Persons with limited-stage small cell lung cancer (LS-SCLC) exhibited better disease control and survival when staged with positron emission tomography (PET) than did patients who did not undergo staging with PET.
According to a statement from the International Association for the Study of Lung Cancer (IASLC), approximately 39% of persons with SCLC have limited-stage disease, in which the cancer is present in only one lung but may have metastasized to lymph nodes or tissues situated between the lungs (intrathoracic disease). Until 2011, the National Comprehensive Cancer Network had recommended a bone scan as part of the initial evaluation of all persons with a new diagnosis of SCLC. In 2012, however, the alliance began recommending PET computed tomography (CT) instead of bone scans.
To assess the clinical impact of PET staging in LS-SCLC, researchers administered concurrent chemoradiation to 54 consecutive persons with LS-SCLC. Most patients (40) underwent PET, 14 did not, and all underwent thoracoabdominopelvic CT and magnetic resonance imaging neuroimaging. Although more PET-staged patients had presented with nodal metastases, most patient characteristics were balanced between the comparison groups.
Median overall survival from diagnosis was 32 months for PET-staged patients, compared with 17 months in persons staged without PET. Those who underwent staging with PET also had better 3-year survival, at 47% vs 19%.
Median time-to-distant failure was 29 months with PET, compared with 12 months without PET. Median time-to-local failure, which was 16 months in the non-PET group, was not reached in the PET group.
As the authors concluded in the IASLC’s Journal of Thoracic Oncology (2013;8:899-905), improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in persons with LS-SCLC.