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Prognostic Significance of (18) F-Fluorodeoxyglucose – Positron Emission Tomography After Treatment in Patients With Limited Stage Small Cell Lung Cancer

Adedayo A. Onitilo, MD, MSCR, FACP, Department of Hematology/Oncology Marshfield Clinic – Weston Center 3501 Cranberry Boulevard Weston, Wisconsin 54476
Jessica M. Engel, MSN, FNP, Department of Hematology/Oncology Marshfield Clinic 1000 North Oak Avenue Marshfield, Wisconsin 54449
Jennifer M. Demos, BA, Department of Hematology/Oncology Marshfield Clinic 1000 North Oak Avenue Marshfield, Wisconsin 54449
Bickol Mukesh, PhD, Biomedical Informatics Research Center Marshfield Clinic Research Foundation 1000 North Oak Avenue Marshfield, Wisconsin 54449

Reprint Requests: Adedayo A. Onitilo, MD, MSCR, FACP, Marshfield Clinic – Weston Center, 3501 Cranberry Boulevard, Weston, WI 54476, Tel: 715-393-1400, Fax: 715-393-1399, Email: onitilo.adedayo{at}marshfieldclinic.org

Objective: Small cell lung cancer (SCLC) represents 15% to 25% of lung cancers. Despite favorable initial treatment response rates, recurrence is likely and long-term prognosis dismal. Accurate measurement of therapy response is critical to determine which patients might be spared additional treatment, and potential side effects. ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) may help distinguish necrotic or fibrous tissue from residual cancer, thus informing further treatment and prognosis.

Design/Setting/Participants and Methods: Retrospective chart review study of limited stage SCLC patients with PET scanning within 4 months post-chemotherapy at Marshfield Clinic, Marshfield, Wisconsin. Diagnosis of SCLC occurred from December 1, 2001 through December 31, 2007.

Results: Twenty-two patients (~7%) had post-treatment PET: 11 positive, 11 negative. Median duration from last chemotherapy to PET was 36 days (range, 3 to 125 days). Median follow-up for all patients was 34.4 months (range, 6.8 to 65.9 months). Estimated median progression-free survival for all patients was 8.1 months (95% confidence intervals [CI], 4.3 to 11.9 months), 10.5 months for PET negative (95% CI, 8.1 to >57.8 months) and 4.3 months for PET positive patients (95% CI, 2.8 to >7.2 months) (P<0.007, log-rank test). Median survival for all patients was 19.2 months (95% CI, 10.3 to >65.8 months). Estimated median survival for PET negative patients was longer than PET positive (29.2 versus 10.3 months, P=0.10).

Conclusion: Post-treatment PET, prognostically significant, may be underutilized.

Key Words: ¹⁸F-FDG-PET • Limited stage small cell lung cancer • Prognosis • Recurrence • Treatment