Effect of PET/CT on management of patients with non-small cell lung cancer: results of a prospective study with 5-year survival data.
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).


CONCLUSIONS
PET/CT frequently affects patient management and strongly predicts OS in NSCLC, supporting the appropriateness of such changes.
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Deborah L
DL
Gregory
Rodney J
RJ
Hicks
Annette
A
Hogg
David S
DS
Binns
Poh Lin
PL
Shum
Alvin
A
Milner
Emma
E
Link
David L
DL
Ball
Michael P
MP
Mac Manus
D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000628:therapy*; D019090:Case Management; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010348:Patient Care Team; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D016019:Survival Analysis
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18