PET Scanning Found To Be Powerful Imaging Modality Across all Cancer Types

With the most recent release of data from the U.S. oncologic PET registry, researchers validated the effectiveness of positron emission tomography (PET) imaging in the monitoring of tumor activity across a broad range of cancers.

The registry, called the U.S. National Oncologic PET Registry (NOPR), is a collaboration of the American College of Radiology Imaging Network (ACRIN; Philadelphia, PA, USA), the American College of Radiology (ACR; Philadelphia, PA, USA), and the Academy of Molecular Imaging (AMI; Los Angeles, CA, USA). "During the first year of the study, we verified that PET finds more areas of active cancer than other imaging tools and leads, in some cases, to earlier initiation of subsequent treatment,” said Bruce E. Hillner, M.D., professor of medicine at Virginia Commonwealth University (Richmond, VA, USA), and lead author of the article. "We noted that PET has a clinically significant impact on cancer management, resulting in a change in treatment in more than one out of three cases--or 36% of the time.”

In the article, published in the December 2008 issue of The Journal of Nuclear Medicine (JNM), researchers reported results by cancer type for the first two years of data collected from nearly 41,000 PET studies conducted at more than 1,300 cancer centers nationwide. Analysis was restricted to the use of PET for staging, restaging or detection of suspected recurrences in patients with pathologically proven cancers.

Study data released in March 2008 showed a striking consistency of the impact of PET on referring physicians' intended management plans. At that time, NOPR researchers felt that the significance of the evidence was such that they formally asked the Centers for Medicare and Medicaid Services (CMS) to reconsider the current U.S. National Coverage Determination on oncologic use of PET.

"As a result of the data, the follow-up question for the second year was: Does the impact of PET vary between cancers?” questioned Dr. Hillner. "We found that it did not vary significantly, and that changes in treatment plans for rare cancers--such as stomach cancer--clustered around the same one-third mark as the more common cancers. As a result, we believe that coverage for PET in the staging, restaging and detection of recurrence of cancer should be handled the same across the board.”

According to the researchers, a considerable body of national and international literature now exists showing that PET is a highly effective technique for imaging cancer. "From the data, we concluded that, although the effectiveness of PET may differ somewhat between individual cancers, it's in the same ballpark,” said Barry A. Siegel, M.D., professor of radiology at the Mallinckrodt Institute of Radiology (St. Louis, MO, USA) and one of the co-authors of the article. "This result was a little unexpected, but leads us to believe that a continual parsing of PET's usefulness, cancer by cancer and indication by indication, for purposes of reimbursement does not make clinical sense.”

The NOPR was launched in 2006 in response to a proposal from CMS to expand coverage for PET in the United States to include cancers and indications not presently eligible for reimbursement, including cancers of the ovary, uterus, prostate, pancreas, stomach, kidney, and bladder. "The NOPR has been a collaborative process with CMS,” said Dr. Siegel. "The purpose of our partnership has been to get the best data into the public domain for decision-making. We are hopeful that a decade-long process leading to an understanding of the usefulness of PET in cancer management is finally completed.”

A draft decision by CMS is expected on January 10, 2009. Following a 30-day comment period, the final U.S. National Coverage Determination will be made April 9, 2009.

Related Links:
National Oncologic PET Registry
Virginia Commonwealth University
Mallinckrodt Institute of Radiology