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

Prakash Manoharan; Ahmed Salem; Hitesh Mistry; Michael Gornall; Susan Harden; Peter Julyan; Imogen Locke; Jonathan McAleese; Rhona McMenemin; Nazia Mohammed; Michael Snee; Sarah Woods; Thomas Westwood; Corinne Faivre-Finn

doi:10.1016/j.jtho.2019.03.023

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

Prakash Manoharan, Ahmed Salem, Hitesh Mistry, Michael Gornall, Susan Harden, Peter Julyan, Imogen Locke, Jonathan McAleese, Rhona McMenemin, Nazia Mohammed, Michael Snee, Sarah Woods, Thomas Westwood, Corinne Faivre-Finn

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Early online date	16 Apr 2019
DOIs	https://doi.org/10.1016/j.jtho.2019.03.023
Publication status	Published - 2019

Keywords

small-cell
lung cancer
18F-FDG PET/CT
staging
survival

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jtho.2019.03.023

CRUK Imaging Centres.
Jackson, A. (PI), Asselin, M.-C. (CoI), Coope, D. (CoI), Dive, C. (CoI), Faivre-Finn, C. (CoI), Herholz, K. (CoI), Hinz, R. (CoI), Illidge, T. (CoI), Manoharan, P. (CoI), Marais, R. (CoI), Matthews, J. (CoI), McMahon, A. (CoI), O'Connor, J. (CoI), Parker, G. (CoI), Stivaros, S. (CoI), Thacker, N. (CoI), Williams, K. (CoI) & Withers, P. (CoI)
1/12/13 → 30/11/19
Project: Research

Radiotherapy research changes standard clinical practice and improves survival for patients with small-cell lung cancer
Faivre-Finn, C. (Corresponding participant), Blackhall, F. (Participant) & Lorigan, P. (Participant)
Impact: Health and wellbeing

Cite this

Manoharan, P., Salem, A., Mistry, H., Gornall, M., Harden, S., Julyan, P., Locke, I., McAleese, J., McMenemin, R., Mohammed, N., Snee, M., Woods, S., Westwood, T., & Faivre-Finn, C. (2019). [18F]fludeoxyglucose PET/CT in small-cell lung cancer: Analysis of the CONVERT randomized controlled trial. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. https://doi.org/10.1016/j.jtho.2019.03.023

@article{d54e8c7c67b24133a134f9fa587319e7,

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

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.",

keywords = "small-cell, lung cancer, 18F-FDG PET/CT, staging, survival",

author = "Prakash Manoharan and Ahmed Salem and Hitesh Mistry and Michael Gornall and Susan Harden and Peter Julyan and Imogen Locke and Jonathan McAleese and Rhona McMenemin and Nazia Mohammed and Michael Snee and Sarah Woods and Thomas Westwood and Corinne Faivre-Finn",

note = "Copyright {\textcopyright} 2019. Published by Elsevier Inc.",

year = "2019",

doi = "10.1016/j.jtho.2019.03.023",

language = "English",

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issn = "1556-0864",

publisher = "Elsevier BV",

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Manoharan, P, Salem, A , Mistry, H, Gornall, M, Harden, S, Julyan, P, Locke, I, McAleese, J, McMenemin, R, Mohammed, N, Snee, M, Woods, S, Westwood, T & Faivre-Finn, C 2019, '[18F]fludeoxyglucose PET/CT in small-cell lung cancer: Analysis of the CONVERT randomized controlled trial', Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. https://doi.org/10.1016/j.jtho.2019.03.023

TY - JOUR

T1 - [18F]fludeoxyglucose PET/CT in small-cell lung cancer

T2 - Analysis of the CONVERT randomized controlled trial

AU - Manoharan, Prakash

AU - Salem, Ahmed

AU - Mistry, Hitesh

AU - Gornall, Michael

AU - Harden, Susan

AU - Julyan, Peter

AU - Locke, Imogen

AU - McAleese, Jonathan

AU - McMenemin, Rhona

AU - Mohammed, Nazia

AU - Snee, Michael

AU - Woods, Sarah

AU - Westwood, Thomas

AU - Faivre-Finn, Corinne

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - small-cell

KW - lung cancer

KW - 18F-FDG PET/CT

KW - staging

KW - survival

U2 - 10.1016/j.jtho.2019.03.023

DO - 10.1016/j.jtho.2019.03.023

M3 - Article

C2 - 31002954

SN - 1556-0864

JO - Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

JF - Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

ER -

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

Abstract

Keywords

UN SDGs

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Projects

CRUK Imaging Centres.

Impacts

Radiotherapy research changes standard clinical practice and improves survival for patients with small-cell lung cancer

Cite this