The Utility of 18F-FDG PET for Suspected Recurrent Non–Small Cell Lung Cancer After Potentially Curative Therapy: Impact on Management and Prognostic Stratification

Journal of Nuclear Medicine

David L. Ball¹  Michael P. MacManus¹  Jane P. Matthews¹  Victor Kalff¹  Robert E. Ware¹  Rodney J. Hicks¹  Allan F. McKenzie¹ 

[1] Department of Diagnostic Imaging, Pratt Foundation Statistical Centre, and Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia Department of Diagnostic Imaging, Pratt Foundation Statistical Centre, and Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia Department of Diagnostic Imaging, Pratt Foundation Statistical Centre, and Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia

关键词: lung cancer;    FDG;    recurrence;    PET;   

DOI  :  

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

After potentially curative therapy of non–small cell lung cancer (NSCLC), masses or symptoms suggestive of relapse are common but may be difficult to characterize. Early detection is important because salvage therapies are available for localized recurrence. This study evaluated whether 18F-FDG PET is useful and predictive of outcome in this setting. Methods: For 63 consecutive patients with suspected relapse >6 mo after definitive treatment of NSCLC, the apparent extent of disease on conventional restaging was compared with that on FDG PET. Patients with already confirmed systemic metastases were excluded unless locally aggressive treatment of these was being considered. Serial imaging and pathologic results were obtained during a median follow-up of 19 mo to validate diagnostic findings. Prognostic significance was tested using the Cox proportional hazards regression model. Results: PET had positive findings in 41 of 42 patients with confirmed relapse (sensitivity, 98%). No disease was evident during a minimum follow-up of 12 mo in 14 of 15 patients with clinically suspected relapse but negative PET findings (negative predictive value, 93%). PET induced a major management change in 40 patients (63%), including 6 whose treatment was changed from curative to palliative, 3 whose treatment was changed from palliative to curative, and 9 for whom negative PET findings prevented active management. Both the presence (P = 0.012) and the extent (P < 0.0001) of relapse on PET were highly significant prognostic factors. There was also significant prognostic stratification based on the treatment delivered after the PET study (P = 0.011), but after adjustment for this treatment, PET status remained highly predictive of survival. Conclusion: PET better assesses the status of disease and stratifies prognosis than does conventional staging, affects patient management, and should be incorporated into paradigms for suspected recurrence of NSCLC.

【 授权许可】

Unknown