Klaus L. Irion, MD, PhD, FBCR, FRCR
Is positron emission tomography plus computed tomography (PET-CT) better than conventional methods for correctly upstaging early non–small-cell lung cancer (NSCLC)?
Randomized controlled trial (RCT). ClinicalTrials.gov NCT00136890.
Median 22 months.
8 hospitals and 5 PET-CT centers in academic institutions in Ontario, Canada.
337 patients > 18 years of age (mean age 67 y, 51% women) with histologically or cytologically confirmed clinical stage I to IIIA NSCLC and technically resectable primary lesions based on chest radiography and thoracic CT done within 8 weeks of randomization. Exclusion criteria included poor pulmonary function or performance status (Eastern Cooperative Oncology Group grade 3 or 4), being unfit for surgery, inability to lie supine for PET, active cancer within 5 years (other than nonmelanotic skin cancer or cervical carcinoma in situ), and having any part of the investigational staging strategy within 8 weeks of randomization.
PET-CT using 18F-fluorodeoxyglucose (FDG), 5 MBq/kg of body weight (maximum 500 MBq), plus cranial imaging (n = 170), or conventional staging (abdominal CT that included the liver and adrenals and a whole-body bone scan) plus cranial imaging (n = 167).
Correct upstaging of cancer to stage IIIB or IV (confirmed by biopsy or other diagnostic imaging procedures) with avoidance of stage-inappropriate surgery. Other outcomes included incorrect upstaging of disease, incorrect understaging (pathologic stage IIIA or B disease on mediastinoscopy or thoracotomy, or local recurrence or distant metastases within 1 y of thoracotomy), and survival.
98% (modified intention-to-treat analysis).
Mediastinoscopy (49% vs 51%) and thoracotomy (81% vs 78%) rates were similar in PET-CT and conventional staging groups. PET-CT upstaged more patients, both correctly and incorrectly, than conventional staging and incorrectly understaged fewer patients (Table). Groups did not differ for mortality (Table).
In early non–small-cell lung cancer, positron emission tomography plus computed tomography was better than conventional methods for correctly upstaging disease and avoiding stage-inappropriate surgery.
PET-CT vs conventional methods for staging early NSCLC†
†NSCLC = non–small–cell lung cancer; PET-CT = positron emission tomography–computed tomography; other abbreviations defined in Glossary. RBI, RRI, RRR, NNT, NNH, and CI calculated from data in article.
‡Based on ≥ 263 (78%) patients available for survival evaluation at 12 months.
Klaus L. Irion. PET plus CT was better than conventional methods for correctly upstaging early NSCLC. Ann Intern Med. 2009;151:JC6–10. doi: 10.7326/0003-4819-151-12-200912150-02010
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Published: Ann Intern Med. 2009;151(12):JC6-10.
Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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