Source: Annual Congress 2009 - Epidemiology and management of lung cancer
Disease area: Thoracic oncology

Abstract

NICE recommended in 2005 that all patients being considered for radical lung cancer treatment should have a PET scan which is more sensitive than thoracic CT at detecting lung cancer. However PET scanning is unreliable at detecting cerebral metastasis due to background uptake of glucose by brain tissue. Our study aims to clarify the need for head imaging prior to surgery.
Patient databases were retrospectively examined for those having undergone PET and thoracic surgery between March 2007 and March 2008. We excluded those with small cell cancer and mesothelioma. We noted at the time of surgery if they had had a CT head prior to a PET scan and / or pre-operatively . We noted both their staging pre and post-operatively, and whether they had evidence of brain metastases up to the censure date (1st July 2008).
47 patients were identified who had had a PET scan and gone on to have thoracic surgery. 20 were females (43%) and 27 were males (57%). The mean age was 69.7 years (48-85). Only 6 patients (13%) had had pre-operative CT head imaging for neurological symptoms. The mean follow up from surgery to either death or the censure date was 239 days (2 - 468). No cerebral recurrences were seen. 10 patients died in total. 6 died in the immediate post operative stage. 1 died during adjuvant chemotherapy. 3 died during follow up. None of the 3 late deaths had CT imaging. None of the 3 had focal neurology, however 2 were confused.
Studies pre-PET showed cerebral recurrence rates of 5.8%-8.6% in the first year. No cerebral recurrences were seen in this study in those having undergone thoracic surgery. This suggests that the rate of recurrence post-operatively is lower in the post-PET era.

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Citations should be made in the following way:
L. Jones, L. Burke, P. Plant (Leeds, United Kingdom). Study to assess the utility of head CT in the staging of lung cancer in the post-PET era. Eur Respir J 2009; 34: Suppl. 53, 4694

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