Caroline Chiles, MD, Chair
Wake Forest University

Specific Aims

Complete follow-up and analysis on the National Lung Screening Trial aimed at definitively establishing the effect of CT lung cancer screening on lung cancer specific mortality
Investigate the role of PET/CT in early detection of lung cancer recurrence to support earlier endpoints for adjuvant therapy trials
Investigate targeted functional imaging approaches to predict and monitor the therapeutic response of non-small cell lung cancer (NSCLC) to chemotherapy and radiation therapy.
Study FDG-PET as a response marker for esophageal cancer.

Future Plans Overview

Continued follow-up and data collection are planned for ACRIN 6654: ACRIN-NLST in support of the disease-specific mortality endpoint through 2009. Secondary analyses relating to stage distribution, psychological impacts of screening, medical resource utilization, and economic consequences of screening with CT vs. CXR

are anticipated as well. The analysis of a large archive of blood, urine, and sputum specimens and tissue microarrays of resected lung cancer specimens from ACRIN-NLST is also expected to answer many important questions about molecular biomarkers. In addition, the use of the NLST database for evaluating computer aided detection systems for lung nodule detection is being explored.

A new concept under development will compare FDG-PET with CT for detection of recurrent disease in patients with stage IB – IIIA NSCLC treated with complete resection and adjuvant chemotherapy. The hypothesis is that PET/CT is superior to either CXR or CT in distinguishing disease recurrence from post-treatment changes.

In continuing its work on functional imaging approaches to predict and monitor therapeutic response, the committee proposes to develop functional markers related to angiogenesis and hypoxia, and is seeking to collaborate with partners conducting relevant treatment studies. A second study will evaluate hypoxia imaging as a marker for predicting and monitoring response to radiation therapy.

ACRIN 6679 will examine FDG-PET/CT in the prediction of pathologic tumor response in patients with localized esophageal cancer who undergo chemotherapy and/or chemoradiation prior to surgical resection. The committee hypothesizes that using PET/CT, which differentiates responding from nonresponding patients, will allow more appropriate selection of patients for surgery and may result in improved outcome and a reduction in futile surgeries.