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Zirakchian Zadeh M. PET/CT in assessment of colorectal liver metastases: a comprehensive review with emphasis on 18F-FDG. Clin Exp Metastasis 2023; 40:465-491. [PMID: 37682423 DOI: 10.1007/s10585-023-10231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Approximately 25% of those who are diagnosed with colorectal cancer will develop colorectal liver metastases (CRLM) as their illness advances. Despite major improvements in both diagnostic and treatment methods, the prognosis for patients with CRLM is still poor, with low survival rates. Accurate employment of imaging methods is critical in identifying the most effective treatment approach for CRLM. Different imaging modalities are used to evaluate CRLM, including positron emission tomography (PET)/computed tomography (CT). Among the PET radiotracers, fluoro-18-deoxyglucose (18F-FDG), a glucose analog, is commonly used as the primary radiotracer in assessment of CRLM. As the importance of 18F-FDG-PET/CT continues to grow in assessment of CRLM, developing a comprehensive understanding of this subject becomes imperative for healthcare professionals from diverse disciplines. The primary aim of this article is to offer a simplified and comprehensive explanation of PET/CT in the evaluation of CRLM, with a deliberate effort to minimize the use of technical nuclear medicine terminology. This approach intends to provide various healthcare professionals and researchers with a thorough understanding of the subject matter.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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2
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Czerner CP, Derlin T, Bengel FM, Weiberg D. [Positron emission tomography in oncology]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01174-z. [PMID: 37326633 DOI: 10.1007/s00117-023-01174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Positron emission tomography (PET) is a highly sensitive imaging tool that noninvasively characterizes metabolic processes and molecular targets. PET has become an integral part of oncological diagnostics and an increasingly important tool for oncological therapy management. PET assessment, for example, directly influences treatment escalation or de-escalation in context of Hodgkin lymphomas or is, in case of lung cancer, able to reduce unnecessary surgeries. Hence, molecular PET imaging represents an indispensable tool in the development of personalized treatments. Furthermore, the development of new radiotracers for specific cell surface structures offers a promising potential for diagnostics and-combined with therapeutic nuclides-also for therapies. One recent example are radioligands targeting prostate-specific membrane antigen, which are relevant in prostate cancer.
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Affiliation(s)
- Christoph P Czerner
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Thorsten Derlin
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Desiree Weiberg
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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3
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Miao Z, Zhao X, Li X. [18F]FDG PET/CT versus [18F]FDG PET/MRI for the diagnosis of colorectal liver metastasis: A systematic review and meta-analysis. Front Oncol 2023; 13:1114059. [PMID: 36860315 PMCID: PMC9969139 DOI: 10.3389/fonc.2023.1114059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose The purpose of our meta-analysis and systematic review was to compare the diagnostic performance of [18F]FDG PET/CT and [18F]FDG PET/MRI in colorectal liver metastasis. Methods We searched PubMed, Embase, and Web of Science for eligible articles until November 2022. Studies focusing on the diagnostic value of [18F]FDG PET/CT or PET/MRI for colorectal liver metastasis were included. Using a bivariate random-effect model, the pooled sensitivity and specificity for [18F]FDG PET/CT and [18F]FDG PET/MRI were reported as estimates with 95% confidence intervals (CIs). Heterogeneity among pooled studies was assessed using the I2 statistic. The Quality Assessment of Diagnostic Performance Studies (QUADAS-2) method was used to evaluate the quality of the studies that were included. Results There were a total of 2743 publications identified in the initial search, finally, a total of 21 studies comprising 1036 patients were included. The pooled sensitivity, specificity, and AUC of [18F]FDG PET/CT in were 0.86 (95% CI: 0.76-0.92), 0.89 (95% CI: 0.83-0.94), and 0.92(95% CI: 0.90-0.94). [18F]FDG PET/MRI were 0.84 (95% CI: 0.77-0.89), 1.00 (95% CI: 0.32-1.00), and 0.89(95% CI: 0.86-0.92), respectively. Conclusion [18F]FDG PET/CT shows similar performance compared to [18F]FDG PET/MRI in detecting colorectal liver metastasis. However, pathological results were not obtained for all patients in the included studies and PET/MRI results were derived from studies with small sample sizes. There is a need for additional, larger prospective studies on this issue. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42023390949).
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Affiliation(s)
- Zhi Miao
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, China,School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin, China,*Correspondence: Zhi Miao,
| | - Xiaomeng Zhao
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, China,School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin, China
| | - Xuanwen Li
- Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
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Shi Y, Wang M, Zhang J, Xiang Z, Li C, Zhang J, Ma X. Tailoring the clinical management of colorectal cancer by 18F-FDG PET/CT. Front Oncol 2022; 12:1062704. [PMID: 36620584 PMCID: PMC9814158 DOI: 10.3389/fonc.2022.1062704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is among the most commonly diagnosed gastrointestinal malignancies worldwide. It is inadequate to handle in terms of staging and restaging only based on morphological imaging modalities and serum surrogate markers. And the correct and timely staging of CRC is imperative to prognosis and management. When compared to established sequential, multimodal conventional diagnostic methods, the molecular and functional imaging 18F-FDG PET/CT shows superiorities for tailoring appropriate treatment maneuvers to each patient. This review aims to summarize the utilities of 18F-FDG PET/CT in CRC, focusing on primary staging, follow-up assessment of tumor responses and diagnostic of recurrence. In addition, we also summarize the technical considerations of PET/CT and the conventional imaging modalities in those patients who are either newly diagnosed with CRC or has already been treated from this cancer.
