Abstract
Background: Molecular imaging methods are currently used in the management of patients with lung cancer. Compared to non-small cell lung cancer, less data are available about the impact of molecular imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging patients with small cell lung cancer (SCLC). Performing a systematic review and meta-analysis, we aimed to provide quantitative data about the impact of 18F-FDG PET/CT in staging SCLC.Methods: A comprehensive literature search of studies on the use of 18F-FDG PET/CT in patients with SCLC was performed. Three different databases were screened (PubMed/MEDLINE, EMBASE, and Cochrane library databases) until June 2019. Only articles describing the impact of 18F-FDG PET/CT in staging patients with SCLC were selected. A pooled analysis evaluating the change of binary SCLC staging (limited-stage vs. extensive-stage disease) using 18F-FDG PET/CT was carried out.Results: Nine articles including 721 patients with SCLC were included in the systematic review. Compared to conventional staging, a superior diagnostic accuracy of 18F-FDG PET/CT was found. A change of binary SCLC staging using 18F-FDG PET/CT was demonstrated in 15% (95% confidence interval, 9–21%) of patients with SCLC. Currently, it is not clearly demonstrated that the use of 18F-FDG PET/CT for staging may improve the survival outcome of patients with SCLC.Conclusions: 18F-FDG PET/CT is a useful molecular imaging method for staging patients with SCLC because it can change the management in a significant number of patients. More large prospective studies and cost-effectiveness analyses on the impact of 18F-FDG PET/CT in staging patients with SCLC are needed.
Highlights
METHODSNeuroendocrine tumors are ∼20% of all lung cancers, and small cell lung cancer (SCLC) is the most frequent neuroendocrine tumor of the lung
Nine articles including 791 patients who underwent 18F-FDG PET/Computed tomography (CT) were eligible for the systematic review [19,20,21,22,23,24,25,26,27]
Six articles about change of binary SCLC staging using 18F-FDG PET/CT in 277 patients were included in the meta-analysis [6, 20,21,22, 24, 27]
Summary
METHODSNeuroendocrine tumors are ∼20% of all lung cancers, and small cell lung cancer (SCLC) is the most frequent neuroendocrine tumor of the lung. Even if SCLC is usually highly sensitive to chemotherapy and radiation therapy, most patients develop recurrent disease [2, 3]. In patients with LD-SCLC, the standard treatment is usually chemotherapy plus thoracic radiation therapy. In this setting of patients, prophylactic cranial irradiation is indicated to increase overall survival. Using a binary staging system in SCLC patients, only disagreement on the presence or absence of metastatic lesions outside one hemithorax or malignant pleural effusion will have a significant impact on patient management [4]. Compared to non-small cell lung cancer, less data are available about the impact of molecular imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging patients with small cell lung cancer (SCLC). Performing a systematic review and meta-analysis, we aimed to provide quantitative data about the impact of 18F-FDG PET/CT in staging SCLC
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