Effect of PET/CT on Management of Patients with Non–Small Cell Lung Cancer: Results of a Prospective Study with 5-Year Survival Data

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FIGURE 1.
Survival according to stage groupings determined by conventional imaging (top) or PET/CT (bottom). Est = estimated.
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FIGURE 2.
Survival curves for 100 patients found to have anatomically resectable disease by conventional imaging (stage I or II) according to their conventional imaging stage (top) or their PET/CT stage (bottom), showing prognostic stratification only by PET/CT stage. Est = estimated.
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FIGURE 3.
OS by treatment actually received for 131 patients managed according to stated post-PET/CT plan. Est = estimated.

TABLE 1.

Comparison of Conventional Imaging and PET Stages

	PET stage group
Conventional imaging stage group	0	1A	1B	2A	2B	3A	3B	4	Total	Downstaged	Upstaged
0	0	0	0	0	0	0	0	0	0	0 (0)	0 (0.0)
1A	2	24	3	1	0	3	1	9	43	2 (4.7)	17 (39.5)
1B	0	0	19	0	8	4	4	6	41	0 (0.0)	22 (53.7)
2A	1	0	0	0	0	2	0	1	4	1 (25.0)	3 (75.0)
2B	0	0	0	0	9	2	0	1	12	0 (0.0)	3 (25.0)
3A	0	0	4	1	3	14	9	10	41	8 (19.5)	19 (46.3)
3B	0	1	0	0	1	1	9	5	17	3 (17.6)	5 (29.4)
4	0	0	0	0	1	0	1	8	10	2 (20.0)	0 (0.0)
Total										16 (10)	69 (41.1)

TABLE 2

Impact of PET/CT on Patient Management Plan

Before PET/CT		After PET/CT		PET/CT impact
Management plan	No. of patients	Management plan	No. of patients	High	Medium	Low	None
Observation	1	Surgery	1	1	0	0	0
Invasive biopsy	28	Invasive biopsy	9	19	0	9	0
		Observation	1
		Surgical	9
		Radical RT^*	3
		Palliative^†	6
Surgery	80	Surgery	54	26	0	50	4
		Diagnostic (invasive biopsy)	2
		Observation	2
		Radical RT^‡	8
		Radical RT, for both NSCLC and PET-detected pharynx cancer	1
		Palliative^§	13
Radical RT	49	Radical RT as planned^∥	19	23	7	18	1
		Radical CRT, field increased	6
		Radical CRT, field decreased	1
		Surgery	4
		Induction chemotherapy, followed by surgery	1
		Palliative chemotherapy or RT^¶	18
Palliative	10	Palliative chemotherapy or RT, as planned^#	8	2	2	6	0
		Palliative CRT, RT field increased	2
Total	168		168	71 (42%)	9 (5%)	83 (49%)	5 (3%)

↵* Radical RT no chemotherapy (n = 1), radical CRT (n = 2).
↵† Palliative chemotherapy and RT (n = 5), chemotherapy (n = 1).
↵‡ Radical RT alone (n = 1), radical CRT (n = 7).
↵§ Palliative chemotherapy and RT (n = 10), chemotherapy only (n = 2), expectant palliative (n = 1).
↵∥ Radical RT (n = 5), radical CRT (n = 14).
↵¶ Palliative chemotherapy and RT (n = 17).
↵# Palliative chemotherapy and RT (n = 5), chemotherapy only (n = 3).
CRT = chemotherapy and radiation therapy.

TABLE 3.

Impact of PET/CT by Conventional Imaging Stage Group

Conventional imaging stage group	No. of cases	% of cases	High	% high	Low	% low	Medium	% medium	None	% none
1	84	50.0	31	36.9	51	60.7	0	0.0	2	2.4
2	16	9.5	6	37.5	10	62.5	0	0.0	0	0.0
3	58	34.5	30	51.7	17	29.3	9	15.5	2	3.4
4	10	6.0	4	40.0	5	50.0	0	0.0	1	10.0
Total	168	100	71	42.3	82	48.8	9	5.4	6	3.6