PET/CT prior to surgery benefits lung cancer patients

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The use of PET/CT for preoperative staging of non-small-cell lung cancer (NSCLC) reduced both the total number of thoracotomies and the number of futile thoracotomies but did not affect overall mortality, according to a study in the July 2 issue of the New England Journal of Medicine.

Barbara Fischer, PhD, from the Rigshospitalet, Copenhagen University Hospital in Denmark, and colleagues said the purpose of the randomized study was to evaluate the clinical effect of PET/CT on preoperative staging of NSCLC.

The researchers assigned patients who were referred for preoperative staging of NSCLC to either conventional staging plus PET/CT or conventional staging alone. Patients were followed until death or for at least 12 months.

The authors said the primary end point was the number of futile thoracotomies, defined as any one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB, stage IV disease or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause within one year after randomization.

From January 2002 through February 2007, the investigators randomly assigned 98 patients to the PET/CT group and 91 to the conventional-staging group. Mediastinoscopy was performed in 94 percent of the patients.

After PET/CT, 38 patients were classified as having inoperable NSCLC, and after conventional staging, 18 patients were classified thus. Sixty patients in the PET/CT group and 73 in the conventional-staging group underwent thoracotomy, the authors wrote. Among these thoracotomies, 21 in the PET/CT group and 38 in the conventional-staging group were futile. The number of justified thoracotomies and survival were similar in the two groups.

Fischer and colleagues found that adding a PET/CT exam to the diagnostic regimen for patients with NSCLC improves sensitivity in preoperative staging. They noted that the addition of a PET/CT reduces the frequency of futile thoracotomies and the total number of thoracotomies, with no effect (negative or positive) on overall survival.