The Role of Whole-Body Positron Emission Tomography With [18F]Fluorodeoxyglucose in Identifying Operable Colorectal Cancer Metastases to the Liver

Lai, David; Fulham, Michael; Stephen, Michael S.; Chu, Kent‐Man; Solomon, Michael; Thompson, John F.; Sheldon, Donald M.; Storey, David

doi:10.1001/archsurg.1996.01430190025007

Cited by 233 publications

(137 citation statements)

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“…However, for patients with recurrence localized to the liver, there is general agreement that multiple hepatic metastases and the presence of extrahepatic lesions confer an adverse prognosis. 18 F-FDG PET has been shown to be highly accurate in the detection of recurrent and metastatic colorectal cancer (10)(11)(12)(13)(14)(15). A PET scan has comparable sensitivity to a CT scan for the detection of colorectal liver metastases (12)(13)(14) but has superior sensitivity in the detection of extrahepatic disease, compared with CT, and changes the estimation of disease extent in over one third of patients (11,13,16).…”

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“…18 F-FDG PET has been shown to be highly accurate in the detection of recurrent and metastatic colorectal cancer (10)(11)(12)(13)(14)(15). A PET scan has comparable sensitivity to a CT scan for the detection of colorectal liver metastases (12)(13)(14) but has superior sensitivity in the detection of extrahepatic disease, compared with CT, and changes the estimation of disease extent in over one third of patients (11,13,16). Several reports also indicate that PET can influence the management of patients with metastatic colorectal cancer (11,(17)(18)(19)(20), but there are few prospective studies (11,17).…”

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PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study

Scott¹,

Gunawardana²,

Kelley³

et al. 2008

J Nucl Med

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The aims of our study were to examine the impact of PET in changing management in patients with proven or suspected colorectal cancer recurrence and to assess the impact of management change on disease-free survival. Methods: Symptomatic patients with a residual structural lesion suggestive of recurrent tumor (group A) or patients with pulmonary or hepatic metastases considered to be potentially resectable (group B) underwent PET scans. Pre-PET management plans were documented by referring clinicians unaware of the PET results, and follow-up to 12 mo was performed to determine actual management and clinical outcomes. Results: A total of 191 patients (118 men and 73 women; mean age, 66 y) were studied. PET detected additional sites of disease in 48.4% of patients in group A and in 43.9% of patients in group B. A change in planned management was documented in 65.6% of group A and in 49.0% of group B patients. These management plans were implemented in 96% of patients. Follow-up data in group A showed progressive disease in 60.5% of patients with additional lesions detected by PET, compared with conventional imaging, and in 36.2% of patients with no additional lesions detected by PET (P 5 0.04). In group B, progressive disease was identified in 65.9% of patients with additional lesions detected by PET and in 39.2% of patients with no additional lesions detected by PET (P 5 0.01). PET also provided valuable prognostic information on patients stratified into curative-or palliative-intent groups. Conclusion: These data demonstrate the significant impact of PET on management and outcomes in patients with suspected recurrent colorectal cancer.

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PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study

Scott¹,

Gunawardana²,

Kelley³

et al. 2008

J Nucl Med

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“…Several recent studies have demonstrated a high accuracy of fluorine 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) for colorectal cancer. [8][9][10] However, PET is limited by poor resolution and poor anatomic localization of positive PET lesions. To overcome these limitations, PET has been combined with CT. 11 This combination provides simultaneous functional and anatomic information.…”

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Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Wildi

