General thoracic surgery
Positron emission tomography combined with diagnostic chest computed tomography enhances detection of regional recurrence after stereotactic body radiation therapy for early stage non–small cell lung cancer

Read at the 38th Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 27-30, 2012.
https://doi.org/10.1016/j.jtcvs.2012.12.024Get rights and content
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Objective(s)

Recommendations for surveillance after stereotactic body radiation therapy (SBRT) for early stage non–small cell lung cancer (NSCLC) are not well defined. Prospective studies evaluating the efficacy of SBRT have used interval posttreatment imaging with computed tomography (CT). We set out to determine whether positron emission tomography (PET) combined with diagnostic chest CT (PET/d-chest) can enhance detection of potentially salvageable recurrence after SBRT.

Methods

We performed a retrospective analysis of posttreatment imaging for 35 patients consecutively treated with SBRT for biopsy-proven early-stage NSCLC. PET/d-chest was generally performed every 3 months after treatment. A board-certified radiologist who did not have access to the PET results retrospectively interpreted the CT scans. CT results were reported according to response criteria used in Radiation Therapy Oncology Group 0236 and compared with PET/d-chest readings. Local and regional recurrence-free survival was compared using the Mantle-Cox (log–rank) test.

Results

Median follow-up was 12.8 months. Twenty-four patients had stage IA, 7 stage IB, 3 stage IIA, and 1 stage IIB biopsy-proven NSCLC. Two-year overall survival was 62%. CT scans indicated no regional recurrences. PET/d-chest indicated 10 regional recurrences. The 1-year rate of regional recurrence-free survival as evaluated by CT and PET/d-chest was 100% and 69.4%, respectively (P = .0045). Four of 10 patients with a diagnosis of regional recurrence underwent salvage treatment with definitive chemoradiotherapy.

Conclusions

PET/d-chest enhances the detection of regional progression of NSCLC after SBRT over currently recommended practices. In patients who are fit for salvage treatment, where early detection of recurrence can increase the likelihood of successful treatment, PET/d-chest appears critical for follow-up.

CTSNet classification

10.2
10.4
36.1

Abbreviations and Acronyms

ACOSOG
American College of Surgeons Oncology Group
ASTRO
American Society for Therapeutic Radiology and Oncology
CT
computed tomography
EBUS
endobronchial ultrasound
FDG
fluorodeoxyglucose
NCCN
National Comprehensive Cancer Network
NSCLC
non–small cell lung cancer
PET
positron emission tomography
PET/d-chest
positron emission tomography combined with diagnostic chest computed tomography
RECIST
Response Evaluation Criteria in Solid Tumors
rRFS
regional recurrence-free survival
RTOG
Radiation Therapy Oncology Group
SBRT
stereotactic body radiation therapy

Cited by (0)

This work was supported in part by the DOD 06131010 grant (B.U.) (P.I. Kachnic).

Disclosures: Authors have nothing to disclose with regard to commercial support.

M.I.E. and G.A.R. contributed equally to this research effort.