Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review

  • M. Smoragiewicz British Columbia Cancer Agency
  • J. Laskin British Columbia Cancer Agency
  • D. Wilson British Columbia Cancer Agency
  • K. Ramsden British Columbia Cancer Agency
  • J. Yee Vancouver General Hospital
  • S. Lam British Columbia Cancer Agency
  • T. Shaipanich British Columbia Cancer Agency
  • Y. Zhai University of British Columbia
  • C. Ho British Columbia Cancer Agency
Keywords: non-small-cell lung cancer, positron-emission tomography–computed tomography, thoracotomy, lymphatic metastasis or pathology, mediastinal staging, endobronchial ultrasonography, mediastinoscopy, endoscopic ultrasonography

Abstract

Background

Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct.

Methods

We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009–2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery.

Results

Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease.

Conclusions

To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

Author Biography

M. Smoragiewicz, British Columbia Cancer Agency
Medical Oncology Resident
Published
2014-09-12
How to Cite
Smoragiewicz, M., Laskin, J., Wilson, D., Ramsden, K., Yee, J., Lam, S., Shaipanich, T., Zhai, Y., & Ho, C. (2014). Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review. Current Oncology, 21(6), e768-e774. https://doi.org/10.3747/co.21.2125
Section
Surgical Oncology