Primary tumor SUVmax and ratio of SUVmax to primary tumor size on pretreatment 18F-FDG-PET/CT scan in small cell lung cancer : Which is superior for the prognosis?

BACKGROUND

The prognostic impact of tumor SUVmax (t-SUVmax) in small cell lung cancer (SCLC) has been questioned with controversial results, and the significance of the ratio of tumor SUVmax to primary tumor size (SUVmax/t-size) in SCLC has yet to be clarified as well. In this study, a retrospective analysis was carried out to figure out the prognostic and predictive powers of pretreatment primary t‑SUVmax and t‑SUVmax/t-size ratio in patients with SCLC.

METHODS

A total of 349 SCLC patients who underwent pretreatment staging with PET/CT scan were enrolled in the study and analyzed retrospectively.

RESULTS

In limited disease SCLC (LD-SCLC), tumor size was significantly associated with both t‑SUVmax (p = 0.02) and t‑SUVmax/t-size (p = 0.0001). Furthermore, performance status, tumor size (p = 0.001), and liver metastasis were significantly associated with t‑SUVmax in extended disease SCLC (ED-SCLC). Moreover, tumor size (p = 0.0001), performance status, cigarette smoking history, and pulmonary/pleural metastasis were found to be correlated with t‑SUVmax/t-size. No associations were found between clinical stages and either t‑SUVmax or t‑SUVmax/t-size (p = 0.9 for both), and t‑SUVmax and t‑SUVmax/t-size values were found to have similar survival rates in both LD-SCLC and ED-SCLC patients. In univariate and multivariate analyses, both t‑SUVmax and t‑SUVmax/t-size were found not to be associated with overall survival (p > 0.05) CONCLUSION: This study does not advocate the use of either t‑SUVmax or t‑SUVmax/t-size on pretreatment 18F‑FDG-PET/CT scan as prognostic and predictive tools for both LD-SCLC and ED-SCLC patients. Likewise, we did not find that t‑SUVmax/t-size was superior to t‑SUVmax in that respect.

Prognostic value of metabolic parameters on baseline 18F-FDG PET/CT in small cell lung cancer

BACKGROUND

Maximum standardized uptake value (SUV<inf>max</inf>) is the primary quantitave parameter given in 18F-FDG PET/CT reports. Calculations derived from three dimensional metabolic volumetric images have been proposed to be more successful than SUV<inf>max</inf> alone in prognostification with a lower interobserver variability in many cancers. We aimed to determine the prognostic value of metabolic parameters derived from 18F-FDG PET/CT studies in small cell lung cancer (SCLC) patient population with a long follow-up time.

METHODS

In this study, 38 consecutive SCLC patients (34M, 4F, age:65.76 ±8.18 years) who were referred to 18F-FDG PET/CT for staging between October 2006-January 2011 were included. SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Overall survival (OS) was calculated from the date of the initial PET/CT to death from any cause. Survival tables were obtained and Kaplan Meier curves were reconstructed. Mantel-Cox regression analysis was performed in order to investigate if any of these parameters have an effect on survival along with other clinical risk factors.

RESULTS

Median SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, MTV, TLG and LDH values were calculated as 13.9 g/dL, 6.4 g/dL,10.69 g/dL, 147 cm³, 1898.52 and 375U/L respectively. Median follow-up was 761.23±873.21 days (25.37 months, range:110-3338 days). Since basal 18F-FDG PET/CT scans, all patients were lost in the follow-up except for two patients. MTV was a significant prognostic factor in SCLC patients. Estimated mean survival times were 261.0±45.6 (95% CI: 171.6-350.3) days in patients with MTV value above the calculated median 147, and 577.0±124.0 (95% CI: 333.7-820.2) days in patients with MTV<147. The difference was statistically significant with a P=0.037.

CONCLUSIONS

Baseline whole body MTV reflecting total tumor load is a prognostic index in SCLC. SUV is insufficient to predict prognosis.

