PET Prognosis

June 1, 2015

New study validates prognostic value of PET scans in stage 3 non-small cell lung cancer

Innovations in Cancer - Summer 2015 -View Full PDF
 

MITCHELL MACHTAY, MD 

Chairman, Department of Radiation Oncology, UH Seidman Cancer Center, Vincent K. Smith Chair in Radiation Oncology, Professor of Radiation Oncology, Case Western Reserve University School of Medicine

Stage 3 non-small cell lung cancer remains one of radiation oncology’s most intractable challenges. Surgery is usually not an option, leaving definitive chemoradiation as the standard of care.

“Some of these people can be cured with well-designed chemotherapy and radiation together. But while there have been some advances in radiation technology, the overall treatment unfortunately hasn’t changed much in more than 10 years,” says Mitchell Machtay, MD, Chairman of the Department of Radiation Oncology at University Hospitals Seidman Cancer Center.

Prognostic factors for the disease, too, have been hard to come by. 

“In stage 3 non-small cell lung cancer, other than the age and general health of the patient, there has never been a truly validated prognostic factor,” Dr. Machtay says.

That changed somewhat two years ago, when the first results of a large trial examining the prognostic value of pre- and post-treatment PET scans were published in the Journal of Clinical Oncology (Machtay, et al, 2013; DOI 10.1200/JCO.2012.47.5947). The research group, led by Dr. Machtay, found that patients with elevated uptake of F-fluorodeoxyglucose (FDG), as shown on the post-treatment PET scan, tended to have poorer survival than other patients.

“We hypothesized that the PET scan you use for radiation planning could also give you valuable information about prognosis, and that proved to be the case,” Dr. Machtay says. 

Now, Dr. Machtay and his group have expanded on this work. In a paper recently published in the Journal of the National Cancer Institute, they report that metabolic tumor volume (MTV) before treatment, as measured on FDG-PET scan, predicts clinical outcomes for stage 3 non-small cell lung cancer patients treated with chemoradiotherapy (Ohri, et al, 2015; DOI 10.1093/ jnci/djv004). Specifically, they found that patients with higher pretreatment MTV were more likely to experience treatment failure. Median survival for those in the lowest third for MTV was 29.7 months, 21.2 months for the middle third of MTV and 13.6 months for those with the greatest MTV. For its determinations of tumor edges and other PET metrics, the research group used “PET Edge” and other software from MIMVista, developed by former University Hospitals biophysicist Dennis Nelson, PhD. 

The prospective, multicenter study included 214 patients with stage 3 non-small cell lung cancer – one of the largest prospective PET-scan trials in this population to date. It included academic medical centers like UH Seidman Cancer Center, but also community hospitals and international sites in Canada and South Korea. 

For Dr. Machtay, the findings of this study point toward a more effective method of stratifying stage 3 non-small cell lung cancer patients for future clinical trials. “Right now, patients are stratified by age, stage and performance status. This new information about MTV really tells us something about the biology of the tumor. 

“We hypothesize that selectively intensifying therapy may benefit those patients with high-volume disease, who are at increased risk for early local disease progression,” he adds. Dr. Machtay is currently one of the national leaders of a clinical trial evaluating intensified radiation therapy, based on findings from patients’ mid-treatment PET scans. This study, and several other stage 3 non-small cell lung cancer clinical trials, are available at UH. 

For more information on the thoracic oncology program at UH Seidman Cancer Center or to refer a patient, contact Dr. Machtay at Mitchell.Machtay@UHhospitals.org

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