This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Viney, R. C. Articles by Fulham, M. J. Search for Related Content PubMed PubMed Citation Articles by Viney, R. C. Articles by Fulham, M. J. Related Articles Related Correspondence Social Bookmarking                            What's this?

Randomized Controlled Trial of the Role of Positron Emission Tomography in the Management of Stage I and II Non-Small-Cell Lung Cancer

From the Centre for Health Economics Research and Evaluation, University of Technology, Sydney; Medical Oncology Unit, Sydney Cancer Centre; Cardiothoracic Surgical Unit, PET Unit, and Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital; and Faculty of Medicine, University of Sydney, Sydney, Australia

Address reprint requests to Rosalie Viney, Centre for Health Economics Research and Evaluation, University of Technology, Sydney, PO Box 123, Broadway, Sydney, NSW 2007, Australia; e-mail: rosalie.viney{at}chere.uts.edu.au

PURPOSE: Positron emission tomography (PET) is a costly new technology with potential to improve preoperative evaluation for patients with non–small-cell lung cancer (NSCLC). There is increasing pressure for PET to be included in standard diagnostic work-up before decisions about surgical management of NSCLC. The resource implications of its widespread use in staging NSCLC are significant.

METHODS: A randomized controlled trial was conducted to investigate the impact of PET on clinical management and surgical outcomes for patients with stage I-II NSCLC. The primary hypothesis was that PET would reduce the proportion of patients with stage I-II NSCLC who underwent thoracotomy by at least 10% through identification of patients with inoperable disease.

RESULTS: One hundred eighty-four patients with stage I-II NSCLC were recruited and randomly assigned; 92% had stage I disease. Following exclusion of one ineligible patient, 92 patients were assigned to no PET and 91 to PET. Compared with conventional staging, PET upstaged 22 patients, confirmed staging in 61 and staged two patients as benign. Stage IV disease was rarely detected (two patients). PET led to further investigation or a change in clinical management in 13% of patients and provided information that could have affected management in a further 13% of patients. There was no significant difference between the trial arms in the number of thoracotomies avoided (P = .2).

CONCLUSION: For patients who are carefully and appropriately staged as having stage I-II disease, PET provides potential for more appropriate stage-specific therapy but may not lead to a significant reduction in the number of thoracotomies avoided.

Supported by a National Health and Medical Research Council Project Grant.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• FDG-PET in Addition to Conventional Work-Up in Non–Small-Cell Lung Cancer
  Harm van Tinteren, Egbert F. Smit, and Otto S. Hoekstra
  JCO 2005 23: 1591 [Full Text]

This article has been cited by other articles:

				D. E. Maziak, G. E. Darling, R. I. Inculet, K. Y. Gulenchyn, A. A. Driedger, Y. C. Ung, J. D. Miller, C.-S. Gu, K. J. Cline, W. K. Evans, et al. Positron Emission Tomography in Staging Early Lung Cancer: A Randomized Trial Ann Intern Med, July 6, 2009; (2009) 0000605-200908180-00132. [Abstract] [Full Text] [PDF]

				M. L. Margolis The PET and the Pendulum Ann Intern Med, July 6, 2009; (2009) 0000605-200908180-00134. [Full Text]

				B. Fischer, U. Lassen, J. Mortensen, S. Larsen, A. Loft, A. Bertelsen, J. Ravn, P. Clementsen, A. Hogholm, K. Larsen, et al. Preoperative Staging of Lung Cancer with Combined PET-CT N. Engl. J. Med., July 2, 2009; 361(1): 32 - 39. [Abstract] [Full Text] [PDF]

				B. D. Kozower, B. F. Meyers, C. E. Reed, D. R. Jones, P. A. Decker, and J. B. Putnam Jr Does Positron Emission Tomography Prevent Nontherapeutic Pulmonary Resections for Clinical Stage IA Lung Cancer? Ann. Thorac. Surg., April 1, 2008; 85(4): 1166 - 1170. [Abstract] [Full Text] [PDF]

				J. W. Fletcher, B. Djulbegovic, H. P. Soares, B. A. Siegel, V. J. Lowe, G. H. Lyman, R. E. Coleman, R. Wahl, J. C. Paschold, N. Avril, et al. Recommendations on the Use of 18F-FDG PET in Oncology J. Nucl. Med., March 1, 2008; 49(3): 480 - 508. [Abstract] [Full Text] [PDF]

				J. F. Bruzzi, R. Komaki, G. L. Walsh, M. T. Truong, G. W. Gladish, R. F. Munden, and J. J. Erasmus Imaging of Non-Small Cell Lung Cancer of the Superior Sulcus: Part 2: Initial Staging and Assessment of Resectability and Therapeutic Response RadioGraphics, March 1, 2008; 28(2): 561 - 572. [Abstract] [Full Text] [PDF]

