This study aims to assess the influence of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) detection of recurrent disease on the management of patients with colorectal cancer and suspected recurrence. One hundred and twenty patients with suspected recurrence were studied with FDG-PET. Fifty-eight patients were referred for FDG-PET because of the elevation of serum tumour markers. Thirty-one patients were referred because of inconclusive results of conventional imaging modalities. Twenty-five patients had known recurrence and were referred for pre-surgical assessment. Six patients were referred because of abdominal pain. A major management change was considered when, as a consequence of FDG-PET results, medical treatment was changed to surgical, or surgical to medical or to no treatment. A minor management change was considered when changes were made within a treatment modality. Of the 58 patients with elevated serum carcinoembryonic antigen (CEA), FDG-PET detected recurrence and led to a major management change in 34 (58%). Eighteen underwent curative surgery and 16 were treated with systemic therapy. Of the 31 patients evaluated because of inconclusive results of conventional imaging modalities, FDG-PET was positive for recurrence in 24 and negative in seven. A major management change took place in 14 patients (45%). Of the 25 patients evaluated to rule out other sites of disease before surgery, FDG-PET did not show any other site of recurrence in 13 (52%) and showed more lesions in the remaining patients. Major management change took place in eight patients (32%). Overall, in the 120 patients studied, FDG-PET resulted in major management changes in 58 (48%), minor changes in four (3%) and no change in 54 (45%). It can be concluded that FDG-PET has a significant impact on the management of patients with suspected recurrence of colorectal cancer. FDG-PET detection of recurrence frequently allows curative surgical intervention. The early identification of distant metastases may also facilitate the implementation of systemic treatment.
Only few patients with PSA relapse after radical treatment will show clinically detectable disease. Although the natural history of recurrent prostate cancer is often one of the slowly progressing diseases, in some men it can be rapid and may need a salvage treatment. In general, time to PSA relapse, PSA velocity and PSA doubling time are useful in patient assesment. In patients with PCa disease relapse after primary therapy, salvage treatment for a local recurrence should only be offered to patients with little risk of already having metastases. In these patients a systemic imaging negative for metastases is mandatory, a positive biopsy is not always necessary before radiotherapy, but is mandatory before salvage prostatectomy. In patients with a high risk of distant metastases and suitable for systemic salvage therapy, a positive lesion must be obviously visualized with one of the currently available imaging techniques. Transrectal ultrasound has low accuracy in the detection of the recurrence. Multiparametric Magnetic Resonance Imaging may have a role in the early phase of PSA relapse. Conventional imaging, such as bone scan and CT, are not suggested in the initial phase of BCR. Today, it has been reported that PET/CT allows changing the therapeutic strategy (from palliative to curative treatment and vice-versa) in about 20% of cases. In recent years, the new radiotracer 18F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. The aim of the present paper is to evaluate the management of patients with BCR after radical treatment of PCa from the urologist point of view.
BackgroundOnly about 1% of all head and neck lateral or paramedian cancers described in the scientific literature shows, in staging, contralateral cervical adenopathy without ipsilateral pathological involvement of lymph nodes.Case PresentationThis case is one of them, in which 18F–FDG PET/CT scan is confirmed by pathology findings, and has correctly identified all metastatic disease foci.ConclusionsTo date, PET/CT is not recommended in head and neck cancer staging. However, the use of PET/CT in head and neck cancer staging can define possible metastatic disease foci, clarify c.e. CT suspicious findings and, in some cases, change the TNM stage, with a strong prognostic and therapeutic impact.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.