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The Centers for Medicare and Medicaid Services has opened a new chapter in the practice of PET with the announcement for a national Medicare payment policy that expands coverage of PET scans in the initial treatment strategy of most solid cancers and for myeloma.

CMS determined that available scientific evidence was strong enough to show that FDG-PET could guide the appropriate initial treatment strategy for patients with suspected solid tumors and myeloma and lead to improved health outcomes.

CMS will reimburse PET imaging done for the initial diagnosis and management of breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroid cancers.

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Early PET-CT Predicts Treatment Response of Head and Neck Cancer
NEW YORK (Reuters Health) Nov 16 - In patients with advanced squamous cell carcinoma of the head and neck, negative findings on post-treatment positron emission tomography/computed tomography (PET-CT) predict a good treatment response, researchers say.

In 31 patients with clinical stage III and IV tumors treated with cisplatin and concurrent external beam radiotherapy, PET-CT was performed 6 to 8 weeks after therapy was completed, along with a comprehensive physical examination of the head and neck, as reported by Dr. James P. Malone, from the Southern Illinois School of Medicine, Springfield, and colleagues in the November Archives of Otolaryngology -- Head and Neck Surgery.

Seventeen patients had evidence of persistent disease on physical exam, CT, and/or PET-CT, and these individuals had surgery for further evaluation. Fourteen patients had complete clinical responses, including no evidence of FDG uptake on PET-CT; these subjects were observed with routine follow-up.

According to the researchers, all but one of these 14 patients remained disease free at the primary tumor site during a median follow-up of 26 months.

Thus, the authors point out, the sensitivity of PET-CT was 83%, and its negative predictive value was "excellent" at 92% for detection of persistent disease at the primary tumor site. Because of a high false-positive rate, specificity was low at 54%, with a positive predictive value of 31%.

Dr. Malone's group attributes the high false-positive rate to inflammation related to recent treatment.

The investigators also note that 5 of 16 patients with abnormal FDG update developed local disease. "For patients with abnormal FDG uptake at the primary site on early PET-CT and no evidence of local disease on physical examination, we recommend close outpatient follow-up with consideration of repeating PET-CT in 6 to 8 weeks or evaluation under anesthesia and biopsy of the primary tumor site," they said.

"On the basis of this study, PET-CT performed 6 to 8 weeks after the completion of (chemoradiotherapy) for advanced squamous cell carcinoma of the head and neck is a valuable tool for measuring treatment response and facilitating clinical decision making," the research team concludes.

Ref: Arch Otolaryngol Head Neck Surg 2009;135:1119-1125.