Triage of Limited Versus Extensive Disease on 18F-FDG PET/CT Scan in Small Cell lung Cancer

Document Type : Original Article

Authors

1 Department of Nuclear medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

2 Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

Abstract

Objective(s): Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma, which accounts for 10-15% of pulmonary cancers and exhibits early metastatic spread. This study aimed to determine the added value of 18F-FDG PET/CT imaging in tumor, node, and metastasis (TNM) staging of SCLC, compared to the conventional computed tomography (CT) scan and its potential role as a prognosticator.
Methods: This retrospective review was conducted on 23 patients, who were histopathologically diagnosed to have SCLC and referred for undergoing 18F-FDG PET/CT scanning during October 2009-December 2015. The rate of agreement between the CT and 18F-FDG PET/CT findings for TNM staging was calculated using the Cohen’s kappa (κ). The median follow-up time was eight months, ranging 27-3 months). The overall and disease-free survival rates were calculated based on the extent of disease.
Results: 19 cases were male and four female with the mean age of 58±9 years. The 18F-FDG PET/CT identified limited and extensive diseases in 2 (8.7%) and 21 (91.3%) patients, respectively. In addition, the results of the Cohen’s kappa demonstrated a strong (κ=0.82), fair (κ=0.24), and poor (κ=0.12) agreement between the PET/CT and CT findings for determining tumor, node, and metastasis stages, respectively. The 18F-FDG PET/CT scans upstaged disease in 47% of the cases with visceral and osseous metastasis. The disease-free survival rates for the limited and extensive diseases were 100% and 23% within the 12-month follow-up. In addition, 8 (35%) patients expired during the follow-up period.
Conclusion: Improved nodal and metastatic disease identification highlights the role of 18F-FDG PET/CT scanning in initial staging of SCLC with prognostic implications.

 

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References

  1.  

    1. Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24(28):4539-44.
    2. van Loon J, Offermann C, Bosmans G, Wanders R, Dekker A, Borger J, et al. 18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: a planning study. Radiother Oncol. 2008;87(1):49-54.
    3. Decker RH, Wilson LD. Advances in radiotherapy for lung cancer. Semin Respir Crit Care Med. 2008;29(3):285-90.
    4. UyBico SJ, Wu CC, Suh RD, Le NH, Brown K, Krishnam MS. Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. Radiographics. 2010;30(5):1163-81.

    5.     Kalemkerian GP, Gadgeel SM. Modern staging of small cell lung cancer. J Natl Compr Canc Netw. 2013;11(1):99-104.

    6.     Kut V, Spies W, Spies S, Gooding W, Argiris A. Staging and monitoring of small cell lung cancer using [18F] fluoro-2-deoxy-D-glucose-positron emission tomography. Am J Clin Oncol. 2007;30(1):45–50.

    7.    Fischer BM, Mortensen J, Langer SW, Loft A, Berthelsen AK, Petersen BI, et al. A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis. Ann Oncol. 2007;18:338–45.

    8.    Arslan N, Tuncel M, Kuzhan O, Alagoz E, Budakoglu B, Ozet A, et al. Evaluation of outcome prediction and disease extension by quantitative 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography in patients with small cell lung cancer. Ann Nucl Med. 2011;25(6):406–13.

    9.     Verschakelen JA, De Wever W, Bogaert J. Role of computed tomography in lung cancer staging. Curr Opin Pulm Med. 2004;10(4):248–55.

    10.   Darling GE, Maziak DE, Inculet RI, Gulenchyn KY, Driedger AA, Ung YC, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol. 2011;6(8):1367–72.

    11.  Brink I, Schumacher T, Mix M, Ruhland S, Stoelben E, Digel W, et al. Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer. Eur J Nucl Med Mol Imaging. 2004; 31(12):1614–20.

    12.   Fischer BM, Mortensen J, Langer SW, Loft A, Berthelsen AK, Petersen BI, et al. A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis. Ann Oncol. 2007;18(2):338-45.

    13.   Azad A, Chionh F, Scott AM, Lee ST, Berlangieri SU, White S, et al. High impact of 18F-FDG-PET on management and prognostic stratification of newly diagnosed small cell lung cancer. Mol Imaging Biol. 2010;12(4):443-51.

     

Asia Oceania Journal of Nuclear Medicine and Biology
Volume 5, Issue 2
July 2017
Pages 113-118

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