Gubler

Hany

et al. 2007

J of Clinical Ultrasound

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Background. Combined fluorine 18-fluorodeoxyglucose-positron emission tomography-CT imaging has been shown to be of good diagnostic value in the preoperative evaluation of patients with colorectal cancer and liver metastases. The adjunctive use of intraoperative sonography (IOUS) may have a limited impact on treatment selection in these patients.Purpose. To compare the diagnostic performance of preoperative positron emission tomography (PET)-CT alone and PET-CT combined with IOUS in the evaluation of patients who are considered for curative resection of hepatic metastases from colorectal carcinoma.Materials and Methods. Patients with colorectal cancer who underwent resection of hepatic metastases and preoperative PET-CT (with or without contrast-enhanced CT) and IOUS were identified. The performance of the imaging techniques was evaluated through review of the radiologic reports, correlation with surgical and histopathologic findings, and clinical follow-up.Results. Thirty-one patients (mean age, 63.5 years [range, 53-82 years]) were analyzed. Fifteen patients had received preoperative chemotherapy. The mean interval between PET-CT and IOUS was 22.6 days (range, 1-56 days). In 4 cases, neither PET-CT nor IOUS correctly diagnosed the liver metastases. In all 31 patients, the sensitivity of PET-CT alone and PET-CT combined with IOUS was 63% (95% CI 44-80%) and 93% (95% CI 78-98%), respectively; the positive predictive value was 81% and 89%, respectively. In patients without preoperative chemotherapy (n 5 16), the sensitivity of PET-CT alone and PET-CT combined with IOUS was 77% (95% CI 49-94%) and 100% (95% CI 79-100%), respectively. In 11 cases (35%), IOUS altered the surgical strategy.Conclusion. In patients with colorectal carcinoma and potentially resectable liver metastases on preoperative PET-CT, IOUS can provide additional information that may alter decision making with regard to surgical technique. Keywords: colorectal cancer; liver metastases; intraoperative sonography; FDG-PET-CT C olorectal cancer is the second leading cause of cancer-related death in the western hemisphere. Up to 70% of patients with colorectal cancer eventually develop liver metastases. In 30-40% of these patients, metastases are confined to the liver at the time of detection. Hepatic resection is the only therapeutic strategy that offers a chance of cure. In patients who undergo successful hepatic resection with curative intent, the expected 5-year survival rate is approximately 33%, and the 5-year disease-free survival rate is 22%. 1 A large number of patients develop intraor extrahepatic tumor recurrence after curative

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“…En los pacientes tratados de una neoplasia colorectal, con la sospecha de recurrencia basada en la elevación sérica del antígeno carcinoembrionario, el cambio de manejo terapéutico provocado por la PET es del 39% y no difiere de los resultados previamente obtenidos por Vitola 20 (25%), Lai 21 (29%), Delbeke 22 (33%), Ogunbiyi 23 (44%) o Valk 24 (31%). Este cambio de actitud terapéutica se explica por una una mayor sensibilidad de la PET con respecto a la TAC en la valoración de la infiltración tumoral del abdomen, la pelvis y el retroperitoneo, así como por su capacidad de detectar enfermedad tumoral en localizaciones pocos habituales (mediastino, hueso y glándulas suprarrenales) 24 .…”

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Impacto clínico de la PET con 18FDG en la selección de la terapia de los pacientes oncológicos

et al. 2006

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ResumenObjetivo: Determinar el impacto clínico de la PET en la actitud terapéutica de los pacientes oncológicos. Material y métodos:Hemos incluido en este trabajo los cien primeros estudios oncológicos consecutivos de PET con 18 FDG de cuerpo completo (75 varones/22 mujeres, edad media de 67 años) procedentes de un mismo hospital público de nuestra comunidad. El impacto de la PET se calculó mediante los resultados de una encuesta enviada a cada uno de los médicos solicitantes de la prueba. Este cuestionario se diseñó fundamentalmente para valorar el tipo de cambio de tratamiento (intramodalidad/intermodalidad) ocasionado tras los hallazgos de la PET.Resultados: Las tres neoplasias estudiadas más frecuentes fueron: carcinoma broncogénico (34%), neoplasia colo-rectal (24%) y nódulo pulmonar solitario (15%). La PET cambió la actitud terapéutica inicialmente prevista en 53 (55%) de los 97 casos evaluados (tipo intramodalidad en 5 e intermodalidad en 48). Diecisiete pacientes (17.5%) candidatos a cirugía curativa fueron finalmente tratados con un tratamiento sistémico de quimioterapia con o sin radioterapia. Los médicos encuestados consideraron que la PET constituía una herramienta diagnóstica útil en el 69% de los casos y que evitaba maniobras diagnósticas agresivas en 56%.Conclusión: En nuestra serie de pacientes, la PET con FDG ha sido una herramienta diagnóstica de gran utilidad. Mejora la estadificación inicial de las neoplasias, en especial del carcinoma broncogénico y estadifica de forma más precisa la recidiva tumoral de diferentes tipos de tumores, especialmente de la neoplasia colo-rectal. De este modo, la PET ayuda a seleccionar el tratamiento óptimo en cada caso, evitando cirugías innecesarias.

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The Role of Whole-Body Positron Emission Tomography With [18F]Fluorodeoxyglucose in Identifying Operable Colorectal Cancer Metastases to the Liver

Abstract: The FDG-PET method enabled selection of patients with apparently curable colorectal cancer metastases to the liver for hepatic resection.

Cited by 233 publications

References 12 publications

PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study

PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Impacto clínico de la PET con 18FDG en la selección de la terapia de los pacientes oncológicos

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