Application of novel quantitative techniques for fluorodeoxyglucose positron emission tomography/computed tomography in patients with non-small-cell lung cancer.

AIM: Flurodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is routinely used in non-small-cell lung cancer. This study aims to assess the prognostic value of quantitative FDG-PET/CT parameters including standard uptake value (SUV), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in non-small-cell lung cancer. METHODS: A retrospective review of 92 nonsurgical patients with pathologically confirmed stage I-III non-small-cell lung cancers treated with radical dose radiotherapy (≥50 Gy) was conducted. Metabolically active tumor regions on FDG-PET/CT scans were contoured manually. SUV, MTV and TLG were calculated for primary, nodal and whole-body disease. Univariate and multivariate (adjusting for age, sex, disease stage and primary tumor size in centimeters) Cox regression modeling were performed to assess the association between these parameters and both overall and progression-free survival (PFS). RESULTS: On univariate analysis, overall survival (OS) was significantly associated with primary MTV (P = 0.03), whole-body MTV (P = 0.02), whole-body maximum SUV (P = 0.05) and whole-body TLG (P = 0.03). PFS was significantly associated with primary MTV (P = 0.01), primary TLG (P = 0.04), whole-body MTV (P < 0.01) and whole-body TLG (P = 0.01). On multivariate analysis, OS was significantly associated with whole-body MTV (P = 0.05). PFS was significantly associated with whole-body MTV (P = 0.02) and whole-body TLG (P = 0.05). CONCLUSIONS: Whole-body MTV was significantly associated with overall and PFS, and whole-body TLG was significantly associated with PFS on multivariate analysis. These two parameters may be significant prognostic factors independent of other factors such as stage. SUV was not significantly associated with survival on multivariate analysis.

A decade of community-based outcomes of patients treated with curative radiotherapy with or without chemotherapy for non-small cell lung cancer.

AIM: Clinical trials have reported good outcomes for non-small cell lung cancer (NSCLC) patients treated with curative radiotherapy. These populations are highly selected and may not be representative of lung cancer population. We aim to evaluate the outcomes of NSCLC patients treated with radiotherapy ± chemotherapy in Australian community setting and to assess the effect of comorbidity on outcomes. METHOD: Oncology records at Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia, were queried to retrieve patient, tumor and treatment data for stage I-III NSCLC patients who were treated with radiotherapy (minimum dose 60 Gy) between 1 January 2000 and 31 December 2010. Simplified comorbidity score (SCS) was used to score comorbidity. Kaplan-Meier and Cox hazards models were used for survival analysis. RESULTS: A total of 160 patients were identified with median follow-up of 22 months. Median age was 69 years (range 36-89); 76 patients received radiotherapy alone, 25 received sequential chemoradiation and 59 received concurrent chemoradiation. Median overall survivals for stages I, II and III were 29, 26 and 18 months, respectively. On multivariate analysis, stage II or III and weight loss > 5% were predictive of cancer-specific survival with hazard ratios of 4.47 (1.08-18.55, P = 0.04) and 2.23 (1.13-4.39, P = 0.02), respectively. Toxicities were grade ≥ 3 pneumonitis in 2% of patients, grade ≥ 3 esophagitis in 6% and grade ≥ 3 febrile neutropenia in 2%. There were no treatment-related deaths. SCS was neither prognostic nor predictive of toxicity or survival. CONCLUSION: Curative radiotherapy ± chemotherapy is a well-tolerated and effective treatment for inoperable or locally advanced NSCLC. Patients should not be excluded from radiotherapy on basis of comorbidity since higher SCS was not correlated with worse survival.

Metastatic cutaneous squamous cell carcinoma to parotid nodes: the role of bolus with adjuvant radiotherapy.

INTRODUCTION: Information regarding the addition of tissue equivalent bolus to adjuvant radiotherapy (RT) for intra-parotid metastatic head and neck cutaneous squamous cell carcinoma is lacking. This study aimed to evaluate the effect of bolus versus no bolus on the patterns of regional and distant recurrence, regional control (RC), cancer-specific survival (CSS), overall survival, RT toxicity and RT interruption. METHODS: A retrospective study was performed on consecutive patients diagnosed between 1994 and 2008 with metastatic head and neck cutaneous squamous cell carcinoma who were treated with parotidectomy ± selective neck dissection and adjuvant RT ± parotid bolus. RESULTS: Seventy-five patients were identified: 64 males and 11 females, with median age of 79 years (range 40-96) of which 39 had bolus during RT. Median follow up was 48 months (range 4-177). There were 23 regional recurrences - 14 dermal, six dermal + nodal and three isolated nodal - and only two systemic recurrences. Nine patients had RT interruption >6 days due to acute skin toxicity. Bolus was associated with increased grade ≥3 radiation dermatitis (P = 0.02). RT interruption >6 days was significantly associated with inferior RC and hazard ratio, 2.83 (95% confidence interval: 1.04-7.71, P = 0.042). Lympho-vascular space invasion, positive margins and nodes >2 cm were adversely significant on CSS multivariate analysis. RC, CSS and overall survival at 5 years were 67, 66 and 52%, respectively. CONCLUSIONS: Dermal involvement dominated the pattern of regional recurrence. Bolus was associated with significantly worse skin reaction. Bolus use was not associated with a significant overall benefit on RC. This analysis does not support the use of bolus as applied in this cohort.