STAGING OF LUNG CANCER GETS NEW CLARITY WITH PET
SCANS
----------------------------------------------------------
MELBOURNE,
Australia--There’s more evidence that PET scans with 18F
fluorodeoxyglucose
are likely to stage non-small-cell lung cancer
accurately.
When 97 consecutive patients with non-small-cell lung cancer had an 18F
FDG PET scan, 62 had their treatment plans altered significantly on the
basis of the new information, according to a nuclear-medicine team at the
Peter MacCallum Cancer Institute here. Excluding radiotherapy patients,
modality or intent was changed for 48.
For eight others,
who had a scan before treatment plans had been set, PET
determined or
influenced therapy decisions.
The scans identified more advanced
disease than originally suspected by
referring physicians in 27 patients,
including 14 with systemic metastases,
and less extensive disease in 10
patients. Seven of 18 Stage I patients
were upstaged, including four to
Stage IV.
On the basis of the PET scans, treatment plans were changed for 27 of
50 patients from curative to palliative, three of six patients were
changed from palliative to curative, and 12 patients had surgery for
what was originally deemed an inoperable tumor, Dr. Rodney J. Hicks
and
colleagues reported in the Jan. 1 Journal of Clinical Oncology. Also,
22 of
the 34 patients being treated with radiotherapy had dosage
adjustments.
The PET scans missed one primary tumor (a 5-mm
scar carcinoma) and one
small intrapulmonary metastasis apparent on
CT.
The investigators predicted the expensive test might lead to
cost savings
via more appropriate and targeted treatment.
The study’s publication coincided with HCFA’s announcement last week that
it had extended Medicare coverage of PET scans to the investigation of
residual or recurrent non-small-cell lung cancer. PET scans for the
staging of suspected metastatic non-small-cell lung cancer and solitary
pulmonary nodules have been covered since 1998.
Fifty-nine of
the PET scans in the study were done for initial staging,
34 for suspected
recurrence, and 12 for a suspected additional lung
malignancy. Under
HCFA’s new policy, all 105 would have been covered
by
Medicare.
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