News | Lung Cancer | March 13, 2017

FDG PET/CT Found Useful in Certain Lung Cancer Patients

New evidence discussed in AJR study on treatment response, follow-up and surveillance of lung cancer

FDG PET/CT, lung cancer, radiation therapy, AJR study, American Journal of Roentgenology

March 13, 2017 — FDG positron emission tomography/computed tomography (PET/CT) is a valuable imaging tool for treatment assessment of patients with lung cancer, though systematic evidence for its comparative effectiveness with conventional imaging, such as chest CT, is still evolving, according to a new study.

Authors of the study titled "The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer" published their findings in the February 2017 issue of the American Journal of Roentgenology.

In this review, the authors summarized the existing evidence in the literature concerning use of PET/CT for both assessing the efficacy of treatment response and performing post-treatment follow-up of lung cancer.

"FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases," said study coauthor Rathan M. Subramaniam, of the department of radiology, University of Texas Southwestern Medical Center, Dallas. "Using FDG PET/CT for routine surveillance without any clinical suspicion should be discouraged until its value for patient survival outcomes is fully established."

The National Comprehensive Cancer Network (NCCN) recommends the use of FDG PET/CT for appropriately staging lung cancer and avoiding futile thoracotomies. It also recommends the imaging for accurate radiation therapy (RT) planning for both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). However, NCCN does not recommend routine use of FDG PET/CT for treatment response evaluation and follow-up in lung cancer.

According to the study authors, FDG PET/CT is usually recommended 12 weeks after completion of concurrent chemoradiation therapy to minimize radiation-related inflammatory uptake leading to false-positive studies. In some cases, radiation-related therapy changes, especially with stereotactic body radiotherapy, can last for many months. In these circumstances, a follow-up FDG PET/CT in three months is suggested to ensure resolution of therapy-related FDG uptake. FDG PET/CT can be performed four weeks after completion of chemotherapy or surgery (without concurrent radiation), because the therapy-related inflammatory uptake is less and subsides within a shorter time.

The sequencing, cost analysis and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated.

Lung cancer remains the leading cause of cancer-related mortality worldwide, accounting for about 1.6 million deaths yearly. Despite significant advances in both diagnostic and therapeutic approaches, the overall five-year survival rate for lung cancer is 17.4 percent. However, this is largely dependent on the stage of diagnosis, with a survival rate of 54.8 percent for localized and 4.2 percent for disease that has metastasized in other parts of the body.

Lung cancer has historically been divided into two main types: NSCLC (85 percent of cases) and SCLC (10-15 percent of cases). A multidisciplinary approach including the use of advanced imaging techniques for early accurate staging of disease and delivery of treatment is needed to avoid futile treatments and improve overall survival, which, in turn, influence the patient's quality of life.

Surgery is usually the primary treatment modality for localized disease in patients with lung cancer. Even after curative surgery, patients remain at risk for the development of recurrence or a secondary pulmonary malignancy. Post-treatment follow-up usually consists of a combination of physical examination, laboratory tests and imaging. No single modality is simultaneously sensitive, specific and cost-effective; thus, a combined approach is needed for the detection of tumor recurrence.

PET is a noninvasive imaging modality that is promising in the evaluation of lung cancer and is currently used clinically for initial antitumor treatment strategy (for staging, treatment planning, and delivery of radiation treatment) and for subsequent antitumor treatment strategy (treatment response assessment and detection of recurrence in follow-up).

For more information: www.ajronline.org

Related Content

Study Demonstrates First Human Application of Novel PET Tracer for Prostate Cancer

Transaxial 11Csarcosine hybrid PET/CT showed a (triangulated) adenocarcinoma in the transition zone of the anterior right prostate gland on PET (A), CT (B), and a separately obtained T2?weighted MR sequence (C) with resulting PET/MRI registration (D). Image courtesy of M. Piert et al., University of Michigan, Ann Arbor, Mich.

News | Radiopharmaceuticals and Tracers | August 16, 2017
In the featured translational article in the August issue of The Journal of Nuclear Medicine, researchers at the...
DOSIsoft Releases ISOgray Proton Therapy Treatment Planning System
Technology | Treatment Planning | August 15, 2017
DOSIsoft SA announced the official release, with CE marking, of ISOgray Treatment Planning System (TPS) release 4.3 for...
First Radixact Results Presented at AAPM 2017
News | Radiation Therapy | August 10, 2017
Accuray Inc. announced that the first studies validating the benefits of the Radixact System were presented at the 59th...
MRI Reveals Striking Brain Differences in People with Genetic Autism

Example images for a control participant , a deletion carrier, and a duplication carrier. In the sagittal image of the deletion carrier, the thick corpus callosum, dens and craniocervical abnormality, and cerebellar ectopia are shown. For the duplication carrier, the sagittal image shows the thin corpus callosum and the axial image shows the increased ventricle size and decreased white matter volume. Image courtesy of the Radiological Society of North America (RSNA).

News | Neuro Imaging | August 09, 2017
August 9, 2017 — In the first major study of its kind, researchers using magnetic...
Clinical Data Supports Use of Xoft System for Endometrial Cancer
News | Brachytherapy Systems | August 03, 2017
Researchers presented clinical data supporting use of the Xoft Axxent Electronic Brachytherapy (eBx) System for the...
Aktina’s interchangeable cones are lightweight and extremely accurate
News | Radiation Therapy | August 02, 2017
Aktina Medical announced a collaboration with Philips Medical Systems and Elekta Instruments for SRS interlocking at...
brain with chronic traumatic injury
News | Magnetic Resonance Imaging (MRI) | August 02, 2017
Fighters are exposed to repeated mild traumatic brain injury (mTBI), which has been associated with neurodegenerative...
The American Lung Association created LUNG FORCE, a national movement to defeat lung cancer
News | Lung Cancer | August 02, 2017
To raise public awareness of lung cancer—the leading cancer killer of men and women—the American Lung Association's...
Overlay Init