| Summary: | Objective: To determine the impact of Fluorine-18 fluorodeoxy glucose (18F-FDG) positron emission tomography
with computed tomography (PET/CT scan) on management of non-small cell lung cancer (NSCLC) in contexts
of university-based hospital in Thailand where most patients were in advanced disease and conventional imaging
(CI) had previously been done.
Methods: Between December 2006 to December 2014, PET/CT scan and CI - e.g. chest and upper abdominal CT scan
and bone scintigraphy of 120 pathologically proven NSCLC patients were independently reviewed. Stagings based
on CI and PET/CT scan were evaluated. Proposed treatment plan based on CI and given treatment based on PET/
CT scan were compared in patients whose medical records were available. Impact of PET/CT scan on management
was categorized into inter-modality and intra-modality treatment change – i.e. change in radiation fields.
Results: Of 120 NSCLC patients, PET/CT scans were performed for initial staging (INS) in 60 patients, post-
treatment evaluation (PTE) in 41 patients and restaging at time of recurrence or progression (RR) in 19 patients.
PET/CT scan changed the disease status in 38 patients (31.7%). Changes to more advanced and less advanced disease
were found in 26 patients (11 INS, 8 PTE and 7 RR patients) and 12 patients (3 INS, 6 PTE and 3 RR patients),
respectively. Among 83 patients with available proposed treatment plan, inter-modality treatment changes were
observed in 19 patients (22.9%). Changes were more frequent in setting of PTE and RR (14/19 patients; 73.7%). The
most common changes were toward palliative chemotherapy (15/19 patients, 78.9%) owing to unexpected distant
metastasis. Among 43 patients who received radiation therapy, changes in radiation approach were found in 18
patients (41.9%), mostly due to positive or negative lymph node (LN) metastasis.
Conclusion: PET/CT scan has considerable impact on staging and both inter-modality and intra-modality treatment
change in NSCLC patients in all settings – INS, PTE and RR even with the presence of CI. Therefore, PET/CT scan
should be considered for staging and guiding the multidisciplinary treatment.
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