Role of FDG-PET in the Pre-Operative Evaluation of Surgical Resection of Hepatic Metastases from Colorectal Cancer

Rk, Halkar; Toro, M. Á.; Eh, Lim; Staley, CA; St, Grafton; Ev, Garcia; Hoffman, James C.

doi:10.1016/s1095-0397(99)00095-3

Cited by 4 publications

(2 citation statements)

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“…Currently, there is a general consensus that PET/CT is the most accurate method for staging advanced colorectal cancer, particularly when metastasectomy is being considered and when the patient has possible locoregional recurrent disease. [86][87][88] In a comparison of contrast-enhanced CT vs combined PET/CT, Selzner et al 83 reported that CT and PET/CT provided similar information regarding hepatic metastases of colorectal cancer, with each modality having greater than 90% sensitivity for the detection of intrahepatic metastases. Combined PET/CT, however, was superior to CT alone for the detection of recurrent intrahepatic tumors after hepatectomy, extrahepatic metastases, and local recurrence at the site of the initial colorectal surgery.…”

Section: Imagingmentioning

confidence: 99%

Surgical Therapy for Colorectal Metastases to the Liver

Pawlik

Choti

2007

Journal of Gastrointestinal Surgery

203

118

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Colorectal cancer is the fourth most common type of cancer in the West and the second leading cause of cancer-related deaths in the United States. Approximately 35 to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease. Surgical resection of colorectal liver metastases represents the only chance at potential cure, and long-term survival can be achieved in 35 to 58% of patients after resection. The goal of hepatic resection should be to resect all metastases with negative histologic margins while preserving sufficient functional hepatic parenchyma. In patients with extensive metastatic disease who would otherwise be unresectable, ablative approaches can be used instead of or combined with hepatic resection. The use of portal vein embolization and preoperative chemotherapy may also expand the population of patients who are candidates for surgical treatment. Despite these advances, many patients still experience a recurrence after hepatic resection. More active systemic chemotherapy agents are now available and are being increasingly employed as adjuvant therapy either before or after surgery. Modern treatment of colorectal liver metastasis requires a multidisciplinary approach in an effort to increase the number of patients who may benefit from surgical treatment of colorectal cancer liver metastasis.

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Section: Imagingmentioning

confidence: 99%

Surgical Therapy for Colorectal Metastases to the Liver

Pawlik

Choti

2007

Journal of Gastrointestinal Surgery

203

118

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“…[12][13][14]29 Moreover, extensive preoperative staging involving positron emission tomography and magnetic resonance imaging might be performed in patients who have high scores but are otherwise suitable for major liver resection. [37][38][39][40][41] Similarly, intensities of follow-up may be organized according to individual prognosis.…”

Section: Validation Of the Prognostic Scoring Systemmentioning

confidence: 99%

Prognostic Scoring in Colorectal Cancer Liver Metastases

Schindl

Wigmore²,

Currie³

et al. 2005

Arch Surg

118

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Hypothesis: A prognostic scoring system for colorectal cancer liver metastases that is derived from unselected patients referred for hepatic resection would improve the applicability and increase the accuracy of prognostication. Design: Retrospective analysis of prospectively documented data; validation against an unrelated cohort from another institution. The median follow-up was 16.4 months (95% confidence interval, 15.0-17.8 months) (original cohort). Setting: Two tertiary referral centers at unrelated university hospitals. Patients: Independent prognosticators of survival were derived from 337 patients with colorectal cancer liver metastases referred for consideration of liver resection, and prognostic scores were calculated in 269 patients (79.8%) (original cohort). Calculation of prognostic scores was also applied to 193 patients referred and treated in an unrelated institution (validation cohort). Main Outcome Measures: Kaplan-Meier survival curve analysis (log-rank test) between different prognostic groups in the original and the validation cohorts. Results: Independent prognosticators of survival were Dukes stage, number of metastases, and serum concentrations of carcinoembryonic antigen, alkaline phosphatase, and albumin. Significant differences were found in cumulative overall survival between patients assigned to good, moderate, and poor prognoses in the original and validation cohorts (PϽ.05). Liver resection improved survival in all prognostic groups. However, no patient with poor prognosis and only 19.7% (13 of 66) of patients with moderate prognosis survived 5 years, compared with 62.5% (10 of 16) of patients with good prognosis (PϽ.001). Conclusions: This prognostic scoring system is derived from and can be applied to patients with colorectal cancer liver metastases at the time of referral for consideration of surgery. Patients with poor prognosis have no long-term benefit from curative liver resection and should therefore be considered for combined multimodal treatment.

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Positron Emission Tomography/Computerized Tomography Functional Imaging of Esophageal and Colorectal Cancer

2004

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Positron Emission Tomography/Computerized Emission Tomography (PET/CT) creates fusion images which are a combination of tissue function (PET) and anatomy (CT). PET/CT imaging for esophageal and colorectal cancers improves staging, detection of recurrence, and treatment monitoring. Both tumor types are highly metabolically active in the untreated state, and the glucose analog, 2-[18F]-2-fluoro-2-deoxy-D-glcuose, (FDG), is widely useful as a PET imaging tracer for these malignancies. For esophageal and colorectal malignancies, diagnostic imaging sensitivity and specificity are greater than 90%. For esophageal tumors, PET imaging is standard of care for staging of locally advanced tumor. Fifteen to 20% of patients will have other wise occult metastatic sites detected by PET imaging at initial staging. Progression free survival and survival are correlated with the magnitude of reduction in PET-FDG measured metabolic activity post-treatment. For colorectal cancers, PET-FDG is standard of care to detect recurrence, and to monitor treatment response. The addition of CT to the PET imaging, causes a significant reduction in uncertainty of image interpretation and improves the distinction between benign and malignant causes for FDG-PET positive sites.

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Role of FDG-PET in the Pre-Operative Evaluation of Surgical Resection of Hepatic Metastases from Colorectal Cancer

Cited by 4 publications

References 0 publications

Surgical Therapy for Colorectal Metastases to the Liver

Surgical Therapy for Colorectal Metastases to the Liver

Prognostic Scoring in Colorectal Cancer Liver Metastases

Positron Emission Tomography/Computerized Tomography Functional Imaging of Esophageal and Colorectal Cancer

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