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Affiliation(s)
- Yang Shi
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,State Key Laboratory for the Prevention and Treatment of Esophageal Cancer, Zhengzhou University, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
| | - Meiqi Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jiyu Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,State Key Laboratory for the Prevention and Treatment of Esophageal Cancer, Zhengzhou University, Zhengzhou, China
| | - Zheng Xiang
- Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, China
| | - Can Li
- Department of Administration, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jingjing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
| | - Xing Ma
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
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5
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Mogensen AW, Petersen LJ, Torp-Pedersen C, Nørgaard M, Pank MT, Zacho HD. Use of 18F-NaF PET in the staging of skeletal metastases of newly diagnosed, high-risk prostate cancer patients: a nationwide cohort study. BMJ Open 2022; 12:e058898. [PMID: 35705343 PMCID: PMC9204404 DOI: 10.1136/bmjopen-2021-058898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether preoperative staging of high-risk prostate cancer with 18F-sodium-fluoride (18F-NaF) positron emission tomography (PET) reduces the risk of skeletal metastases. DESIGN Nationwide, population-based cohort study using real-world data. SETTING The study used national health registries, including all sites in Denmark from 2011 to 2018. PARTICIPANTS Newly diagnosed high-risk prostate cancer patients who underwent radical prostatectomy from 2011 to 2018. Patients were stratified into two groups according to the preoperative imaging modality of either 18F-NaF PET or bone scintigraphy. MAIN OUTCOME MEASURES The risk of skeletal-related events (SREs) as a proxy for skeletal metastases following radical prostatectomy. The secondary endpoint was overall survival. RESULTS Between 1 January 2011 and 31 December 2018, 4183 high-risk patients underwent radical prostatectomy. Of these patients, 807 (19.3%) underwent 18F-NaF PET and 2161 (51.7%) underwent bone scintigraphy. The remaining 30% were examined by a different imaging method or did not undergo imaging. Using the inverse probability of treatment weighting to control potential confounding, the HR of experiencing an SRE for patients in the 18F-NaF PET group versus the bone scintigraphy group was 1.15 (95% CI 0.86 to 1.54). The 3-year survival rates were 97.4% (95% CI 96.1 to 98.7) and 97.1% (95% CI 96.4 to 97.9) for patients receiving 18F-NaF PET and bone scintigraphy, respectively. CONCLUSION Patients with high-risk prostate cancer undergoing preoperative staging with 18F-NaF PET did not display a lower risk of developing SREs after prostatectomy compared with patients undergoing bone scintigraphy. The survival rates were similar between the two groups.
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Affiliation(s)
| | - Lars J Petersen
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie T Pank
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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6
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Hunt S, Zandifar A, Alavi A. Molecular imaging in management of colorectal metastases by the interventional oncologist. Int J Hyperthermia 2022; 39:675-681. [DOI: 10.1080/02656736.2021.1998657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Stephen Hunt
- Penn Image-Guided Interventions Lab, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Abass Alavi
- University of Pennsylvania, Philadelphia, PA, USA
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7
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Mahmoud NN. Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:127-141. [DOI: 10.1016/j.soc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Görgec B, Hansen I, Kemmerich G, Syversveen T, Abu Hilal M, Belt EJT, Bisschops RHC, Bollen TL, Bosscha K, Burgmans MC, Cappendijk V, De Boer MT, D'Hondt M, Edwin B, Gielkens H, Grünhagen DJ, Gillardin P, Gobardhan PD, Hartgrink HH, Horsthuis K, Kok NFM, Kint PAM, Kruimer JWH, Leclercq WKG, Lips DJ, Lutin B, Maas M, Marsman HA, Morone M, Pennings JP, Peringa J, Te Riele WW, Vermaas M, Wicherts D, Willemssen FEJA, Zonderhuis BM, Bossuyt PMM, Swijnenburg RJ, Fretland ÅA, Verhoef C, Besselink MG, Stoker J. Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): study protocol for an international multicentre prospective diagnostic accuracy study. BMC Cancer 2021; 21:1116. [PMID: 34663243 PMCID: PMC8524830 DOI: 10.1186/s12885-021-08833-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI. METHODS In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI. DISCUSSION The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy. TRIAL REGISTRATION The CAMINO study was registered in the Netherlands National Trial Register under number NL8039 on September 20th 2019.
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Affiliation(s)
- B Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Hansen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - G Kemmerich
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - T Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - M Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - E J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - R H C Bisschops
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - T L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - V Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M T De Boer
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - B Edwin
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - H Gielkens
- Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P Gillardin
- Department of Radiology, Hospital Oost-Limburg, Genk, Belgium
| | - P D Gobardhan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Horsthuis
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P A M Kint
- Department of Radiology, Amphia Hospital, Breda, The Netherlands
| | - J W H Kruimer
- Department of Radiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - W K G Leclercq
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - D J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - B Lutin
- Department of Radiology, Groeninge Hospital, Kortrijk, Belgium
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H A Marsman
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - M Morone
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - J P Pennings
- Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Peringa
- Department of Radiology, OLVG, Amsterdam, The Netherlands
| | - W W Te Riele
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - D Wicherts
- Department of Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - F E J A Willemssen
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B M Zonderhuis
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - P M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Å A Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - C Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Pirasteh A, Lovrec P, Pedrosa I. Imaging and its Impact on Defining the Oligometastatic State. Semin Radiat Oncol 2021; 31:186-199. [PMID: 34090645 DOI: 10.1016/j.semradonc.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Successful treatment of oligometastatic disease (OMD) is facilitated through timely detection and localization of disease, both at the time of initial diagnosis (synchronous OMD) and following the initial therapy (metachronous OMD). Hence, imaging plays an indispensable role in management of patients with OMD. However, the challenges and complexities of OMD management are also reflected in the imaging of this entity. While innovations and advances in imaging technology have made a tremendous impact in disease detection and management, there remain substantial and unaddressed challenges for earlier and more accurate establishment of OMD state. This review will provide an overview of the available imaging modalities and their inherent strengths and weaknesses, with a focus on their role and potential in detection and evaluation of OMD in different organ systems. Furthermore, we will review the role of imaging in evaluation of OMD for malignancies of various primary organs, such as the lung, prostate, colon/rectum, breast, kidney, as well as neuroendocrine tumors and gynecologic malignancies. We aim to provide a practical overview about the utilization of imaging for clinicians who play a role in the care of those with, or at risk for OMD.
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Affiliation(s)
- Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI
| | - Petra Lovrec
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - Ivan Pedrosa
- Departments of Radiology, Urology, and Advanced Imaging Research Center. University of Texas Southwestern, Dallas, TX.
