Lung Cancer 45 Suppl. 2 (2004) S75–S78 www.elsevier.com/locate/lungcan Value of FDG PET in the management of NSCLC D. Ukena a, *, D. Hellwig b a Medizinische Universit¨ atsklinik, Innere Medizin V, b Radiologische Universit¨ atsklinik, Klinik f¨ ur Nuklearmedizin, Universit¨atsklinikum des Saarlandes, D-66421 Homburg, Germany KEYWORDS Lung cancer; PET; Response assessment; Radiotherapy planning Summary Metabolic imaging with positron emission tomography (PET) using 18 F-fluoro-2-deoxy-glucose (FDG) has been accepted as an important imaging modality in lung cancer. FDG PET may have important impacts on the management of lung-cancer patients, for instance by improvement of locoregional (mediastinal) and extrathoracic staging (unexpected metastases). Interesting findings have now been reported in the response assessment to induction therapy providing results of greater prognostic significance than that obtained by conventional imaging methods. In the field of thoracic irradiation, FDG PET may provide advantages in terms of reduced toxicity, treatment intensification, better local tumour control and increased survival. © 2004 Elsevier Science Ltd. 1. Introduction Positron emission tomography (PET) using 18 F- fluoro-2-deoxyglucose (FDG) consistently proved to be superior to structure-based imaging modalities in both the diagnosis and staging of lung cancer. The standard clinical indications for FDG PET imaging in lung cancer have been detailed in recent reviews [1,2]. In most of these indications, the use of PET has to be validated in multi-centre large-scale randomised studies, focussing mainly on treatment outcome parameters, survival and cost-efficacy. With respect to the implications of FDG PET for the therapeutic management in non- * Correspondence to: Dieter Ukena MD, PhD. Klinik f¨ ur Pneumologie, Klinikum Bremen-Ost, Z¨ uricher Str. 40, D-28235 Bremen, Germany. Tel.: +49-(421)-408-1800; fax: +49-(421)-408-2801. E-mail: Dieter.Ukena@Klinikum-Bremen-Ost.de small-cell lung cancer (NSCLC), several aspects may be considered: – detection of distant metastases/change of stage; – response assessment after induction therapy; – radiotherapy planning. There is convincing evidence that FDG PET is very accurate in the mediastinal lymph-node staging. With the high negative predictive value, a negative mediastinum on FDG PET may lead directly to thoracotomy, without further preoperative mediastinal staging [3,4]. The impact of FDG PET on mediastinal lymph-node staging in NSCLC will be dealt with by other contributors to this symposium. 2. Detection of distant metastases/ Change of tumour stage PET has the ability to detect metastatic disease unrecognised by conventional staging algorithms. 0169-5002/$ – see front matter © 2004 Published by Elsevier Ireland Ltd. doi:10.1016/j.lungcan.2004.07.000