PET alters managementfor one in three patients

Preliminary results from the National Oncologic PET Registry indicate that FDG-PET led referring physicians to alter the clinical management for more than one-third of nearly 23,000 cancer patients who underwent the procedures.

The NOPR was devised to confirm that FDG-PET is as efficacious in clinical practice as it appeared to be in clinical trials. Those trials preceded the decision of the Centers for Medicare and Medicaid Services in 2005 to conditionally grant reimbursement for most applications for cancer diagnosis, staging, and treatment monitoring. The requirement for a registry, to be managed by the American College of Radiology Imaging Network, was included in Medicare’s coverage determination in order to measure FDG-PET’s influence on clinical decision making.

The first year of data compiled by the NOPR suggest that using FDG-PET as a cancer imaging tool for all types of malignancies makes sense, said coauthor Dr. Barry A. Siegel, director of nuclear medicine at the Mallinckrodt Institute of Radiology and cochair of the NOPR working group.

“Medicare should, when given the opportunity to look at these data formally, strongly consider opening up the coverage to include either all cancers or most cancers,” he said.

Siegel was part of a team of eight investigators who gathered the data under the lead of Dr. Bruce E. Hillner, associate chair of internal medicine at Virginia Commonwealth University. They reviewed 22,975 cases entered in the registry from May 8, 2006, to May 7, 2007. The most common cancer types in the registry affected the prostate, ovary and uterine adnexa, pancreas, and bladder.

On average, physicians changed their management in 36% of cases based on PET results. For 28% of the cases, FDG-PET led the referring physician to shift from nontreatment to treatment. For 8%, the imaging results led the physician to decide against treatment.

Researchers expressed satisfaction that NOPR results are consistent with prior published literature for covered cancers and expect that CMS will consider them in a positive way, Siegel said.

“We hope CMS shares our belief that these data go a long way toward demonstrating that it would be appropriate to cover additional cancers,” he said.