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10
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Behrenbruch C, Prabhakaran S, Udayasiri D D, Michael M, Hollande F, Hayes I, Heriot AG, Knowles B, Thomson BN. Association between imaging response and survival following neoadjuvant chemotherapy in patients with resectable colorectal liver metastases: A cohort study. J Surg Oncol 2021; 123:1263-1273. [PMID: 33524184 DOI: 10.1002/jso.26400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/12/2020] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The association between the imaging response (structural or metabolic) to neoadjuvant chemotherapy (neoCT) before colorectal liver metastasis (CRLM) and survival is unclear. METHOD A total of 201 patients underwent their first CRLM resection. A total of 94 (47%) patients were treated with neoCT. A multivariable, Cox proportional hazard regression analysis was performed to compare overall survival (OS) and progression-free survival (PFS) between response groups. RESULTS Multivariable regression analysis of the CT/MRI (n = 94) group showed no difference in survival (OS and PFS) in patients who had stable disease/partial response (SD/PR) or complete response (CR) versus patients who had progressive disease (PD) (OS: HR, 0.36 (95% CI: 0.11-1.19) p = .094, HR, 0.78 (95% CI: 0.13-4.50) p = .780, respectively), (PFS: HR, 0.70 (95% CI: 0.36-1.35) p = .284, HR, 0.51 (0.18-1.45) p = .203, respectively). In the FDG-PET group (n = 60) there was no difference in the hazard of death for patients with SD/PR or CR versus patients with PD for OS or PFS except for the PFS in the small CR subgroup (OS: HR, 0.75 (95% CI: 0.11-4.88) p = .759, HR, 1.21 (95% CI: 0.15-9.43) p = .857), (PFS: HR, 0.34% (95% CI: 0.09-1.22), p = .097, HR, 0.17 (95% CI: 0.04-0.62) p = .008, respectively). CONCLUSION There was no convincing evidence of association between imaging response to neoCT and survival following CRLM resection.
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Affiliation(s)
- C Behrenbruch
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - S Prabhakaran
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - D Udayasiri D
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - M Michael
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Victorian Comprehensive Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Hollande
- Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - I Hayes
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - A G Heriot
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Australia
| | - B Knowles
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - B N Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
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Abstract
At the moment, international guidelines for rectal cancer suggest to consider F-FDG PET/CT scan in a few conditions: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma with potentially curable M1 disease; (2) in the recurrence workup for serial carcinoembryonic antigen level elevation; (3) in the recurrence workup with metachronous metastases documented by CT, MRI, or biopsy; (4) in case of strong contraindication to IV contrast agent administration; and (5) to evaluate an equivocal finding on a contrast-enhanced CT or MRI. PET/CT is not indicated in the follow-up or surveillance of rectal cancer. On the other hand, an attentive evaluation of the literature shows that PET/CT may also be used in some circumstances with significant levels of diagnostic accuracy. This review article aims to emphasize differences between current international guidelines and scientific literature in the role of PET/CT in rectal cancer.
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12
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Abstract
International colon cancer guidelines suggest F-FDG PET/CT in a few circumstances: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma; (2) in the workup of recurrent colon cancer with metachronous metastases documented by CT, MRI, or biopsy and in case of serial CEA elevation with negative colonoscopy and negative CT; and (3) in case of contraindication to iodine- and gadolinium-based contrast agents. However, review of the literature has shown that PET/CT can also be used in other scenarios with significant levels of diagnostic advantage. This review aims to emphasize differences between guidelines and scientific literature for the use of PET/CT in colon cancer.
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Abstract
There have been significant developments in the management of advanced and recurrent colorectal cancer in recent decades. 70% of primary colorectal tumours arise in the colon and for patients with stage I-III disease, the standard of care is surgical resection followed by adjuvant therapy where appropriate. Locoregional recurrence (LR) occurs in 4-11.5% of patients following treatment of primary colon cancer with curative intent, and can be categorised as peri-anastomotic, mesenteric/paracolic (nodal), retroperitoneal and peritoneal. Of these, peritoneal recurrence is usually recognised as the most challenging type of recurrence to manage. Patients with isolated peri-anastomotic or limited nodal recurrence in the mesentery or retroperitoneum may be curable by radical salvage surgery, which often requires en bloc multi-visceral resection, while patients with low volume peritoneal metastases may be candidates for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ensuring complete resection along embryonic mesocolic planes or en bloc resection of contiguously involved structures are best strategies to reduce the likelihood of local recurrence through a R1 resection margin. The role of complete mesocolic excision (CME) with high vascular ligation has been demonstrated to increase nodal yield and improve overall survival although this is more contentious. In patients with T4a disease and serosal surface involvement, peritoneal recurrence represents the greatest threat. Efforts for early diagnosis of peritoneal recurrence in these patients or prophylactic treatment, while intuitive have not demonstrated the survival benefit that would be expected. Other than locoregional recurrence (LR), systemic recurrence may occur in up to 50% of patients who have undergone curative resection for colorectal cancer. In keeping with portal venous outflow, the most common site of systemic recurrence is the liver. Although previously thought to be a fatal condition, liver resection is now the standard of care where liver metastases can be completely resected with clear margins plus leaving an adequate liver remnant with intact vascular inflow, outflow and biliary drainage. This can usually be achieved in 26-45% of patients presenting with liver metastases. Liver surgeons at the forefront of liver resection have also developed techniques to induce liver hypertrophy so as to improve likelihood of resectability. Even where patients have non-resectable disease, ablative techniques have become increasingly common. Naturally, none of these would be possible without the advent of improved chemotherapeutic and biological options in the field of medical oncology. Pulmonary metastasectomy with curative intent may be possible in a small number (10%) of patients with lung metastases, which is associated with an overall survival of up to 40%. Unlike liver metastases, proportionally less patients with pulmonary metastases will be resectable. For these patients, several ablative options are available. For all patients with recurrent colon cancer, patient selection for radical salvage surgery and decisions surrounding treatment strategy (including use of systemic therapy or ablative procedures) should take place in a multidisciplinary team setting.
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Affiliation(s)
- Kilian G M Brown
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry E Koh
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, Discipline of Surgery, University of Sydney, Australia
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14
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Serrano PE, Gu CS, Moulton CA, Husien M, Jalink D, Martel G, Tsang ME, Hallet J, McAlister V, Gallinger S, Levine M. Effect of PET-CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long-term results of a randomized controlled trial. J Surg Oncol 2020; 121:1001-1006. [PMID: 32034769 DOI: 10.1002/jso.25864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Preoperative evaluation of resectable colorectal cancer liver metastases with positron emission tomography (PET) combined with computed tomography (PET-CT) is used extensively. The PETCAM trial evaluated the effect of PET-CT (intervention) vs no PET-CT (control) on surgical management. PET-CT resulted in 8% change in surgical management, therefore, we aimed to compare long-term outcomes (disease-free [DFS], overall survival [OS]). METHODS Trial recruitment (2005-2010) had prospective follow-up until 2013. Events from 2013 to 2017 were collected retrospectively. Survival was described by the Kaplan-Meier method and compared with log-rank test. Oncologic risk factors were calculated using Cox proportional hazard models. RESULTS Among 404 patients randomized, there were no differences in DFS (hazard ratio [HR] = 1.13; 95% confidence interval [CI], 0.89 to 1.43) or OS (HR, 1.02; 95% CI, 0.78-1.32) between groups. For all patients randomized, median DFS (PET-CT vs no PET-CT) was 16 months (95% CI, 13-18) and 15 months (95% CI, 11-22), P = .33. For patients who underwent liver resection (n = 368), DFS (17 vs 16 months, P = .51) and OS (58 months vs 52 months, P = .90) were similar between groups, respectively. Risk factors for DFS and OS were age, tumor size, node-positive disease, extrahepatic metastases and disease-free duration. CONCLUSION Preoperative PET-CT changes surgical management in a small percentage of cases, without effect on recurrence rates or long-term survival.
