1. Home>
2. Specialties>
3. Oncology and Hematology>
4. Summary and Comment

Preoperative Staging for Lung Cancer

Integrating PET data with CT scan results reduced futile thoracotomies but not mortality.

Preoperative staging to determine optimal treatment for patients with non–small-cell lung cancer (NSCLC) is crucial, considering, for example, that mediastinal involvement and metastatic disease are indications that surgical resection would be futile. Such staging typically involves computed tomography (CT) scanning, magnetic resonance imaging, and bone scan tests, and accuracy is improved when positron emission tomography (PET) imaging results are combined with CT scan data (N Engl J Med 2003; 348:2500). However, whether staging based on integrated PET and CT results leads to better clinical outcomes is unknown.

To investigate this issue, researchers in Denmark assessed 189 patients who had NSCLC deemed resectable by CT imaging. Patients were randomized to undergo additional endoscopic procedures (mediastinoscopy or endoscopic or endobronchial ultrasonography) with or without PET and CT imaging (conventional-staging group and PET–CT staging group, respectively). The primary endpoint was number of futile thoracotomies, which were defined as exploratory thoracotomies; thoracotomies with findings of pathologically confirmed mediastinal lymph node involvement, stage IIIB/IV disease, or benign lung lesions; or thoracotomies in patients who experienced recurrent disease or death within 1 year of randomization.

After staging evaluation, fewer patients in the PET–CT staging group than in the conventional-staging group were confirmed to have operable disease (61% vs. 80%; P=0.004). Among patients who underwent surgery, fewer of those who received PET–CT than who received conventional-staging procedures underwent futile thoracotomies (29% vs. 52%; P=0.009). However, overall survival was similar in those in the PET–CT staging group and in the conventional-staging group (31 months and 49 months; P=0.29).

Comment: These results show that integrating diagnostic PET and CT data improved the accuracy of preoperative staging and reduced the number of overall thoracotomies, as well as futile thoracotomies. However, this staging strategy did not affect survival of patients who underwent surgery, perhaps because of improvements in adjuvant therapy or the heterogeneity of the NSCLC population.

— Lin-Chi Chen, MD, PhD

Dr. Chen is a medical oncologist specializing in lung cancer at the Nevada Cancer Institute.

Published in Journal Watch Oncology and Hematology July 1, 2009

Citation(s):

Fischer B et al. Preoperative staging of lung cancer with combined PET–CT. N Engl J Med 2009 Jul 2; 361:32.

• Original article (Subscription may be required)
• Medline abstract (Free)