Objectives: Restaging of patients with locally-advanced NSCLC is of paramount importance, since only patients with down staging after induction therapy will benefit from surgery. In this study, we assessed the aetiology of new FDG-positive focal abnormalities on restaging PET/CT in patients with a good response after induction chemotherapy in the primary tumor and lymph nodes.
Methods: Between 2004 and 2008, 31 patients with histological proven stage III NSCLC had a PET/CT prior and after induction chemotherapy. Their medical charts were retrospectively reviewed.
Results: Restaging PET/CT revealed a new FDG-positive lesion in 6/31 (20%) patients. Initial clinical stage of the disease was IIIA N2 in 4 and IIIB T4 in 2 patients. The maximal standard uptake value (SUV max) in the primary tumor (p=0.043) and in the initially involved mediastinal nodes (p=0.068) decreased after induction treatment in all patients. The new PET/CT findings were located in an ipsilateral cervical in 2, a contralateral mediastinal in 1 and an ipsilateral mammary internal lymph node in 1 patients. Two other patients had a lesion on the contralateral lung. Malignant lymph node infiltrations were excluded following fine-needle punction, intraoperative biopsy or follow-up PET/CT. Contralateral pulmonary lesions were diagnosed as benign following mini thoracotomy and pulmonary wedge resection.
Conclusions: New solitary FDG-positive lesions on restaging PET/CT after induction chemotherapy for NSCLC are not rare in good responders to chemotherapy. In our experience, all these lesions were not associated with malignancy.
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22 ارديبهشت 1395 ساعت 10:19 ب.ظ
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