Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial

Tinteren, Harm van; Hoekstra, Otto S.; Smit, Egbert F.; Bergh, Jan H.A.M. Van Den; Schreurs, A. J. M.; Stallaert, Roland A. L. M.; Velthoven, Piet C.M. Van; Comans, Emile F.I.; Diepenhorst, Fred W.; Verboom, Paul; Mourik, Johan C. van; Postmus, Pieter E.; Boers, Maarten; Teule, G. J. J.

doi:10.1016/s0140-6736(02)08352-6

Cited by 788 publications

(406 citation statements)

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“…The likelihood of inadvertently treating benign disease can be reduced by applying the criteria described by Swenson et al (age, smoking history, previous cancer, greatest tumor dimension, spiculation, and tumor location 7 ) combined with the results of FDG-PET 6 to estimate the probability of malignancy. Although the use of FDG-PET reduces the likelihood of benign disease to <5%, 32 we continue to recommend a cytologic or histologic diagnosis when possible, particularly because a preoperative transthoracic biopsy has not been associated with an increased risk of death. 33 In our patients, identical outcomes were observed between patients with and without histologic proof of malignancy (Fig.…”

Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

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Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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“…It is well known that combined 18 F-FDG PET/CT has a greater diagnostic accuracy when compared with CT alone, PET alone or the conventional visual correlation of PET and CT in assessing primary tumor, lymph node (LN), and metastasis of non-small-cell lung cancer. It also leads to a change of treatment more frequently when compared with PET alone or CT alone [8,9].…”

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confidence: 99%

“…contrast agent on the interpretation of 18 F-FDG PET/CT in both technical and clinical aspects. For this purpose, in patients with lung cancer, we fi rst measured the changes in standardized uptake value (SUV) caused by the i.v.…”

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confidence: 99%

Nonionic intravenous contrast agent does not cause clinically significant artifacts to 18F-FDG PET/CT in patients with lung cancer

Sheen

et al. 2007

Ann Nucl Med

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6.11% for aorta, 5.85% ± 4.99% for liver, 5.47% ± 6.81% for muscle, and 2.81% ± 3.05% for bone marrow, and those of SUV ave were 10.17% ± 9.00%, 10.51% ± 7.89%, 4.95% ± 3.89%, 5.66% ± 9.12%, and 2.49% ± 2.50%, respectively. The mean differences of SUV max between enhanced and nonenhanced PET/CT were 5.89% ± 3.92% for lung lesions (n = 41), 6.27% ± 3.79% for LNs (n = 76), and 3.55% ± 3.38% for metastatic lesions (n = 35), and those of SUV ave were 3.22% ± 3.01%, 2.86% ± 1.71%, and 2.33% ± 3.95%, respectively. Although one LN status changed from benign to malignant because of contrast-related artifact, there was no up-or downstaging in any of the patients after contrast enhancement. Conclusions An i.v. contrast agent may be used in PET/CT without producing any clinically signifi cant artifact.

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“…Interestingly, PET/CT did not impact survival which, after clinical follow-up for 1 year, was similar in both groups. Similar to previous trials reporting on the diagnostic accuracy of dedicated PET (without coregistration of CT) [8], about five PET/CT scans have to be performed to avoid one futile thoracotomy.…”

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confidence: 73%

“…Prevention of unnecessary surgical interventions has been reported to occur in up to 14% of patients [9]. Recently, a randomized study has shown that the number of futile thoracotomies was significantly reduced in 19/82 patients compared to 29/96 patients, based on the addition of fluorodeoxyglucose (FDG) PET to the diagnostic algorithm [8]. The present study by Søgaard et al showed similar results with 21/98 futile thoracotomies in the PET/CT group compared to 38/91 surgical interventions in the control group which were interpreted as futile.…”

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confidence: 99%