TY - JOUR
T1 - Impact of PET staging in limited-stage small-cell lung cancer
AU - Xanthopoulos, Eric P.
AU - Corradetti, Michael N.
AU - Mitra, Nandita
AU - Fernandes, Annemarie T.
AU - Kim, Miranda
AU - Grover, Surbhi
AU - Christodouleas, John P.
AU - Evans, Tracey L.
AU - Stevenson, James P.
AU - Langer, Corey J.
AU - Lee, Tony T.
AU - Pryma, Daniel A.
AU - Lin, Lilie L.
AU - Simone, Charles B.
AU - Apisarnthanarax, Smith
AU - Rengan, Ramesh
N1 - Funding Information:
Disclosure: Daniel Pryma received honoraria and research funding from Siemens. The other authors declare no conflict of interest.
PY - 2013/7
Y1 - 2013/7
N2 - INTRODUCTION:: Although positron emission tomography computed tomography (PET-CT) has been widely used for small-cell lung cancer (SCLC) staging, no study has examined the clinical impact of PET staging in limited-stage (LS) SCLC. METHODS:: We identified patients with LS-SCLC treated definitively with concurrent chemoradiation. Outcomes were assessed using the Kaplan-Meier approach, Cox regression, and competing risks method. RESULTS:: We treated 54 consecutive LS-SCLC patients with concurrent chemoradiation from January 2002 to August 2010. Forty underwent PET, 14 did not, and all underwent thoracoabdominopelvic CT and magnetic resonance imaging neuroimaging. Most patient characteristics were balanced between the comparison groups, including age, race, sex, bone scanning, median dosage, and performance status. More number of PET-staged patients presented with nodal metastases (p = 0.05). Median follow-up was similar for PET-staged and non-PET-staged patients (p = 0.59). Median overall survival from diagnosis in PET-staged patients was 32 versus 17 months in patients staged without PET (p = 0.03), and 3-year survival was 47% versus 19%. Median time-to-distant failure was 29 versus 12 months (p = 0.04); median time-to-local failure was not reached versus 16 months (p = 0.04). On multivariable analysis, PET staging (odds ratio [OR] = 0.24; p = 0.04), performance status (OR = 1.89; p = 0.05), and N-stage (OR = 4.94; p < 0.01) were associated with survival. CONCLUSION:: LS-SCLC patients staged with PET exhibited improved disease control and survival when compared with non-PET-staged LS-SCLC patients. Improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in these patients.
AB - INTRODUCTION:: Although positron emission tomography computed tomography (PET-CT) has been widely used for small-cell lung cancer (SCLC) staging, no study has examined the clinical impact of PET staging in limited-stage (LS) SCLC. METHODS:: We identified patients with LS-SCLC treated definitively with concurrent chemoradiation. Outcomes were assessed using the Kaplan-Meier approach, Cox regression, and competing risks method. RESULTS:: We treated 54 consecutive LS-SCLC patients with concurrent chemoradiation from January 2002 to August 2010. Forty underwent PET, 14 did not, and all underwent thoracoabdominopelvic CT and magnetic resonance imaging neuroimaging. Most patient characteristics were balanced between the comparison groups, including age, race, sex, bone scanning, median dosage, and performance status. More number of PET-staged patients presented with nodal metastases (p = 0.05). Median follow-up was similar for PET-staged and non-PET-staged patients (p = 0.59). Median overall survival from diagnosis in PET-staged patients was 32 versus 17 months in patients staged without PET (p = 0.03), and 3-year survival was 47% versus 19%. Median time-to-distant failure was 29 versus 12 months (p = 0.04); median time-to-local failure was not reached versus 16 months (p = 0.04). On multivariable analysis, PET staging (odds ratio [OR] = 0.24; p = 0.04), performance status (OR = 1.89; p = 0.05), and N-stage (OR = 4.94; p < 0.01) were associated with survival. CONCLUSION:: LS-SCLC patients staged with PET exhibited improved disease control and survival when compared with non-PET-staged LS-SCLC patients. Improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in these patients.
KW - Chemoradiation
KW - Positron emission tomography
KW - Positron emission tomography computed tomography
KW - Radiation
KW - Small-cell lung cancer
KW - Stage migration
KW - Staging
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U2 - 10.1097/JTO.0b013e31828e8996
DO - 10.1097/JTO.0b013e31828e8996
M3 - Article
C2 - 23608814
AN - SCOPUS:84880916430
SN - 1556-0864
VL - 8
SP - 899
EP - 905
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 7
ER -