title: Impact of (18)F-Fluoride PET on Intended Management of Patients with Cancers Other Than Prostate Cancer: Results from the National Oncologic PET Registry.
abstract: The National Oncologic PET Registry prospectively assessed the impact of PET with (18)F-sodium fluoride (NaF PET) on intended management of Medicare patients with suspected or known osseous metastasis. We report our findings for cancers other than prostate and make selected comparisons to our previously reported prostate cancer cohort.
  
  
  METHODS
  Data were collected from both referring and interpreting physicians before and after NaF PET in patients (age ≥ 65 y) stratified for initial staging (IS; n = 570), for suspected first osseous metastasis (FOM; n = 1,814; breast, 781 [43%]; lung, 380 [21%]; and all other cancers, 653 [36%]), and for suspected progression of osseous metastasis (POM; n = 435).
  
  
  RESULTS
  The dominant indication was bone pain. If NaF PET were unavailable, conventional bone scintigraphy would have been ordered in 85% of patients. In IS, 28% of patients had suspected or confirmed nonosseous metastasis. If neither conventional bone scintigraphy nor NaF PET were available, referring physicians would have ordered other advanced imaging more than 70% of the time rather than initiate treatment for suspected FOM (11%-16%) or POM (18%-22%). When intended management was classified as either treatment or nontreatment, the intended management change for each cancer type was highest in POM, lower in IS, and lowest in FOM. For suspected FOM, intended management change was lower in breast (24%), lung (36%), or other cancers (31%), compared with prostate cancer (44%) (P < 0.0001), but the NaF PET finding (normal/benign/equivocal, probable, or definite metastases) frequencies were similar across cancer types. After normal/benign/equivocal PET results, 15% of breast, 30% lung, and 38% prostate cancer patients had treatment, likely reflecting differences in management of nonosseous disease. For patients with definite metastasis on NaF PET, nonprostate, compared with prostate, cancer patients had post-PET plans for more frequent biopsy, alternative imaging, chemotherapy, and radiotherapy. In the smaller IS and POM cohorts, differences among cancer types were not significant.
  
  
  CONCLUSIONS
  Overall, NaF PET led to change in intended management in a substantial fraction of nonprostate cancer patients. In the setting of suspected FOM, NaF PET had a lower immediate impact on the treat/nontreat decision in nonprostate versus prostate cancer patients, which is consistent with current practice guidelines.
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia Hillner@vcu.edu.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
authors.affiliation: Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.affiliation: Departments of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hanna
authors.affiliation: Departments of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island.
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Shields
authors.affiliation: Foley Hoag LLC, Boston, Massachusetts; and.
authors.forename: Bruce
authors.initials: B
authors.lastname: Quinn
authors.affiliation: Department of Radiology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: R Edward
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D015331:Cohort Studies; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D010346:Patient Care Management / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D012042:Registries; D012969:Sodium Fluoride
chemical_list: D005462:Fluorine Radioisotopes; D012969:Sodium Fluoride
keywords: bone scintigraphy; breast cancer; lung cancer; patient registry; positron emission tomography; prostate cancer; sodium fluoride/diagnostic use