelon-2, and echelon-3 EBUS-TBNA findings. Results In total, 180 patients were enrolled. Various patterns of LN-spread could be identified. Skip lesions with an involved echelon distal from an uninvolved one were detected in less than 10% of patients by both EBUS-TBNA and PET. The pattern with largest asymmetry was detected in cases with EBUS-TBNA- or PET-positivity at all three echelons (p < 0.0001, exact symmetry test). In a multivariable logistic model for EBUS-positivity at echelon-3, prognostic factors were PET-positivity at echelon-3 (Hazard ratio (HR) = 12.1; 95%-CI: 3.2–46.5), EBUS-TBNA positivity at echelon-2 (HR = 6.7; 95%-CI: 1.31–31.2) and left-sided tumor location (HR = 4.0; 95%-CI: 1.24–13.2). There were significantly less combined ipsilateral upper (LN-stations 2 and 4) and lower (LN-station 7) mediastinal involvements (16.8% of patients) with EBUS-TBNA than with PET (38.9%, p < 0.0001, exact symmetry test). EBUS-TBNA detected a lobe specific heterogeneity between the odds ratios of LN-positivity in the upper versus lower mediastinum (p = 0.0021, Breslow-Day test), while PET did not (p = 0.19). Conclusion Frequent patterns of LN-metastatic spread could be defined by EBUS-TBNA and PET and discrepancies in the pattern were seen between both methods. EBUS-TBNA showed more lobe and tumor laterality specific patterns of LN-metastases than PET and skipped lymph node stations were rare. These systematic relations offer the opportunity to further refine multi-parameter risk of LN-involvement models for target volume delineation based on pattern of spread by EBUS-TBNA and PET.

scholarly journals Impact of EBUS-TBNA in addition to [18F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC

2021 ◽  
Author(s):  
Maja Guberina ◽  
Kaid Darwiche ◽  
Hubertus Hautzel ◽  
Till Ploenes ◽  
Christoph Pöttgen ◽  
...  
Keyword(s):  
False Discovery Rate ◽  
Primary Tumor ◽  
Fdg Pet ◽  
Target Volume ◽  
Stage Iii ◽  
Exact Test ◽  
False Discovery ◽  
Pet Ct ◽  
Stage Iii Nsclc ◽  
Fdg Pet Ct

Abstract Purpose/introduction [18F]FDG-PET/CT is the standard imaging-technique for radiation treatment (RT) planning in locally advanced non-small cell lung cancer (NSCLC). The purpose of this study was to examine the additional value of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) to standard PET/CT for mediastinal lymph-node (LN) staging and its impact on clinical target volume (CTV). Materials and methods All consecutive patients with primary stage III NSCLC who underwent [18F]FDG-PET/CT and EBUS-TBNA prior to RT were analyzed from 12/2011 to 06/2018. LN-stations were assessed by an expert-radiologist and a nuclear medicine-physician. CTV was evaluated by two independent radiation oncologists. LNs were grouped with increasing distance along the lymphatic chains from primary tumor into echelon-1 (ipsilateral hilum), echelon-2 (LN-station 7 and ipsilateral 4), and echelon-3 (remaining mediastinum and contralateral hilum). Results A total of 675 LN-stations of which 291 were positive for tumor-cells, were sampled by EBUS-TBNA in 180 patients. The rate of EBUS-positive LNs was 43% among all sampled LNs. EBUS-positivity in EBUS-probed LNs decreased from 85.8% in echelon-1 LNs to 42.4%/ 9.6% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher’s exact test). The false discovery rate of PET in comparison with EBUS results rose from 5.3% in echelon-1 to 32.9%/ 69.1% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher’s exact test). Sensitivity and specificity of FDG-PET/CT ranged from 85 to 99% and 67 to 80% for the different echelons. In 22.2% patients, EBUS-TBNA finding triggered changes of the treated CTV, compared with contouring algorithms based on FDG-avidity as the sole criterion for inclusion. CTV was enlarged in 6.7% patients due to EBUS-positivity in PET-negative LN-station and reduced in 15.5% by exclusion of an EBUS-negative but PET-positive LN-station. Conclusion The false discovery rate of [18F]FDG-PET/CT increased markedly with distance from the primary tumor. Inclusion of systematic mediastinal LN mapping by EBUS-TBNA in addition to PET/CT has the potential to increase accuracy of target volume definition, particularly in echelon-3 LNs. EBUS-TBNA is recommended as integral part of staging for radiochemotherapy in stage III NSCLC.

Differential role of residual metabolic tumor volume in patients with inoperable stage III NSCLC after chemoradiotherapy ± immune checkpoint inhibition.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20558-e20558
Author(s):  
Marcus Unterrainer ◽  
Julian Taugner ◽  
Lukas Käsmann ◽  
Chukwuka Eze ◽  
Wolfgang G. Kunz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Fdg Pet ◽  
Tumor Volume ◽  
Metabolic Tumor Volume ◽  
Stage Iii ◽  
Free Survival ◽  
Pet Ct ◽  
Stage Iii Nsclc ◽  
Fdg Pet Ct ◽  
Nsclc Patients

