New Study Shows Impact of Low Adherence to Guideline-Based Imaging Before Radiotherapy on Outcomes in Medicare Patients With NSCLC

Get Permission

Investigators revealed that approximately one out of every two patients on Medicare who have non–small cell lung cancer (NSCLC) may not receive the appropriate imaging prior to receiving radiation therapy, according to a new study published by Sterbis et al in The Journal of Nuclear Medicine. Significant improvements in overall and cancer-specific survival rates were found among patients who underwent F-18–fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging—recommended by the National Comprehensive Cancer Network (NCCN)—compared with those who underwent CT imaging alone.


Screening for NSCLC with FDG-PET/CT imaging may offer high sensitivity for staging, and has been shown to change treatment decisions for up to 72% of patients with the disease. As such, the NCCN Guidelines currently recommend that all patients with recurrent NSCLC receive FDG-PET/CT imaging to evaluate for metastatic disease.

Study Methods and Findings

To assess guideline adherence, researchers conducted a retrospective study of patients with NSCLC in the Surveillance, Epidemiology, and End Results–Medicare linked database. Over 5,000 patients with NSCLC requiring radiation therapy were included in the study and were split into two cohorts: those who received only CT imaging and those who received FDG-PET/CT imaging. Next, researchers analyzed the overall and cancer-specific survival rates of both groups.

The analysis found that 56.3% of patients underwent FDG PET/CT imaging prior to radiation therapy, while 43.6% underwent CT imaging alone. When patient survival rates were compared over a 3-year follow-up period, those who received only CT imaging demonstrated statistically significant decreases in their overall and cancer-specific survival rates compared with those who received FDG PET/CT imaging.


“This research shows a clear lack of adherence to guidelines and raises important questions as to why. 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,” concluded study author Rustain L. Morgan, MD, MS, Associate Professor of Radiology; the Howard M. Sheridan, MD, Endowed Vice Chair of Education; and Director of the Diagnostic Radiology Residency program at the University of Colorado School of Medicine.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.