Early warning report
Clinical benefit of PET integrated with CT for non-small-cell lung cancer
Health technology assessment
|Updated
Clinical effectiveness of PET-CT compared to conventional investigations for patients with non-small-cell lung cancer.
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Key message
Positron emission tomography is a radioisotope imaging technique which, when integrated with computer tomography (PET-CT), can be a useful investigation in patients with lung cancer. For patients with non-small cell lung cancer (NSCLC) surgery is the primary curative treatment. However, surgery is seldom performed if the cancer has spread outside the lung. PET-CT investigations are helpful in finding metastases and help identify patients who will not benefit from surgery.
Question: What is the clinical effectiveness of PET-CT compared to conventional investigations for patients with NSCLC?
Systematic search:We searched in all relevant databases September 1, 2009 and included one systematic overview and two randomized controlled trials.
Clinical efficacy: One of every six patients with NSCLC that will not benefit from surgery because of advanced disease can, with the help of PET-CT, avoid futile surgery. One out of every 24 patients are probably wrongly diagnosed and excluded from potentially curative surgery. The studies showed no effect on survival. PET-CT increases the precision in staging of NSCLC. There is not sufficient research documentation to draw conclusions about whether or not PET-CT provides higher diagnostic accuracy than alternative methods when it comes to tumors smaller than 1cm and monitoring response to treatment.
Ongoing studies:Results of ongoing randomized controlled trials concerning the clinical usefulness of PET-CT for NSCLC may reveal important information about this subject.
Conclusion: Using PET–CT to stage the cancer before surgery probably eliminates the need of every sixth thoracotomy in patients with NSCLC. Every 24th patient was probably wrongly diagnosed and excluded from potentially curable surgery. Use of PET-CT probably does not affect long-term survival. The diagnostic accuracy of PET-CT is better than conventional methods for staging cancer in patients with NSCLC and investigation of solitary malignant lung infiltrates larger than 1 cm. There is insufficient data to draw a conclusion as to whether or not the usefulness of PET-CT in monitoring response to treatment. PET-CT is probably better at identifying malignant lymph nodes and distant metastases.