Positron Emission Tomography/Computed Tomography (PET/CT) Versus Non-Contrast CT Alone For Surveillance 1-Year Post Lobectomy For Stage I Non-Small-Cell Lung Cancer

Dane, Bari; Grechushkin, Vadim; Moore, William S.

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5071

Cited by 12 publications

(17 citation statements)

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“…However, the benefit of PET/CT imaging over standard CT imaging was not compared. Another report compared PET/CT and CT imaging in lung cancer surveillance in stage I patients following lobectomy, and PET/CT imaging indeed was more sensitive and specific 8 . However, in this study PET/CT was compared to the non-contrast CT obtained during PET imaging; therefore, it is possible that the use of a contrast CT would have mitigated this benefit.…”

Section: Discussionmentioning

confidence: 99%

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

Reddy

Tang

Shih

et al. 2017

Clinical Lung Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

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

Reddy

Tang

Shih

et al. 2017

Clinical Lung Cancer

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“…The role of PET/CT for follow-up after resection for NSCLC has been investigated by various groups [17, 18]. Compared with CT alone, PET/CT was more sensitive in the detection of recurrences, and this improved sensitivity was largely attributable to the detection of extrathoracic metastatic disease [18]. However, with this higher sensitivity comes higher costs, greater radiation exposure, and the risk of false-positives.…”

Section: Commentmentioning

confidence: 99%

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Lou

Sima

Rusch

et al. 2014

The Annals of Thoracic Surgery

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Background The benefits of screening for non-small cell lung cancer (NSCLC) have been established for high-risk individuals, and recent guidelines advocate continued surveillance after curative therapy. Yet the optimal posttreatment surveillance strategy remains to be determined. We compared patterns of recurrence and modes of detection in surgically treated patients with pathologic early-stage and locally advanced NSCLC. Methods Consecutive patients who had undergone resection for stage I-IIIA NSCLC from 2004 to 2009 were identified from a prospectively maintained institutional database. All patients received interval chest computed tomography (CT) scans every 6 to 12 months after treatment. Results In total, 1640 patients were identified: 181 of 346 patients with stage IIIA NSCLC (52%) and 257 of 1294 patients with stage I-II NSCLC (20%) developed recurrences. Surveillance CT scan detected asymptomatic recurrences in 157 stage I-II patients (61%) and 89 stage IIIA patients (49%) (p=0.045). Symptoms led to detection of recurrences more often in stage IIIA patients (73 [40%]) than in stage I-II patients (81 [32%]). Distant were more common in stage IIIA patients than in stage I-II patients (153 [85%] vs. 190 [74%]; p=0.01). In stage IIIA patients, the risk of recurrence was highest during the first 2 years after surgery, but it remained substantial into year 4. Conclusions Stage IIIA patients had fewer recurrences detected by surveillance CT, a higher rate of symptomatic presentation, a markedly higher risk of recurrence, and a higher propensity for distant recurrence. Surveillance strategies may need to account for stage-specific differences.

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“…The National Comprehensive Cancer Network recommends chest CT with or without a contrast agent every 6-12 mo for 2 y, followed by annual unenhanced chest CT for surveillance of lung cancer (4). 18 F-FDG PET/CT is a valuable investigation for many oncology patients for staging, therapy assessment, management, and prognosis (5-9).…”

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confidence: 99%

¹⁸F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

et al. 2015

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The Centers for Medicare and Medicaid Services recently ruled that only 3 posttherapy follow-up 18 F-FDG PET/CT scans are funded for a tumor type per patient and any additional follow-up PET/CT scans will be funded at the discretion of the local Medicare administrator. The purpose of this study was to evaluate the added value of 4 or more follow-up PET/CT scans to clinical assessment and impact on patient management. Methods: This was an institutional review board-approved, retrospective study. A total of 1,171 patients with biopsy-proven lung cancer who had undergone 18 F-FDG PET/CT at a single tertiary center from 2001 to 2013 were identified. Among these, 85 patients (7.3%) had undergone 4 or more follow-up PET/ CT scans, for a total of 285 fourth and subsequent follow-up PET/CT scans. Median follow-up from the fourth follow-up PET/CT scan was 31.4 mo (range, 0-155.2 mo). The follow-up PET/CT scan results were correlated with clinical assessment and treatment changes. Results: Of the 285 fourth and subsequent follow-up PET/CT scans, 149 (52.28%) were interpreted as positive and 136 (47.7%) as negative for recurrence or metastasis. A total of 47 patients (55.3%) died during the study period. PET/CT identified recurrence or metastasis in 44.3% of scans performed without prior clinical suspicion and ruled out recurrence or metastasis in 24.2% of scans performed with prior clinical suspicion. The PET/CT scan resulted in a treatment change in 28.1% (80/285) of the patients. New treatment was initiated for 20.4% (58/ 285) of the scans, treatment was changed in 5.6% (16/285), and ongoing treatment was stopped in 2.1% (6/285). Conclusion: The fourth and subsequent 18 F-FDG PET/CT scans performed during follow-up after completion of primary treatment added value to clinical assessment and changed management 28.1% of the time.

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Positron Emission Tomography/Computed Tomography (PET/CT) Versus Non-Contrast CT Alone For Surveillance 1-Year Post Lobectomy For Stage I Non-Small-Cell Lung Cancer

Cited by 12 publications

References 0 publications

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

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

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

¹⁸F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

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Positron Emission Tomography/Computed Tomography (PET/CT) Versus Non-Contrast CT Alone For Surveillance 1-Year Post Lobectomy For Stage I Non-Small-Cell Lung Cancer

Cited by 12 publications

References 0 publications

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

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

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

18F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

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¹⁸F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management