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Affiliation(s)
- Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario.,Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
| | | | | | - Diederick Jalink
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario
| | | | | | - Julie Hallet
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
| | | | | | - Mark Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
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15
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Zamboni G, Mazzaro A, Mansueto G. How to Best Image Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-019-00447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Schobert I, Chapiro J, Pucar D, Saperstein L, Savic LJ. Fluorodeoxyglucose PET for Monitoring Response to Embolotherapy (Transarterial Chemoembolization) in Primary and Metastatic Liver Tumors. PET Clin 2019; 14:437-445. [DOI: 10.1016/j.cpet.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Derlin T, Grünwald V, Steinbach J, Wester HJ, Ross TL. Molecular Imaging in Oncology Using Positron Emission Tomography. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:175-181. [PMID: 29607803 DOI: 10.3238/arztebl.2018.0175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/04/2017] [Accepted: 11/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anatomical and molecular data can be acquired simultaneously through the use of positron emission tomography (PET) in combination with computed tomography (CT) or magnetic resonance imaging (MRI) as a hybrid technique. A variety of radiopharmaceuticals can be used to characterize various metabolic processes or to visualize the expression of receptors, enzymes, and other molecular target structures. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on guidelines from Germany and abroad and on systematic reviews and meta-analyses. RESULTS Established radiopharmaceuticals for PET, such as 2-[18F]fluoro-2- deoxyglucose ([18F]FDG), enable the visualization of physiological processes on the molecular level and can provide vital information for clinical decision-making. For example, PET can be used to evaluate pulmonary nodules for malignancy with 95% sensitivity and 82% specificity. It can be used both for initial staging and for the guidance of further treatment. Alongside the PET radiopharmaceuticals that have already been well studied and evaluated, newer ones are increasingly becoming available for the noninvasive phenotyping of tumor diseases, e.g., for analyzing the expression of prostate-specific membrane antigen (PSMA), of somatostatin receptors, or of chemokine receptors on tumor cells. CONCLUSION PET is an important component of diagnostic algorithms in oncology. It can help make diagnosis more precise and treatment more individualized. An increasing number of PET radiopharmaceuticals are now expanding the available options for imaging. Many radiopharmaceuticals can be used not only for noninvasive analysis of the expression of therapeutically relevant target structures, but also for the ensuing, target-directed treatment with radionuclides.
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Affiliation(s)
- Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School; Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School; Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; Department of Pharmaceutical Radiochemistry, Technical University of Munich, Garching
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19
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Abstract
BACKGROUND Hybrid imaging FDG PET/CT (18F‑fluordeoxyglucose positron emission tomography/computed tomography) has gained increasing importance in oncology in recent years. DIAGNOSIS A focal increase in FDG uptake in the gastrointestinal tract may be due to colorectal carcinoma. Such a finding requires further clarification. PRIMARY STAGING Staging of the primary and locoregional lymph nodes remains a domain of established imaging modalities as FDG PET/CT does not provide a clear additional benefit. Liver metastases can be detected with high sensitivity by FDG PET/CT, but MRI is superior in small lesions. RADIATION THERAPY PLANNING So far FDG PET/CT plays a subordinate role in the radiation therapy planning of rectal cancer. However, it can potentially contribute to the optimization of planning target volumes. THERAPY MONITORING FDG PET/CT is suitable for monitoring therapy because morphological and metabolic changes of the tumor can be detected in early stages. This enables early detection of nonresponders after beginning neoadjuvant chemoradiation therapy of rectal cancer. FDG PET/CT can also be used for therapy control of liver metastases, especially after local therapeutic procedures. DETECTION OF RECURRENCE With clinical suspicion of local recurrence and increased tumor markers, FDG PET/CT is a valuable tool as tumor recurrence can be detected with high sensitivity and specificity.
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20
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, Serrano PE. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol 2019; 45:1341-1348. [DOI: 10.1016/j.ejso.2019.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
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21
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Chow FCL, Chok KSH. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11:150-172. [PMID: 30820266 PMCID: PMC6393711 DOI: 10.4254/wjh.v11.i2.150] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the commonest form of distant metastasis in colorectal cancer. Selection criteria for surgery and liver-directed therapies have recently been extended. However, resectability remains poorly defined. Tumour biology is increasingly recognized as an important prognostic factor; hence molecular profiling has a growing role in risk stratification and management planning. Surgical resection is the only treatment modality for curative intent. The most appropriate surgical approach is yet to be established. The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach; these two strategies have comparable long-term outcomes. For patients with a limited future liver remnant, portal vein embolization, combined ablation and resection, and associating liver partition and portal vein ligation for staged hepatectomy have been advocated, and each has their pros and cons. The role of neoadjuvant and adjuvant chemotherapy is still debated. Targeted biological agents and loco-regional therapies (thermal ablation, intra-arterial chemo- or radio-embolization, and stereotactic radiotherapy) further improve the already favourable results. The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials. Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
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Affiliation(s)
| | - Kenneth Siu-Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
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22
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Pfannenberg C, Gueckel B, Wang L, Gatidis S, Olthof SC, Vach W, Reimold M, la Fougere C, Nikolaou K, Martus P. Practice-based evidence for the clinical benefit of PET/CT-results of the first oncologic PET/CT registry in Germany. Eur J Nucl Med Mol Imaging 2018; 46:54-64. [PMID: 30269155 DOI: 10.1007/s00259-018-4156-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of PET/CT on clinical management of cancer patients based on a prospective data registry. The study was developed to inform consultations with public health insurances on PET/CT coverage. METHODS We evaluated a prospective patient cohort having a clinically indicated PET/CT at a single German University Center from April 2013 to August 2016. The registry collected questionnaire data from requesting physicians on intended patient management before and after PET/CT. A total of 4,504 patients with 5,939 PET/CT examinations were enrolled in the registry, resulting in evaluable data from 3,724 patients receiving 4,754 scans. The impact of PET/CT on patient management was assessed across 22 tumor types, for different indications (diagnosis, staging, suspected recurrence) and different categories of management including treatment (curative or palliative) and non-treatment (watchful waiting, additional imaging, invasive tests). RESULTS The most frequent PET/CT indication was tumor staging (59.7%). Melanoma, lung cancer, lymphoma, neuroendocrine tumor and prostate cancer accounted for 70% of cases. Overall, the use of PET/CT resulted in a 37.1% change of clinical management (95% CI, 35.7-38.5), most frequently (30.6%) from an intended non-treatment strategy before PET/CT to active treatment after PET/CT. The frequency of changes ranged from 28.3% for head and neck cancers up to 46.0% for melanomas. The impact of PET/CT was greatest in reducing demands for additional imaging which decreased from 66.1% before PET/CT to 6.1% after PET/CT. Pre-PET/CT planned invasive tests could be avoided in 72.7% of cases. The treatment goal changed after PET/CT in 21.7% of cases, in twice as many cases from curative to palliative therapy than vice versa. CONCLUSIONS The data of this large prospective registry confirm that physicians often change their intended management on the basis of PET/CT by initiating treatment and reducing additional imaging as well as invasive tests. This applies to various cancer types and indications.
