Effect of PET/CT on Management of Patients with Non–Small Cell Lung Cancer: Results of a Prospective Study with 5-Year Survival Data

F-FDG PET/CT in patientswith non–small cell lung cancer (NSCLC) being considered forpotentially curative therapies. Methods: Information on 168consecutive patients with NSCLC being considered for surgeryor definitive radiotherapy with curative intent before PET/CTwas entered into a prospective database. The pre-PET/CTmanagement plan, based on conventional imaging (conven-tional CT, appropriately supplemented by bone scintigraphyor other modalities), was defined prospectively by referringclinicians before PET/CT results became available. After PET/CT, actual clinical management was recorded, and patientswere followed up until 5 y or death. The appropriateness ofPET/CT management plans was assessed by biopsy whenavailable, clinical follow-up, and survival analysis. Results:Stage was discordant on PET/CT and conventional imaging in50.6% of patients (41.1% upstaged, 9.5% downstaged), withhigh management impact (change in treatment modality or cu-rative intent) in 42.3% of patients. Both conventional imagingstage and PET/CT stage were strongly predictive of overall sur-vival (OS) but there were greater differences between hazardrates and separations in the OS curves for stage groupingsdetermined using PET/CT. OS was also strongly predicted byPET/CT-directed choice of therapy (P , 0.0001). Conclusion:PET/CT frequently affects patient management and stronglypredicts OS in NSCLC, supporting the appropriateness of suchchanges.Key Words: non–small cell lung cancer; positron emissiontomography; CT; PET/CT; diagnosis; treatmentJ Nucl Med 2012; 53:1–9DOI: 10.2967/jnumed.111.099713