Impact of FDG-PET findings on decisions regarding patient management strategies: a multicenter trial in patients with lung cancer and other types of cancer

Abstract

ObjectiveTo date, numerous studies have been conducted on the diagnostic capabilities of positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET). However, no studies designed to evaluate the influence of FDG-PET on the selection of patient management strategies within the Japanese healthcare system have been reported to date. The aim of the present study was to investigate prospectively the proportion of patients whose management strategies were modified based on FDG-PET findings (strategy modification rate).MethodsThe strategy modification rate was calculated by comparing the patient management strategy (test and treatment plans) after FDG-PET with the strategy before FDG-PET for 560 cancer patients with nine types of cancer (lung cancer, breast cancer, colorectal cancer, head/neck cancer, brain tumor, pancreas cancer, malignant lymphoma, cancer of unknown origin, and melanoma). In addition, the details of the modifications to the patient management strategies were analyzed.ResultsThe strategy modification rate for patients with lung cancer was 71.6 % (149 of 208 patients, 95 % confidence interval 65.0–77.7 %), which was higher than previously reported strategy modification rates for lung cancer before and after FDG-PET (25.6 %). The strategy modification rates for patients with cancers other than lung cancer were as follows: breast, 44.4 % (56/126); colorectal, 75.6 % (62/82); head and neck, 65.2 % (15/23); malignant lymphoma, 70.0 % (35/50); pancreas, 85.0 % (17/20); and cancer of unknown origin, 78.0 % (32/41). The mean modification rate (major and minor modifications) of the treatment plans after FDG-PET, relative to the plans before FDG-PET, was 55.4 % (range 44.0–69.2 %), with major modifications pertaining to the treatment plan made in 43.3–68.2 % of the patients based on the objectives of the FDG-PET examination.ConclusionsThe results from this study indicate that FDG-PET can contribute to the modification of management strategies (particularly treatment plans), especially for lung cancer patients but also for patients with other types of cancer.

18F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation

“…FDG PET/CT is recognized to have a great impact on diagnosing, staging and restaging cancer patients [39][40][41]. Recently, Kubota et al [42] evaluated the impact of FDG PET findings on decisions regarding patient management strategies (i.e., the strategy modification rate) in a prospective multicenter trial in neoplastic patients. The authors reported a strategy modification rate of 71.6 % and 70.0 %, respectively, for patients with lung cancer and malignant lymphoma.…”

The prognostic value of PET/CT in clinical stage I lung cancer patients: A propensity-match analysis.

“…22 Kubota et al even showed that PET/CT could contribute to 71.6% of the modifications of management strategies in lung cancer patients. 23 Our data indicated that clinical stage I lung cancer patients who received PET/CT had a higher lobectomy rate and a lower wedge resection rate. Moreover, patients were more likely to receive chemotherapy after receiving PET/CT.…”

Predictive and Prognostic Role of Metabolic Response in Patients With Stage III NSCLC Treated With Neoadjuvant Chemotherapy

“…In fact, modifications in tumor glucose metabolism occur earlier than those in tumor size, thus resulting useful in differentiating persistent disease from scar tissue. 24,25 In our study, we investigated whether 18F-FDG PET/CT parameters, at baseline and after induction therapy, were useful to assess the response to chemotherapy and to predict outcomes in patients with stage III NSCLC, which still represents a challenge for clinicians. In particular, we studied metabolic parameters derived from primary tumor and regional lymph nodes separately.…”