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Affiliation(s)
- Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Brigitte Gueckel
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Lisa Wang
- Institute of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Matthias Reimold
- Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Christian la Fougere
- Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University Tuebingen, Tübingen, Germany
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23
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Importance of 18F-FDG PET/CT to select patients with nonresectable colorectal liver metastases for liver transplantation. Nucl Med Commun 2018; 39:621-627. [DOI: 10.1097/mnm.0000000000000843] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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24
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Mohamed E, Adiamah A, Dunn WK, Higashi Y, Cameron IC, Gomez D. Outcome of indeterminate liver lesions on computed tomography in patients with colorectal cancer. Ann R Coll Surg Engl 2018; 100:382-387. [PMID: 29692186 PMCID: PMC5956611 DOI: 10.1308/rcsann.2018.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction The aim of this study was to determinate the outcome of indeterminate liver lesions on computed tomography (CT) in patients with a background history of colorectal cancer (CRC) and to identify clinicopathological variables associated with malignancy in these lesions. A secondary aim was to devise a management algorithm for such patients. Methods Patients referred to our institution with indeterminate liver lesions on CT with a background history of CRC between January 2012 and December 2014 were included in the study. Clinicopathological factors, surveillance period and histological findings were analysed. Results Fifty-six patients with indeterminate liver lesions were identified. Fifty-three (94.6%) of these required further imaging (magnetic resonance imaging [MRI; n=50] and positron emission tomography combined with CT [n=3]). For the patients who had MRI, the underlying diagnosis was benign in 19 and colorectal liver metastasis (CRLM) in 8 while 23 patients and an indeterminate lesion. In cases that remained indeterminate following MRI, liver resection was performed in 2 patients for a high suspicion of CRLM while the 21 remaining patients underwent interval surveillance (median: 9 months, range: 3-52 months). Of these 21 patients, 14 had benign lesions while CRLM was noted in 6 patients and an incidental hepatocellular carcinoma in a single patient. Age ≥65 years was the only statistically significant clinicopathological factor in predicting an underlying malignancy in patients with indeterminate liver lesions on CT. Conclusions Over a third of the patients diagnosed with indeterminate liver lesions on CT subsequently showed evidence of CRLM. These indeterminate lesions are more likely to be malignant in patients aged ≥65 years.
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Affiliation(s)
- E Mohamed
- Nottingham University Hospitals NHS Trust, UK
| | - A Adiamah
- Nottingham University Hospitals NHS Trust, UK
| | - WK Dunn
- Nottingham University Hospitals NHS Trust, UK
| | - Y Higashi
- Nottingham University Hospitals NHS Trust, UK
| | - IC Cameron
- Nottingham University Hospitals NHS Trust, UK
| | - D Gomez
- Nottingham University Hospitals NHS Trust, UK
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25
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Prognostic significance of 18F-FDG PET/CT in patients with colorectal cancer liver metastases after hepatectomy. Eur J Surg Oncol 2018; 44:670-676. [PMID: 29459018 DOI: 10.1016/j.ejso.2018.01.243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Colorectal cancer liver metastasis (CRLM) can be cured with surgery. To improve survival, optimal selection of CRLM patients should be done cautiously, which may be facilitated by preoperative [F-18] fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). METHODS A total of 245 patients with CRLM between February 2007 and January 2015 were retrospectively studied. All clinical variables, pathological data, and various PET/CT parameters were correlated with disease-free survival (DFS) and overall survival (OS). Metastatic tumor maximum standardized uptake value (SUVmax) and normal liver mean SUV (SUVmean) ratio was selected for group classification. RESULTS The median DFS in months were 24.5 months and median OS were 41.7 months. Multivariate analysis found an increased risk of worse prognosis in DFS for primary colon cancer T3∼T4, N2 stage, neoadjuvant chemotherapy, synchronous metastasis, multiple metastatic tumor number and metastatic tumor SUVmax/normal liver SUVmean ratio >4.3. The DFS rate of each group classified by SUV ratio was 58.1%, 39.0%, and 33.6% vs. 39.3%, 20.8%, and 15.8% at 1, 3, and 5 years (p = 0.017). Patients with multiple tumors and SUV ratio of >4.3 showed worst survival (OS rate: 74.2%, 41.5%, and 24.2%, p = 0.001 at 1, 3, and 5 years, respectively). CONCLUSIONS PET/CT variables can be a valuable prognostic factor in patients with CRLM for the prediction of recurrence. Preoperative PET/CT may improve risk stratification and optimize outcomes of patients with CRLM.
