CT scan prior to radiotherapy in unresectable, locally advanced, non-small cell carcinoma of the lung: is it always necessary?

• Published in: Clinical & translational oncology 2017, Vol.19 (1), p.105-110
• Main Authors: Calvo Temprano, D., Esteban, E., Jiménez Fonseca, P., Fernández-Mariño, B.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adult; Aged; Carcinoma, Large Cell - diagnostic imaging; Carcinoma, Large Cell - pathology; Carcinoma, Large Cell - radiotherapy; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Female; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Radiography, Thoracic - methods; Research Article; Tomography, X-Ray Computed - methods
• ISSN: 1699-048X; 1699-3055
• DOI: 10.1007/s12094-016-1510-4

Purpose There is broad consensus regarding evaluating response to chemotherapy (CHT) by means of computerized tomography (CT) in patients with localized or locally advanced non-small cell lung carcinoma (NSCLC). We present a study comparing the usefulness of CT versus chest X-ray (XR) and clinical findings when indicating radiotherapy (RT) following CHT. Methods Ninety-eight of 150 subjects with unresectable locally advanced NSCLC were blindly and independently evaluated by XR and CT, with pairs of chest XR and CT (before and after CHT). A null hypothesis (H0) was established of the conditioned probability of detecting progression by CT and not by XR of 10 % or more, with a statistical power of 80 %. Results Sensitivity, specificity, positive and negative predictive value of XR versus CT were 98, 89, 99, and 80 % respectively. A 4 % ( p  = 0.0451) probability of improvement of CT versus XR was calculated, enabling the H0 to be ruled out. Conclusion The CT failed to prove to be significantly superior to the chest XR + clinical picture in indicating a change in treatment approach in patients with unresectable locally advanced NSCLC after CHT.