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J Clin Oncol. 2013 Oct 20;31(30):3823-30. doi: 10.1200/JCO.2012.47.5947. Epub 2013 Sep 16.

Prediction of survival by [18F]fluorodeoxyglucose positron emission tomography in patients with locally advanced non-small-cell lung cancer undergoing definitive chemoradiation therapy: results of the ACRIN 6668/RTOG 0235 trial.

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Mitchell Machtay, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center and Case Western Reserve University; Gregory Videtic, Donald R. Neumann, Cleveland Clinic and Lerner College of Medicine, Cleveland, OH; Fenghai Duan, Bradley S. Snyder, and Jeremy J. Gorelick, Brown University, Providence, RI; Barry A. Siegel and Jeffrey D. Bradley, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Janet S. Reddin and Abass Alavi, University of Pennsylvania, Philadelphia; Albert DeNittis and Nancy Sherwin, Lankenau Hospital and Lankenau Institute for Medical Research, Lower Merion, PA; Reginald Munden, Ritsuko Komaki, and Homer Macapinlac, The University of Texas MD Anderson Cancer Center, Houston, TX; Douglas W. Johnson, Baptist Cancer Institute; Larry H. Wilf, Integrated Community Oncology Network, Jacksonville, FL; and Kwan Ho Cho and Seok-ki Kim, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea.



In this prospective National Cancer Institute-funded American College of Radiology Imaging Network/Radiation Therapy Oncology Group cooperative group trial, we hypothesized that standardized uptake value (SUV) on post-treatment [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) correlates with survival in stage III non-small-cell lung cancer (NSCLC).


Patients received conventional concurrent platinum-based chemoradiotherapy without surgery; postradiotherapy consolidation chemotherapy was allowed. Post-treatment FDG-PET was performed at approximately 14 weeks after radiotherapy. SUVs were analyzed both as peak SUV (SUVpeak) and maximum SUV (SUVmax; both institutional and central review readings), with institutional SUVpeak as the primary end point. Relationships between the continuous and categorical (cutoff) SUVs and survival were analyzed using Cox proportional hazards multivariate models.


Of 250 enrolled patients (226 were evaluable for pretreatment SUV), 173 patients were evaluable for post-treatment SUV analyses. The 2-year survival rate for the entire population was 42.5%. Pretreatment SUVpeak and SUVmax (mean, 10.3 and 13.1, respectively) were not associated with survival. Mean post-treatment SUVpeak and SUVmax were 3.2 and 4.0, respectively. Post-treatment SUVpeak was associated with survival in a continuous variable model (hazard ratio, 1.087; 95% CI, 1.014 to 1.166; P = .020). When analyzed as a prespecified binary value (≤ v > 3.5), there was no association with survival. However, in exploratory analyses, significant results for survival were found using an SUVpeak cutoff of 5.0 (P = .041) or 7.0 (P < .001). All results were similar when SUVmax was used in univariate and multivariate models in place of SUVpeak.


Higher post-treatment tumor SUV (SUVpeak or SUVmax) is associated with worse survival in stage III NSCLC, although a clear cutoff value for routine clinical use as a prognostic factor is uncertain at this time.

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