The impact of fluor‐18‐deoxyglucose‐positron emission tomography in the management of colorectal liver metastases

Wiering, Bastiaan; Krabbe, Paul F M; Jager, Gerrit J.; Oyen, Wim J.G.; Ruers, Theo J.M.

doi:10.1002/cncr.21569

Cited by 233 publications

(139 citation statements)

References 49 publications

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“…CT has previously been established as a way to evaluate response to chemotherapy treatment in solid tumors as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria [25]. FDG-PET, due to its superior sensitivity in detecting extrahepatic disease, is extremely useful in reducing the number of futile operative procedures performed in patients with otherwise occult metastatic disease [26][27][28][29]. The utility of this preoperative study was also shown by Strasberg et al [30] to lessen tumor recurrence in a chemo-naïve patient cohort undergoing hepatic resection for colorectal metastases.…”

Section: Discussionmentioning

confidence: 99%

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Small¹,

Lubezky²,

Shmueli³

et al. 2008

Journal of Surgical Oncology

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Background: Prognosis of patients following resection of CRC metastases to the liver has traditionally been predicted by clinical risk factors. In the era of neoadjuvant chemotherapy, determination of new prognostic indicators of outcome are necessary. Methods: This retrospective study includes patients with CRC liver metastases, who received oxaliplatin or irinotecan based neoadjuvant chemotherapy and underwent R0 resection. Patients were followed by CT and PET-CT, before, during and after chemotherapy and surgery. The predictive value of the Memorial Sloan-Kettering Cancer Center Clinical Score (MSKCC-CS) and degree of response to chemotherapy (measured by CT and PET-CT), were analyzed by univariate and multivariate COX regression. Results: Included are 54 patients. Overall 1-, 2-, 3-year survival rates 88%, 70%, and 39%. Response to chemotherapy on CT was a significant predictor of survival on univariate (P ¼ 0.03) and multivariate analysis (P ¼ 0.03), whereas MSKCC-CS and response to chemotherapy on PET-CT were not. Multivariate analysis demonstrated response to chemotherapy as a predictor of time to recurrence on CT (P ¼ 0.02) and PET-CT (P ¼ 0.03), while the MSKCC-CS (P ¼ 0.64) was not. Conclusions: In this cohort of patients treated by neoadjuvant chemotherapy, the outcome was not predicted by the traditional clinical scoring system, but rather by response to chemotherapy as evaluated by CT and PET-CT.

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Section: Discussionmentioning

confidence: 99%

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Small¹,

Lubezky²,

Shmueli³

et al. 2008

Journal of Surgical Oncology

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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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confidence: 99%

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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“…23 In a recent meta-analysis, 24 both the sensitivity and the specificity of FDG-PET imaging for the detection of extrahepatic lesions exceeded 90%, as compared with only 60.9% and 91.1%, respectively, for CT. Furthermore, a systematic review 25 of FDG-PET imaging results in patients with colorectal liver metastasis has revealed that FDG-PET may detect extrahepatic disease not identified by other modal- In the past, almost all initially unresectable patients were treated by systemic or locoregional chemotherapy, which yielded 5-year survival rates less than 5%.…”

Section: Discussionmentioning

confidence: 99%

Significance of Hepatic Lymph Node Metastasis in Patients With Unresectable Synchronous Liver Metastasis of Colorectal Cancer

Ishida

Ishibashi

Ohsawa

et al. 2011

International Surgery

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The frequency and significance of hepatic lymph node (HLN) metastasis were retrospectively evaluated in 43 patients with unresectable synchronous liver metastasis of colorectal cancer who underwent resection of the primary tumor and histopathologic evaluation of HLNs between March 1997 and August 2007. HLN metastasis was detected in 12 patients (27.9%). No significant correlations were observed between the presence of HLN metastasis and any of the 12 clinicopathologic factors examined. On multivariate analysis using the Cox proportional hazards model, the presence of HLN metastasis (P = 0.002), along with a large number ($4) of regional lymph node metastases (P = 0.003), and nonuse of oxaliplatin-based chemotherapy (P = 0.005) were identified as independent risk factors for shorter survival. To establish a new therapeutic strategy for initially unresectable liver metastasis of colorectal cancer, HLNs should be examined histologically in patients undergoing resection of hepatic lesions when they are rendered resectable by effective chemotherapy.Key words: Hepatic lymph node -Liver metastasis -Colorectal cancer H epatic lymph node (HLN) metastasis, known to be a re-metastasis 1 from liver metastasis in cases of colorectal cancer, is considered to be a poor prognostic factor following potentially curative hepatic metastatectomy. 2,3 Recent advances in effective chemotherapy [4][5][6][7][8] have increased the resection rate of liver metastases of colorectal cancer that are considered unresectable at initial diagnosis. How- ever, little has been reported about the frequency and significance of HLN metastasis in such cases. This retrospective study was performed to examine the status of HLN metastasis in patients with initially unresectable synchronous liver metastasis of colorectal cancer, and to highlight the significance of HLN metastasis in the era of effective chemotherapy. Patients and MethodsThis study was approved by the local ethical committee of Saitama Medical University. PatientsData on 43 patients with unresectable synchronous liver metastasis of colorectal cancer who underwent resection of the primary lesion and histologic examination of HLNs between March 1997 and August 2007 were retrospectively evaluated. In terms of the level of lymph node dissection, along with resection of the primary lesion, D3-level dissection, including removal of pericolic, intermediate, and main lymph nodes, according to the Japanese Classification of Colorectal Carcinoma, 9 was performed in 41 patients, and D2-level dissection, which included removal of the same lymph node groups as above, except the main lymph nodes, was performed in the remaining 2 patients. No patients had peritoneal dissemination, paraaortic lymph node involvement, or distant metastasis other than liver metastasis. During this period, we defined 5 or more hepatic lesions located in both lobes, lesions infiltrating all 3 hepatic veins, and lesions associated with massive infiltration of the inferior vena cava as ''unresectable.'' HLN examinationSystematic ...

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The impact of fluor‐18‐deoxyglucose‐positron emission tomography in the management of colorectal liver metastases

Cited by 233 publications

References 49 publications

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

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

Significance of Hepatic Lymph Node Metastasis in Patients With Unresectable Synchronous Liver Metastasis of Colorectal Cancer

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