[18F]fludeoxyglucose PET/CT in small-cell lung cancer: Analysis of the CONVERT randomized controlled trial

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  • External authors:
  • Prakash Manoharan
  • Michael Gornall
  • Susan Harden
  • Peter Julyan
  • Imogen Locke
  • Jonathan McAleese
  • Rhona McMenemin
  • Nazia Mohammed
  • Michael Snee
  • Sarah Woods
  • Thomas Westwood

Abstract

INTRODUCTION: We used phase-3 CONVERT trial data to investigate the impact of 18fludeoxyglucose (18F-FDG) PET/CT in small-cell lung cancer (SCLC).

METHODS: CONVERT randomized limited-stage SCLC patients to twice-daily (45Gy in 30-fractions) or once-daily (66Gy in 33-fractions) chemoradiotherapy. Patients were divided into 2 groups in this unplanned analysis: those staged with conventional imaging (contrast-enhanced thorax and abdomen CT and brain imaging with/without bone scintigraphy) and those staged with 18F-FDG PET/CT in addition.

RESULTS: 540 patients were analyzed. Compared to patients who underwent conventional imaging (n=231), patients also staged with 18F-FDG PET/CT (n=309) had smaller gross tumor volume (P=0·003), were less likely to have elevated pre-treatment serum lactate dehydrogenase (P=0·035), and received more chemotherapy (P=0·026). There were no significant differences in overall (HR 0·87 [95% CI 0·70-1·08]; P=0·192) and progression-free survival (HR 0·87 [95% CI 0·71-1·07]; P=0·198) between patients staged with or without 18F-FDG PET/CT. In the conventional imaging group, we found no survival difference between patients staged with or without bone scintigraphy. While there were no differences in delivered radiotherapy dose, 18F-FDG PET/CT-staged patients received lower normal tissue (lung, heart, and esophagus) radiation doses. Apart from higher incidence of late esophagitis in patients staged with conventional imaging (grade ≥1: 19% vs 11%; P=0·012), the incidence of acute and late radiotherapy-related toxicities was not different between the two groups.

CONCLUSION: In CONVERT, survival outcomes were not significantly different in patients staged with or without 18F-FDG PET/CT. However, this analysis cannot support the use or omission of 18F-FDG PET/CT due to study limitations.

Bibliographical metadata

Original languageEnglish
JournalJournal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Early online date16 Apr 2019
DOIs
Publication statusPublished - 2019

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