				P. M. Kenny, M. T. King, R. C. Viney, M. J. Boyer, C. A. Pollicino, J. M. McLean, M. J. Fulham, and B. C. McCaughan Quality of Life and Survival in the 2 Years After Surgery for Non-Small-Cell Lung Cancer J. Clin. Oncol., January 10, 2008; 26(2): 233 - 241. [Abstract] [Full Text] [PDF]

				Y. C. Ung, D. E. Maziak, J. A. Vanderveen, C. A. Smith, K. Gulenchyn, C. Lacchetti, W. K. Evans, and Lung Cancer Disease Site Group of Cancer Care Onta 18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review J Natl Cancer Inst, December 5, 2007; 99(23): 1753 - 1767. [Abstract] [Full Text] [PDF]

				G. Giaccone 18Fluorodeoxyglucose Positron Emission Tomography, a Standard Diagnostic Tool in Lung Cancer J Natl Cancer Inst, December 5, 2007; 99(23): 1741 - 1743. [Full Text] [PDF]

				F. C Detterbeck Evolution and science, progress and change Thorax, August 1, 2007; 62(8): 654 - 655. [Full Text] [PDF]

				A. Lemaire, I. Nikolic, T. Petersen, J. C. Haney, E. M. Toloza, D. H. Harpole Jr, T. A. D'Amico, and W. R. Burfeind Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann. Thorac. Surg., October 1, 2006; 82(4): 1185 - 1190. [Abstract] [Full Text] [PDF]

				G. J.M. Herder, H. Kramer, O. S. Hoekstra, E. F. Smit, J. Pruim, H. van Tinteren, E. F. Comans, P. Verboom, C. A. Uyl-de Groot, A. Welling, et al. Traditional Versus Up-Front [18F] Fluorodeoxyglucose-Positron Emission Tomography Staging of Non-Small-Cell Lung Cancer: A Dutch Cooperative Randomized Study J. Clin. Oncol., April 20, 2006; 24(12): 1800 - 1806. [Abstract] [Full Text] [PDF]

				D. Lardinois New Horizons in Staging for Non-Small-Cell Lung Cancer J. Clin. Oncol., April 20, 2006; 24(12): 1785 - 1787. [Full Text] [PDF]

				B. F. Meyers, F. Haddad, B. A. Siegel, J. B. Zoole, R. J. Battafarano, N. Veeramachaneni, J. D. Cooper, and G. A. Patterson Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 822 - 829. [Abstract] [Full Text] [PDF]

				J. L. Port, R. S. Andrade, M. A. Levin, R. J. Korst, P. C. Lee, D. E. Becker, and N. K. Altorki Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1611 - 1615. [Abstract] [Full Text] [PDF]

				R. F. Munden, S. S. Swisher, C. W. Stevens, and D. J. Stewart Imaging of the Patient with Non-Small Cell Lung Cancer Radiology, December 1, 2005; 237(3): 803 - 818. [Abstract] [Full Text] [PDF]

				V. W. Rusch Mediastinoscopy: An Endangered Species? J. Clin. Oncol., November 20, 2005; 23(33): 8283 - 8285. [Full Text] [PDF]

				F. Pozo-Rodriguez, J. L. Martin de Nicolas, M. A. Sanchez-Nistal, A. Maldonado, S. Garcia de Barajas, R. Calero-Garcia, M. A. Pozo, P. Martin-Escribano, I. Martin-Garcia, R. Garcia-Lujan, et al. Accuracy of Helical Computed Tomography and [18F] Fluorodeoxyglucose Positron Emission Tomography for Identifying Lymph Node Mediastinal Metastases in Potentially Resectable Non-Small-Cell Lung Cancer J. Clin. Oncol., November 20, 2005; 23(33): 8348 - 8356. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, J. M. Hoffman, B. Johnson, H. I. Scher, B. A. Siegel, E. Y. Cheng, B. D. Cheson, J. O'Shaughnessy, K. Z. Guyton, D. A. Mankoff, et al. Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development Clin. Cancer Res., April 15, 2005; 11(8): 2785 - 2808. [Abstract] [Full Text] [PDF]

				H. van Tinteren, E. F. Smit, and O. S. Hoekstra FDG-PET in Addition to Conventional Work-Up in Non-Small-Cell Lung Cancer J. Clin. Oncol., March 1, 2005; 23(7): 1591 - 1591. [Full Text] [PDF]

				M.J. Fulham, B.C. McCaughan, M.J. Boyer, J.M. McLean, P.M. Kenny, M.T. King, C.A. Pollicino, and R.C. Viney In Reply: J. Clin. Oncol., March 1, 2005; 23(7): 1591 - 1592. [Full Text] [PDF]

				B. Davies, S. Ghosh, D. Hopkinson, R. Vaughan, and G. Rocco Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions Interactive CardioVascular and Thoracic Surgery, February 1, 2005; 4(1): 18 - 20. [Abstract] [Full Text] [PDF]