Clinical impact of F-18 fluorodeoxyglucose positron emission tomography inpatients with non-small-cell lung cancer: A prospective study

Purpose: To prospectively study the impact of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) on clinical management of patients with nonsmall-cell lung cancer (NSCLC). Patients and Methods: One hundred five consecutive patients with NSCLC unde rgoing F-18 FDG PET were analyzed. Before PET, referring physicians recorde d 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 ma nagement 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 pall iative therapy by upstaging disease extent. Validity of the PET result was established in all but one ease. PET appropriately downstaged 10 of 16 pati ents initially planned for palliative therapy, allowing either potentially curative treatment (four patients) or no treatment (six patients). PET infl uenced the radiation delivery in 22 (65%) of 34 patients who subsequently r eceived radical radiotherapy. Twelve patients considered probably inoperabl e on conventional imaging studies were downstaged by PET and underwent pote ntially curative surgery, PET missed only one primary tumor (5-mm scar carc inoma), CT and PET understaged three of 20 surgical patients (two with N1 l esions < 5 mm and one with unrecognized atrial involvement), and PET missed one small intrapulmonary metastasis apparent on CT. No pathological N2 dis ease was missed on PET. Conclusion: FDG PET scanning changed or influenced management decisions in 70 patients (67%) with NSCLC. Patients were frequently spared unnecessary t reatment, and management was more appropriately targeted. J Clin Oncol 19:1 11-118. (C) 2001 by American Society of Clinical Oncology.