PET for Mediastinal Restaging of Patients with Non Small Cell Lung Cancer after Induction Therapy

Abstract

Despite significant advancement in the multimodality approach to lung cancer, the optimal management of patients with stage IIIA non-small cell lung cancer (NSCLC) continues to be a challenge. Identifying pathological N2 disease is of importance because it significantly affects outcomes and potential treatment strategies. More widespread utilization of endobronchial ultrasound techniques and refinements in fluorodeoxyglucose positron emission tomography (FDG PET) imaging have considerably increased our ability to accurately stage patients with advanced lung cancer, consequently increasing the number of patients in the IIIA “borderline” resectable category. Improved stratification of patients in this category enables surgeons to select surgery for those most likely to benefit, improving outcomes and eliminating unnecessary thoracic morbidity. Recent phase III clinical trials demonstrate improved survival after surgical resection in patients who had mediastinal node clearance after induction therapy.^1–4 These data emphasize the potential utility of a highly accurate test to preoperatively identify those patients who have achieved clearance of their mediastinal nodal metastases after induction therapy. Such a test would allow surgeons to limit resection to those patients with the greatest likelihood of long term benefit.