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Shangguan C, Gan G, Zhang J, Wu J, Miao Y, Zhang M, Li B, Mi J. Cancer-associated fibroblasts enhance tumor 18F-FDG uptake and contribute to the intratumor heterogeneity of PET-CT. Theranostics 2018; 8:1376-1388. [PMID: 29507627 PMCID: PMC5835943 DOI: 10.7150/thno.22717] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose: Elevated glucose uptake is a hallmark of cancer. Fluorodeoxyglucose (FDG) uptake was believed to indicate the aggressiveness of tumors and the standardized uptake value (SUV) is a well-known measurement for FDG uptake in positron emission tomography-computed tomography (PET/CT). However, the SUV is variable due to the heterogeneity of tumors. Methods: 126 patients with colorectal cancer underwent 18F-FDG PET/CT scanning before surgery between Jan 2011 and April 2016. Cancer-associated fibroblast (CAF) densities were calculated with the inForm Advanced image analysis software and were comparatively analyzed between patients with high and low maximum SUV (SUVmax-high and SUVmax-low). Glucose uptake was evaluated in induced and isolated CAFs and CAF-cocultured colon cancer HCT116 cells. Moreover, micro-PET/CT was performed on xenografted tumors and autoradiography was performed in the AOM/DSS induced colon cancer model. Results: CAFs were glycolytic, evidenced by glucose uptake and upregulated HK2 expression. Compared to non-activated fibroblasts (NAFs), CAFs were more dependent on glucose and sensitive to a glycolysis inhibitor. CAFs increased the SUVmax in xenograft tumors and spontaneous colon cancers. Moreover, multivariate analysis revealed that the SUVmax was only associated with tumor size among conventional parameters in colon cancer patients (126 cases, p = 0.009). Besides tumor size, the CAF density was the critical factor associated with SUVmax and outcome, which was 2.27 ± 0.74 and 1.68 ± 0.45 in the SUVmax-high and the SUVmax-low groups, respectively (p = 0.014). Conclusion: CAFs promote tumor progression and increase SUVmax of 18F-FDG, suggesting CAFs lead to the intratumor heterogeneity of the SUV and the SUVmax is a prognostic marker for cancer patients.
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Jadvar H, Colletti PM, Delgado-Bolton R, Esposito G, Krause BJ, Iagaru AH, Nadel H, Quinn DI, Rohren E, Subramaniam RM, Zukotynski K, Kauffman J, Ahuja S, Griffeth L. Appropriate Use Criteria for 18F-FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease. J Nucl Med 2017; 58:2026-2037. [DOI: 10.2967/jnumed.117.197988] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
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Bisschop C, van Dijk TH, Beukema JC, Jansen RLH, Gelderblom H, de Jong KP, Rutten HJT, van de Velde CJH, Wiggers T, Havenga K, Hospers GAP. Short-Course Radiotherapy Followed by Neoadjuvant Bevacizumab, Capecitabine, and Oxaliplatin and Subsequent Radical Treatment in Primary Stage IV Rectal Cancer: Long-Term Results of a Phase II Study. Ann Surg Oncol 2017; 24:2632-2638. [PMID: 28560600 PMCID: PMC5539276 DOI: 10.1245/s10434-017-5897-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Indexed: 12/12/2022]
Abstract
Background In a Dutch phase II trial conducted between 2006 and 2010, short-course radiotherapy followed by systemic therapy with capecitabine, oxaliplatin, and bevacizumab as neoadjuvant treatment and subsequent radical surgical treatment of primary tumor and metastatic sites was evaluated. In this study, we report the long-term results after a minimum follow-up of 6 years. Methods Patients with histologically confirmed rectal adenocarcinoma with potentially resectable or ablatable metastases in liver or lungs were eligible. Follow-up data were collected for all patients enrolled in the trial. Overall and recurrence-free survival were calculated using the Kaplan–Meier method. Results Follow-up data were available for all 50 patients. After a median follow-up time of 8.1 years (range 6.0–9.8), 16 patients (32.0%) were still alive and 14 (28%) were disease-free. The median overall survival was 3.8 years (range 0.5–9.4). From the 36 patients who received radical treatment, two (5.6%) had a local recurrence and 29 (80.6%) had a distant recurrence. Conclusions Long-term survival can be achieved in patients with primary metastatic rectal cancer after neoadjuvant radio- and chemotherapy. Despite a high number of recurrences, 32% of patients were alive after a median follow-up time of 8.1 years.
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Affiliation(s)
- C Bisschop
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T H van Dijk
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J C Beukema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R L H Jansen
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - K P de Jong
- Department of Hepato-Pancreato-Biliary Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - T Wiggers
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Havenga
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Vach W, Gerke O. [Benefit assessment of diagnostic procedures: quo vadimus?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 58:256-62. [PMID: 25633469 DOI: 10.1007/s00103-014-2111-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Not only therapeutic procedures, but also diagnostic procedures, have to demonstrate their patient-relevant benefits if they are to be reimbursed by public health insurance. Randomized trials comparing two diagnostic procedures allow us to assess these benefits directly if appropriate outcomes are used. However, owing to the widespread lack of such studies, it is now necessary to use the "linked evidence" approach as well, trying to predict the patient-relevant benefits from the results of comparative accuracy studies. Such a prediction is based on explicitly specifying our expectations with regard to the consequences of a change in diagnosis at the level of a single patient. We discuss the basic properties of these two approaches, which are relevant to the understanding of their possible role in the benefit assessment of diagnostic procedures. We try to predict the future roles of the two approaches and outline some of the issues on which a consensus is required to allow their successful use in benefit assessment. Furthermore, we indicate some of the developments related to the paradigm of individualized care that may influence the use of benefit assessments for diagnostic studies in the future.
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Affiliation(s)
- Werner Vach
- Department für Medizinische Biometrie und Medizinische Informatik, Universität Freiburg, Stefan Meier Str. 26, 79104, Freiburg, Deutschland,
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Viganò L, Lopci E, Costa G, Rodari M, Poretti D, Pedicini V, Solbiati L, Chiti A, Torzilli G. Positron Emission Tomography-Computed Tomography for Patients with Recurrent Colorectal Liver Metastases: Impact on Restaging and Treatment Planning. Ann Surg Oncol 2017; 24:1029-1036. [PMID: 27807727 DOI: 10.1245/s10434-016-5644-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Indexed: 09/18/2023]
Abstract
BACKGROUND The impact of fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for patients with colorectal liver metastases (CLM) still is debated. Its relevance could be enhanced in the case of recurrent disease. The current study aimed to elucidate the role of PET-CT in restaging and treatment planning for recurrent CLM. METHODS A series of 352 consecutive patients undergoing their first liver resection for CLM between 2005 and 2014 was reviewed. Of these patients, 224 (63.6 %) had a recurrence. The 107 patients who had received PET-CT at diagnosis of recurrence before chemotherapy were analyzed. CT was available in all cases, and magnetic resonance imaging (MRI) was available in 64 cases. RESULTS Extrahepatic lesions were found in 59 patients. Liver and lung recurrences were detected with excellent sensitivity by CT/MRI and PET-CT (liver: 100 vs. 96.7 %; lung: 95.8 vs. 95.8 %). In detecting other recurrence sites, PET-CT had higher sensitivity than CT/MRI (91.5 vs. 54.2 %, p < 0.01; lymph nodes: 93.5 vs. 64.5 %, p = 0.011; peritoneum: 80 vs. 20 %, p = 0.023; bones: 87.5 vs. 37.5 %, nonsignificant difference). For 28.8 % (17/59) of the patients, the diagnosis of extrahepatic disease was obtained thanks to PET-CT (39.5 % considering nonpulmonary lesions). PET-CT modified treatment strategy in 16 (14.9 %) patients, excluding from surgery 15 (20.3 %) of 74 patients resectable at CT/MRI. This latter subgroup had a lower survival rate than the patients resectable after PET-CT (2-year survival, 22.7 vs. 77.8 %; p = 0.004), similar to the patients unresectable at CT/MRI (57.6 %). CONCLUSIONS In the authors' experience, PET-CT has offered a relevant contribution to restaging of recurrent CLM. It disclosed one fourth of extrahepatic lesions and prevented worthless surgery for about 20 % of patients.
