PT  - JOURNAL ARTICLE
AU  - Deborah L. Gregory
AU  - Rodney J. Hicks
AU  - Annette Hogg
AU  - David S. Binns
AU  - Poh Lin Shum
AU  - Alvin Milner
AU  - Emma Link
AU  - David L Ball
AU  - Michael P. Mac Manus
TI  - Effect of PET/CT on Management of Patients with Non–Small Cell Lung Cancer: Results of a Prospective Study with 5-Year Survival Data
AID  - 10.2967/jnumed.111.099713
DP  - 2012 Jul 01
TA  - Journal of Nuclear Medicine
PG  - 1007--1015
VI  - 53
IP  - 7
4099  - http://jnm.snmjournals.org/content/53/7/1007.short
4100  - http://jnm.snmjournals.org/content/53/7/1007.full
SO  - J Nucl Med2012 Jul 01; 53
AB  - We investigated the incremental management impact and prognostic value of staging with 18F-FDG PET/CT in patients with non–small cell lung cancer (NSCLC) being considered for potentially curative therapies. Methods: Information on 168 consecutive patients with NSCLC being considered for surgery or definitive radiotherapy with curative intent before PET/CT was entered into a prospective database. The pre-PET/CT management plan, based on conventional imaging (conventional CT, appropriately supplemented by bone scintigraphy or other modalities), was defined prospectively by referring clinicians before PET/CT results became available. After PET/CT, actual clinical management was recorded, and patients were followed up until 5 y or death. The appropriateness of PET/CT management plans was assessed by biopsy when available, clinical follow-up, and survival analysis. Results: Stage was discordant on PET/CT and conventional imaging in 50.6% of patients (41.1% upstaged, 9.5% downstaged), with high management impact (change in treatment modality or curative intent) in 42.3% of patients. Both conventional imaging stage and PET/CT stage were strongly predictive of overall survival (OS) but there were greater differences between hazard rates and separations in the OS curves for stage groupings determined using PET/CT. OS was also strongly predicted by PET/CT-directed choice of therapy (P < 0.0001). Conclusion: PET/CT frequently affects patient management and strongly predicts OS in NSCLC, supporting the appropriateness of such changes.