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  • Title: Effect of PET/CT on management of patients with non-small cell lung cancer: results of a prospective study with 5-year survival data.
    Author: Gregory DL, Hicks RJ, Hogg A, Binns DS, Shum PL, Milner A, Link E, Ball DL, Mac Manus MP.
    Journal: J Nucl Med; 2012 Jul; 53(7):1007-15. PubMed ID: 22677701.
    Abstract:
    UNLABELLED: We investigated the incremental management impact and prognostic value of staging with (18)F-FDG PET/CT in patients with non-small cell lung cancer (NSCLC) being considered for potentially curative therapies. METHODS: Information on 168 consecutive patients with NSCLC being considered for surgery or definitive radiotherapy with curative intent before PET/CT was entered into a prospective database. The pre-PET/CT management plan, based on conventional imaging (conventional CT, appropriately supplemented by bone scintigraphy or other modalities), was defined prospectively by referring clinicians before PET/CT results became available. After PET/CT, actual clinical management was recorded, and patients were followed up until 5 y or death. The appropriateness of PET/CT management plans was assessed by biopsy when available, clinical follow-up, and survival analysis. RESULTS: Stage was discordant on PET/CT and conventional imaging in 50.6% of patients (41.1% upstaged, 9.5% downstaged), with high management impact (change in treatment modality or curative intent) in 42.3% of patients. Both conventional imaging stage and PET/CT stage were strongly predictive of overall survival (OS) but there were greater differences between hazard rates and separations in the OS curves for stage groupings determined using PET/CT. OS was also strongly predicted by PET/CT-directed choice of therapy (P < 0.0001). CONCLUSION: PET/CT frequently affects patient management and strongly predicts OS in NSCLC, supporting the appropriateness of such changes.
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