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PET/CT plus conventional staging reduced futile thoracotomies in NSCLC

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Staging patients with PET/CT scanning resulted in fewer futile thoracotomies, according to researchers in Denmark, but did not improve survival for patients with non-small cell lung cancer.

The researchers recruited 189 patients with newly diagnosed or highly suspected NSCLC and randomly assigned them to conventional staging plus PET/CT (n=98) or conventional staging alone (n=91). The primary endpoint was the number of futile thoracotomies; the researchers defined the procedure as futile if disease recurred or if the patient died within 12 months of surgery.

After staging, 64% of the PET/CT group were considered operable and underwent surgery compared with 80% of the conventional staging group (P=.004). Thoracotomy was futile in 35% of patients in the PET/CT group compared with 52% in the conventional staging group (P=.05). Futile thoractomy was further reduced to 29% of the PET/CT group when patients assigned to that group who did not undergo staging were excluded from the analysis.

“For every five PET/CT scans, one futile thoracotomy was avoided,” the researchers wrote.

Patients were followed until death or 12 months and mean follow-up time was 27 months. Survival in the PET/CT group was 31 months vs. 49 months in the conventional staging group. There was no significant difference in survival between the two groups. – by Jason Harris

Fischer B. N Engl J Med. 2009;361:32-39.

These results affirm the accuracy of the PET-CT and its importance in the preoperative evaluation of lung cancer. Using PET-CT in staging NSCLC is the current standard of care in the United States. This paper out of Denmark reaffirms our knowledge that PET-CT is sensitive at indicting where we should be operating, but their guidelines for surgery are less aggressive than in the United States. The researchers exclude patients who are IIIA, IIIB and stage IV. That's unfortunate for their patients, because patients with non-bulky IIIA disease or even very rarely in stage IV disease (with a single brain metastasis) are often surgical candidates. There are many surgical series out there showing a 25% to 40% five-year survival when multimodality therapy is employed.

– Abraham Lebenthal, MD, MHA

Staff Thoracic Surgeon, Fox Chase Cancer Center, Philadelphia