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David S. Ettinger, MD, FACP, FCCP


Study Finds Link Between Guideline Adherence for Imaging and Survival in NSCLC

By: Vanessa A. Carter, BS
Posted: Thursday, March 23, 2023

Rustain Morgan, MD, MS, of the University of Colorado, Aurora, and colleagues evaluated whether the use of fluorodeoxyglucose positron-emission tomography (FDG PET/CT) imaging prior to radiation therapy in patients with non–small cell lung cancer (NSCLC), as recommended by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®), impacts cancer-specific survival. Published in The Journal of Nuclear Medicine, this study revealed that many patients are not being imaged according to guidelines, which appears to correlate with lower survival.

“This research shows a clear lack of adherence to guidelines and raises important questions as to why,” noted Dr. Morgan in a press release. “We believe these findings are the tip of the iceberg for guideline nonadherence. More work needs to be done in order to better understand the scope of the issue, with future work focused on interventions [that] ensure guideline adherence.”

This retrospective study focused on 5,017 patients who were diagnosed with NSCLC who underwent FDG PET/CT– or CT-based imaging prior to subsequent radiation therapy. Eligible participants received their first treatment within 6 months of diagnosis and had subsequent radiation therapy within 36 months of initial treatment completion.

Despite the recommendations in the NCCN Guidelines, just over half of patients underwent FDG PET/CT prior to subsequent radiation therapy (56.3%), with the remainder undergoing CT alone. Of note, patients who initially received chemotherapy had decreased use of PET/CT compared with those first treated with surgery (38.9% vs. 65.4%). In addition, there was a significant improvement in cancer-specific survival observed in participants who had FDG PET/CT imaging before radiation therapy compared with those who underwent CT alone (P < .0001).

Additionally, patients receiving CT alone rather than FDG PET/CT prior to radiotherapy demonstrated a lower overall survival (P < .0001) when controlling for histologic subtype, initial diagnostic imaging, and initial stage. Overall, male sex, histologic subtype other than adenocarcinoma, increased age, higher disease stage, and initial diagnostic imaging with CT alone correlated with decreased survival.

Disclosure: For full disclosures of the study authors, visit

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