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Affiliation(s)
- Luca Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Dario Poretti
- Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Vittorio Pedicini
- Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Arturo Chiti
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
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Fehr M, Müller J, Knitel M, Fornaro J, Horber D, Koeberle D, Cerny T, Güller U. Early Postoperative FDG-PET-CT Imaging Results in a Relevant Upstaging in the pN2 Subgroup of Stage III Colorectal Cancer Patients. Clin Colorectal Cancer 2017; 16:343-348. [PMID: 28412138 DOI: 10.1016/j.clcc.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/26/2017] [Accepted: 03/09/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Clinical practice guidelines regarding follow-up in patients after curative resection of colorectal cancer (CRC) vary widely. Current follow-up recommendations do not include additional postoperative imaging before starting adjuvant treatment in any patients. We evaluated the potential benefit of our institutional approach, recommending 18fluor-deoxy-glucose (FDG)-positron emission tomography (PET)-computed tomography (CT) imaging in CRC stage III patients with ≥4 locoregional lymph node metastases (pN2). PATIENTS AND METHODS Our study included all patients from a single center with complete resection of a pT1-4, pN2, cM0 CRC. All patients were considered free of distant metastases on the basis of preoperative CT imaging of the chest, abdomen, and pelvis. The main objective of the present study was to assess the proportion of patients with changes of therapeutic management (defined as any other treatment than the preplanned adjuvant chemotherapy) because of the results of additional postoperative FDG-PET-CT imaging. RESULTS Fifty patients (22 female/28 male) were included; the median age was 64 years (range, 37-78 years). Previously undiagnosed metastatic disease resulting in a change of the therapeutic management was detected using postoperative FDG-PET-CT imaging in 7 patients (14.0%; 95% confidence interval, 5.8%-26.7%). The number needed to screen to detect new or previously occult metastases was 7 (7 of 50). CONCLUSION To our knowledge, this is the first study to evaluate the role of an additional postoperative FDG-PET-CT scan before adjuvant treatment in patients with completely resected CRC with ≥4 lymph node metastases (pT1-4, pN2) and without distant metastases on preoperative CT imaging (cM0). Postoperative FDG-PET-CT imaging represents a valuable tool for the detection of new macrometastases in the subgroup of pN2 cM0 CRC patients. The low number needed to screen for consequent therapeutic changes is clinically relevant and should be further evaluated.
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Affiliation(s)
- Martin Fehr
- Department of Oncology/Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
| | - Joachim Müller
- Department of Nuclear Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Meinhard Knitel
- Department of Radiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Daniel Horber
- Department of Oncology/Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Thomas Cerny
- Department of Oncology/Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Ulrich Güller
- Department of Oncology/Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Sivesgaard K, Jöhnk ML, Larsen LP, Sørensen M, Kramer S, Løgager VB, Hansen F, Pedersen EM. Comparison of four MRI protocols for detection of extrahepatic colorectal cancer metastases. J Magn Reson Imaging 2017; 46:1619-1630. [PMID: 28301099 DOI: 10.1002/jmri.25704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare three magnetic resonance imaging (MRI) protocols containing diffusion-weighted imaging with background suppression (DWIBS) and one traditional protocol for detecting extrahepatic colorectal cancer metastases. MATERIALS AND METHODS Thirty patients with extrahepatic colorectal cancer metastases were scanned in three stations from the skull base to the upper thighs using a 1.5T MRI system with six different MRI sequences; transverse and coronal T2 -weighted (T2 W) turbo spin-echo (TSE), coronal short tau inversion recovery (STIR), 3D T1 W TSE, DWIBS, and a contrast-enhanced T1 W 3D gradient echo (GRE) sequence. The six sequences were used to build four hypothetical MRI interpretive sets which were read by two readers in consensus, blinded to prior imaging. Lesions were categorized into 13 anatomic regions. Fluorodeoxyglucose / positron emission tomography / computed tomography (FDG-PET/CT) read with full access to prior imaging and clinical records was used as the reference standard. Sensitivity, specificity, and false discovery rate (FDR) were calculated as appropriate and receiver operating characteristic (ROC) curves were constructed. RESULTS In all, 177 malignant lesions were detected by FDG-PET/CT and distributed in 92 out of 390 scanned anatomic regions. The sensitivity was statistically higher in two out of three sets incorporating DWIBS on a per-lesion basis (66.7%, 63.3%, and 66.7% vs. 57.6%) (P = 0.01, P = 0.11, and P = 0.01, respectively) and in all sets incorporating DWIBS on a per-region basis (75.0%, 75.0%, and 77.2 vs. 66.3%) (P = 0.04, P = 0.04, and P = 0.01, respectively). There was no difference in specificity, FDR, or AUCROC . There was no difference between sets containing DWIBS irrespective of the use of a contrast-enhanced sequence. CONCLUSION MRI sets containing DWIBS had superior sensitivity. This sensitivity was retained when omitting a contrast-enhanced sequence. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1619-1630.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Berg Løgager
- Department of Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Flemming Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Jones RP, Brudvik KW, Franklin JM, Poston GJ. Precision surgery for colorectal liver metastases: Opportunities and challenges of omics-based decision making. Eur J Surg Oncol 2017; 43:875-883. [PMID: 28302330 DOI: 10.1016/j.ejso.2017.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022] Open
Abstract
Precision surgery involves improving patient selection to ensure that surgical intervention that is proven to benefit on a population level is the optimal treatment for each individual patient. For patients with colorectal liver metastases (CRLM), existing prognostic scoring systems rely on well-recognised histopathological features such as size and number of lesions. Advances in preoperative imaging algorithms mean that increasingly low volume disease can be detected, improving assessment of these factors. In addition, novel imaging modalities mean that underlying tumour biology and metabolic behaviour during therapy can be assessed. Molecular analysis of tumours can provide crucial prognostic information, with the critical role of RAS/RAF mutations in prognosis well recognised. The optimal source of tissue for this level of analysis is debated, with good concordance between primary and metastatic lesions for some recognised prognostic factors but marked discrepancies for a variety of other relevant mutations. As well as mutational heterogeneity between primary and metastatic lesions, heterogeneity within tumours and dynamic changes in tumour biology over time present a significant challenge in assessing tumour for prognostic biomarkers. Circulating tumour cells offer one potential method of longitudinal tumour analysis, but are limited by current technologies. This review article summarises some of the key advances in prognostication for patients with resectable colorectal liver metastases, as well as highlighting the potential limitations of such an approach.
