PET changes staging and treatment for newly diagnosed and recurrent lung cancer patients

November 05, 2001

Reston, Virginia...Positron Emission Tomography (PET) can have a dramatic impact on patient staging and subsequent treatment of persons recently diagnosed or with suspected recurrent non-small cell lung cancer (NSCLC) according to two studies published in the November, 2001 issue of The Journal of Nuclear Medicine. One study of 63 patients with suspected recurring disease revealed that PET scans were significantly more accurate in identifying the extent of the possible recurrent disease for 86% of the patients, whereas conventional staging was correct for only 24% of the patients. In the same study PET scans found that 33% of the patients had less extensive disease and 37% had more extensive disease than conventional evaluation using computed tomography (CT) had suggested. In cases in of recurring cancer, in which the PET scan and CT findings differed, PET was found to be correct 86% of the time, while the conventional evaluation was correct for only one patient (3%).

The PET scan findings resulted in a major change in treatment for 63% of the patients with recurrent cancer. Of these, treatment for 6 patients was changed from curative to palliative care. More importantly, 9 persons who were going to receive either active palliative therapy or an invasive diagnostic procedure were spared these costly, and potentially painful treatments, when the PET scan revealed no active disease. Major changes were classified as changing the treatment intent or modality, i.e., from palliative to curative treatment or from surgery to radiotherapy. PET had a medium impact on management of 8 patients (13%), which generally meant changes in radiation treatment volume. It had a low impact on 13 patients (21%).

"Telling people they are free of active disease has an enormously reassuring psychological impact on patients, and therefore we felt that this result--while often overlooked--qualified it as a major impact of the PET study results," stated study author Dr. Rodney J. Hicks, of the Peter MacCallum Cancer Institute in Australia.

For newly diagnosed patients, the impact of PET on their primary staging and treatment planning was also significant. PET results led to patients staged differently from conventional (i.e., CT) staging in 42% of the 153 patients. Stage IV disease was found in 11% of those patients thought to have either stage I or stage II disease under conventional staging. Nineteen patients (24%) thought to have stage III disease were found post-PET to be at stage IV.

Treatment planning for the newly diagnosed was also impacted. The study authors noted that the PET scan had a high impact (i.e., changed planned treatment) for 35% of the patients. Reflecting the large number of those with upstaged disease, 54 patients had their planned therapy change from curative to palliative, whereas for 6 patients, the planned therapy moved from palliative to curative. The PET results had a medium impact on 25% of the newly diagnosed patients. These changes were mostly in the area of radiation treatment.

According to the authors, because of its ability to more accurately stage disease compared with convention evaluation, PET also demonstrated its ability to produce accurate prediction of survival among patients.

"The impact of PET on patient care and well-being cannot be overstated," said author Rodney Hicks. "By allowing patients with a poor prognosis to receive palliative rather than futile curative therapy, the patient is spared the often harrowing effects of the treatments. The costs are also reduced as unproductive treatments are reduced."

Lung cancer is the most common cause of cancer death in western society, and is increasing in incidence. In the United States, the American Cancer Society estimates that 164,000 Americans were diagnosed with the disease in 2000, and an estimated 156,900 died, the largest number of deaths of any single cancer.
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The Utility of 18F-FDG PET for Suspected Recurrent Non-Small Cell Lung Cancer After Potentially Curative Therapy: Impact on Management and Prognostic Stratification and 18F-FDG PET Provides High-Impact and Powerful Prognostic Stratification in Staging Newly Diagnosed Non-Small Cell Lung Cancer were written by Rodney J. Hicks, MD, Victor Kalff, MD, Michael P. MacManus, MD, Robert E. Ware, MD, Allan F. McKenzie, PhD, Jane P. Matthews, PhD, and David L. Ball, MD, of the Department of Diagnostic Imaging, Pratt Foundation Statistical Centre, and Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia. FDG/Recurrent studied 63 consecutive patients with suspected relapse at least 6 months after definitive treatment of NSCLC. FDG/Newly Diagnosed studied 153 consecutive patients with newly diagnosed NSCLC. Results were validated through serial imaging and pathological results.

Copies of the article and images related to the study are available to media upon request to Karen Lubieniecki at Karenlub@aol.com; (703) 683-0357. Copies of this and past issues of The Journal of Nuclear Medicine are available online at jnm.snmjournals.org. Print copies can be obtained at $15 per copy by contacting the SNM Service Center, Society of Nuclear Medicine, 1850 Samuel Morse Drive, Reston, VA 20190-5315; phone: (703) 326-1186; fax: (703) 708-9015; e-mail: servicecenter@snm.org. A yearly subscription to the journal is $170. A journal subscription is a member benefit of the Society of Nuclear Medicine.

Society of Nuclear Medicine

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