Pretreatment SUV(max) value to predict outcome in patients with stage III NSCLC receiving concurrent chemoradiotherapy

OBJECTIVE: Stage III disease accounts for approximately one-fourth of all non-metastatic non-small cell lung cancer (NSCLC). The patients who are not candidates for curative resection are offered concomitant chemoradiotherapy. In this subgroup, which is difficult to manage, studies that address the role of PET-CT to predict outcome measures specifically for stage III NSCLC receiving concurrent chemoradiotherapy may help better risk stratification. This study aimed to assess whether baseline PET maximum standardized uptake value (SUV(max)) value in stage III NSCLC treated with concurrent chemoradiotherapy would independently identify patients with high risk of progression and death. METHODS: The study population consisted of patients aged 18 years or more with unresectable stage III histologically or cytologically proven NSCLC who received concurrent chemoradiotherapy. From 2007 to 2014, medical records of patients admitted to our institution were retrospectively analyzed. Pretreatment PET-CT SUV(max) values were recorded for each patient. These values were categorized as low or high according to the median SUV(max) measure of the study population. RESULTS: A total of 175 patients were analyzed. The median follow-up time was 23 months (range 6–109). The PET-CT SUV(max) values ranged from 3.5 to 46 with a median value of 14. The median overall survival was 25 months in SUV(max) <14 and 18 months in SUV(max) ≥14 group (p=0.023). The median progression-free survival was 16 months in SUV(max) <14 and 11 months in SUV(max) ≥14 group (p=0.033). Multivariate analysis revealed that both PET-CT SUV(max) value (p<0.001) and age (p=0.016) were independent significant predictors for overall survival (OS). CONCLUSION: The results of this study involving patients with stage III NSCLC receiving concurrent chemoradiotherapy provide evidence that suggests that high values of pretreatment SUV(max), an indicator of metabolic tumor burden, predicted a higher risk of disease progression and death.