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Positron Emission Tomography in Limited-Stage Small-Cell Lung Cancer: A Prospective Study

From the Departments of Radiation Oncology and Radiology, Mallinckrodt Institute of Radiology; Department of Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO

Address reprint requests to Jeffrey D. Bradley, MD, Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St Louis, MO 63110; e-mail: Bradley{at}radonc.wustl.edu

PURPOSE: To determine how often positron emission tomography with [¹⁸F]fluoro-2-deoxy-D-glucose (FDG-PET) detects extensive-stage small-cell lung cancer (SCLC) in patients considered to have limited-stage disease based on conventional staging procedures, and to determine the impact of PET on treatment planning for presumed limited-stage SCLC.

PATIENTS AND METHODS: We prospectively performed pretreatment FDG-PET on 24 patients determined by conventional staging methods to have limited-stage SCLC (defined as disease that could be encompassed within a reasonable radiotherapy portal, excluding bilateral supraclavicular disease). PET images were evaluated for evidence of extensive-stage disease. Tumor-node-metastasis system staging was also assigned for each patient, with and without PET information.

RESULTS: FDG-PET demonstrated findings consistent with extensive-stage SCLC in three of 24 patients. FDG-PET correctly upstaged two (8.3%) of 24 patients to extensive-stage disease (95% CI, 1.03% to 27.0%). PET correctly identified tumor in each SCLC mass (primary or nodal) that was suspected on computed tomography (CT) imaging, thus giving a lesion-based sensitivity relative to CT of 100%. PET identified unsuspected regional nodal metastasis in six (25%) of 24 patients, and the radiation therapy plan was significantly altered to include the PET-positive/CT-negative nodes within the high-dose region in each of these patients. Brain PET images in 23 patients disclosed no evidence of brain metastasis.

CONCLUSION: FDG-PET has high sensitivity for SCLC and appears to be of value for initial staging and treatment planning of patients with presumed limited-stage disease.

This work was funded by an American Cancer Society Institutional Research Grant (ACS-IRG-58-010-44).

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

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