Influence of Surveillance PET/CT on Detection of Early Recurrence After Definitive Radiation in Stage III Non–small-cell Lung Cancer

Abstract

Purpose There is little data to support the use of varying imaging modalities in evaluating recurrence in non-small cell lung cancer (NSCLC). We compared the efficacy of surveillance PET/CT vs. CT scans of the chest in detecting recurrences following definitive radiation for NSCLC. Materials/Methods We retrospectively analyzed 200 patients treated between 2000–2011 that met the inclusion criteria of stage III NSCLC, completion of definitive radiation treatment, and absence of recurrence within the initial 6 months. These patients were then grouped based on the use of PET/CT imaging during post-radiation surveillance. Patients who received ≥1 PET/CT scans within 6 months of the end of radiation treatment were placed in the PET-group while all others were placed in the CT-group. We compared survival times from the end of treatment to the date of death or last follow-up utilizing log-rank tests. Multivariate analysis was conducted to identify factors associated with decreased survival. Results In the entire cohort, median event-free survival (EFS) was 26.7 months, and median overall survival (OS) was 41.2 months. The CT-group had a median EFS of 21.4 months vs. 29.4 months for the PET-group (p=0.59). There was no difference in OS between the CT- and PET-groups (median OS of 41.2 and 41.3 months, respectively, p=0.59). There was also no difference in local recurrence-free survival or distant metastases-free survival between the CT-only and PET-high groups (p=0.92 and p=0.30, respectively). Similarly, on multivariate analysis, stratification into the PET-group was not associated with improved EFS (HR: 0.90, 95% CI: 0.61–1.34, p=0.60) or OS (HR: 1.2, 95% CI: 0.83–1.7, p=0.34). Conclusions In stage III NSCLC patients treated with definitive radiation and without early recurrence, PET/CT scan surveillance did not result in decreased time to detection of locoregional or distant recurrence or improved survival.

Cost Analysis of PET/CT Versus CT as Surveillance for Stage III Non–Small-Cell Lung Cancer After Definitive Radiation Therapy

“…A previous study compared PET/CT versus CT for surveillance in patients after (chemo)radiation treatment for stage III NSCLC with regard to several outcomes, including overall survival (OS) and the detection of local and distant recurrence; no differences in outcomes were found according to surveillance modality. 4 Those results were concordant with the fact that PET/CT is not currently recommended for NSCLC surveillance imaging 5 because of lack of evidence indicating a clinical benefit over CT. Nevertheless, PET/CT remains a preferred modality of surveillance among some providers, and PET/CT usage has increased substantially from 1997/1998 to 2005.…”

“…The previous study of patients with stage III NSCLC was the largest to date to directly examine the differences between PET/CT and CT for post-treatment surveillance in such patients. 4 …”

“…Our findings contribute to the literature by elucidating the differences (or lack thereof) in charges for PET/CT versus CT for surveillance and by identifying the patient and provider qualities correlated with a preference for PET/CT in a group of patients with concordant clinical data. 4 …”

“…Note that in doing the analysis, we determined that the relationship between clinical significance and statistical significance was stronger at earlier time points, and as such we included data only up to 2 years. As described in our previous report, 4 we triaged our patients according to their first 2 surveillance scans, because our long follow-up period resulted in highly heterogeneous surveillance patterns that were difficult to interpret across patients. In addition, many patients did not have multiple post-treatment scans, and it was therefore challenging to detect surveillance imaging patterns after the first 2 scans.…”

Die Nachsorge des Lungenkarzinoms

“…Einige Daten zur PET-CT bei der Nachsorge von operierten Patienten liegen vor, jedoch handelt es sich dabei um monozentrische retrospektive Erfassungen. Ein Überlebensvorteil nach Nachsorge mittels PET-CT wurde bislang nicht gezeigt [21][22][23].…”