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Previous Volume 361:32-39 July 2, 2009 Number 1 Next

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ABSTRACT

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 [ClinicalTrials.gov] .)

Source Information

From Rigshospitalet, Copenhagen University Hospital, Copenhagen (B.F., U.L., J.M., A.L., A.B., J.R., I.S., G.J., J.P., L.H.); Odense University Hospital, Odense (B.F.); Bispebjerg Hospital, Copenhagen (S.L., K.L., H.H., V.B., H.N.); Gentofte Hospital, Hellerup (P.C., A.D., P.V., N.M.); Naestved Hospital, Naestved (A.H.); Aarhus University Hospital, Aarhus (T.R., S.K., H.M.); University of Southern Denmark, Odense (O.G.); and Herlev Hospital, Hellerup (B.S.) — all in Denmark.

Address reprint requests to Dr. Fischer at the Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark, or at bjerregaard.fischer{at}gmail.com.

Full Text of this Article

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Lung-Cancer Staging with PET–CT
Bruzzi J. F., Bölükbas S., Baierlein S. A., Schirren J., Hung J.-J., Jeng W.-J., Liu J.-S., Kloecker G., Civelek C., Janjua M., Sharieff W., Fischer B. M., Lassen U., Mortensen J.
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N Engl J Med 2009; 361:1606-1608, Oct 15, 2009. Correspondence

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