FDG–PET/CT improves staging and modifies radiotherapy management

Sep 13 2012

By medwireNews Reporters

The addition of FDG-positron emission tomography (PET)/computed tomography (CT) revised radiotherapy decision-making and enhanced tumor staging capabilities in patients with non-small-cell lung cancer (NSCLC), research shows.

In a study of 104 patients from a single European center, implementing FDG-PET/CT revised radiotherapy decisions in 34% of patients.

The researchers, led by Andrij Abramyuk (University Hospital Carl Gustav Carus, Dresden, Germany), say that FDG-PET/CT allows for an "improved selection of patients suitable for curative intention."

In addition, the use of FDG-PET/CT can help avoid unnecessary irradiation and costs in patients eligible for palliative management, write the researchers in Lung Cancer.

Of the 104 patients, 59 were without tumor stage migration, 23 were upstaged, and 22 were downstaged based on the inclusion of the FDG-PET/CT data.

"According to our results and some previously published data, combined FDG-PET/CT seems to be a more sensitive imaging modality as compared with conventional CT for T-staging of NSCLC," Abramyuk et al comment.

Regarding node-stage modifications, 29 patients were downstaged and 20 were upstaged. Before the use of FDG-PET/CT, there were 41 patients with critical mediastinal lymph nodes but just 32 after the inclusion of FDG-PET/CT.

And finally, there were 80 patients without stage migration, two patients were metastasis-downstaged and 22 were metastasis-upstaged. "These changes were also the cause of corresponding alterations in the radiotherapy intention," write the researchers.

The addition of FDG-PET/CT modified the clinical staging in the majority of patients, with most patients upstaged and 18 patients downstaged. Forty-four patients were stage III NSCLC after FDG-PET/CT compared with 61 after conventional staging, and 26 patients, compared with six prior, were upstaged to stage IV after FDG-PET/CT.

Radiation therapy was adjusted from curative to palliative in 26 of the 104 patients and from palliative to curative in nine patients as result of modifications of metastasis-staging. In total, 66% of patients remained within their initial category of curative or palliative irradiation.

Prior to FDG-PET/CT, 83 patients were intended to undergo curative irradiation and 21 for palliative irradiation, but this was modified to 66 and 28, respectively, after FDG-PET/CT.

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