RESUMEN
PURPOSE: The standard treatment for patients with stage III non-small cell lung cancer (NSCLC), unsuitable for resection and with good performance, is definitive radiotherapy with cisplatin-based chemotherapy. Our aim is to evaluate the effect of the maximum value of standardized uptake values (SUVmax) of the primary tumor in positron emission tomography-computed tomography (PET/CT) before treatment on complete response (CR) and overall survival. METHODS: The data of 73 stage III NSCLC patients treated with concurrent definitive chemoradiotherapy (CRT) between 2008 and 2017 and had PET/CT staging in the pretreatment period were evaluated. ROC curve analysis was performed to determine the ideal cut-off value of pretreatment SUVmax to predict CR. RESULTS: Median age was 58 years (range 27-83 years) and 66 patients were male (90.4%). Median follow-up time was 18 months (range 3-98 months); median survival was 23 months. 1-year overall survival (OS) rate and 5-year OS rate were 72 and 19%, respectively. Median progression-free survival (PFS) was 9 months; 1-year PFS rate and 5-year PFS rate were 38 and 19%, respectively. The ideal cut-off value of pretreatment SUVmax that predicted the complete response of CRT was 12 in the ROC analysis [AUC 0.699 (0.550-0.833)/P < 0.01] with a sensitivity of 83%, and specificity of 55%. In patients with SUVmax < 12, CR rate was 60%, while, in patients with SUV ≥ 12, it was only 19% (P = 0.002). Median OS was 26 months in patients with pretreatment SUVmax < 12, and 21 months in patients with SUVmax ≥ 12 (HR = 2.93; 95% CI 17.24-28.75; P = 0.087). CR rate of the whole patient population was 26%, and it was the only factor that showed a significant benefit on survival in both univariate and multivariate analyses. CONCLUSION: Pretreatment SUVmax of the primary tumor in PET/CT may predict CR in stage III NSCLC patients who were treated with definitive CRT. Having clinical CR is the only positive predictive factor for prolonged survival.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioradioterapia , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pronóstico , Curva ROC , Radiofármacos/farmacocinética , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Angiogenesis is a very essential process in tumor biology. Vascular endothelial growth factor (VEGF), angiopoietin and its receptor (TIE-2) are very important mediators for angiogenesis. In this trial, we aimed to analyze the role of these mediators on chemotherapy response and survival. PATIENTS AND METHODS: Forty four cancer patients and 22 healthy controls were included in the study. Baseline serum samples were obtained from all participants and post-chemotherapy serum samples were obtained from the cancer patients. Serum vascular endothelial growth factor and TIE-2 levels were measured with quantitative enzyme-linked immunosorbent assay techniques. RESULTS: The baseline serum vascular endothelial growth factor level was 187.5 and 120.2 pg/ml in cancer patients and the control group (p = 0.006). The baseline serum TIE-2 level was 615.9 and 242.5 pg/ml in the patients and control group (p < 0.001). There was a significant difference between patients' baseline and post-chemotherapy VEGF levels (111.9 pg/ml; p < 0.001) and patients' baseline and post-chemotherapy TIE-2 levels (344.5 pg/ml; p < 0.001). The overall survival rate was better in patients who had lower baseline VEGF and TIE-2 levels and whose TIE-2 level had decreased with chemotherapy. CONCLUSIONS: Higher baseline TIE-2 and VEGF levels are related and worsen survival. Decreasing levels of TIE-2, but not VEGF, which, with chemotherapy, may be predictive for survival.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Pulmonares/patología , Receptor TIE-2/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Anciano , Antineoplásicos/farmacología , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/patología , Estudios de Casos y Controles , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/tratamiento farmacológico , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/patología , Pronóstico , Receptor TIE-2/efectos de los fármacos , Tasa de Supervivencia , Factor A de Crecimiento Endotelial Vascular/efectos de los fármacosRESUMEN
PURPOSE: Multiple primary malignant neoplasms (MPMNs) are defined as a diagnosis of two or more indepen-dent primary malignancies of different histologies/origins in an individual. The frequency of MPMN is being increasing. In this study we aimed to determine the frequency and clinical features of second primary cancers (SPCs). METHODS: From January 1990 to December 2010, patients with MPMNs were screened in 5 centers. Data were obtained retrospectively from hospital charts. RESULTS: Three hundred seventy-seven patients with MPMNs were evaluated. The median age at initial cancer diagnosis was 61 years (range 18-88). The median age at second cancer was 64 years (range 20-89). The median time between two cancer diagnoses was 15 months (range 0-504). Male to female ratio was 1.44 (M/F 223/154). The most frequent initial cancer types were head and neck (54 patients, 14.3%), breast (54 patients, 14.3%), and colorectal (43 patients, 11.4%). The most frequent second cancer types were lung (76 patients, 20.2%), colorectal (39 patients, 10.3%) and breast (33 patients, 8.8%). The most common cancer pairs in females were breast-gynecologic cancers (15 patients, 9.7%), colorectal-breast cancers (9 patients, 5.8%) and breast-colorectal cancers (7 patients, 4.5%). The most common cancer pairs in males were head and neck-lung cancers (29 patients, 13%), bladder-lung cancers (9 patients, 4%), and bladder-prostate cancers (7 patients, 3%). The median follow up was 36 months (range 17horbar;595). CONCLUSION: Physicians should be aware of SPCs probabilities. Newly developed suspicious lesions should be evaluated rigorously. Histopathologic evaluations of suspicious lesions for second tumors should be used extensively if needed. In our series, the most common pairs were breast-gynecologic cancers in females and head and neck-lung cancers in males.