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

Abstract

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.

Prognostic Ability of 18F-FDG PET/CT in the Assessment of Colorectal Liver Metastases

“…PET has been widely used and has become an integral part of staging of CRLM (13). PET has progressively come to the forefront as a minimally invasive method of studying functional and metabolic processes in tumors.…”

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

“…Previous series have included between 23 [12] and 107 [18] patients with 5 [12] to 40 [14] PC, but not all PC were of colorectal origin, possibly associated with various FDG uptake. The PET/CT method for CRC has been evaluated in larger series [19][20][21][22][23][24][25] but without a focus on PC. The prevalence of PC in our centre which is a regional reference centre for relapse cancer was 24% (35/146 patients).…”

Diagnostics of intrapulmonary metastases from colorectal cancer (literature survey)

“…staging, it gives prognosis for the development of the disease, for plan of the treatment, for assessment of the therapeutic response and for establishment of the possible development of relapse (48). In a prospective trial is reported that the approach in the treatment of patients with colorectal cancer could be changed in 56% of the cases in result of PET, because this method diagnoses additional lesions in comparison with conventional imaging which worsens the prognosis (49).These data clearly show the powerful prognostic ability of PET accurately to identify the patients who are believed to be with localized form of the disease in comparison with conventional imaging diagnostics (49). Despite the diagnostics of the colorectal cancer, PET/CT does not provide assessment of the tumor invasion, but provides better information for the status of the distant lymph nodes and the metastases in them (1,31,50).…”