Prognostic Value of 18F-FDG-PET Parameters in Patients with Small Cell Lung Cancer: A Meta-Analysis and Review of Current Literature

Many studies have suggested a prognostic value of one or several positron emission tomography (PET) parameters in patients with small cell lung cancer (SCLC). However, studies are often small, and there is a considerable interstudy disagreement about which PET parameters have a prognostic value. The objective of this study was to perform a review and meta-analysis to identify the most promising PET parameter for prognostication. PubMed^®, Cochrane, and Embase^® were searched for papers addressing the prognostic value of any PET parameter at any treatment phase with any endpoint in patients with SCLC. Pooled hazard ratios (HRs) were calculated by a random effects model for the prognostic value of the baseline maximum standardized uptake value (SUV_max) and metabolic tumor volume (MTV). The qualitative analysis included 38 studies, of these, 19 studies were included in the meta-analyses. The pooled results showed that high baseline MTV was prognostic for overall survival (OS) (HR: 2.83 (95% confidence interval [CI]: 2.00–4.01) and progression-free survival (PFS) (HR: 3.11 (95% CI: 1.99–4.90)). The prognostic value of SUV_max was less pronounced (OS: HR: 1.50 (95% CI: 1.17–1.91); PFS: HR: 1.24 (95% CI: 0.94–1.63)). Baseline MTV is a strong prognosticator for OS and PFS in patients with SCLC. MTV has a prognostic value superior to those of other PET parameters, but whether MTV is superior to other prognosticators of tumor burden needs further investigation.

Neuroendocrine Lung Cancer Mouse Models: An Overview

Simple Summary

Neuroendocrine lung tumors are a heterogeneous group of malignancies that share a common neuroendocrine nature. They range from low- and intermediate-grade typical and atypical carcinoma, to the highly malignant large cell neuroendocrine lung carcinoma and small cell carcinoma, with marked differences in incidences and prognosis. This review delineates the current knowledge of the genetic landscape of the human tumors, its influence in the development of genetically engineered mouse models (GEMMs) and the molecular imaging tools available to detect and monitor these diseases. While small cell lung carcinoma is one of the diseases best represented by GEMMs, there is a worrying lack of animal models for the other members of the group, these being understudied diseases. Regardless of the incidence and material available, they all are in urgent need of effective therapies.

Abstract

Neuroendocrine lung tumors comprise a range of malignancies that extend from benign tumorlets to the most prevalent and aggressive Small Cell Lung Carcinoma (SCLC). They also include low-grade Typical Carcinoids (TC), intermediate-grade Atypical Carcinoids (AC) and high-grade Large Cell Neuroendocrine Carcinoma (LCNEC). Optimal treatment options have not been adequately established: surgical resection when possible is the choice for AC and TC, and for SCLC chemotherapy and very recently, immune checkpoint inhibitors. Some mouse models have been generated based on the molecular alterations identified in genomic analyses of human tumors. With the exception of SCLC, there is a limited availability of (preclinical) models making their development an unmet need for the understanding of the molecular mechanisms underlying these diseases. For SCLC, these models are crucial for translational research and novel drug testing, given the paucity of human material from surgery. The lack of early detection systems for lung cancer point them out as suitable frameworks for the identification of biomarkers at the initial stages of tumor development and for testing molecular imaging methods based on somatostatin receptors. Here, we review the relevant models reported to date, their impact on the understanding of the biology of the tumor subtypes and their relationships, as well as the effect of the analyses of the genetic landscape of the human tumors and molecular imaging tools in their development.

Combining 18F-FDG PET/CT and Serum Lactate Dehydrogenase for Prognostic Evaluation of Small Cell Lung Cancer

Objective: To investigate the value of using ¹⁸F-FDG PET/CT in combination with serum lactate dehydrogenase (LDH) for prognostic evaluation of newly diagnosed small cell lung cancer (SCLC). Methods: We reviewed 118 patients with pathologically proven SCLC who underwent ¹⁸F-FDG PET/CT imaging evaluation in our hospital. Among these patients, 64 patients had extensive disease (ED) and 54 patients had limited disease (LD). The maximum standardized uptake value (SUV_max) of primary tumor was measured. A Cox proportional hazards model was used to evaluate age, sex, performance status, serum LDH, tumor stage and SUV_max on the prediction of overall survival (OS) and median survival time (MST) of patients. Subgroup analysis was performed based on the SUV_max in combination with serum LDH. Results: According to the Receiver Operating Characteristic (ROC) curve, the optimal cut-off value of SUV_max was 10.95. The AUC was 0.535 (95% CI: 0.407-0.663). The patients were divided into four groups according to the SUV_max (higher or lower than 10.95) and LDH (higher or lower than 245 U/L). The univariate and multivariate analyses showed that curative thoracic radiotherapy, Prophylactic Cranial Irradiation (PCI) and the combination of primary tumor SUV_max ≤ 10.95 and LDH ≤ 245 U/L were prognostic factors of OS in patients with all patients (p < 0.05). Smoking status, PCI, the combination of primary tumor SUV_max ≤ 10.95 and LDH ≤ 245 U/L were prognostic factors of OS in patients with LD (p < 0.05). N stage and PCI were significant predictors in both of univariate and multivariate analysis of OS for ED SCLC (p < 0.05). Among all patients, 27 had low SUV_max and normal LDH, and their MST was 36 months (95% CI: 12.98-59.02). Ninety-one patients had high SUV_max and/or high LDH, and their MST was 20 months (95% CI: 15.47-24.53). The difference between these two groups was significant (p = 0.045). In patients with LD, 16 patients had low SUV_max and normal LDH, and their MST was 72 months (95% CI: 26.00-118.0). Thirty-eight patients had high SUV_max and/or high LDH, and their MST was 27 months (95% CI: 20.80-33.21). The difference between these two groups was significant (p = 0.012). In patients with ED SCLC, 10 patients had low SUV_max and normal LDH, with an MST of 18 months (95% CI: 13.69-22.32. Fifty-four patients had high SUV_max and/or high LDH, and their MST was 12 months (95% CI: 10.61-13.39). The difference of MST between these two groups was not statistically significant (p = 0.686). Conclusion: ¹⁸F-FDG PET/CT in combination with serum LDH were prognostic factors of overall survival in patients with SCLC. The prognosis of patients with LD SCLC who had low SUV_max of primary tumor and normal LDH was better than those with high SUV_max and/or high LDH.

