J Clin Oncol 2001 Jan 1;19(1):111-118
Clinical Impact of (18)F Fluorodeoxyglucose Positron Emission Tomography
in Patients With Non-Small-Cell Lung Cancer: A Prospective Study.
Kalff V V, Hicks RJ, P MacManus M, Binns DS, McKenzie AF, Ware RE, Hogg A, Ball DL.
PURPOSE: To prospectively study the impact of (18)F fluorodeoxyglucose (FDG) positron
emission tomography (PET) on clinical management of patients with non-small-cell lung
cancer (NSCLC). PATIENTS AND METHODS: One hundred five consecutive patients with NSCLC
undergoing (18)F FDG PET were analyzed. Before PET, referring physicians recorded scan
indication, conventional clinical stage, and proposed treatment plan. PET scan results
were reported in conjunction with available clinical and imaging data, including results
of computed tomography (CT). Subsequent management and appropriateness of PET-induced
changes were assessed by follow-up for at least 6 months or until the patient's death.
RESULTS: Indications for PET were primary staging (n = 59), restaging (n = 34), and
suspected malignancy subsequently proven to be NSCLC (n = 12). In 27 (26%) of 105 of
cases, PET results led to a change from curative to palliative therapy by upstaging
disease extent. Validity of the PET result was established in all but one case. PET
appropriately downstaged 10 of 16 patients initially planned for palliative therapy,
allowing either potentially curative treatment (four patients) or no treatment (six
patients). PET influenced the radiation delivery in 22 (65%) of 34 patients who
subsequently received radical radiotherapy. Twelve patients considered probably inoperable
on conventional imaging studies were downstaged by PET and underwent potentially curative
surgery. PET missed only one primary tumor (5-mm scar carcinoma). CT and PET understaged
three of 20 surgical patients (two with N1 lesions < 5 mm and one with unrecognized
atrial involvement), and PET missed one small intrapulmonary metastasis apparent on CT. No
pathological N2 disease was missed on PET. CONCLUSION: FDG PET scanning changed or
influenced management decisions in 70 patients (67%) with NSCLC. Patients were frequently
spared unnecessary treatment, and management was more appropriately targeted.
PMID: 11134203
