Non-small-cell Lung Carcinoma
Conditions
Keywords
Positron-Emission Tomography, PET Scan, Lung Cancer, Thoracic Surgery, Diagnostic, Randomized Controlled Trial, Oncology
Brief summary
Lung cancer remains the leading cause of cancer deaths in men and women. Although overall survival remains poor, early stage non-small cell lung cancer (NSCLC) is potentially curable. Improved staging has led to stage-specific therapies such that patients with early stage NSCLC are potential candidates for surgical resection, and those with more advanced disease are spared the morbidity and risk of mortality from thoracotomy and pulmonary resection. Despite contemporary staging techniques, 25-50% of patients who appear to have limited disease amenable to surgical resection go on to die from metastatic lung cancer. If occult micro-metastatic disease that becomes evident later could be detected reliably during the pre-operative assessment, patients harboring such disease could be spared a non-curative thoracotomy. PET imaging has the potential to detect mediastinal and extrathoracic metastatic disease not detected by conventional imaging modalities. This prospective, multicenter trial will enroll patients with biopsy-proven clinical stage I-IIIA NSCLC who are considered to be candidates for surgical resection with curative intent. Preoperatively, patients will be randomized to conventional staging for metastatic disease (CT liver/adrenals, total body bone scan, and CT with contrast or MRI with gadolinium of the brain) versus whole body PET or PET-CT and brain CT or MRI with contrast/gadolinium.
Interventions
PROCEDUREPET Imaging
Patients randomized to PET staging will undergo FDG-PET or PET-CT as well as some form of cranial imaging (CT or MRI)
Sponsors
Ontario Ministry of Health and Long Term Care
Ontario Clinical Oncology Group (OCOG)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histological or cytological proof of NSCLC * Stage I, II, or IIIA NSCLC based upon clinical staging * The primary lesion appears technically appropriate for surgical resection, based on information from the chest x-ray (CXR) and CT thorax. * Age over 18 years
Exclusion criteria
* Poor pulmonary function precluding radical surgery (inadequate pulmonary reserve for radical surgery) with predicted post-resection forced expiratory volume in 1 second (FEV1) \< 0.8 liter or \< 40% predicted, and diffusing capacity of the lung for carbon monoxide (DLCO) \< 40% predicted * Poor performance status (Eastern Cooperative Oncology Group \[ECOG\] 3-4) * Significant concurrent medical problems (e.g. uncontrolled diabetes, active cardiac problems, significant chronic obstructive pulmonary disease) making the patient unfit for surgery * Pregnant or lactating females * Unable to lie supine for imaging with PET * Patients with previously treated cancer other than non-melanotic skin cancer or carcinoma in situ of the cervix, unless disease-free for 5 years or greater * Patients who, at the time of the initial evaluation, have already undergone a whole body PET/PET-CT, CT brain, MRI brain, total body bone scan or mediastinoscopy within 8 weeks prior to randomization will be excluded. However, patients who have had a CT scan of the thorax with abdomen are not excluded. * Failure to provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Patients correctly upstaged by PET versus conventional staging | November 2007 |
Secondary
| Measure | Time frame |
|---|---|
| Patients erroneously understaged by PET versus conventional staging | November 2008 |
| Overall survival | August 2012 |
| Prognostic ability of PET standard uptake value | August 2011 |
| Sensitivity and specificity of PET in the mediastinum | November 2008 |
| Cost-effectiveness of using PET versus conventional staging | August 2012 |
Countries
Canada
Outcome results
None listed