Metabolic activity of primary tumour on PET/CT has a relationship with survival in stages I-III small-cell lung carcinoma

INTRODUCTION

There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system.

OBJECTIVES

The aim of this study is to examine the prognostic value of pretreatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system.

METHODS

A total of 344 (292 male) SCLC patients with pretreatment FDG- PET/CT were included. One hundred fifty-three of cases were stages I-III, 191 were stage IV. SUVmax values were obtained for primary tumour, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pretreatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS).

RESULTS

Median OS and PFS for patients with stages I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumour (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stages I-III (HR;1.88, 95% CI:1.15-3.08, P = .012). But the SUVmax -PT (HR; 1.60, 95% CI: 0.99-2.60; P = .057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease.

CONCLUSION

Pretreatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.

Role of Thyroglobulin Doubling Time in Differentiated Thyroid Cancer and Its Relationship with Demographic-Histopathologic Risk Factors and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters

Background: Aim of this study was to investigate the relationship between thyroglobulin doubling time (TgDT) and basal risk factors and metabolic parameters derived from ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in differentiated thyroid cancer (DTC). Materials and Methods: An analysis of 95 DTC patients who had rising serum thyroglobulin (Tg) levels under levothyroxine (LT4) suppression after radioiodine therapy was made. TgDT was calculated for 28/95 patients. The relationship between TgDT and basal demographic and histopathologic risk factors, preablative Tg, and antithyroglobulin antibody (ATg) levels and metabolic parameters was analyzed. Results: In 28 patients (15M, 13F, mean age: 52.6 ± 17.6) that TgDT could be calculated, ¹⁸F-FDG PET/CT was positive in 12 patients. Median TgDT was lower in ¹⁸F-FDG PET/CT positive patients compared to the negative cases (p < 0.05). Patients with skeletal metastasis or local recurrence had a shorter DT compared to the patients with lung metastasis. TgDT was correlated with peak standardized uptake value (SUV_peak) (p < 0.05). Maximum standardized uptake value (SUV_max) was correlated with tumor size (p < 0.05) and mean standardized uptake value (SUV_mean) with tumor size and vascular invasion (p < 0.05). Median SUV_max and SUV_mean were higher in follicular cancer or poor histological variants of papillary DTC compared to papillary cancer classical variant patients Conclusion: TgDT may be predictive of a positive ¹⁸F-FDG PET/CT in DTC. Skeletal metastasis and local recurrence are related to shorter TgDT. Greater tumor size, vascular invasion, and follicular cancer or poor variants of papillary carcinoma are related with higher SUV_max and SUV_mean. Larger scale studies are needed to confirm results and to calculate a possible cutoff of TgDT for a positive ¹⁸F-FDG PET/CT study.

Prognostic value of 18F-FDG PET/CT metabolic parameters in small cell lung cancer

Objective

To compare the prognostic values of metabolic parameters from pretreatment PET/CT between limited disease (LD) and extensive disease (ED) small cell lung cancer (SCLC) patients.

Methods

Data on 118 newly diagnosed SCLC patients (50 LD and 68 ED) who underwent pretreatment positron emission tomography–computed tomography (PET/CT) were reviewed. For PET, metabolic parameters were measured for: (1) primary tumor, maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis; and (2) all tumor lesions, SUVmax of the hottest tumor, whole body metabolic tumor volume (WBMTV), and whole body total lesion glycolysis (WBTLG). Prognostic values of metabolic parameters and other clinical variables were analyzed to predict overall survival (OS).

