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¹⁸F-FDG PET Provides High-Impact and Powerful Prognostic Stratification in Staging Newly Diagnosed Non–Small Cell Lung Cancer

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

View larger version (12K): [in a new window]   FIGURE 1. As expected, clinical stage as assessed by conventional staging techniques, primarily including dynamic contrast CT and bone scintigraphy, was significantly associated with survival in the 153 patients evaluated.

View larger version (12K): [in a new window]   FIGURE 2. Assessment of survival by post-PET clinical stage, which incorporated FDG PET information, led to markedly stronger prognostic stratification than observed with conventional staging techniques. Early separation of each clinical stage suggests more accurate definition of disease burden.

View larger version (9K): [in a new window]   FIGURE 3. After PET, only 109 patients received curative treatment whereas 44 received palliative radiotherapy. These 44 included 34 whose treatment was changed from curative after PET showed more extensive disease than expected. Marked difference in survival was noted between these groups.

View larger version (10K): [in a new window]   FIGURE 4. Of 109 patients who received curative treatment, 14 had PET findings suggesting that palliative treatment ought to have been given. Giving curative rather than palliative treatment to this group may have adversely affected its survival. Excluding these patients from analysis showed even more dramatic difference in survival between curative and palliative groups.

View larger version (26K): [in a new window]   FIGURE 5. Example of high-impact study. This patient was assessed as having stage IIB disease on basis of CT findings and was being considered for radical radiotherapy. In addition to confirming mediastinal nodal disease (vertical arrow), PET showed previously unrecognized metastases on left adrenal (oblique arrow) and dome of right hepatic lobe (horizontal arrow). Accordingly, patient received only palliative radiotherapy. Follow-up confirmed progressive systemic metastasis within 6 mo.