FDG PET/CT for assessing the resectability of NSCLC patients with N2 disease after neoadjuvant therapy

Abstract

FDG PET/CT after neoadjuvant therapy accurately defined response in metastatic N2 nodes of NSCLC patients, presenting very high sensitivity and NPV for detecting responding nodes. PET/CT may enable selection of candidates for curative resection of stage III NSCLC. Mediastinoscopy may not be mandatory in patients with a negative PET/CT after neoadjuvant therapy.

Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients

“…Previous studies also evaluated the value of 18 F-FDG PET/CT imaging after rising tumor markers or clinical suspicion of tumor recurrence, concluding that 18 F-FDG PET/CT is a good noninvasive imaging modality in these 2 settings to confirm or rule out tumor recurrences (4,12,29,30). Also, multiple studies confirmed the value of 18 F-FDG PET/CT scan in the therapy assessment setting after chemoradiation therapy in several cancer types (31)(32)(33).…”

Variations in positron emission tomography-computed tomography findings for patients receiving neoadjuvant and non-neoadjuvant therapy for non-small cell lung cancer

“…When N2 disease is suspected using PET-CT, neoadjuvant therapy instead of prompt surgery is considered as an initial treatment after pathological confirmation, if clinically feasible (7,9,10). Thus, PET-CT contributes to appropriate management of NSCLC by providing of qualitative and quantitative information from measuring lesion metabolic activity (1,12,14).…”

“…However, after neoadjuvant therapy, invasive mediastinal LN staging might be not needed because of frequent discrepancies between PET-CT and pathological findings, especially with previous mediastinal pathological staging (5,10). In addition, some studies show that DFS and OS are sufficiently high to warrant surgery for persistent N2 disease after neoadjuvant therapy (10,11,(19)(20)(21). We propose with caution that surgery should not be delayed or withheld only based on preoperative PET-CT findings after neoadjuvant therapy, especially after previous LN pathological confirmation.…”

“…Neoadjuvant therapy is usually recommended for NSCLC with N2 disease status by pathological confirmation, if clinically feasible (7,(9)(10)(11). A lesion is usually regarded to be malignant or metastatic when SUVmax is 2.5 or higher and the lesion diameter is larger than 1cm on PET-CT (3,12,13).…”

PET-CT in the UK: current status and future directions

“…The potential role of FDG PET-CT in assessing treatment response after neoadjuvant therapy has been investigated in several studies in variable groups of patients 106 . Despite this, treatment response in NSCLC is still largely assessed with conventional CT. A recent study from Israel evaluating the use of FDG PET-CT to assess the resectability of patients with stage III NSCLC after neoadjuvant therapy reported a very high sensitivity and negative predictive value for detecting responding nodes, which may guide optimal patient selection for curative resection 107 . Another recent study from Korea evaluating a similar patient cohort reported significantly increased relapse-free and overall survival in patients undergoing surgery who showed CMR within mediastinal nodal disease on FDG PET-CT following neoadjuvant treatment compared to incomplete responders 108 .…”