PET-CT scanners reduce futile lung cancer surgery

By Gene Emery

BOSTON (Reuters) - Devices that simultaneously take a PET scan and a CT scan can eliminate unnecessary surgery for lung cancer, although they do little to save lives, researchers in Denmark reported on Wednesday.

"Our study is the first to test PET-CT in a randomized setting in any cancer," Barbara Fischer of Copenhagen University Hospital, who led the study, said in the New England Journal of Medicine.

A computed tomography or CT scan uses X-rays to look at anatomy. Positron emission tomography or PET scans detect cell activity and can help light up fast-growing tumors.

"When performing a stand-alone PET, you will lack anatomical details," Fischer said via e-mail. "In a PET-CT you get both metabolic and anatomic details in one examination."

Her team studied 189 volunteers with newly diagnosed cancer, whose tumors were thought to be treatable with surgery based in part on a CT scan.

After further examination, 18 of the 91 people who received conventional evaluation were judged to have inoperable cancer, compared to 38 of 98 scanned by a PET-CT unit.

That left 73 people who underwent surgery after conventional evaluation, and 60 who were operated on after being scanned by a PET-CT unit.

Out of those, doctors determined after surgery that 38 patients who did not get the combined scan endured surgery that ended up not helping them, compared with 21 evaluated with PET-CT.

Fisher said the results will make it unjustifiable to perform surgery on a patient with lung cancer "without performing a PET-CT as part of the staging procedures, before reaching a decision on operability."

She said PET-CT scans probably improve the quality of life for non-small-cell lung cancer patients by eliminating unnecessary surgery, although "it should be stressed that we have not performed a quality-of-life analysis."

Fischer said she worried that people who skipped surgery because of the scans might die sooner. But she added: "We were glad to conclude that this was not the case."

The devices are widely available in the United States and a number of western European countries, although they are relatively scarce in places like Norway and Sweden.

(Editing by Maggie Fox and Sandra Maler)