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Original Research: Lung Cancer |

Assessing the Usefulness of 18F-fluorodeoxyglucose PET-CT Scan After Stereotactic Body Radiotherapy for Early-Stage Non-small Cell Lung CancerUsefulness of 18F-fluorodeoxyglucose PET-CT Scan

Nicholas J. Pastis, Jr, MD, FCCP; Travis J. Greer, MD; Nichole T. Tanner, MD, FCCP; Amy E. Wahlquist, MS; Leonie L. Gordon, MBChB; Anand K. Sharma, MBBS; Nicholas C. Koch, PhD; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Division of Pulmonary/Critical Care (Drs Pastis, Greer, Tanner, and Silvestri), Public Health Services (Ms Wahlquist), the Department of Radiology (Dr Gordon), and the Department of Radiation Oncology (Drs Sharma and Koch), Medical University of South Carolina, Charleston, SC.

CORRESPONDENCE TO: Nicholas J. Pastis Jr, MD, FCCP, Division of Pulmonary/Critical Care, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425; e-mail: pastisn@musc.edu


FUNDING/SUPPORT: This study was supported by the National Center for Research Resources [UL1RR029882 and UL1TR000062].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):406-411. doi:10.1378/chest.13-2281
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BACKGROUND:  Although stereotactic body radiation therapy (SBRT) is an established treatment option for early-stage lung cancer, there are no guidelines for reassessing patients for local treatment failure or intrathoracic recurrence after treatment. This study reports the sensitivity, specificity, and positive and negative predictive values for 18F-fluorodeoxyglucose (FDG) PET-CT scanning when used to evaluate patients after SBRT.

METHODS:  Charts were reviewed of all patients who received SBRT and a subsequent FDG PET-CT scan at a university hospital over a 5-year period. Pretreatment and 3-month posttreatment tumor characteristics on PET-CT scan and outcome data (adverse events from SBRT, need for repeat biopsy, rate of local treatment failure and recurrent disease, and all-cause mortality) were recorded.

RESULTS:  Eighty-eight patients were included in the study. Fourteen percent of patients (12 of 88) had positive 3-month PET scans. Of the positive results, 67% (eight of 12) were true positives. Eighty-six percent (76 of 88 patients) had negative 3-month FDG PET-CT scans, with 89% (68 of 76) true negatives. FDG PET-CT scan performed 3 months after SBRT for non-small cell lung cancer (NSCLC) had a sensitivity of 50% (95% CI, 0.26-0.75), a specificity of 94% (95% CI, 0.89-1.0), a positive predictive value of 67% (95% CI, 0.4-0.93), and a negative predictive value of 89% (95% CI, 0.83- 0.96).

CONCLUSIONS:  FDG PET-CT scan 3 months after treatment of NSCLC with SBRT was a specific but insensitive test for the detection of recurrence or treatment failure. Serial CT scans should be used for early surveillance following SBRT, whereas FDG PET-CT scans should be reserved to define suspected metastatic disease or to evaluate new abnormalities on CT scan, or for possible reassessment later in the follow-up period after radiation-related inflammation subsides.

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