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

Abstract

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.

Prognostic stratification using F-18 FDG PET/CT in patients with advanced stage (Stage III and IV) non-small cell lung cancer

“…However, these tumor response evaluations based on anatomical changes before and after treatment had several weak points. F-18 FDG PET/CT has emerged as a significant molecular imaging technique in clinical oncology and cancer research [13][14][15]. Tumor response evaluation by F-18 FDG PET and PET/CT appears to be more sensitive and accurate because F-18 FDG PET is able to assess viable tumor cells.…”

S3-Leitlinie – Kolorektales Karzinom

“…In einer randomisierten Studie [1284] mit sehr engmaschigen Nachsorgeuntersuchungen wurden durch eine PET nach 9 und 15 Monaten Rezidive früher erkannt und konnten häufiger R0-reseziert werden.…”

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016

“…Most surveillance guidelines recommend a 5-year evaluation calendar, including history, physical examination and carcinoembryonic antigen testing; imaging of abdomen, pelvis, and chest; and colonoscopy. Imaging by pet-ct leads to false-negative and false-positive results and should not be routinely used for surveillance 9 . Imaging by pet-ct can be considered in the context of rising serum carcinoembryonic antigen and negative ct imaging.…”