Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and ...survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival.
We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (± radiotherapy) vs surgery alone (± radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group.
Results are based on 698 patients who received surgery alone (± radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%.
This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.
Surgery alone is currently still accepted “standard of care” for patients with operable NSCLC, this includes stages IA and IIB, as well as selected early subsets of IIIA disease. In more advanced and ...inoperable stage III disease, combinations of chemotherapy and radiotherapy remain the standard treatment approach for patients with good performance status. The role of surgery following induction therapy in these advanced stage III patients is at the moment not conclusively defined. More evidence from randomized trials is clearly needed to tailor treatment for the large number of patients that present in these locally advanced stages. Enrollment of patients into ongoing prospective clinical trials should be encouraged, whenever possible, to further define prognostic factors and improve multimodality strategies in this clinical setting.
Actuellement la TEP au 18F-FDG est la technique de référence pour objectiver la réponse tumorale après chimiothérapie chez des patients atteints de carcinome bronchique non à petites cellules ...(CBNPC). La TEP permet également de préciser des volumes à traiter lors de la radiothérapie pratiquée chez certains patients non opérables. Nous avons réalisé une étude mixte (prospective et rétrospective) sur 28 patients atteints de CBNPC afin de quantifier la modification de l’activité métabolique des lésions et de leur volume en post-chimiothérapie. Nous avons également étudié l’incidence de changement de ces volumes sur la définition des volumes cibles de radiothérapie. Les patients inclus étaient atteints d’un CBNPC de stade clinique II à IV non opérable. Deux examens TEP ont été réalisés : avant tout traitement (TEP1), puis à l’issue de deux à six cures de chimiothérapie (TEP2). Selon les critères PERSIST, sur 28 patients inclus, six patients (21,4 %) étaient en réponse métabolique complète, 13 (46,4 %) en réponse métabolique partielle, sept (25 %) en maladie métabolique stable et deux (7,1 %) en progression métabolique. Nous avons observé une variation significative de l’activité métabolique estimée par la SULpeak ou la SUVmax (p<0,001) aussi bien pour les lésions primitives que pour l’ensemble des lésions entre les deux examens TEP. En conséquence, les volumes cibles tumoraux diminuaient de manière significative (p<0,01) sur la TEP2. Ainsi, nos résultats confirment qu’au-delà d’une technique performante d’évaluation thérapeutique, la TEP/TDM est un outil intéressant pour la planification de la radiothérapie après chimiothérapie, dans une optique de personnalisation des traitements.
Currently 18F-FDG-PET is the gold standard to evaluate tumor response after chemotherapy in patients with advanced or metastatic non-small cell lung cancer (NSCLC). PET can also determine the volumes to be treated by radiotherapy, in inoperable patients. The aim of our mixed (prospective and retrospective) study concerned 28 patients with NSCLC, was to quantify the variation of the metabolic activity of lesions and their volumes after chemotherapy. We also studied the impact of change of these volumes on the definition of radiotherapy target volumes. Patients with stage II–IV and inoperable NSCLC were included. Two PET scans were performed: before treatment (PET1), then after two to six courses of chemotherapy (PET2). Of the 28 patients included, we observed complete metabolic response in six patients (21%), partial metabolic response in 13 patients (46%), stable disease in seven patients (25%), and progressive metabolic disease in two patients (7%), according to the PERCIST criteria. We observed significant variation (P<0.001) of metabolic activity (estimated by SULpeak or SUVmax) for primary tumor as well as for overall lesions between the two PET scans. Thus, the target volumes of radiotherapy decreased significantly (P<0.01) in PET2. Our results confirm that 18F-FDG-PET is not only a powerful technique for treatment evaluation but also a useful tool for radiotherapy planning after chemotherapy, in the context of personalized treatments.
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