Elvira Fritz, Abstract Co-Author: Nothing to Disclose

N. D. Klass, Abstract Co-Author: Nothing to Disclose

Michael Schmuecking MD, Presenter: Nothing to Disclose

Richard P. Baum MD, PhD, Abstract Co-Author: Stockholder, OctreoPharm Sciences GmbH Principal Investigator, AAA Research Consultant, Novartis AG Research Consultant, Ipsen SA Research Grant, ITG-Medical, Inc

R. Bonnet, Abstract Co-Author: Nothing to Disclose

Bernd Klaeser MD, Abstract Co-Author: Nothing to Disclose

T. G. Wendt, Abstract Co-Author: Nothing to Disclose

S. C. Schaefer, Abstract Co-Author: Nothing to Disclose

B. Hoksch, Abstract Co-Author: Nothing to Disclose

A. Schmid, Abstract Co-Author: Nothing to Disclose

Norbert Presselt, Abstract Co-Author: Nothing to Disclose

K. M. Mueller, Abstract Co-Author: Nothing to Disclose

Barbara E Denker, Abstract Co-Author: Nothing to Disclose

Urs R Meier, Abstract Co-Author: Nothing to Disclose

To evaluate the role of molecular remission as detected by 18F-FDG/CT and regression grade according to Junker et al. after neoadjuvant treatment of patients with NSCLC stage III, findings in 58 patients were analyzed retrospectively.  

For 58 patients with NSCLC stage IIIA (44%) / IIIB (56%) received neoadjuvant treatment consisting of chemotherapy and radiation therapy.  Documentation of involved lymph node stations as detected by PET and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with PET for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests.

Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation: complete vs. incomplete metabolic remission after 60 months: 40% vs. 24% (p = .018), RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p < .006). 18/32 (56%) patients with RG III/IIb, 8/32 (25%) patients with regression grade III. 1/8 pts. with RG III were in the 18F-FDG PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the 18F-FDG PET/CT false negative, 1 pts. with RG IIa was in the 18F-FDG PET/CT false negative: Hence, the cut-off level in detecting vital tumor cells by 18F-FDG PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Actuarial tumor specific survival for the 26 patients with sequential chemoradiation or chemotherapy as a sole neoadjuvant treatment: RG III vs. RG IIb/IIa/I after 60 months: 50% vs. 16%. 05/26 (19%) patients with RG III.

Molecular remission in mediastinal lymph nodes as detected by 18F-FDG PET correlates well with regression grade as proposed by Junker et al. and both may predict (long-term) therapeutic outcome in patients with stage III NSCLC. The cut-off level in detecting vital tumor cells by 18F-FDG PET after neoadjuvant chemoradiation for NSCLC is about 10%. Our preliminary data of 58 patients suggest that intensification of neoadjuvant treatment may lead to an higher amount of complete remission resulting in an increased survival. However this hypothesis has to be tested in prospective trials.

18F-FDG PET/CT is a non-invasive tool for treatment stratification

Fritz, E, Klass, N, Schmuecking, M, Baum, R, Bonnet, R, Klaeser, B, Wendt, T, Schaefer, S, Hoksch, B, Schmid, A, Presselt, N, Mueller, K, Denker, B, Meier, U, Is 18F-FDG PET/CT a Valid Non-invasive Predictor for Regression Grade after Neoadjuvant Treatment in Patients with NSCLC Stage III?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019518.html