Non Small Cell Lung Cancer
Conditions
Keywords
positron emission tomography, parametric imaging, lung cancer
Brief summary
The purpose of this study is to evaluate the concordance between Positron E mission tomography parametric imaging versus standard PET for the 1 year prognosis of patients with NSCLC treated by radiochemotherapy. The ancillary study will evaluate the interest of parametric PET imaging during the treatment (around 42 Gray) to detect the local relapse of the lesion in order to propose a treatment re-planification or intensification (not realized on the present study).
Detailed description
In oncology, Positron Emission Tomography imaging with 18Fluor-FDG quantifies glucose metabolism lesions. Conventionally, the metabolism is quantified using the Standard Uptake Value (SUV) from a static acquisition obtained 60 minutes post-injection. Some teams reported SUV variation coefficients as high as 30% in NSCLC lesions for repeated PET examinations in patients without treatment. Moreover, information regarding the binding kinetics of 18Fluor-FDG by tumor cells is not accessible through this method. Much more elaborated FDG quantification methods and considered as reference methods exist in PET imaging (compartmental analysis, Patlak). Simplified kinetic methods have also been proposed which correlate better with Patlak reference method than the conventional SUV. The investigators proposed a new methodological approach to obtain the parametric information in PET. This approach allows to define new indexes (average percentage of FDG-metabolized or not metabolized; time required to metabolize 80% of FDG). The approach has been clinically evaluated in a pilot study for the differentiation between benign and paraganglioma lesions. Tsuchida observed that the parametric PET imaging allowed histological differentiation of subtypes of lung tumors, reflecting the difference in glucose transporters and hexokinase between adenocarcinoma and squamous cell carcinoma. Xue et al showed that the FDG uptake (based on the only SUV) could be a tool to predict the subtype and thus tumor staging in patients suffering from NSCLC. The investigators can then hypothesize that some subtype of lung tumor, with increased proliferation rate (kinetic indexes k3, Ki or other parameters offered by our previous work), will be more sensitive to radiotherapy and thus the evaluation of tumor subtype by PET would allows radiotherapy adaption accordingly. This study is a preliminary methodological study , strictly descriptive and will only assess the comparison of measurements obtained on a parametric imaging and imaging static in patients suffering from NSCLC . The measures of the uptake and volumes estimated by two approaches will be correlated and compared with the 1 year clinical outcome (primary objective). An ancillary study will assess the relevance of the approach to detect, at the tumor level , an early recurrence of the disease. For this, the images acquired during the radiotherapy treatment (at 42Gy) will be analyzed retrospectively and the correlation with the images to 3 months or 1 year of relapsing patients will be analyzed.
Interventions
PROCEDUREParametric Imaging
2 parametric PET (one at the inclusion and one at 42 gray of the beginning of radiotherapy)
Sponsors
Assistance Publique Hopitaux De Marseille
Centre Henri Becquerel
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or female patient * Age over 18 years old * Histological evidence of non-small cell lung cancer * Treatment by curative intent radio-chemotherapy based on platinum salt * Stage superior or equal to T2a * Tumour FDG uptake higher than mediastinal background noise on FDG PET/CT * Affiliated or beneficiary of a social benefit system
Exclusion criteria
* Histology other than non-small cell lung cancer * Patient without measurable target * Absence of FDG uptake on FDG-PET/CT scan * Previous neoplastic disease of less than 2 years duration or progressive * Pregnant women or women of child-bearing potential or breast feeding mothers * World Health Organisation scale superior or equal to 2 * Adult subjects who are under protective custody or guardianship * Patient unable to comply with the specific obligations of the study (geographic, social or physical reasons) Uncontrolled diabetes with blood glucose ≥10 mmol/L, Hypersensitivity to the active substance (FDG) or to any of the excipients, Patients unable to understand the purpose of the study (language, etc.) * Unaffiliated or not beneficiary of a social benefit system
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prognosis of recurrence | one year | Comparison between parametric Imaging and standard Imaging in PET for the diagnosis of recurrence |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| analysis method of Parametric Imaging quantification determination | one year | Determinate a method of analysis of the quantification of the parametric imaging |
| recurrence-free survival predictive value determination | 3 months | Evaluate the predictive value of the technique of parametric Imaging on the recurrence-free survival at 3 months |
Countries
France
Outcome results
None listed