Original article: general thoracic
An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
https://doi.org/10.1016/S0003-4975(01)03257-XGet rights and content

Abstract

Background. The 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) imaging is an advance over computed tomography alone in the staging of untreated nonsmall cell lung cancer (NSCLC). Aside from one 9-patient study, there are no data comparing FDG-PET imaging with surgical staging of NSCLC after induction therapy.

Methods. We reviewed our institutional experience with FDG-PET imaging followed by surgical staging of nonsmall cell lung cancer after induction therapy. A nuclear physician blinded to surgical findings reviewed the FDG-PET scans and assigned a clinical TNM stage. A thoracic surgeon assigned a pathologic TNM stage. Then the clinical TNM stage and the pathologic TNM stage were compared.

Results. Fifty-six patients (30 males and 26 females; median, age 60) with nonsmall cell lung cancer underwent chemotherapy (40 patients), chemoradiation (11 patients), or radiation alone (5 patients) followed by PET and operations. PET had a positive predictive value of 98% for detecting residual viable disease in the primary tumor. PET over-staged nodal status in 33% of patients, under staged nodal status in 15%, and was correct in 52%. PET correctly classified all patients with M1 disease.

Conclusions. Positron emission tomography after induction therapy accurately detects residual viable primary tumor, but not the involvement of mediastinal lymph nodes.

Section snippets

Patients and methods

The subjects were identified by systematic queries of the PET and the thoracic surgical databases; search criteria included the administration of induction therapy for biopsy-proven NSCLC followed by an FDG-PET scan at the Memorial Sloan-Kettering Cancer Center followed by the performance of an intrathoracic surgical procedure.

Database analysis

Between July 1, 1996, and August 1, 2000, 1,314 FDG-PET scans were performed on patients with NSCLC at the Memorial Sloan-Kettering Cancer Center. During the same time interval, approximately 290 thoracic explorations with curative intent were performed after the administration of induction therapy for biopsy-proven NSCLC. Of these 290 patients, 56 patients (40 treated with chemotherapy alone, 5 with radiation alone, and 11 with chemoradiation) had been restaged post-induction therapy with

Comment

This retrospective review assesses the accuracy of restaging NSCLC patients after induction therapy with a single FDG-PET scan. Although the patient population was heterogeneous in that radiation and chemotherapy were frequently administered outside the Memorial Sloan-Kettering Cancer Center, and the time of post completion of therapy to PET and operation were not controlled, all FDG-PET scans and operations were performed in a homogeneous manner by members of the thoracic disease management

Acknowledgements

The authors thank Dr Nael Martini for reviewing the manuscript and providing his insightful comments. Supported in part by the Laurent and Alberta Gerschel Foundation.

References (22)

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