Prognostic value of 18F-FDG PET parameters in patients with locally advanced non-small cell lung cancer treated with induction chemotherapy

Aim To investigate predictive and prognostic role of metabolic parameters using [F-18]-2-fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG PET) in patients with locally advanced non-small cell lung cancer (NSCLC) treated with docetaxel-platinum induction chemotherapy (IC). Methods Medical records of 31 patients with pre- and post-IC F-18-FDG PET were reviewed. Using F-18-FDG PET, metabolic parameters, including metabolic tumor response, adjusted peak standardized uptake values using lean body mass at baseline (pre-SULpeak) and after IC (post-SULpeak), and percentage change of pre- and post-SULpeak (Delta SULpeak), were assessed. Results Response rate (RR) was 71%, with a metabolic RR of 83.9%. Nineteen (61.3%) patients underwent surgery, R0 resection was achieved for 17 (89.5%) patients. Median relapse-free survival (RFS) and overall survival (OS) were 8.9 months (95% CI: 4.5-12.1) and 24.1 months (95% CI: 17.1-34.1), respectively. Post-SULpeak < 2 was identified as a favorable prognostic factor for RFS (hazard ratio [HR]: 0.12; P = .004), while Delta SULpeak >= 60% and R0 resection were found as positive prognostic factors for OS (HR: 0.09 and 0.13; P = .011 and P = .042, respectively). Using a receiver operating characteristics curve, post-SULpeak > 1.4 could predict recurrence with a sensitivity of 84% and a specificity of 100%. Conclusion In patients with locally advanced NSCLC receiving IC, post-SULpeak and Delta SULpeak showed clinical significance for survival outcome.