Introducing FDG PET/CT-guided chemoradiotherapy for stage III NSCLC in low- and middle-income countries: preliminary results from the IAEA PERTAIN trial.

Autor: Konert T; Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. t.konert@nki.nl., Vogel WV; Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Paez D; Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria., Polo A; Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria., Fidarova E; Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria., Carvalho H; Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil., Duarte PS; Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil., Zuliani AC; Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil., Santos AO; Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil., Altuhhova D; Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia., Karusoo L; Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia., Kapoor R; Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Sood A; Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Khader J; Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan., Al-Ibraheem A; Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan., Numair Y; Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan., Abubaker S; Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan., Soydal C; Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey., Kütük T; Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey., Le TA; Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam., Canh NX; Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam., Bieu BQ; Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam., Ha LN; Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam., Belderbos JSA; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., MacManus MP; Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia., Thorwarth D; Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany., Hanna GG; Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. gerry.hanna@petermac.org.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia. gerry.hanna@petermac.org.
Jazyk: angličtina
Zdroj: European journal of nuclear medicine and molecular imaging [Eur J Nucl Med Mol Imaging] 2019 Oct; Vol. 46 (11), pp. 2235-2243. Date of Electronic Publication: 2019 Jul 31.
DOI: 10.1007/s00259-019-04421-5
Abstrakt: Purpose: Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC.
Methods: The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan-Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts.
Results: Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan-Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012).
Conclusion: In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje