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S. Kudo
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-025 - New PET/CT Criterion for Nodal Staging in Lung Cancer: Area of SUV ≥ 2.5 / Lymph Node Area (ID 61)
09:30 - 09:30 | Author(s): S. Kudo
- Abstract
Background:
Surgical resection is the accepted standard of care for patients with non-small cell lung cancer (NSCLC) at an early stage, patients have a favorable prognosis. Unfortunately, however, only about 25% of NSCLC patients are eligible for surgery, and once the surgical candidates are selected, mediastinal staging is mandatory because up to 50% of these patients have regional metastasis. Accurate nodal staging is crucial for determining optimal treatment strategies and optimizing prognoses. The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique for improving nodal staging using routine preoperative PET/CT in patients presenting with localized and clinically resectable NSCLC.
Methods:
The institutional review board approved this retrospective study, and written informed consent to perform the initial and follow-up CT studies was obtained from all patients. Preoperative PET/CT findings (n=163 patients with resectable NSCLC) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images, lymph node surface area (SA), the maximum standardized uptake value (SUV~max~), SA of SUV ≥2.5 (Figure) and ≥3.0 were drawn freehand and measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze those data. Figure 1
Results:
Based on ROC analyses, the cut-off values for SA of SUV ≥2.5, SA of SUV ≥3.0, SUV ≥2.5 SA / node SA ratio and SUV ≥3.0 SA / node SA ratio for diagnosis of lymph node metastasis were 200 mm[2], 30 mm[2], 1.0 and 0.4. When the conventional SUV~max~ ≥2.5 was used for diagnosis, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of nodal staging were 61.1%, 62.2%, 28.9%, 86.4%, 62.0% , respectively. SUV ≥2.5 SA / node SA ≥1.0 had the highest negative predictive value, and when a cut-off value of SUV ≥2.5 SA / node SA ≥1.0 was used for diagnosis, the sensitivity, specificity, PPV, NPV and accuracy were 61.1%, 73.4%, 36.7%, 88.2% and 70.9%, respectively.
Conclusion:
When diagnosing nodal staging based a lymph node SUV ≥2.5 SA / node SA ratio of ≥1.0, we achieved a higher performance level than was achieved using the conventional of SUV~max~ criterion. Furthermore, determination of this ratio from PET/CT images is a simple noninvasive procedure.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-021 - Neoadjuvant Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer (NSCLC) Patients (ID 1372)
09:30 - 09:30 | Author(s): S. Kudo
- Abstract
Background:
Neoadjuvant chemotherapy (NAC) has gained popularity in recent years, becoming a standard treatment for locally advanced non-small cell lung cancer (NSCLC) to improve resectability and downstage nodal disease, which have clear impacts on prognosis. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate outcomes in a series of patients with locally advanced NSCLC receiving NAC followed by surgery.
Methods:
A total of 12 patients (66.7% males; median age, 71 years) affected by NSCLC in clinical stage IIA-IIIB underwent platinum-based NAC followed by surgery between 2008 and 2014. The clinical stage was IIA in 3 patients, IIIA in 8 (4 of which were IIIAN2), and IIIB in 1. Histology was adenocarcinoma in 8, squamous cell carcinoma in 3, and adenosquamous carcinoma in 1.
Results:
All patients received platinum-based chemotherapy (median, 4 cycles). The NAC regimen was weekly paclitaxel-carboplatin in 6 patients, pemetrexed-carboplatin in 3, paclitaxel-carboplatin-bevacizumab in 2, and gemcitabine-cisplatin in 1. Radiologic response to NAC was complete in 1 patient (8.3%), partial in 8 (66.7%) and stable disease in 3 (25.0%). Overall response rate was 75.0% (95% confidence interval, 51-100%). Grade 3 or 4 hematological toxicities were common, including neutropenia (50%) and anemia (8.3%), but were transient and manageable. Non-hematological toxicities were moderate and no treatment-related deaths were encountered. Eleven patients (91.7%) underwent complete surgical resection after induction. Surgical procedures comprised lobectomy in 10 patients, bilobectomy in 1 and pneumonectomy in 1. No severe intraoperative complications or 30-/90-day mortality were seen. At pathological evaluation, 8 patients (66.7%) showed downstaging of disease, with complete in 1 (8.3%), major in 3 (25.0%) and minor in 7 (58.3%). With a median follow-up of 12.7 months (range, 5.2-50.8 months), the 1-year relapse-free survival rate was 56.6%. Four of the 12 patients developed metastasis (at 4.7, 6.0, 8.4, and 9.2 months), and 2 patients died at 14.7 and 23.9 months.
Conclusion:
NAC using platinum-based chemotherapy with new-generation cytotoxic agents for locally advanced NSCLC seems justified by low morbidity and mortality, good response rates, and high resectability. Although the evidence level for induction chemotherapy is low, incorporation of chemotherapy and surgery will greatly impact strategies for future lung cancer treatment.
