The impact of staging FDG-PET/CT on treatment for stage III NSCLC - an analysis of population-based data from Ontario, Canada

Frontiers in Oncology

Oncology

Anand Swaminath¹  Craig A. Beers¹  Gordon S. Okawara¹  Theodoros Tsakiridis¹  James R. Wright¹  Gregory R. Pond² 

[1] Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada;Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada;Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada;

关键词: positron emission tomography;    PET;    non-small cell lung cancer;    NSCLC;    Ontario;    Canada;   

DOI  :  10.3389/fonc.2023.1210945

 received in 2023-04-23, accepted in 2023-07-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposeFluoro-2-deoxyglucose positron-emission tomography (FDG-PET/CT) is now considered a standard investigation for the staging of new cases of stage III NSCLC. However, there is not published level 3 evidence demonstrating the impact of FDG-PET/CT on appropriate therapy in this setting. Using retrospective population-based data, we sought to examine the role and timing that FDG-PET/CT scans play in influencing treatment choice, as well as survival in patients diagnosed with stage III NSCLC.Materials and methodsA retrospective cohort of patients diagnosed with stage III NSCLC from 2009-2017 in Ontario were identified from the IC/ES (formerly Institute of Clinical Evaluative Sciences) database. FDG-PET/CT utilization over time, trends in mediastinal biopsy technique and usage, the impact of FDG-PET/CT on overall survival (OS), and its influence on use of concurrent chemoradiotherapy (CRT) were explored. The impact of timing of pre-treatment FDG-PET/CT on OS was also analyzed (≤28 days prior to treatment, 29-56 days prior, and >56 days prior).ResultsBetween 2007 and 2017, a total of 13 796 people were diagnosed with stage III NSCLC in Ontario. FDG-PET/CT utilization increased over time with 0% of cases in 2007 and 74% in 2017 with pre-treatment FDG-PET/CT scans. The number of patients who received a mediastinal biopsy similarly increased in this timeframe increasing from 41% to 53%. More patients with pre-treatment FDG-PET/CT scans received curative-intent therapy than those who did not: 23% vs 13% for CRT (p<0.001), and 23% vs 10% for surgery (p<0.001). Median OS was longer in those with FDG-PET/CT scans prior to treatment (17 vs 11 months), as was 5-year survival (22% vs 14%, p<0.001), and this held true on both univariate and multivariate analyses. Timing of FDG-PET/CT scan relative to treatment was not associated with differences in OS.ConclusionImprovements in OS were seen in this cohort of stage III NSCLC patients who underwent a pre-treatment FDG-PET/CT scan. This can likely be attributed to stage-appropriate therapy due to more complete staging using FDG-PET/CT. This study stresses the importance of complete staging for suspected stage III NSCLC using FDG-PET/CT, and a need for continued advocacy for increased access to FDG-PET/CT scans.

【 授权许可】

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Copyright © 2023 Beers, Pond, Wright, Tsakiridis, Okawara and Swaminath