Preoperative staging of lung cancer with combined PET-CT

Barbara Fischer; Ulrik Lassen; Jann Mortensen; Søren Larsen; Annika Loft; Anne Bertelsen; Jesper Ravn; Paul Clementsen; Asbjørn Høgholm; Klaus Larsen; Torben Rasmussen; Susanne Keiding; Asger Dirksen; Oke Gerke; Birgit Skov; Ida Steffensen; Hanne Hansen; Peter Vilmann; Grete Jacobsen; Vibeke Backer; Niels Maltbaek; Jesper Pedersen; Henrik Madsen; Henrik Nielsen; Liselotte Højgaard

doi:10.1056/NEJMoa0900043

Preoperative staging of lung cancer with combined PET-CT

Barbara Fischer, Ulrik Lassen, Jann Mortensen, Søren Larsen, Annika Loft, Anne Bertelsen, Jesper Ravn, Paul Clementsen, Asbjørn Høgholm, Klaus Larsen, Torben Rasmussen, Susanne Keiding, Asger Dirksen, Oke Gerke, Birgit Skov, Ida Steffensen, Hanne Hansen, Peter Vilmann, Grete Jacobsen, Vibeke BackerNiels Maltbaek, Jesper Pedersen, Henrik Madsen, Henrik Nielsen, Liselotte Højgaard

Department of Clinical Medicine

405 Citations (Scopus)

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.)

Original language	English
Journal	New England Journal of Medicine
Volume	361
Issue number	1
Pages (from-to)	32-9
Number of pages	8
ISSN	0028-4793
DOIs	https://doi.org/10.1056/NEJMoa0900043
Publication status	Published - 2009

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10.1056/NEJMoa0900043

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Fischer, B., Lassen, U., Mortensen, J., Larsen, S., Loft, A., Bertelsen, A., Ravn, J., Clementsen, P., Høgholm, A., Larsen, K., Rasmussen, T., Keiding, S., Dirksen, A., Gerke, O., Skov, B., Steffensen, I., Hansen, H., Vilmann, P., Jacobsen, G., ... Højgaard, L. (2009). Preoperative staging of lung cancer with combined PET-CT. New England Journal of Medicine, 361(1), 32-9. https://doi.org/10.1056/NEJMoa0900043

Fischer, B, Lassen, U , Mortensen, J, Larsen, S, Loft, A, Bertelsen, A, Ravn, J, Clementsen, P, Høgholm, A, Larsen, K, Rasmussen, T, Keiding, S, Dirksen, A, Gerke, O, Skov, B, Steffensen, I, Hansen, H, Vilmann, P, Jacobsen, G, Backer, V, Maltbaek, N, Pedersen, J, Madsen, H, Nielsen, H & Højgaard, L 2009, 'Preoperative staging of lung cancer with combined PET-CT', New England Journal of Medicine, vol. 361, no. 1, pp. 32-9. https://doi.org/10.1056/NEJMoa0900043

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title = "Preoperative staging of lung cancer with combined PET-CT",

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.)",

author = "Barbara Fischer and Ulrik Lassen and Jann Mortensen and S{\o}ren Larsen and Annika Loft and Anne Bertelsen and Jesper Ravn and Paul Clementsen and Asbj{\o}rn H{\o}gholm and Klaus Larsen and Torben Rasmussen and Susanne Keiding and Asger Dirksen and Oke Gerke and Birgit Skov and Ida Steffensen and Hanne Hansen and Peter Vilmann and Grete Jacobsen and Vibeke Backer and Niels Maltbaek and Jesper Pedersen and Henrik Madsen and Henrik Nielsen and Liselotte H{\o}jgaard",

note = "Keywords: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Follow-Up Studies; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Preoperative Care; Sensitivity and Specificity; Thoracotomy; Tomography, X-Ray Computed",

year = "2009",

doi = "10.1056/NEJMoa0900043",

language = "English",

volume = "361",

pages = "32--9",

journal = "New England Journal of Medicine",

issn = "0028-4793",

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T1 - Preoperative staging of lung cancer with combined PET-CT

AU - Fischer, Barbara

AU - Lassen, Ulrik

AU - Mortensen, Jann

AU - Larsen, Søren

AU - Loft, Annika

AU - Bertelsen, Anne

AU - Ravn, Jesper

AU - Clementsen, Paul

AU - Høgholm, Asbjørn

AU - Larsen, Klaus

AU - Rasmussen, Torben

AU - Keiding, Susanne

AU - Dirksen, Asger

AU - Gerke, Oke

AU - Skov, Birgit

AU - Steffensen, Ida

AU - Hansen, Hanne

AU - Vilmann, Peter

AU - Jacobsen, Grete

AU - Backer, Vibeke

AU - Maltbaek, Niels

AU - Pedersen, Jesper

AU - Madsen, Henrik

AU - Nielsen, Henrik

AU - Højgaard, Liselotte

N1 - Keywords: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Follow-Up Studies; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Preoperative Care; Sensitivity and Specificity; Thoracotomy; Tomography, X-Ray Computed

PY - 2009

Y1 - 2009

N2 - 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.)

AB - 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.)

U2 - 10.1056/NEJMoa0900043

DO - 10.1056/NEJMoa0900043

M3 - Journal article

C2 - 19571281

SN - 0028-4793

VL - 361

SP - 32

EP - 39

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 1

ER -

Preoperative staging of lung cancer with combined PET-CT

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