The Cost-Utility Analysis of PET-Scan in Diagnosis and Treatment of Non-Small Cell Lung Carcinoma in Iran

18013 Background: Given the success of Stereotactic Body Radiotherapy (SBRT) for Non-Small Cell Lung Carcinoma (NSCLC), early surrogates of local failure (LF) are necessary to allow timely surgical salvage. This study tries to determine the utility of PET response as an early surrogate for LF. Methods: Eligible patients(pts) had biopsy proven NSCLC < 5 cm in size who underwent a pre- and post- SBRT PET scans. Pts treated at Fox Chase Cancer Center were either: 1. early stage (10 pts), 2. biopsy-proven local recurrences (4 patients) or 3. oligometastases (3 patients). Eleven of the 17 pts were treated on a prospective phase I dose escalation protocol and received either 40 Gy or 48 Gy in 4 fractions over 8 days. Non-protocol pts generally received 48 Gy in 4 fractions (5 of 6 pts). Treatment volumes were individualized for each pt using either 4 D or multi-phase CT simulation. As part of the prospective study design, PETs scan was obtained pre- and post-SBRT to correlate metabolic response with LF based on the work by MacManus. The post-SBRT PET scan was obtained at a median of 3 months following treatment (range, 2 to 6 months). LF was defined by my an increase in size on CT on serial imaging. Results: With a median follow up of 14 months (range 4 to 31 months), 3 LF have been documented. The median SUV max pre-SBRT was 4.7 (range 1.32 to 18.2) and 1.9 (range 0.9 to 7.0) post-SBRT. Only four pts had a post-SBRT SUV max > 2.5 (2.8, 5.1, 5.3 and 7). Overall, twelve pts had a drop in their SUV max following SBRT, while 1 pt had stabilization and 4 had an increase . Of these last 5 pts, 3 developed LF. The other two have been followed without any intervention and remain free of recurrence for > 2 years, respectively. No pt with an initial drop in post SBRT PET scan SUV has had LF. Conclusions: PET response (defined as a drop in the SUV max by 3 months) correlates with LF, and appears to be a good early surrogate of outcomes following SBRT. Larger studies are required to confirm this finding. No significant financial relationships to disclose.

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Paraneoplastic Choreoathetosis in a Patient with Small Cell Lung Carcinoma and Anti-CRMP5/CV2: A Case Report

Case Reports in Neurology ◽

10.1159/000443522 ◽

2016 ◽

Vol 8 (1) ◽

pp. 16-19 ◽

Cited By ~ 5

Author(s):

Dogu Aydin ◽

Finn Somnier ◽

Lisbeth H. Lassen

Keyword(s):

Case Report ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Small Cell ◽

Pet Scan ◽

Whole Body ◽

Small Cell Lung ◽

Cell Lung Carcinoma ◽

Bronchoscopic Biopsy ◽

Mri Scans

Introduction: The occurrence of more or less monosymptomatic paraneoplastic choreoathetosis associated with anti-CRMP5/CV2 antibodies is rare. Typically, such autoantibodies are associated with a more classical syndrome - paraneoplastic encephalomyelitis. Frequently, small cell lung carcinoma (SCLC) is the related neoplastic finding. Case Report: We present a 71-year-old woman who developed visual symptoms with papilledema and chorea. Anti-CRMP5/CV2 antibodies were a feature of both the serum and cerebrospinal fluid. Although SCLC was suspected already at the time of the initial examinations, no signs of primary or metastatic tumors were revealed on chest X-ray, MRI or whole-body PET scan. EEG and bronchoscopy were also unremarkable. However, 6 months after the onset, a repeated PET scan and subsequent bronchoscopic biopsy revealed SCLC. In spite of chemotherapy, the SCLC progressed, and the patient died 14 months after the onset of the symptoms. Conclusion: We report paraneoplastic choreoathetosis associated with anti-CRMP5/CV2 antibodies. Such published case histories are rare. Although expected, we did not find any reduced signal intensity at the basal ganglia on the T1-weighted or increased intensity on the T2-weighted MRI scans.

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