1
|
Kitajima K, Doi H, Kanda T, Yamane T, Tsujikawa T, Kaida H, Tamaki Y, Kuribayashi K. Present and future roles of FDG-PET/CT imaging in the management of lung cancer. Jpn J Radiol 2016; 34:387-99. [PMID: 27121156 DOI: 10.1007/s11604-016-0546-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) using 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluation in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool for managing patients with lung cancer. We discuss different patient management stages, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.
Collapse
Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomonori Kanda
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tetsuya Tsujikawa
- Department of Biomedical Imaging Research Center, Fukui University, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Hayato Kaida
- Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| |
Collapse
|
2
|
Sahiner I, Vural GU. Positron emission tomography/computerized tomography in lung cancer. Quant Imaging Med Surg 2014; 4:195-206. [PMID: 24914421 DOI: 10.3978/j.issn.2223-4292.2014.03.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/14/2014] [Indexed: 12/25/2022]
Abstract
Positron emission tomography (PET) using 2-(18F)-flouro-2-deoxy-D-glucose (FDG) has emerged as a useful tool in the clinical work-up of lung cancer. This review article provides an overview of applications of PET in diagnosis, staging, treatment response evaluation, radiotherapy planning, recurrence assessment and prognostication of lung cancer.
Collapse
Affiliation(s)
- Ilgin Sahiner
- Ankara Oncology Research and Training Hospital, Turkey
| | | |
Collapse
|
3
|
MacManus MP. Use of PET/CT for patient selection and radiation therapy target volume definition in patients with non-small-cell lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY PET scanning is having an increasing impact on the treatment of non-small-cell lung cancer with radiation therapy (RT) and chemoRT. It has a powerful impact on staging, often revealing evidence of more advanced, frequently incurable, disease in patients who would otherwise be considered suitable for treatment with potentially curative definitive RT. Approximately a third of curative RT candidates are found to be unsuitable for this often highly toxic form of treatment after PET, thereby ensuring that this intensive treatment is only given to those patients who might benefit from it. If a patient remains suitable for treatment with RT after PET staging, PET can play a further critical role in the targeting of the RT. Without the use of PET in this way, a quarter of patients or more would experience geographic misses, in which some tumor regions would be either underdosed or excluded entirely from treatment, thereby compromising the chances of a successful outcome. There is emerging evidence that the overall results of treatment with RT can be improved by the appropriate use of PET in non-small-cell lung cancer.
Collapse
Affiliation(s)
- Michael P MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrew‘s Place, East Melbourne, Victoria 3002, Australia
| |
Collapse
|
4
|
Mac Manus MP, Hicks RJ. The role of positron emission tomography/computed tomography in radiation therapy planning for patients with lung cancer. Semin Nucl Med 2012; 42:308-19. [PMID: 22840596 DOI: 10.1053/j.semnuclmed.2012.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Positron emission tomography (PET)/computed tomography (CT) has rapidly assumed a critical role in the management of patients with locoregionally advanced lung cancers who are candidates for definitive radiation therapy (RT). Definitive RT is given with curative intent, but can only be successful in patients without distant metastasis and if all gross tumor is contained within the treated volume. An increasing body of evidence supports the use of PET-based imaging for selection of patients for both surgery and definitive RT. Similarly, the use of PET/CT images for accurate target volume definition in lung cancer is a dynamic area of research. Most available evidence on PET staging of lung cancer relates to non-small cell lung cancer (NSCLC). In general clinical use, (18)F-fluorodeoxyglucose (FDG) is the primary radiopharmaceutical useful in NSCLC. Other tracers, including proliferation markers and hypoxia tracers, may have significant roles in future. Much of the FDG-PET literature describing the impact of PET on actual patient management has concerned candidates for surgical resection. In the few prospective studies where PET was used for staging and patient selection in NSCLC candidates for definitive RT, 25%-30% of patients were denied definitive RT, generally because PET detected unsuspected advanced locoregional or distant metastatic disease. PET/CT and CT findings are often discordant in NSCLC but studies with clinical-pathological correlation always show that PET-assisted staging is more accurate than conventional assessment. In all studies in which "PET-defined" and "non-PET-defined" RT target volumes were compared, there were major differences between PET and non-PET volumes. Therefore, in cases where PET-assisted and non-PET staging are different and biopsy confirmation is unavailable, it is rational to use the most accurate modality (namely PET/CT) to define the target volume. The use of PET/CT in patient selection and target volume definition is likely to lead to improvements in outcome for patients with NSCLC.
