Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Imaging Factors Predictive of Higher or Lower Risk for Recurrence of Early Stage NSCLC
Author
Howard (Jack) West, MD

Among the many variables that can potentially be helpful in predicting outcomes after surgery are some imaging results. One of these is cavitation, or hollowing out of the inside of some part of the tumor. Although most clinicians think of this as a feature of squamous cancers, it can also be seen with adenocarcinomas and other histologies less frequently. On a CT, this appears as a black area of air in the middle of a nodule or mass, and this generally occurs from a cancer growing to outstrip its blood supply, so that the inside of a tumor no longer gets nutrients and dies, from the inside out. In fact, a study from MD Anderson of stage I cancers with or without cavitation (abstract here) indicated that those with cavitation are associated with a significantly worse survival:

Onn Cavitation and Survival

(Click to enlarge image)

Although this is a small trial, with just 72 patients included, it does suggest that tumor cavitation may be a helpful tiebreaker in cases where people are on the fence about pursuing post-operative therapy.

Another potentially relevant issue is the standard uptake value (SUV), a measure of the metabolic activity of a tumor on a PET scan, which just about everyone now gets before surgery to clarify staging. SUV is a measure of labeled glucose (sugar) uptake by a tumor, which is increased by higher metabolic activity like rapidly dividing cells, which leads to faster tumor growth. At the World Conference on Lung Cancer in Korea, Dr. Goodgame and colleagues evaluated variables that predicted recurrence among 136 patients with stage I NSCLC tumors resected at Washington University in St. Louis (abstract here):

Goodgame SUV table

Goodgame SUV KM Curve

Higher risk of recurrence was associated with several factors, including higher T stage (not surprising, that's what staging is for), and also more likely with adenocarcinomas vs. squamous carcinomas (I described this in another post). It wasn't associated with age. PET SUV of 5.5 or more was associated with a significantly greater risk of recurrence than that seen in patients with an SUV below that. And when they did a multivariate analysis where they determined which variables were more or less important in predicting what would happen (many correlating with each other), the SUV was the strongest independent predictor of outcome. And pretty much all of the little evidence we have about predicting outcomes based on PET results for early stage disease corroborates this same conclusion. While the break point is a little different in one study or another (often in the 5-7 range), the work thus far has uniformly suggested that tumors with a higher SUV are more worrisome and more likely to recur than the early stage cancers with a lower SUV.

Next Previous link

Previous PostNext Post

Related Content

Article
Advance directives are a powerful way to take control of healthcare choices. These documents allow you to outline preferences for medical care and specify end-of-life wishes. These documents can also be a way to appoint loved ones who you would like to help with these decisions, such as a healthcare proxy (someone to make decisions on your behalf, if you cannot). As cancer treatments can involve aggressive treatments and/or complex medical management, having advance directives ensures that your desires regarding treatment options and end-of-life care are clearly communicated. 
Image
2024-25 patient perspectives header
Article
Tell your story and help us help others! Apply online now for this paid opportunity. This program gives a voice to those who have experience in participating in a clinical trial for a cancer diagnosis. Your voice helps to educate and advocate for others who are in or who may be considering a clinical trial.  We want to hear from you!
Image
Foro de Pacientes de Terapias Dirigidas de Cáncer de Pulmón
Video
¡El vídeo completo bajo demanda está disponible para verlo!

Forum Discussions

Hi elysianfields and welcome to Grace.  I'm sorry to hear about your father's progression. 

 

Unfortunately, lepto remains a difficult area to treat.  Recently FDA approved the combo Lazertinib and Amivantamab...

Hello Janine, thank you for your reply.

Do you happen to know whether it's common practice or if it's worth taking lazertinib without amivantamab? From all the articles I've come across...

Hi elysianfields,

 

That's not a question we can answer. It depends on the individual's health. I've linked the study comparing intravenous vs. IV infusions of the doublet lazertinib and amivantamab...

Recent Comments

JOIN THE CONVERSATION
I could not find any info on…
By JanineT GRACE … on
Hi elysianfields,

 

That's…
By JanineT GRACE … on
Hello Janine, thank you for…
By elysianfields on
EGFR
By happybluesun on