An audit of fusion CT-PET in the management of colorectal liver metastases

Khan, Sadia; Tan, Yu Guang; John, Abraham S.; Isaac, J.; Singhvi, Shashi; Guest, Peter; Mirza, D.

doi:10.1016/j.ejso.2006.02.003

Cited by 22 publications

(9 citation statements)

References 18 publications

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“…At present, integrated PET/CT is considered the state of the art for oncologic staging. For clinical implementation of the results of the present study, this means that most probably the number of clinically significant 18 F-FDG PET findings that are disregarded by multidisciplinary teams will decrease, because integrated 18 F-FDG PET/CT provides immediate and a direct correlation of functional changes depicted by 18 F-FDG PET with anatomic abnormalities shown on CT (22). Thus, the actual reduction of futile laparotomies will be larger than 38%, especially because of the reduction of disregarded 18 F-FDG PET findings.…”

Section: Discussionmentioning

confidence: 99%

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

et al. 2009

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With the increasing possibilities for surgical treatment of colorectal liver metastases, careful selection of patients who may benefit from surgical treatment becomes critical. The addition of PET to 18 F-FDG may significantly improve conventional staging by CT. Up to now, definitive evidence that the addition of 18 F-FDG PET to conventional staging leads to superior clinical results and improved clinical management in these patients has been lacking. In this randomized controlled trial in patients with colorectal liver metastases, we investigated whether the addition of 18 F-FDG PET is beneficial and reduces the number of futile laparotomies. Methods: A total of 150 patients with colorectal liver metastases selected for surgical treatment by imaging with CT were randomly assigned to CT only (n 5 75) or CT plus 18 F-FDG PET (n 5 75). Patients were followed up for at least 3 y. The primary outcome measure was futile laparotomy, defined as any laparotomy that did not result in complete tumor treatment, that revealed benign disease, or that did not result in a disease-free survival period longer than 6 mo. Results: Patient and tumor characteristics were similar for both groups. The number of futile laparotomies was 34 (45%) in the control arm without 18 F-FDG PET and 21 (28%) in the experimental arm with 18 F-FDG PET; the relative risk reduction was 38% (95% confidence interval, 4%260%, P 5 0.042). Conclusion: The number of futile laparotomies was reduced from 45% to 28%; thus, the addition of 18 F-FDG PET to the work-up for surgical resection of colorectal liver metastases prevents unnecessary surgery in 1 of 6 patients.

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Section: Discussionmentioning

confidence: 99%

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

et al. 2009

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“…Multimodal treatment for liver/lung metastases is now being developed and recent systemic chemotherapy trials have demonstrated promising results [7, 18]. Any further improvements in survival rates will depend on both identifying patients earlier in order to surgically treat them in a more timely manner as well as in developing new and effective treatment modalities in the future [19,20,21]. …”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Digestive Cancer

Okuno¹

2007

Dig Surg

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Background: Due to the westernization of the diet in Japan, the incidence of colorectal cancer has increased 4.5 times in the last 25 years. In this review, the recent results of surgical treatment for colonic cancer and the future perspectives in Japan are described. Materials and Methods: A multi-institutional registry of large bowel cancer in Japan of 10,809 patients with colonic cancer treated from 1991 to 1994 was investigated. The data have been published in the Guidelines of the Japanese Society for Cancer of the Colon and Rectum (2005). Regarding laparoscopic surgery, 1,495 patients with colon cancer were examined in a multicenter study between April 1993 and August 2002. Results: Radical resection with a curative intent is appropriate for 83–99% of the patients with stage I–III localized colon carcinoma. Adequate lymphadenectomy, including paracolic, intermediate and principal node dissection (D3 lymphadenectomy), is of critical importance for both the accurate staging and local control of the disease. This treatment protocol has now been accepted as a ‘standard’ operation by Japanese colorectal surgeons. For patients undergoing a curative resection for colon cancer, the 5-year survival rates vary between 62 (stage III) and 91% (stage I). Adjuvant chemotherapy using 5-FU/leucovorin or oral compounds is commonly administered to patients with stage III disease. Laparoscopic surgery for colonic cancer yielded a comparable oncological outcome to that reported for conventional open surgery in the Japanese registry for all disease stages. Conclusion: Radical resection with a D3 lymphadenectomy provided satisfactory 5-year survival for patients with stage I–III colon cancer in Japan. However, the survival of patients with stage IV disease is still unsatisfactory (only a 14% 5-year survival). Any further improvements depend on both identifying such patients at an earlier stage as well as developing new and effective treatment modalities.

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“…18 Fluorodeoxyglucose positron emission tomography (FDG-PET) detects changes in glucose uptake and metabolism, and also provides information about the location of a cancer within tissues. It is now considered to be a sensitive and accurate technique, and several studies have suggested that it should be carried out before resection of liver metastases from CRC van der Hiel et al, 2001;Fernandez et al, 2004;Truant et al, 2005;Wiering et al, 2005;Khan et al, 2006).…”

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Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

et al. 2008

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We assessed the potential benefits of including systematic 18 fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting tumour recurrence in a prospective randomised trial. Patients (N ¼ 130) who had undergone curative therapy were randomised to undergo either conventional (Con) or FDG-PET procedures during follow-up. The two groups were matched at baseline. Recurrence was confirmed histologically. 'Intention-to-treat' analysis revealed a recurrence in 46 patients (25 in the FDG-PET group, and 21 in the Con group; P ¼ 0.50), whereas per protocol analysis revealed a recurrence in 44 out of 125 patients (23 and 21, respectively; P ¼ 0.60). In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers). Three false-positive cases of FDG-PET led to no beneficial procedures (two laparoscopies and one liver MRI that were normal). We failed to identify peritoneal carcinomatosis in two of the patients undergoing FDG-PET. The overall time in detecting a recurrence from the baseline was not significantly different in the two groups. However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P ¼ 0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0). Regular FDG-PET monitoring in the follow up of colorectal cancer patients may permit the earlier detection of recurrence, and influence therapy strategies.

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An audit of fusion CT-PET in the management of colorectal liver metastases

Cited by 22 publications

References 18 publications

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

Surgical Treatment for Digestive Cancer

Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

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An audit of fusion CT-PET in the management of colorectal liver metastases

Cited by 22 publications

References 18 publications

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with 18F-FDG PET: A Randomized Study

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with 18F-FDG PET: A Randomized Study

Surgical Treatment for Digestive Cancer

Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

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Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study

Improved Selection of Patients for Hepatic Surgery of Colorectal Liver Metastases with ¹⁸F-FDG PET: A Randomized Study