PET-CT for NSCLC

The NEJM this week has in interesting randomized trial on the utility of PET-CT in the preoperative workup of NSCLC.

Investigators from Denmark randomized 189 patients to receive either PET-CT or conventional CT as preoperative staging for NSCLC. Mediastinoscopy was performed in most patients in both arms(94%). After PET–CT, 38/98 patients were classified as having inoperable NSCLC compared to 18/91 patients in the CT arm. 60/98 in the PET–CT arm and 73/91 in the CT arm underwent thoracotomy (p=0.004). 21/60 surgeries in the PET–CT arm and 38/73 in the CT arm were futile (i.e. posiitive mediastinum, distant disease,p=0.05). Survival and number of curative surgeries were no different between the arms.

While it has been long known that PET added significantly to the sensitivity and specificity of lung cancer staging, this is the first study to demonstrate that it results in clinically meaningful results. A reduction in the number of unnecessary thoracotomies would represent a reduction in the cost of treating NSCLC, both financially and in terms of the morbidity and mortality of the procedure itself.