[en] BACKGROUND: The intensity of the [F]fluorodeoxyglucose (F-FDG) uptake is an independent prognostic indicator in non-small cell lung cancer (NSCLC). We evaluate the relationship between the metabolic activity of the primary and the pleurisy in T4 NSCLC. METHODS: 25 patients (16 males, nine females, mean age 63 years, performance status 1) with pathology-proven, T4 NSCLC and malignant pleurisy were included. All were treated by a platinum salt-based chemotherapy regimen. Positron emission tomography (F-FDG-PET) was performed before treatment, according to a routine procedure. Regions of interest were placed over the primary and the pleural effusion on the transaxial slice showing the highest activity. The maximum pixel standard uptake values (SUVs) were calculated. Overall survival was determined by standard Kaplan-Meier survival analysis. All patients were followed up until death. RESULTS: The median survival for the entire population was 83 days (7-988). The SUVs were higher in the primary than in the pleurisy (9.2+/-5.6 and 5.5+/-2.2, respectively). There was no correlation between primary and pleurisy SUVs (r=0.3, P>0.05). The metabolic activity of the primary tumor did not predict the outcome: the median survival was 77.5 days (range 7-988) and 87 days (19-454) in the groups with SUVs lower and higher than the median value (8.7), respectively (P>0.05). By contrast, the metabolic activity of the pleurisy was significantly correlated with the median survival, which was 196 days (40-988) when the SUVs were lower than the median value (5) and 74 days (7-170) when they were higher (P=0.0096). CONCLUSION: Among patients with T4 NSCLC, those with high metabolic activity in the pleural effusion have a dire prognosis, whereas the metabolic activity of the primary fails to predict the survival.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Duysinx, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Corhay, Jean-Louis ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Larock, Marie-Paule ; Centre Hospitalier Universitaire de Liège - CHU > Médecine nucléaire
Nguyen Dang, Delphine ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Bury, Thierry ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Hustinx, Roland ; Centre Hospitalier Universitaire de Liège - CHU > Médecine nucléaire
Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Language :
English
Title :
Prognostic value of metabolic imaging in non-small cell lung cancers with neoplasic pleural effusion.
Publication date :
2008
Journal title :
Nuclear Medicine Communications
ISSN :
0143-3636
Publisher :
Lippincott Williams & Wilkins, London, United Kingdom
Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s-meta-analytic comparison of PET and CT. Radiology 1999; 213:530-536.
Dedrick CG, McLoud TC, Shepard JA, Shipley RT. Computed tomography of localized pleural mesothelioma. AJR Am J Roentgenol 1985; 144:275-280.
Leung AN, Muller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol 1990; 154:487-492.
Sahn SA. State of the art. The pleura. Am Rev Respir Dis 1988; 138:184-234.
Hughes JM, Brudin LH, Valind SO, Rhodes CG. Positron emission tomography in the lung. J Thorac Imaging 1985; 1:79-88.
Ahuja V, Coleman RE, Herndon J, Patz EF Jr. The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 1998; 83:918-924.
Dhital K, Saunders CA, Seed PT, O'Doherty MJ, Dussek J. [(18)F]fluorodeoxyglucose positron emission tomography and its prognostic value in lung cancer. Eur J Cardiothorac Surg 2000; 18:425-428.
Higashi K, Ueda Y, Ayabe K, Sakurai A, Seki H, Nambu Y, et al. FDG PET in the evaluation of the aggressiveness of pulmonary adenocarcinoma: correlation with histopathological features. Nucl Med Commun 2000; 21:707-714.
Jeong HJ, Min JJ, Park JM, Chung JK, Kim BT, Jeong JM, et al. Determination of the prognostic value of [18F]fluorodeoxyglucose uptake by using positron emission tomography in patients with non-small cell lung cancer. Nucl Med Commun 2002; 23:865-870.
Sugawara Y, Quint LE, Iannettoni MD, Orringer MB, Russo JE, Recker BE, et al. Does the FDG uptake of primary non-small cell lung cancer predict prognosis? A work in progress. Clin Positron Imag 1999; 2:111-118.
Vansteenkiste JF, Stroobants SG, Dupont PJ, De Leyn PR, Verbeken EK, Deneffe GJ, et al. Prognostic importance of the standardized uptake value on (18)F-Fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: an analysis of 125 cases. Leuven Lung Cancer Group. J Clin Oncol 1999; 17:3201-3206.