Results

In LD, SUVmax of the primary tumor was an independent prognostic factor for OS. Patients with high SUVmax showed significantly worse OS than those with low SUVmax. In ED, WBMTV and WBTLG were independent prognostic factors for OS. Patients with high WBMTV or WBTLG showed significantly worse OS than those with low WBMTV or WBTLG.

Conclusions

SUVmax of primary tumor was the only independent prognostic factor for OS in LD SCLC patients. WBMTV and WBTLG were independent prognostic factors in ED SCLC patients.

The prognostic role of PET/CT in small-cell lung cancer

OBJECTIVE

The aim in the present study is to determine the prognostic value of metabolic parameters related to the primary tumors detected in pretreatment Fluorine-18 2-fluoro-2-Deoxy-D-glucose (¹⁸F FDG) positron emission tomography/computerized tomography (PET/CT) scans of patients diagnosed with small-cell lung cancer (SCLC).

MATERIAL AND METHODS

Enrolled in this retrospective study were 63 patients with a histopathologically confirmed diagnosis of SCLC who underwent an ¹⁸F FDG PET/CT scan at baseline. Disease stage, age at diagnosis, gender, albumin level and maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values related to the primary tumor at the baseline PET scan were recorded, and the relationship of these factors with progression-free survival (PFS) and overall survival (OS) was evaluated.

RESULTS

The study included a total of 63 patients (10 female, 53 male, mean age of 64.8 and age range of 43-82 years), 22 of which had limited disease (LD) and 41 had extensive disease (ED). The OS and PFS were significantly higher in patients with LD than in patients with ED (15±2.9 vs. 10±0.9 months, p = 0.002 for OS; 10± 0.7 vs 6±0.6 months, p = 0.014 for PFS). However, no statistically significant relationship was identified between gender, albumin level, age and SUVmax, SUVmean, MTV, TLG values related to the primary tumor and PFS or OS.

CONCLUSION

The present study found that pretreatment PET parameters were of not predictive value for PFS and OS in patients with SCLC.

Differential development of large-cell neuroendocrine or small-cell lung carcinoma upon inactivation of 4 tumor suppressor genes

High-grade neuroendocrine tumors (large-cell neuroendocrine cell carcinoma, LCNEC, and small-cell lung carcinoma, SCLC) are recalcitrant cancers for which more effective treatments and follow-up detection systems are urgently needed. Moreover, the relationship between LCNEC and SCLC is largely unknown and a current matter of debate. Human material is scarcely available, making animal models of pivotal importance. Here we report 2 robust models of LCNEC and SCLC remarkably similar to their human counterparts. We show that SCLC can arise from basal cells, which determines the evolution of the high malignant neuroendocrine lung tumor type. Besides, we provide a noninvasive imaging method based on Ga-DOTATOC to monitor changes and assess evaluation of the diseases.

High-grade neuroendocrine lung malignancies (large-cell neuroendocrine cell carcinoma, LCNEC, and small-cell lung carcinoma, SCLC) are among the most deadly lung cancer conditions with no optimal clinical management. The biological relationships between SCLC and LCNEC are still largely unknown and a current matter of debate as growing molecular data reveal high heterogeneity with potential therapeutic consequences. Here we describe murine models of high-grade neuroendocrine lung carcinomas generated by the loss of 4 tumor suppressors. In an Rbl1-null background, deletion of Rb1, Pten, and Trp53 floxed alleles after Ad-CMVcre infection in a wide variety of lung epithelial cells produces LCNEC. Meanwhile, inactivation of these genes using Ad-K5cre in basal cells leads to the development of SCLC, thus differentially influencing the lung cancer type developed. So far, a defined model of LCNEC has not been reported. Molecular and transcriptomic analyses of both models revealed strong similarities to their human counterparts. In addition, a ⁶⁸Ga-DOTATOC–based molecular-imaging method provides a tool for detection and monitoring the progression of the cancer. These data offer insight into the biology of SCLC and LCNEC, providing a useful framework for development of compounds and preclinical investigations in accurate immunocompetent models.

