Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases

Moulton, Carol‐Anne; Gu, Chu‐Shu; Law, Calvin; Tandan, Véd; Hart, Richard; Quan, Douglas; Smith, Robert J.; Jalink, Diederick; Husien, Mohamed; Serrano, Pablo E.; Hendler, Aaron; Haider, Masoom A.; Ruo, Leyo; Gulenchyn, Karen Y.; Finch, Terri; Julian, Jim A.; Levine, Mark; Gallinger, Steven

doi:10.1001/jama.2014.3740

Cited by 156 publications

(92 citation statements)

References 25 publications

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“…The authors demonstrated that PET/CT changed the treatment plan to curative intent in 37% patients, and there was a statistically significant (P 5 0.004) difference in the median progression-free survival and OS (P 5 0.045) between patients planned to receive curative treatment before and after the PET/CT study (5). In a study by Moulton et al of 263 patients with colorectal cancer treated by surgical resection and who had resectable colorectal liver metastasis, there was change in management in 8.0% patients who underwent a PET/CT study (21). In our study, there was change in management after 34.2% of the fourth and subsequent follow-up PET/CT scans.…”

Section: Discussionsupporting

confidence: 43%

¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

et al. 2015

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The purpose of this study was to evaluate the added value of a fourth and subsequent follow-up PET/CT scans to clinical assessment and impact on patient management in patients with colorectal cancer. Methods: This was an institutional review boardapproved, retrospective study. Eight hundred twenty-two patients with biopsy-proven colorectal cancer, who underwent 18 F-FDG PET/CT, were identified from 2000 to 2012. Among these, 73 (8.9%) patients underwent 4 or more follow-up PET/CT scans, with a total of 313 fourth and subsequent follow-up PET/CT scans. Median follow-up from the fourth follow-up PET/CT scan was 41.7 mo. The added value of each follow-up PET/CT scan, for clinical assessment and the treatment changes subsequent to each follow-up PET/CT scan, was established. Overall survival prediction was established using Kaplan-Meier plots with a Mantel-Cox log-rank test. Results: Of the 313 fourth and subsequent follow-up PET/CT scans, 174 (55.6%) were interpreted as positive and 139 (44.4%) were interpreted as negative for recurrence or metastases. Thirtyfour (46.6%) patients died during the study period. PET/CT identified recurrence or metastasis in 40.0% of scans obtained without prior clinical suspicion and ruled out disease in 23.6% of scans obtained with prior clinical suspicion. The PET/CT scan resulted in treatment change after 34.2% (107/313) of the scans. New treatment was initiated after 24.0% (75/313) of the scans, and treatment was changed after 8.0% (25/313) scans. There was a statistically significant difference in the overall survival between patients with a positive and all negative fourth and subsequent follow-up PET/CT scans at the patient level (log-rank, P 5 0.001). Conclusion: The fourth and subsequent 18 F-FDG PET/CT scans obtained after primary treatment completion add value to clinical assessment and the management plan and provide prognostic information in patients with colorectal cancer.

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Section: Discussionsupporting

confidence: 43%

¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

et al. 2015

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“…In an RCT of patients with resectable CRCLM (not specifically synchronous), the use of PET-CT compared with CT alone did not result in significant changes in surgical management [27]. A role [12]: A, recommendation based on consistent and good-quality patient-oriented evidence; B, recommendation based on inconsistent or limited-quality patient-oriented evidence; C, recommendation based on consensus, usual practice, opinion, disease-oriented evidence or case series for studies of diagnosis, treatment, prevention or screening.…”

Section: The Role Of Imaging In the Detection Of Synchronous Crclmmentioning

confidence: 95%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

488

413

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a b s t r a c tAn international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected 612 months and >12 months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, Contents lists available at ScienceDirectCancer Treatment Reviews j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / c t r v and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

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“…One scenario in particular that may be amenable to PET/CT evaluation is exclusion of occult metastases in patients being considered for liver metastectomy with curative intent (26). In a recent randomized controlled trial (42) in which the effect of preoperative PET/CT was compared with that of standard CT in surgical treatment of resectable hepatic metastases, the authors found that 8% of patients had a change in surgical treatment plan after FDG PET, but the effect on overall survival was not statistically significant. PET/CT also outperforms contrastenhanced CT for detection of extrahepatic metastatic disease (43).…”

Section: Initial Assessment Rectal Cancermentioning

confidence: 99%

Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy

Matalon¹,

Mamon²,

Fuchs³

et al. 2015

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Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases

Abstract: clinicaltrials.gov Identifier: NCT00265356.

Cited by 156 publications

References 25 publications

¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy

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Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases

Abstract: clinicaltrials.gov Identifier: NCT00265356.

Cited by 156 publications

References 25 publications

18F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

18F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy

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¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management

¹⁸F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management