Balogova S, Grahek D, Kerrou K, Montravers F, Younsi N, Aide N, et al. [18F]-FDG imaging in apparently isolated pleural lesions. Rev Pneumol Clin 2003; 59 (5 Pt 1):275-288.
Belhocine TZ, Daenen F, Duysinx B, Bury T, Rigo P. Typical appearance of mesothelioma on an F-18 FDG positron emission tomograph. Clin Nucl Med 2000; 25:636.
Benard F, Sterman D, Smith RJ, Kaiser LR, Albelda SM, Alavi A. Metabolic imaging of malignant pleural mesothelioma with fluorodeoxyglucose positron emission tomography. Chest 1998; 114:713-722.
Bury T, Paulus P, Dowlati A, Corhay JL, Rigo P, Radermecker MF. Evaluation of pleural diseases with FDG-PET imaging: preliminary report. Thorax 1997; 52:187-189.
Carretta A, Landoni C, Melloni G, Ceresoli GL, Compierchio A, Fazio F, et al. 18-FDG positron emission tomography in the evaluation of malignant pleural diseases-a Pilot Study. Eur J Cardiothorac Surg 2000; 17:377-383.
Duysinx B, Nguyen D, Louis R, Cataldo D, Belhocine T, Bartsch P, et al. Evaluation of pleural disease with 18-fluorodeoxyglucose positron emission tomography imaging. Chest 2004; 125:489-493.
Duysinx BC, Larock MP, Nguyen D, Corhay JL, Bury T, Hustinx R, et al. 18F-FDG PET imaging in assessing exudative pleural effusions. Nucl Med Commun 2006; 27:971-976.
Erasmus JJ, McAdams HP, Rossi SE, Goodman PC, Coleman RE, Patz EF. FDG PET of pleural effusions in patients with non-small cell lung cancer. AJR Am J Roentgenol 2000; 175:245-249.
Gupta NC, Rogers JS, Graeber GM, Gregory JL, Waheed U, Mullet D, et al. Clinical role of F-18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion. Chest 2002; 122:1918-1924.
Haberkorn U. Positron emission tomography in the diagnosis of mesothelioma. Lung Cancer 2004; 45 (Suppl 1):S73-S76.
Kramer H, Pieterman RM, Slebos DJ, Timens W, Vaalburg W, Koeter GH, et al. PET for the evaluation of pleural thickening observed on CT. J Nucl Med 2004; 45:995-998.
Schaffler GJ, Wolf G, Schoellnast H, Groell R, Maier A, Smolle-Juttner FM, et al. Non-small cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F FDG PET. Radiology 2004; 231:858-865.
Toaff JS, Metser U, Gottfried M, Gur O, Deeb ME, Lievshitz G, et al. Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography. Invest Radiol 2005; 40:204-209.
Benard F, Sterman D, Smith RJ, Kaiser LR, Albelda SM, Alavi A. Prognostic value of FDG PET imaging in malignant pleural mesothelioma. J Nucl Med 1999; 40:1241-1245.
Flores RM, Akhurst T, Gonen M, Zakowski M, Dycoco J, Larson SM, et al. Positron emission tomography predicts survival in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2006; 132:763-768.
Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77:507-513.
Menda Y, Bushnell DL, Madsen MT, McLaughlin K, Kahn D, Kernstine KH. Evaluation of various corrections to the standardized uptake value for diagnosis of pulmonary malignancy. Nucl Med Commun 2001; 22:1077-1081.
Sugawara Y, Zasadny KR, Neuhoff AW, Wahl RL. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology 1999; 213:521-525.
Mountain CF, Carr DT, Anderson WA. A system for the clinical staging of lung cancer. Am J Roentgenol Radium Ther Nucl Med 1974; 120:130-138.
Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; 111:1710-1717.
Leong SS, Rocha Lima CM, Sherman CA, Green MR. The 1997 international staging system for non-small cell lung cancer: have all the issues been addressed? Chest 1999; 115:242-248.
Mott FE, Sharma N, Ashley P. Malignant pleural effusion in non-small cell lung cancer-time for a stage revision? Chest 2001; 119:317-318.
Naruke T, Tsuchiya R, Kondo H, Asamura H, Nakayama H. Implications of staging in lung cancer. Chest 1997; 112 (Suppl 4):242S-248S.
Sugiura S, Ando Y, Minami H, Ando M, Sakai S, Shimokata K. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res 1997; 3:47-50.
Rami-Porta R, Ball D, Crowley J, Giroux DJ, Jett J, Travis WD, et al. The IASLC lung cancer staging project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2007; 2:593-602.