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Utility of 18F-FDG PET and contrast-enhanced CT scan in the assessment of residual liver metastasis from colorectal cancer following adjuvant chemotherapy
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Abstract
BACKGROUND: Neoadjuvant chemotherapy has been successfully used in the treatment of patients with colorectal liver metastases. The selection of patients for surgical resection after chemotherapy still poses a significant clinical challenge. 18F-FDG PET is a useful tool in the assessment of liver metastases but the data regarding its sensitivity after chemotherapy is scarce. Our aim was to assess the value of this imaging modality in the selection of patients with colorectal liver metastasis for surgery following adjuvant chemotherapy.
MATERIAL AND METHODS: We reviewed the diagnostic performances of 18F-FDG PET and contrast-enhanced CT scan data from patients with colorectal liver metastases following treatment with chemotherapy. Nineteen patients (12 males, 7 females; median age 61 years; range 41-79) were evaluated. Chemotherapy regimens were: FOLFOX (14 patients), FOLFIRI (3 patients), 5-FU/FA (1 patient) and UFT-irinotecan-oxaliplatin (1 patient). Median time between end of chemotherapy and CT scan was 3.4 weeks, between end of chemotherapy and PET was 5.9 weeks and between end of chemotherapy and surgery was 9.9 weeks. All patients underwent surgery and had histopathological confirmation of liver lesions. Nine patients had segmentectomy, 2 patients had wedge resection, 5 patients had right hepatectomy and 3 patients had explorative laparotomy with liver biopsies.
RESULTS: Data from all 19 patients, comprising 65 liver lesions, were confirmed by histo-pathology. Results on a per-lesion basis showed a sensitivity of 62% for 18F-FDG PET and 70% for CT scan. A complete agreement between 18F-FDG PET or CT scan and histology was documented in 5 and 3 patients, respectively. The sensitivity of 18F-FDG PET was shown to increase for lesions larger than 1 cm (74% vs. 18%).
CONCLUSIONS: These results suggest that 18F-FDG PET and CT scan have sub-optimal sensitivity in the evaluation of colorectal liver lesions after neo-adjuvant chemotherapy, especially for lesions < 1 cm. The combined use of the two imaging techcalculatniques does not significantly increase the sensitivity of lesion detection.
Abstract
BACKGROUND: Neoadjuvant chemotherapy has been successfully used in the treatment of patients with colorectal liver metastases. The selection of patients for surgical resection after chemotherapy still poses a significant clinical challenge. 18F-FDG PET is a useful tool in the assessment of liver metastases but the data regarding its sensitivity after chemotherapy is scarce. Our aim was to assess the value of this imaging modality in the selection of patients with colorectal liver metastasis for surgery following adjuvant chemotherapy.
MATERIAL AND METHODS: We reviewed the diagnostic performances of 18F-FDG PET and contrast-enhanced CT scan data from patients with colorectal liver metastases following treatment with chemotherapy. Nineteen patients (12 males, 7 females; median age 61 years; range 41-79) were evaluated. Chemotherapy regimens were: FOLFOX (14 patients), FOLFIRI (3 patients), 5-FU/FA (1 patient) and UFT-irinotecan-oxaliplatin (1 patient). Median time between end of chemotherapy and CT scan was 3.4 weeks, between end of chemotherapy and PET was 5.9 weeks and between end of chemotherapy and surgery was 9.9 weeks. All patients underwent surgery and had histopathological confirmation of liver lesions. Nine patients had segmentectomy, 2 patients had wedge resection, 5 patients had right hepatectomy and 3 patients had explorative laparotomy with liver biopsies.
RESULTS: Data from all 19 patients, comprising 65 liver lesions, were confirmed by histo-pathology. Results on a per-lesion basis showed a sensitivity of 62% for 18F-FDG PET and 70% for CT scan. A complete agreement between 18F-FDG PET or CT scan and histology was documented in 5 and 3 patients, respectively. The sensitivity of 18F-FDG PET was shown to increase for lesions larger than 1 cm (74% vs. 18%).
CONCLUSIONS: These results suggest that 18F-FDG PET and CT scan have sub-optimal sensitivity in the evaluation of colorectal liver lesions after neo-adjuvant chemotherapy, especially for lesions < 1 cm. The combined use of the two imaging techcalculatniques does not significantly increase the sensitivity of lesion detection.
Keywords
liver metastases; PET; neoadjuvant chemotherapy; surgery; colorectal cancer
About this articleTitle
Utility of 18F-FDG PET and contrast-enhanced CT scan in the assessment of residual liver metastasis from colorectal cancer following adjuvant chemotherapy
Journal
Issue
Pages
12-15
Published online
2007-02-15
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1618
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994
Bibliographic record
Nucl. Med. Rev 2007;10(1):12-15.
Keywords
liver metastases
PET
neoadjuvant chemotherapy
surgery
colorectal cancer
Authors
Carlo Carnaghi
Maria Chiara Tronconi
Lorenza Rimassa
Luca Tondulli
Monica Zuradelli
Marcello Rodari
Roberto Doci
Fabio Luttmann
Guido Torzilli
Domenico Rubello
Adil Al-Nahhas
Armando Santoro
Arturo Chiti