e20558 Background: PET-derived metabolic-tumor-volume (MTV) has shown to be an independent prognosticator in non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy (CRT). We analysed the prognostic value of residual MTV after completion of thoracic irradiation (TRT) in inoperable stage III NSCLC patients treated with CRT with and without immune check-point inhibition (ICI). Methods: Fifty-six inoperable stage III NSCLC patients (16 female, median age: 65 years) underwent 18F-FDG PET/CT at the same institution before and after completion of CRT. MTV was delineated on 18F-FDG PET/CT using a standard threshold (hepatic SUVmean + 2 x standard-deviation). Patients were divided in volumetric subgroups using median split dichotomization (residual MTV ≤4.0 ml & > 4.0 ml). Residual MTV, clinical features and ICI maintenance (RCT-IO; 21/56 (37.5%) patients) were correlated with clinical outcome (progression-free survival (PFS), local PFS (LPFS), metastasis-free survival (MFS), and overall survival (OS). Results: Median follow-up was 52.0 months. 52 (93%) patients were treated with CRT, 12 (21%) patients with CRT followed by durvalumab, and 9 (16%) patients treated with CRT plus nivolumab (concurrent and sequential). In the entire cohort, smaller residual MTV was associated with longer PFS (median 29.3 vs. 10.5 months, p = 0.015); PFS in patients treated with CRT and ICI was also significantly longer compared to the CRT-only subgroup (median 29.3 vs. 11.2 months, p = 0.010). However, residual MTV was predictive for longer PFS in CRT-only (median 33.5 vs. 8.6 months, p = 0.001), but not in the CRT-ICI patients (p = 0.909). Analogously, patients with smaller MTV had a longer LPFS (median 49.9 vs. 16.3 months, p = 0.002); CRT-ICI patients showed a significantly longer LPFS compared to CRT-only patients (median not reached vs. 16.9 months, p = 0.016). Residual MTV remained a significant prognosticator for LPFS in the CRT-only (median 49.9 vs. 10.1 months, p = 0.01), but not in CRT-ICI patients (p = 0.291). Again, smaller residual MTV remained a significant prognosticator for OS in the CRT-only subgroup (median 63.0 vs. 16.3 months, p = 0.004), but not in CRT-ICI patients (p = 0.720). Even in patients with larger residual MTV, the application of ICI significantly improved OS compared to CRT-only subgroup (median not reached vs. 22.9 months, p = 0.004). Conclusions: Smaller residual MTV is associated with superior clinical outcome in inoperable stage III NSCLC, especially in patients undergoing CRT-only. In contrast, in patients undergoing concurrent or sequential consolidation clinical outcome was independent of residual MTV. Hence, even patients with extensive residual MTV might significantly profit from ICI consolidation.

Comparison of five segmentation methods for [18F]-FDG-PET-CT-based target volume definition in head and neck cancer

2011 ◽  
Vol 27 ◽  
pp. S6-S7
Author(s):  
X. Bontemps ◽  
R. Abgral ◽  
C. Leleu ◽  
A. Turzo ◽  
G. Valette ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Fdg Pet ◽  
Target Volume ◽  
Target Volume Definition ◽  
Pet Ct ◽  
Segmentation Methods ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals Application of gated FDG PET/CT in target volume definition for radiotherapy in esophageal cancer

2017 ◽  
Vol 28 ◽  
pp. iii31
Author(s):  
Pierre Gustin ◽  
Christine Menard ◽  
Campo Eleonor Rivin del ◽  
Romain Seban ◽  
Guillaume Peyraga ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Fdg Pet ◽  
Target Volume ◽  
Target Volume Definition ◽  
Pet Ct ◽  
Fdg Pet Ct

The study of FDG PET-CT on the value in predicting of patient outcome after treatment of stage III non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7572-7572
Author(s):  
H. Zhang ◽  
J. Yu
Keyword(s):  
Patient Outcome ◽  
Fdg Pet ◽  
Therapy Response ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Percent Change ◽  
Pet Ct ◽  
Stage Iii Nsclc ◽  
Fdg Pet Ct

7572 Background: Up to the present study, the value of FDG PET-CT in patients of non-small cell lung cancer (NSCLC) before and after treatment has been approved. However, the significance of FDG PET-CT during the treatment has not been confirmed. The objective of this study was to evaluate 18FDG PET-CT for assessment of therapy response and prediction of patient outcome after concurrent chemo-radiotherapy (CCRT) of NSCLC. Methods: Forty six patients with histologically proven stage III NSCLC had two repeated FDG PET-CT scans either one week before therapy and at the dose of 40∼50Gy, the SUVmax and Changes of the two group after completion of NARCT were compared with (1) the therapy response and (2) treatment results and long-term survival. Results: Of the 46 eligible patients, the pretreatment SUVmax of the responding and nonresponding groups was7.59±3.14 and 14.72±4.67 respectively. The midtreatment SUVmax of the two groups was 2.89±1.39 and 9.82±3.31 respectively. Significantly difference (t= 4.74,P=0.001; t=7.23,P=0.001) in SUVmax were observed either before and during treatment. Furthermore, the percent change of SUVmax of pretreatment and midtreatment was ΔSUVmax=61.91±86.69 and ΔSUVmax=33.56±90.37, difference between the two groups was also significantly (t=2.83, P=0.007). In addition, the 1 year survival rate of the the respond and non-respond group were 73% and 69% respectively, the 2-year survival rate of the two groups were 40% and 37% respectively, significant difference was observed between the two groups (P=0.001; P=0.001). Conclusions: 18FDG PET-CT is highly effective in detecting therapy response in stage III NSCLC patients, the analysis of percent change of SUVmax provides incremental value in early prediction of therapy response and patient outcome. No significant financial relationships to disclose.

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