Collapse
Affiliation(s)
- Michael P Mac Manus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | |
Collapse
|
5
|
Pommier P, Morelle M, Perrier L, de Crevoisier R, Laplanche A, Dudouet P, Mahé MA, Chauvet B, Nguyen TD, Créhange G, Zawadi A, Chapet O, Latorzeff I, Bossi A, Beckendorf V, Touboul E, Muracciole X, Bachaud JM, Supiot S, Lagrange JL. Évaluation économique prospective de la radiothérapie guidée par l’image des cancers de la prostate dans le cadre du programme national de soutien aux thérapeutiques innovantes et coûteuses. Cancer Radiother 2012; 16:444-51. [DOI: 10.1016/j.canrad.2012.07.178] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
|
6
|
Association of Hospital Characteristics and Diagnosis With the Repeat Use of CT and MRI: A Nationwide Population-Based Study in an Asian Country. AJR Am J Roentgenol 2012; 198:858-65. [PMID: 22451552 DOI: 10.2214/ajr.11.6475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
FDG-PET in Lymphoma: Nuclear Medicine Perspective. PET Clin 2012; 7:21-33. [DOI: 10.1016/j.cpet.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Cerci JJ, Trindade E, Buccheri V, Fanti S, Coutinho AMN, Zanoni L, Linardi CCG, Celli M, Delbeke D, Pracchia LF, Pitela FA, Soares J, Zinzani PL, Meneghetti JC. Consistency of FDG-PET accuracy and cost-effectiveness in initial staging of patients with Hodgkin lymphoma across jurisdictions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:314-20. [PMID: 21816369 DOI: 10.1016/j.clml.2011.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/05/2011] [Accepted: 02/08/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. METHODS All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. RESULTS In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. CONCLUSION FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
Collapse
Affiliation(s)
- Juliano J Cerci
- Department of Nuclear Medicine, University of São Paulo Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Langer A. A systematic review of PET and PET/CT in oncology: a way to personalize cancer treatment in a cost-effective manner? BMC Health Serv Res 2010; 10:283. [PMID: 20932288 PMCID: PMC2959014 DOI: 10.1186/1472-6963-10-283] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 10/08/2010] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A number of diagnostic tests are required for the detection and management of cancer. Most imaging modalities such as computerized tomography (CT) are anatomical. However, positron emission tomography (PET) is a functional diagnostic imaging technique using compounds labelled with positron-emitting radioisotopes to measure cell metabolism. It has been a useful tool in studying soft tissues such as the brain, cardiovascular system, and cancer. The aim of this systematic review is to critically summarize the health economic evidence of oncologic PET in the literature. METHODS Eight electronic databases were searched from 2005 until February 2010 to identify economic evaluation studies not included in previous Health Technology Assessment (HTA) reports. Only full health economic evaluations in English, French, or German were considered for inclusion. Economic evaluations were appraised using published quality criteria for assessing the quality of decision-analytic models. Given the variety of methods used in the health economic evaluations, the economic evidence has been summarized in qualitative form. RESULTS From this new search, 14 publications were identified that met the inclusion criteria. All publications were decision-analytic models and evaluated PET using Fluorodeoxyglucose F18 (FDG-PET). Eight publications were cost-effectiveness analyses; six were cost-utility analyses. The studies were from Australia, Belgium, Canada, France, Italy, Taiwan, Japan, the Netherlands, the United Kingdom, and the United States. In the base case analyses of these studies, cost-effectiveness results ranged from dominated to dominant. The methodology of the economic evaluations was of varying quality. Cost-effectiveness was primarily influenced by the cost of PET, the specificity of PET, and the risk of malignancy. CONCLUSIONS Owing to improved care and less exposure to ineffective treatments, personalized medicine using PET may be cost-effective. However, the strongest evidence for the cost-effectiveness of PET is still in the staging of non-small cell lung cancer. Management decisions relating to the assessment of treatment response or radiotherapy treatment planning require further research to show the impact of PET on patient management and its cost-effectiveness. Because of the potential for increased patient throughput and the possible greater accuracy, the cost-effectiveness of PET/CT may be superior to that of PET. Only four studies of the cost-effectiveness of PET/CT were found in this review, and this is clearly an area for future research.
