Impact of 18F-FDG PET/CT Scan on Management of Non-small Cell Lung Cancer Patients in Contexts of University-Based Hospital in Thailand

Abstract

Objective: To determine the impact of Fluorine-18 fluorodeoxy glucose (18F-FDG) positron emission tomography with computed tomography (PET/CT scan) on management of non-small cell lung cancer (NSCLC) in contexts of university-based hospital in Thailand where most patients were in advanced disease and conventional imaging (CI) had previously been done. Methods: Between December 2006 to December 2014, PET/CT scan and CI - e.g. chest and upper abdominal CT scan and bone scintigraphy of 120 pathologically proven NSCLC patients were independently reviewed. Stagings based on CI and PET/CT scan were evaluated. Proposed treatment plan based on CI and given treatment based on PET/ CT scan were compared in patients whose medical records were available. Impact of PET/CT scan on management was categorized into inter-modality and intra-modality treatment change – i.e. change in radiation fields. Results: Of 120 NSCLC patients, PET/CT scans were performed for initial staging (INS) in 60 patients, post- treatment evaluation (PTE) in 41 patients and restaging at time of recurrence or progression (RR) in 19 patients. PET/CT scan changed the disease status in 38 patients (31.7%). Changes to more advanced and less advanced disease were found in 26 patients (11 INS, 8 PTE and 7 RR patients) and 12 patients (3 INS, 6 PTE and 3 RR patients), respectively. Among 83 patients with available proposed treatment plan, inter-modality treatment changes were observed in 19 patients (22.9%). Changes were more frequent in setting of PTE and RR (14/19 patients; 73.7%). The most common changes were toward palliative chemotherapy (15/19 patients, 78.9%) owing to unexpected distant metastasis. Among 43 patients who received radiation therapy, changes in radiation approach were found in 18 patients (41.9%), mostly due to positive or negative lymph node (LN) metastasis. Conclusion: PET/CT scan has considerable impact on staging and both inter-modality and intra-modality treatment change in NSCLC patients in all settings – INS, PTE and RR even with the presence of CI. Therefore, PET/CT scan should be considered for staging and guiding the multidisciplinary treatment.

Keywords

• PET/CT
• non-small cell lung cancer
• NSCLC
• staging; management
• treatment
• (Siriraj Med J 2018;70: 169-174)