FDG-PET imaging for the staging and follow-up of small cell lung cancer

Abstract

The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

“…Metastatic bone lesions can be classified as osteolytic (bone lysing), osteoblastic (bone forming), and biphenotypic types based on histology. For lung cancer, 20% of non-small cell lung carcinomas and 30-40% of small cell lung carcinomas are complicated by bone metastases (Schumacher et al 2001;Toloza et al 2003). The majority of these appear to be osteolytic by imaging, but some are biphenotypic and, in rare cases, osteoblastic (Koizumi 2004).…”

Use of PET and PET/CT for Radiation Therapy Planning: IAEA expert report 2006–2007

“…SCLC is well imaged by FDG-PET [94] but few studies have directly addressed the role of PET in RT planning. Potential roles for PET include selection for radical RT-CHT, RT planning and selection of patients for prophylactic cranial irradiation (PCI).…”

FDG PET and PET/CT for the detection of the primary tumour in patients with cervical non-squamous cell carcinoma metastasis of an unknown primary

“…Furthermore, PET detected a small cell lung cancer (patient 5; histology of a low diVerentiated neuroendocrine carcinoma). Schumacher et al [15] suggested FDG PET to be of potential use as a simpliWed staging tool for small cell lung cancer. In another patient with metastasis from an adenocarcinoma (patient 6), PET did not detect the primary but was false positive due to oesophageal inXammatory changes with hyperkeratosis.…”