Collapse
Affiliation(s)
- Astrid Langer
- Institute of Health Economics and Health Care Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany.
| |
Collapse
|
10
|
Pommier P, Lievens Y, Feschet F, Borras JM, Baron MH, Shtiliyanova A, Pijls-Johannesma M. Simulating demand for innovative radiotherapies: An illustrative model based on carbon ion and proton radiotherapy. Radiother Oncol 2010; 96:243-9. [DOI: 10.1016/j.radonc.2010.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 03/30/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
|
11
|
Cerci JJ, Trindade E, Pracchia LF, Pitella FA, Linardi CCG, Soares J, Delbeke D, Topfer LA, Buccheri V, Meneghetti JC. Cost effectiveness of positron emission tomography in patients with Hodgkin's lymphoma in unconfirmed complete remission or partial remission after first-line therapy. J Clin Oncol 2010; 28:1415-21. [PMID: 20142591 DOI: 10.1200/jco.2009.25.4367] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To assess the cost effectiveness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with Hodgkin's lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment. PATIENTS AND METHODS One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management. RESULTS After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is -$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving. CONCLUSION FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil.
Collapse
Affiliation(s)
- Juliano J Cerci
- Department of Nuclear Medicine and Health Technology Assessment/Executive Direction, Heart Institute (InCor), University of SãoPaulo Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Remonnay R, Morelle M, Giammarile F, Pommier P, Carrère MO. [Impact of FDG-PET on radiation therapy: economic results of a STIC study]. Cancer Radiother 2009; 13:313-7. [PMID: 19493691 DOI: 10.1016/j.canrad.2009.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/04/2009] [Accepted: 03/08/2009] [Indexed: 11/27/2022]
Abstract
The aim of this study is to assess the effects of Positron Emission Tomography (PET) associated with computed tomography (CT) on resource allocation (costs and savings) of the following treatment in radiotherapy for non small cell lung cancers (NSCLC) and Hodgkin's diseases. A national prospective study was conducted in nine hospitals. Two treatment decisions made on the basis of CT only or on PET associated with, were compared in a before-after design. The direct medical cost of using PET was assessed by micro-costing. The costs of new exams and the costs and savings associated with changes in the chosen treatment were calculated on the basis of reimbursement rates. The economic study was conducted over 2 years and included 209 patients (97 patients with Hodgkin's disease and 112 with NSCLC). The mean cost of using PET, corresponding to an extra cost, was approximately 800 euro (50% for the radionuclide FDG). Radiotherapy treatments were modified for only 10% of patients with Hodgkin's disease with a minor impact on treatment costs versus 40% of patients with lung cancer with a reduction in mean treatment cost of more than 500 euro.
Collapse
Affiliation(s)
- R Remonnay
- Université de Lyon, and Centre Léon-Bérard, 28 rue Laennec, Lyon, France.
| | | | | | | | | |
Collapse
|
13
|
Mac Manus M, Hicks RJ. The use of positron emission tomography (PET) in the staging/evaluation, treatment, and follow-up of patients with lung cancer: a critical review. Int J Radiat Oncol Biol Phys 2008; 72:1298-306. [PMID: 19028270 DOI: 10.1016/j.ijrobp.2008.08.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 08/17/2008] [Accepted: 08/20/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Mac Manus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Australia
| | | |
Collapse
|