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We aimed to investigate the prognostic value of pretreatment positron emission tomography (PET) parameters in high-risk patients undergoing hypofractionated radiotherapy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective analysis was conducted on 42 consecutive patients with inoperable node-positive NSCLC, who underwent hypofractionated radiotherapy between 2014 and 2021 at a single institution. Clinical, treatment-related, and [<jats:sup>18<\/jats:sup>F]FDG PET-based parameters were correlated with progression-free survival (PFS) and overall survival (OS). Median dichotomisation was performed to establish risk groups. Statistical analyses included univariable and multivariable Cox regression and Kaplan-Meier survival analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>After a median follow-up of 47.1 months (range: 0.5-101.7), the median PFS and OS were 11.5 months (95% CI: 7.4-22.0), and 24.3 months (95% CI: 14.1-31.8). In univariable Cox regression analysis, significant predictors of PFS included receipt of salvage systemic treatment (p=0.007), SUVmax (p=0.032), and tMTV (p=0.038). Similarly, ECOG-PS (p=0.014), Histology (p=0.046), and tMTV (p=0.028) were significant predictors of OS. Multivariable Cox regression analysis (MVA) identified SUVmax as a significant predictor for PFS [HR: 2.29 (95% CI: 1.02-5.15); p=0.044]. For OS, ECOG-PS remained a significant prognosticator [HR: 3.53 (95% CI: 1.49-8.39); p=0.004], and tMTV approached significance [HR: 2.24 (95% CI: 0.95-5.26); p=0.065]. Furthermore, the high tMTV group exhibited a median PFS of 5.3 months [95% CI: 2.8-10.4], while the low tMTV group had a PFS of 15.2 months [95% CI: 10.1-33.5] (p=0.038, log-rank test). Median OS was 33.5 months [95% CI: 18.3-56.8] for tMTV \u2264 36.6 ml vs. 14.1 months [95% CI: 8.1-27.2] for tMTV &gt; 36.6 ml (p=0.028, log-rank test).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Pretreatment PET parameters, especially tMTV, hold promise as prognostic indicators in NSCLC patients undergoing hypofractionated radiotherapy. The study highlights the potential of PET metrics as biomarkers for patient stratification.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41824-024-00220-w","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T23:02:16Z","timestamp":1728342136000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic significance of pretreatment PET parameters in inoperable, node-positive NSCLC patients with poor prognostic factors undergoing hypofractionated radiotherapy: a single-institution retrospective study"],"prefix":"10.1186","volume":"8","author":[{"given":"Annemarie Barbara","family":"Zinn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saskia","family":"Kenndoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrien","family":"Holzgreve","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"K\u00e4smann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian Elias","family":"Guggenberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svenja","family":"Hering","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sina","family":"Mansoorian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina-Sophie","family":"Schmidt-Hegemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Reinmuth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Tufman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Dinkel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farkhad","family":"Manapov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Belka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-1398","authenticated-orcid":false,"given":"Chukwuka","family":"Eze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"220_CR25","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1111\/1754-9485.13294","volume":"65","author":"R Alipour","year":"2021","unstructured":"Alipour R, Bucknell N, Bressel M, Everitt S, MacManus M, Siva S, Hofman MS, Akhurst T, Hicks RJ, Iravani A (2021) Nodal metabolic tumour volume on baseline 18F-FDG PET\/CT and overall survival in stage II and III NSCLC patients undergoing curative\u2010intent chemoradiotherapy\/radiotherapy. 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ABZ, SK, JG, SH, SM, NR, LK, NSSH, AT, and JD report no conflicts of interest. AH reports compensation for scientific consulting by ABX advanced biochemical compounds, unrelated to the current study. FM reports a research grant from AstraZeneca and honoraria from AstraZeneca, Novartis, Roche, Lilly, Elekta and Brainlab outside the submitted work. FM serves on the advisory board of AstraZeneca, Novartis. CB reports receiving grants or contracts from ViewRay, Brainlab, and Elekta; payment or honoraria from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Opasca, C-RAD, Elekta, and ViewRay; receiving support for attending meetings or travel from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Elekta, and ViewRay; and having a leadership or fiduciary role with ESTRO, all outside the submitted work. CE reports consulting fees from Novartis outside the submitted work.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"32"}}