Are there radiographic, metabolic, and prognostic differences between cavitary and noncavitary nonsmall cell lung carcinoma? A retrospective fluorodeoxyglucose positron emission tomography/computed tomography study

Abstract

AIMS:The prognosis of nonsmall cell lung cancer with cavitation (NSCLC-c) is not well-known. We compared the positron emission tomography/computed tomography (PET/CT) findings and survival data of patients with NSCLC-c patients with those without cavitation (NSCLC-nc).METHODS:Between 7/2004 and 6/2007, cavitary lung lesions were identified in 46/248 patients undergoing fluorodeoxyglucose (FDG) PET/CT for lung nodule characterization or lung cancer staging. Within the same period, 40 of 202 patients with NSCLC-nc were randomly selected for comparison. The primary was assessed by location, size, cell type, and standardized uptake value (SUV). Disease stage was determined according to American Joint Committee on Cancer guidelines for lung cancer. Kaplan–Meier method was used for survival analysis and Cox regression to assess the effect of clinical and imaging variables on survival.RESULTS:NSCLC-c was found in 87% of patients that had a cavitary lung lesion at PET/CT. Squamous cell carcinoma, primary size and primary-to-liver SUV ratio differed significantly between NSCLC-c and NSCLC-nc, whereas age, gender, primary location, primary SUV, type of treatment, and disease stage did not. Median survival and overall 5-year survival were 19 months and 24% for NSCLC-c, and 31 months and 31% for NSCLC-nc, P = 0.23. Disease stage was the only predictor of survival.CONCLUSION:Cavitary lung lesions in patients undergoing FDG PET/CT harbor a significant risk for cancer. NSCLC-c is associated with squamous cell carcinoma, larger size, and greater FDG metabolism compared with NSCLC-nc, although these variables may not be predictive of survival. Nonetheless, PET/CT contributes to accurate staging and has an indirect impact on prognosis.

Apatinib monotherapy for advanced non‐small cell lung cancer after the failure of chemotherapy or other targeted therapy

“…23 A cavernous tumor response could be assessed by volume assessment for target lesions or fluorodeoxyglucose metabolism. 24,25 We expect that evaluation criteria for tumor cavities is forthcoming. Although the dose of 250 mg apatinib in a second-line setting adopted in this study is not widely recommended, the safety and efficacy observed were promising.…”

“…During anti‐angiogenesis therapy, patients with advanced lung cancer commonly developed cavitation in their lung lesions . A cavernous tumor response could be assessed by volume assessment for target lesions or fluorodeoxyglucose metabolism . We expect that evaluation criteria for tumor cavities is forthcoming.…”

The value of bronchial and cavity contraction rates in differentiating benign and malignant pulmonary cavities

“…Bronchial smooth muscles affect airway contraction. Both benign and malignant pulmonary cavities form due to the excretion of necrotic material from necrotic tissues [ 13 – 15 ]. The bronchial wall of the malignant cavity thickens and becomes stiff due to tumor infiltration.…”