ESMO2008 the impact of imaging techniques on choice of

The impact of imaging techniques on choice of treatment ESMO 2008 Harry J.M Groen Department of Pulmonary Diseases University Medical Center Groningen The Netherlands Imaging and treatment choice • • • • • • FDG-PET and chemotherapy selection FDG-PET and chemotherapy prediction FDG-PET and chemoradiotherapy Novel PET tracers MRI Is there an optimal imaging test to use? FDG PET in treatment selection and FDG prediction • FDG-PET has been used to stage and monitor tumor response after completion of preoperative chemotherapy or chemoradiotherapy in patients with NSCLC • Magnitude in changes of the FDG uptake in tumors correlated with pathologic response and overall survival • A return of the standard uptake value (SUV) to normal levels after treatment seems to be a marker of complete histological response and a sensitive indicator of good prognosis • Post-treatment PET response correlates with the treatment failure pattern It is a better predictor of survival outcome than computed tomography (CT) response, stage, or pretreatment performance status Adjuvant chemotherapy in resected NSCLC patients: NVALT study PET-SUV < 10 S U R G E R Y R E G I S T R A T I O N PET-SUV ≥10 NVALT 8A NVALT 8B Stratification: Study center PS (0,1 VS 2) TNM stage Type of resection Prior other malignancy (present vs absent) Observation only versus cycles cisplatin based chemotherapy cycles Cisplatin/Pemetrexed versus cycles Cisplatin/Pemetrexed + Nadroparin for 16 weeks Is there an impact of changes in FDG uptake in the tumor on prognosis? Prognostic impact of late change in FDG uptake Tumor type Year No pts MS(mo) RR NR p • Lymphoma • Oesophagus • Lung • • Head and Neck Cervix 2001 2001 2001 2003 2004 2002 2004 2003 2004 2003 2003 >46 >40 >50 >60 >30 >34 >24 >36 56 >60 >45