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Is FDG-PET suitable for evaluating neoadjuvant therapy in non-small cell lung cancer? Evidence with systematic review
Angel C Rebollo-Aguirre1, Carlos Ramos-Font, Román Villegas Portero
1Department of Nuclear Medicine, University Hospital Virgen de las Nieves, Granada, Spain. angelc.rebollo.sspa@juntadeandalucia.es
Background:
Neoadjuvant therapy response assessment is crucial in patients with non-small cell lung cancer (NSCLC). FDG-PET has emerged as a valuable tool for defining therapy response assessment in other tumours.
Aim:
To systematically review publications appearing in the literature describing induction therapy response assessment with FDG-PET in NSCLC.
Methods:
We performed a bibliographic search and selected only prospective studies in order to include the highest levels of evidence.
Results:
Nine of 497 potentially relevant publications were selected. The ranges of sensitivity, specificity, positive predictive value and negative predictive value for primary tumour response assessment were 80-100%, 0-100%, 42.9-100%, and 66.7-100%, respectively. Pooling data for N2 restaging after neoadjuvant response the overall sensitivity was 63.8% (95% CI, 53.3-73.7%) and overall specificity was 85.3% (95% CI, 80.4-89.4%).
Conclusion:
The results of the analysis do not support the use of FDG-PET as the only re-assessment tool for mediastinal lymph node evaluation for routine clinical use. FDG-PET seems to predict primary tumour response to induction therapy but it could not be shown by pooling analysis.
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