Early response measurement in non small cell lung cancer.

Patients with stage III lung cancer are mostly treated with a combination of
chemotherapy and radiotherapy. This toxic treatment leads to survival only in a
minority of patients. Intensification of treatment schedules for example by
concomitant chemoradiotherapy leads to some improvement of survival.
Unfortunately this is also accompagnied by increased toxicity. In selected
cases survival can be improved by surgery after induction chemo-radiotherapy
treatment: only in case of down-staging and Ro resection and if pneumonectomie
can be avoided. Assays are needed that can predict tumor response early during
treatment to select patients who are responders and will benefit from the
treatment and minimize side effects for the non-responders with early
modulation of treatment.
Research in other forms of cancer has shown that PET imaging is a usefull tool
in recognizing responders and non-responders early during treatment and that a
PET guided algorithm can be used in the treatment of cancer patients to
modulate therapy.

To assess tumor reponse with FDG-PET-CT imaging early after start of
concomitant chemo-radiotherapy in relation to cytological, histological and
biological tumor characteristics. The ultimate goal is to reveal more insight
in tumor reponse assesment and recognizing responders and and non-responders to
concomitant chemo-radiotherapy for stage III lung cancer.

This is a non-randomized single-centre open label study.

Patients included are diagnosed and treated according to normal local
standards. For the study they will be subjected to an extra FDG-PET-CT and an
extra invasive procedure and an extra bloodsample will be taken on the routine
moments for venapunction during this treatment schedule. Patients cannot use a
meal prior to these extra investigational procedures. The extra exposure to one
extra PET-CT is very low when compared to radiotherapy treatment. The extent of
the burden of these extra procedures can be justified by the rationale of this
study. Study results are expected to give more insight in tumor response
assesment and in recognition of responders and non-responders. We hope this
will justify a PET-decision making study in the future to test our hypothesis
that tumor response can be assesed shortly after start of treatment leading to
an early selection of patients who will benefit of the treatment and patients
whom an unnescecarry toxic treatment can be withheld.