Prognostic value of metabolic tumour volume and total lesion glycolysis measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography in small cell lung cancer: A systematic review and meta-analysis

The aim of this study was to evaluate the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) for small cell lung cancer (SCLC). MEDLINE, EMBASE and Cochrane Library databases were systematically searched. The pooled hazard ratio (HR) was used to measure the influence of MTV and TLG on survival. The subgroup analysis according to VALSG stage and the measured extent of MTV was performed. Patients with high MTV values experienced a significantly poorer prognosis with a HR of 2.42 (95% CI 1.46-4.03) for overall survival (OS) and a HR of 2.78 (95% CI 1.39-5.53) for progression-free survival (PFS) from the random effect model, and the pooled HR from the fixed effect model was 2.10 (95% CI 1.77-2.50) for OS and 2.27 (95% CI 1.83-2.81) for PFS. Patients with high TLG experienced a poorer prognosis with a HR of 1.61 (95% CI: 1.24-2.07) for OS from the random effect model, and the pooled HR from the fixed effect model was 1.64 (95% CI 1.37-1.96). Heterogeneity among studies was high for MTV in both OS and PFS meta-analyses (I²  = 87% and 88% respectively). After removing one outlier study the heterogeneity was substantially reduced (I²  = 0%) and the pooled HR for the effect of MTV on OS was 1.80 (1.51-2.16, P < 0.00001), and on PFS it was 1.86 (1.49-2.33, P < 0.00001), using either the fixed or random effects model. High MTV is associated with a significantly poorer prognosis OS and PFS, and high TLG is associated with a significantly poorer prognosis regarding OS for SCLC.

Prognostic value of the maximum standardized uptake value of pre-treatment primary lesions in small-cell lung cancer on 18F-FDG PET/CT: a meta-analysis

Background 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been widely used in clinical practice. However, the prognostic value of the pre-treatment standardized uptake value (SUV) for patients with small-cell lung cancer (SCLC) remains controversial. Purpose To investigate the prognostic role of pre-treatment 18F-FDG PET on SCLC patients by meta-analysis. Material and Methods Extensive literature searches of the PubMed, EMBASE, Web of Science, and Cochrane Library databases were conducted to identify literature published until 5 May 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with the pre-treatment maximum SUV (SUVmax). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across the studies. Subgroup analyses were performed to assess the robustness of the results. Results Twelve studies with 1062 patients were included. The pooled HR for OS of 11 studies was 1.13 (95% confidence interval [CI] = 1.05-1.22; P = 0.001; I²= 0%) and the pooled HR for EFS of nine studies was 1.09 (95% CI = 1.02-1.17; P = 0.014; I²= 0%), indicating that patients with high SUVs may have poorer prognoses. Begg's test detected no significant publication bias. The prognostic role of the SUVmax remained similar in the subgroup analyses. Conclusion Our meta-analysis indicated that the pre-treatment SUVmax of primary lesions can be an important prognostic factor for OS and EFS in patients with SCLC. A high SUVmax may indicate poorer prognosis.

Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer

Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.

Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer

Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.

Prognostic value of pre-treatment 18F-FDG-PET uptake in small-cell lung cancer

PURPOSE

Small-cell lung cancer (SCLC) is an aggressive disease, despite an initially favorable response to treatment, and its prognosis is still poor. Multiple parameters have been studied as possible prognostic factors, but none of them are reliable enough to change the treatment approach. ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is a novel imaging technique for staging of SCLC. The aim of this study was to evaluate the prognostic value of pre-treatment FDG-PET parameters on clinical outcome in limited stage (LS) SCLC patients treated with curative thoracic radiotherapy (RT) and chemotherapy.

METHODS

Clinical records of 46 LS-SCLC patients with pre-treatment FDG-PET imaging were retrospectively reviewed. Patients were treated with definitive RT for a total dose of 50-60 Gy and chemotherapy. The clinical endpoints were progression-free survival (PFS) and overall survival (OS).

RESULTS

The median age was 59 (range 30-82) years, and median follow-up time was 23.2 months (range 5-82.8 months). Median OS was 30.9 months for pre-treatment tumor maximum standardized uptake value (SUV_max) <9.3 and 20.6 months for SUV_max ≥9.3 (p = 0.027) and PFS was 55.6 months for SUV_max <9.3 and 38.6 months for SUV_max ≥9.3 (p = 0.16). Median OS was 73 months for pre-treatment lymph node SUV_max <5.8 and 21 months for ≥5.8 (p = 0.01) and PFS was 38.6 months (range 6.8-70.3 months) for SUV_max-LN ≥5.8; all patients with SUV_max-LN <5.8 were alive (p = 0.07). Median survival time was 28.2 months (range 21.7-34.7 months) for patients younger than 65 and 8.7 months (range 5.7-11.8 months) for those ≥65 years (p = 0.00).

CONCLUSIONS

Pre-treatment FDG-PET uptake may be a valuable tool to evaluate prognosis in SCLC patients. Patients with a higher pre-treatment FDG uptake may be considered at increased risk of failure and may benefit from more aggressive treatment approaches.