July 3, 2009

PET/CT Improves Detection of Inoperable Lung Cancer


Preoperative lung cancer staging with combined PET/CT imaging allows some patients to avoid futile surgery. These results were published in the New England Journal of Medicine.

Lung cancer remains the leading cause of cancer death in the United States. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer.

Surgery plays an important role in the treatment of early-stage NSCLC, but is less commonly used in advanced-stage disease. Treatment of advanced NSCLC generally relies on systemic (whole-body) treatment such as chemotherapy.

Accurate staging (determination of the extent of the disease) is key to identifying patients who are candidates for surgery. If preoperative staging fails to identify patients with advanced disease, these patients may undergo futile surgery (surgery that provides no benefit). Advances in cancer imaging, however, may allow for improved identification of surgical candidates before surgery occurs.

PET/CT combines two imaging technologies—computed tomography (CT) and positron emission tomography (PET)—into one machine. CT provides information about anatomy and structure, and PET provides information about the function of cells and tissues. When these technologies are combined to produce a single image, doctors are able both to identify abnormal activity within the body and to precisely pinpoint its location. PET/CT scans can be used to identify the extent of the cancer, plan treatment, and assess treatment response.

To evaluate the addition of PET/CT to conventional preoperative staging for NSCLC, researchers in Denmark conducted a study among 189 patients who were potential surgical candidates. Roughly half the patients received conventional staging alone and half received conventional staging plus PET/CT.

The researchers assessed the frequency of futile thoracotomies in the two study groups. A thoracotomy is surgery to open the chest. This surgery was considered to be futile when the patient was found to have advanced, inoperable cancer; benign lung disease; or death or recurrence within a year of the surgery.

After staging, 60 out of 98 patients in the PET/CT group and 73 out of 91 patients in the conventional staging group underwent thoracotomy.

  • 52% of patients in the conventional staging group had a futile thoracotomy, compared with 35% in the PET/CT group.
  • PET/CT had no effect (good or bad) on survival.

These results suggest that preoperative PET/CT for NSCLC reduces the total number of thoracotomies as well as the number of futile thoracotomies, without affecting survival.

Reference: Fischer B, Lassen U, Mortensen J et al. Preoperative staging of lung cancer with combined PET-CT. New England Journal of Medicine. 2009;361:32-9.

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