title: Impact of PET staging in limited-stage small-cell lung cancer.
abstract: BACKGROUND
  Although positron emission tomography computed tomography (PET-CT) has been widely used for small-cell lung cancer (SCLC) staging, no study has examined the clinical impact of PET staging in limited-stage (LS) SCLC.
  
  
  METHODS
  We identified patients with LS-SCLC treated definitively with concurrent chemoradiation. Outcomes were assessed using the Kaplan-Meier approach, Cox regression, and competing risks method.
  
  
  RESULTS
  We treated 54 consecutive LS-SCLC patients with concurrent chemoradiation from January 2002 to August 2010. Forty underwent PET, 14 did not, and all underwent thoracoabdominopelvic CT and magnetic resonance imaging neuroimaging. Most patient characteristics were balanced between the comparison groups, including age, race, sex, bone scanning, median dosage, and performance status. More number of PET-staged patients presented with nodal metastases (p = 0.05). Median follow-up was similar for PET-staged and non-PET-staged patients (p = 0.59). Median overall survival from diagnosis in PET-staged patients was 32 versus 17 months in patients staged without PET (p = 0.03), and 3-year survival was 47% versus 19%. Median time-to-distant failure was 29 versus 12 months (p = 0.04); median time-to-local failure was not reached versus 16 months (p = 0.04). On multivariable analysis, PET staging (odds ratio [OR] = 0.24; p = 0.04), performance status (OR = 1.89; p = 0.05), and N-stage (OR = 4.94; p < 0.01) were associated with survival.
  
  
  CONCLUSIONS
  LS-SCLC patients staged with PET exhibited improved disease control and survival when compared with non-PET-staged LS-SCLC patients. Improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in these patients.
authors.affiliation: Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Eric.XanthopoulosMDJD@gmail.com
authors.forename: Eric P
authors.initials: EP
authors.lastname: Xanthopoulos
authors.forename: Michael N
authors.initials: MN
authors.lastname: Corradetti
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Annemarie T
authors.initials: AT
authors.lastname: Fernandes
authors.forename: Miranda
authors.initials: M
authors.lastname: Kim
authors.forename: Surbhi
authors.initials: S
authors.lastname: Grover
authors.forename: John P
authors.initials: JP
authors.lastname: Christodouleas
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Evans
authors.forename: James P
authors.initials: JP
authors.lastname: Stevenson
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Langer
authors.forename: Tony T
authors.initials: TT
authors.lastname: Lee
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Pryma
authors.forename: Lilie L
authors.initials: LL
authors.lastname: Lin
authors.forename: Charles B
authors.initials: CB
authors.lastname: Simone
authors.forename: Smith
authors.initials: S
authors.lastname: Apisarnthanarax
authors.forename: Ramesh
authors.initials: R
authors.lastname: Rengan
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18