The impact of positron emission tomography (PET) on expected management during cancer treatment

Background: Positron emission tomography (PET) performed during cancer therapy (treatment monitoring) has shown promise for predicting treatment outcome. However, when used for this purpose, PET generally is not considered standard care. Under the Medicare 'coverage with evidence development' policy, PET (and integrated PET/computed tomography) became a covered service for treatment monitoring if prospective registry data were collected. METHODS: The National Oncologic PET Registry collected questionnaire data on intended patient management before and after PET. Data were available from 8240 patients who had 10,497 treatment-monitoring PET scans at 946 centers; these studies were used to monitor chemotherapy alone (82%), radiation therapy alone (6%), or combined-modality treatment (12%). Ovarian, pancreatic, and lung cancers accounted for 37% of the cohort. In 54% of scans, the pre- PET summary stage was metastatic disease. RESULTS: If PET had not been available, then the pre- PET plan would have been other imaging (53%), ongoing treatment (41%), or biopsy or watching (6%). Change in the post-PET intended management was similar in the imaging and treatment groups: 26% to 28% of scans to switching to another therapy, and 16% to 19% scans led to adjustment of the dose or duration of therapy. Changes in management were more frequent if the referring physician judged that the post-PET prognosis was worse rather than improved or unchanged (78% vs 40%). The physicians indicated that PET enabled 91% of their patients to avoid future tests. CONCLUSIONS: Physicians often report plans to modify their therapeutic plans in elderly cancer patients when PET is used for treatment monitoring. Cancer 2009;115:410-8.