One year report from the T.R.P. A.P.-H.P. center; Impact of the PET with [18F] - FDG on the medical decision in oncology

The clinical usefulness of FDG-PET has been recognised by the French Medicine Agency since 1998. A PET centre equipped with a dedicated camera suited for oncological routine examination has been opened at the beginning of the year 2000, associating 5 hospitals and their network of oncologists. The present article has several aims. It reports quantitatively, monthly and indication by indication on the number of examinations performed during the opening year, to give possibly helpful information to the future PET centres in France. During the year 2000, 656 FDG-PET examination has been performed in 605 patients, who dwelt in Paris for 28% of them, in the rest of Ile de France region for 47 %, in other French regions or even abroad for 25%. 83% of the patients came has out-patients. The article also briefly enumerates the clinical study protocols that have been designed and approved by the Scientific Committee and started during the year 2000, the inclusions being still underway. Finally, the article includes the main results of our study on the clinical impact of FDG-PET. Such results have been already published outside France: in a meta-analysis involving more than 5000 patients, the modification rate of patients' management was calculated to be 30%. However, the evaluation of this impact from the referring clinician's perspective that seems more impartial has only been performed recently by two Californian teams by means of a questionnaire retrospective survey. We used the same questionnaire (translated into French language) and the same methodology. One questionnaire was sent to the referring physician for each of the 476 who underwent a routine FDG-PET study for a registered clinical indication during the year 2000. 348 responses (73%) were received and included in the study. Globally, the disease was upstaged in 26% of the cases and down-staged in 9%. Inter-modality management changes (change from a scheduled therapeutic modality for a different one) were reported in 37% of the cases and intra-modality changes in 9%. When comparing with the similar studies performed in California in 1999, there were no significant differences between the rates of inter-modality management changes. In contrast, intra-modality management changes were less frequent in our survey, except for lymphoma. Globally the clinical impact of FDG PET was similar, with a higher response rate in our study (73% versus 35%); it was slightly higher than the rate derived from a recent meta-analysis in more than 5000 patients. (author)