MacManus M, Hicks RPET scanning in lung cancer: current status and future directions. Semin Surg Oncol 21: 149-155

Department of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrew's Place, East Melbourne, Vic, Australia.
Seminars in Surgical Oncology 09/2003; 21(3):149-55. DOI: 10.1002/ssu.10032
Source: PubMed


Positron emission tomography (PET) represents a dramatic advance in the imaging of lung cancer. It is valuable for the diagnosis, staging, prognosis, and restaging of disease, and is most useful in patients considered for potentially curative therapy for non-small-cell lung cancer (NSCLC). In this work the current status and potential future applications of PET scanning in lung cancer are discussed. The relevant literature is also discussed, with an emphasis on studies with clinical applicability. Most of these studies involved the use of 18F-fluorodeoxyglucose (FDG). Numerous studies of the use of PET to assess undiagnosed pulmonary nodules have reported significant improvements in accurate diagnosis or exclusion of malignancy compared to conventional structural imaging alone. All of these studies, including metaanalysis, have shown that PET is more accurate than CT-based structural imaging in staging the mediastinum in surgical candidates. PET may have value in radiotherapy planning, and PET-based staging more accurately predicts survival in radiotherapy-treated patients than conventional staging. The rate of unsuspected distant metastasis detection in stage III disease exceeds 20%. PET also facilitates an accurate assessment of response in patients treated with radical chemoradiation or neoadjuvant therapy prior to surgery. PET has rapidly become an indispensable part of the evaluation of patients with potentially curable lung cancer; however, more work is required to define its role.

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    • "Positron emission tomography (PET) has a rapidly expanding role in oncology, with evidence for its role in the staging and management of a number of tumour types. The fact that PET imaging is functional rather than structural limits its value in local tumour staging, but numerous studies have shown an effect in the identification of regional and distant disease (Rinne et al, 1998; Dwamena et al, 1999; Gould et al, 2001; Hellwig et al, 2001; Kalff et al, 2002), treatment decisions (MacManus et al, 2001; Spaepen et al, 2001; Blum et al, 2003; Heriot et al, 2004), radiotherapy planning (Haustermans et al, 2002; MacManus and Hicks, 2003; Leong et al, 2006) and in the prediction of response (Di Fabio et al, 2005; Duong et al, 2006). A role for 18-fluorodeoxyglucose positron emission tomography (FDG-PET) as a useful imaging modality for anal cancer given the limitations of CIm has been suggested. "
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    ABSTRACT: Accurate inguinal and pelvic nodal staging in anal cancer is important for the prognosis and planning of radiation fields. There is evidence for the role of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging and management of cancer, with early reports of an increasing role in outcome prognostication in a number of tumours. We aimed to determine the effect of FDG-PET on the nodal staging, radiotherapy planning and prognostication of patients with primary anal cancer. Sixty-one consecutive patients with anal cancer who were referred to a tertiary centre between August 1997 and November 2005 were staged with conventional imaging (CIm) (including computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound and chest X-ray) and by FDG-PET. The stage determined by CIm and the proposed management plan were prospectively recorded and changes in stage and management as a result of FDG-PET assessed. Patients were treated with a uniform radiotherapy technique and dose. The accuracy of changes and prognostication of FDG-PET were validated by subsequent clinical follow-up. Kaplan-Meier survival analysis was used to estimate survival for the whole cohort and by FDG-PET and CIm stage. The tumour-stage group was changed in 23% (14 out of 61) as a result of FDG-PET (15% up-staged, 8% down-staged). Fourteen percent of T1 patients (3 out of 22), 42% of T2 patients (10 out of 24) and 40% of T3-4 patients (6 out of 15) assessed using CIm, had a change in their nodal or metastatic stage following FDG-PET. Sensitivity for nodal regional disease by FDG-PET and CIm was 89% and 62%, respectively. The staging FDG-PET scan altered management intent in 3% (2 out of 61) and radiotherapy fields in 13% (8 out of 61). The estimated 5-year overall survival (OS) and progression-free survival (PFS) for the cohort were 77.3% (95% confidence interval (CI): 55.3-90.4%) and 72.2% (95% CI: 51.5-86.4%), respectively. The estimated 5-year PFS for FDG-PET and CIm staged N2-3 disease was 70% (95% CI: 42.8-87.9%) and 55.3% (95% CI: 23.3-83.4%), respectively. FDG-PET shows increased sensitivity over CIm for staging nodal disease in anal cancer and changes treatment intent or radiotherapy prescription in a significant proportion of patients.
    Full-text · Article · Apr 2009 · British Journal of Cancer
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    • "In patients undergoing therapy, imaging can play a crucial role and may aid in predicting the outcome of treatment regimens [85]. After radiotherapy, anatomic imaging alone has limited utility: fibrosis, atelecttasis or inflammatory infiltration related to radiation pneumonitis could hide residual tumour, thus tumour can be differentiated from scarring by using FDG PET [86]. CT has been shown to be suboptimal in restaging the mediastinum after therapy [87-89]. "
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    ABSTRACT: PET (Positron Emission Tomography) is a nuclear medicine imaging method, frequently used in oncology during the last years. It is a non-invasive technique that provides quantitative in vivo assessment of physiological and biological phenomena. PET has found its application in common practice for the management of various cancers. Lung cancer is the most common cause of death for cancer in western countries. This review focuses on radiotracers used for PET scan with particular attention to Non Small Cell Lung Cancer diagnosis, staging, response to treatment and follow-up
    Full-text · Article · Nov 2008 · Journal of Experimental & Clinical Cancer Research
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    • "Lung cancer is the malignancy in which PET has had the greatest impact on selection of patients for radiotherapy and on radiotherapy planning [36]. This relates both to the clarity of imaging of a metabolically active cancer in a location favourable for PET and to the high rate of incremental abnormal findings seen on PET, compared with conventional imaging [37]. "
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    ABSTRACT: PET scanning, because of its impressive sensitivity and accuracy, is being incorporated into the standard staging workup for many cancers. These include lung cancer, lymphomas, head and neck cancers, and oesophageal cancers. PET often provides incremental information about the patient's disease status, adding to the data obtained from structural imaging methods, such as, CT scan or MRI. PET commonly upstages patients into more advanced disease categories. Incorporation of PET information into the radiotherapy planning process has the potential to reduce the risks of geographic miss and can help minimise unnecessary irradiation of normal tissues. The best means of incorporating PET information into radiotherapy planning is uncertain, and considerable effort is being expended in this area of research.
    Full-text · Article · Jan 2007 · Biomedical Imaging and Intervention Journal
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