Preoperative staging of lung cancer with combined PET-CT

Research output: Contribution to journalJournal articleResearchpeer-review

Barbara Fischer, Ulrik Lassen, Jann Mortensen, Søren Larsen, Annika Loft, Anne Bertelsen, Jesper Ravn, Paul Clementsen, Asbjørn Høgholm, Klaus Larsen, Torben Rasmussen, Susanne Keiding, Asger Dirksen, Oke Gerke, Birgit Skov, Ida Steffensen, Hanne Hansen, Peter Vilmann, Grete Jacobsen, Vibeke Backer & 5 others Niels Maltbaek, Jesper Pedersen, Henrik Madsen, Henrik Nielsen, Liselotte Højgaard

BACKGROUND: Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC. METHODS: We randomly assigned patients who were referred for preoperative staging of NSCLC to either conventional staging plus PET-CT or conventional staging alone. Patients were followed until death or for at least 12 months. The primary end point was the number of futile thoracotomies, defined as any one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause within 1 year after randomization. RESULTS: From January 2002 through February 2007, we randomly assigned 98 patients to the PET-CT group and 91 to the conventional-staging group. Mediastinoscopy was performed in 94% of the patients. After PET-CT, 38 patients were classified as having inoperable NSCLC, and after conventional staging, 18 patients were classified thus. Sixty patients in the PET-CT group and 73 in the conventional-staging group underwent thoracotomy (P=0.004). Among these thoracotomies, 21 in the PET-CT group and 38 in the conventional-staging group were futile (P=0.05). The number of justified thoracotomies and survival were similar in the two groups. CONCLUSIONS: The use of PET-CT for preoperative staging of NSCLC reduced both the total number of thoracotomies and the number of futile thoracotomies but did not affect overall mortality. (ClinicalTrials.gov number, NCT00867412.)
Original languageEnglish
JournalNew England Journal of Medicine
Volume361
Issue number1
Pages (from-to)32-9
Number of pages8
ISSN0028-4793
DOIs
Publication statusPublished - 2009

Bibliographical note

Keywords: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Follow-Up Studies; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Preoperative Care; Sensitivity and Specificity; Thoracotomy; Tomography, X-Ray Computed

ID: 20246396