The use of staging 18F-FDG PET in management and prognosis of patients with small cell lung carcinoma

  • Dr Arun Azad, Ludwig Oncology Unit, Austin Hospital, Heidelberg, Victoria, Australia
  • Dr Sze Ting Lee, Centre for PET; Ludwig Institute for Cancer Research; Department of Medicine, Austin Hospital, Victoria, Australia
  • Dr Salvatore Berlangieri, Centre for PET, Austin Hospital, Heidelberg, Victoria, Australia
  • Dr Fiona Chionh, Ludwig Oncology Unit, Austin Hospital, Heidelberg, Victoria, Australia
  • Dr Shane White, Ludwig Oncology Unit, Austin Hospital, Heidelberg, Victoria, Australia
  • A/Prof Paul Mitchell, Ludwig Oncology Unit, Austin Hospital, Heidelberg, Victoria, Australia
  • Prof Andrew Scott, Centre for PET; Ludwig Institute for Cancer Research; Department of Medicine, Austin Hospital, Victoria

    • Background: 18F-FDG PET has been demonstrated to impact upon the stage classification and management of SCLC. However, the prognostic impact of using PET to stage SCLC has not been directly addressed. The aim of this study was to evaluate the prognostic impact of staging PET in SCLC.

    Methods: Patients who had a staging FDG-PET performed for SCLC at Austin Hospital between 1993 and 2008 were retrospectively reviewed. FDG-PET was performed according to standard protocol.

    Results: There were 46 patients reviewed. PET altered staging in 12/46 (26%) patients. Four patients were upstaged from limited disease (LD) to extensive disease (ED), 3 of whom subsequently received chemotherapy alone, rather than combined chemo-radiation. Eight patients were downstaged from ED to LD, with 6/8 patients receiving combined chemo-radiation instead. 7/8 patients had solitary extrathoracic disease on conventional imaging. PET altered target radiation field in 3 patients with LD on conventional imaging and PET. Patients with LD on both conventional imaging and PET had significantly longer median overall survival (OS) than patients who were upstaged to ED on PET (557 days vs. 172 days; p < 0.0001). Patients with ED on conventional imaging downstaged to LD on PET had significantly longer median OS than patients with ED on both conventional imaging and PET (328 days vs. 177 days, p < 0.037).

    Conclusion: Staging 18F-FDG-PET for SCLC had major impact on stage classification, management and prognosis. Routine use of staging PET should be considered in patients with LD or oligometastatic ED on conventional imaging.