Whole-body (18)F-FDG PET improves the management of patients with small cell lung cancer.
The aim of this study was to evaluate the impact of whole-body (18)F-FDG PET on staging and managing patients with small cell lung cancer (SCLC).


METHODS
The treatment records of 42 consecutive patients (27 men, 15 women; mean age, 62 y; age range, 45-83 y) with SCLC were reviewed. Whole-body (18)F-FDG PET was performed for initial staging in 24 patients and for restaging after chemotherapy or radiation treatment in 20 patients. Two patients of the initial staging group were restaged with PET after therapy. PET findings were correlated with clinical and radiologic findings (CT of the chest and abdomen, bone scan, and CT or MRI of the brain). The impact of PET on staging and management decisions was determined.


RESULTS
For 12 of 42 patients (29%), PET results changed the patient's management. In 8 patients (19%), PET resulted in a change of radiation therapy because of the detection of previously unknown tumor foci. Adjuvant radiation therapy was cancelled in 3 patients. A change of radiation field and volume was necessary in 5 patients. In 1 patient, PET results excluded extensive disease, which permitted surgical resection of the tumor. Chemotherapy was discontinued in 2 patients and restarted in 1 patient on the basis of the PET findings. In 5 patients (12%), PET excluded malignancy as the suspicious lesions found with conventional cross-sectional imaging did not take up (18)F-FDG.


CONCLUSIONS
The results of this study show that (18)F-FDG PET has a major impact on the management of patients with SCLC, influencing both the stage and the management in 29% of patients. PET is a highly valuable tool for accurate target definition of radiation treatment by reducing the probability of overlooking involved areas.
Kamel
Ehab M
EM
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland.
Zwahlen
Daniel
D
Wyss
Matthias T
MT
Stumpe
Katrin D
KD
von Schulthess
Gustav K
GK
Steinert
Hans C
HC
D000368:Aged; D000369:Aged, 80 and over; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D004358:Drug Therapy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010346:Patient Care Management / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D011878:Radiotherapy / Q000379:methods; D014055:Tomography, Emission-Computed / Q000379:methods*; D016896:Treatment Outcome; D014915:Whole-Body Counting / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18