Evaluation of outcome prediction and disease extension by quantitative 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography in patients with small cell lung cancer.

OBJECTIVE: The objective of this study is to determine whether 2-deoxy-2-[18F] fluoro-D: -glucose with positron emission tomography (FDG-PET) imaging and quantitative PET parameters can predict outcome and differentiate patients with limited disease (LD) from extensive disease (ED) in patients with small cell lung cancer (SCLC).
METHODS: We retrospectively evaluated data from 25 patients who underwent either initial staging (Group A, n 12) or restaging (Group B, n 13) by conventional imaging methods and FDG-PET according to the simplified staging scheme developed by the Veterans Administration Lung Cancer Study Group-2. FDG-PET images were both visually and quantitatively evaluated with SUV(max), SUV(ave), total metabolic tumor volume (with SUV(max) > %50 and SUV(max) > 2.5), total lesion glycolysis (TLG) (with SUV(max) > %50 and SUV(max) > 2.5). The correlation between quantitative PET parameters, disease stages and survival were analyzed.
RESULTS: By conventional methods 14 of 25 (56%) patients were reported to have LD and 11 of 25 (44%) had ED. FDG-PET scan upstaged 9 out of 25 (36%) and downstaged 2 out of 25 (%8) patients. Among the quantitative PET parameters, TLGs were the only PET parameters that differentiated between Group A and Group B patients. FDG-PET staging (p = 0.019) could predict significant survival difference between stages on contrary to conventional staging (p = 0.055). Moreover, TLG [SUV(max) > %50] was the only quantitative PET parameter that could predict survival (p = 0.027).
CONCLUSION: FDG-PET imaging is a valuable tool in the management of patients with SCLC for a more accurate staging. The use of quantitative PET parameters may have a role in prediction of stage and survival.