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Affiliation(s)
- R P Jones
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK; School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - K W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - J M Franklin
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G J Poston
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
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A prognostic classifier for patients with colorectal cancer liver metastasis, based on AURKA, PTGS2 and MMP9. Oncotarget 2016; 7:2123-34. [PMID: 26497206 PMCID: PMC4811521 DOI: 10.18632/oncotarget.6188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/04/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Prognosis of patients with colorectal cancer liver metastasis (CRCLM) is estimated based on clinicopathological models. Stratifying patients based on tumor biology may have additional value. METHODS Tissue micro-arrays (TMAs), containing resected CRCLM and corresponding primary tumors from a multi-institutional cohort of 507 patients, were immunohistochemically stained for 18 candidate biomarkers. Cross-validated hazard rate ratios (HRRs) for overall survival (OS) and the proportion of HRRs with opposite effect (P(HRR < 1) or P(HRR > 1)) were calculated. A classifier was constructed by classification and regression tree (CART) analysis and its prognostic value determined by permutation analysis. Correlations between protein expression in primary tumor-CRCLM pairs were calculated. RESULTS Based on their putative prognostic value, EGFR (P(HRR < 1) = .02), AURKA (P(HRR < 1) = .02), VEGFA (P(HRR < 1) = .02), PTGS2 (P(HRR < 1) = .01), SLC2A1 (P(HRR > 1) < 01), HIF1α (P(HRR > 1) = .06), KCNQ1 (P(HRR > 1) = .09), CEA (P (HRR > 1) = .05) and MMP9 (P(HRR < 1) = .07) were included in the CART analysis (n = 201). The resulting classifier was based on AURKA, PTGS2 and MMP9 expression and was associated with OS (HRR 2.79, p < .001), also after multivariate analysis (HRR 3.57, p < .001). The prognostic value of the biomarker-based classifier was superior to the clinicopathological model (p = .001). Prognostic value was highest for colon cancer patients (HRR 5.71, p < .001) and patients not treated with systemic therapy (HRR 3.48, p < .01). Classification based on protein expression in primary tumors could be based on AURKA expression only (HRR 2.59, p = .04). CONCLUSION A classifier was generated for patients with CRCLM with improved prognostic value compared to the standard clinicopathological prognostic parameters, which may aid selection of patients who may benefit from adjuvant systemic therapy.
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Fu J, Wu L, Jiang M, Tan Y, Li D, Chen F, Jiang T, Du J. Signet ring cell carcinoma of resectable metastatic colorectal cancer has rare surgical value. J Surg Oncol 2016; 114:1004-1008. [PMID: 27891617 DOI: 10.1002/jso.24437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Signet ring cell carcinoma (SRCC) is a uniquely separated subgroup in metastatic colorectal cancer (mCRC). The aims are to investigate the value of resection in patients with resectable metastatic signet ring cell colorectal cancer. METHODS Patients with mCRC who underwent resection in Surveillance, Epidemiology, and End Results database during 1998-2010 were retrospectively analyzed. Kaplan-Meier and COX models were used to analyze the differences in the survival. Logistic regression models were used to evaluate the relationship between SRCC and other clinicopathological factors. RESULTS Among the 3,568 patients, 94 (2.63%) patients had SRCC. The median survival time of patients with SRCC and non-SRCC were 17 and 29 months, respectively (P < 0.001). Multivariate analysis indicated that SRCC was an independent prognostic factor for poor overall survival. Logistic regression model based on variables identified by univariate analysis indicated that younger age (≤50 years old) (P = 0.005), female (P < 0.001), location in colon (P = 0.012), and N positive status (P = 0.003) were independent variables correlated with the SRCC subgroup. SRCC had a dramatically higher invalid surgical outcome rate than non-SRCC (P = 0.001). CONCLUSION SRCC patients might benefit little from the resection of primary and metastatic lesions with a high rate of undergoing invalid operations. J. Surg. Oncol. 2016;114:1004-1008. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jianfei Fu
- Department of Oncology, Zhejiang University Jinhua Hospital, Jinhua, Zhejiang Province, China
| | - Lunpo Wu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mengjie Jiang
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yinuo Tan
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Dan Li
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fei Chen
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ting Jiang
- Department of Nuclear Medicine, Zhejiang University Jinhua Hospital, Jinhua, Zhejiang Province, China
| | - Jinlin Du
- Department of Colorectal Surgery, Zhejiang University Jinhua Hospital, Jinhua, Zhejiang Province, China
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Metser U, Halankar J, Langer D, Mohan R, Hussey D, Hadas M, Tamir S. Effect of chemotherapy on the impact of FDG-PET/CT in selection of patients for surgical resection of colorectal liver metastases: single center analysis of PET-CAM randomized trial. Ann Nucl Med 2016; 31:153-162. [PMID: 27848159 DOI: 10.1007/s12149-016-1139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
The largest randomized controlled trial (RCT) on the effect of FDG-PET on surgical management for metastatic colorectal adenocarcinoma to liver ("PET-CAM") reported only a modest change in surgical management (8%). PURPOSE To explore the relationship between prior chemotherapy and detection of metastatic disease on PET in patients from PET-CAM. Secondary aim: to determine whether centralized imaging interpretation could have impacted trial results. METHODS The study included 120 patients from a single institution. Local PET interpretation (PET-L) was recorded from the original database. Retrospective PET interpretation was performed independently by at least one additional reader (PET-C). The presence of extrahepatic disease (EHD) and significant additional liver metastases (=SALM), defined as metastases not originally planned for resection, was recorded. Patients were stratified to responders to recent chemotherapy (Group R) versus all others (Group O) according to surgical pathology and RECIST criteria. RESULTS Thirty-seven of 50 patients who received recent chemotherapy (<90 days) were responders (Group R). EHD was present in 30/120 (25%) patients. There was no difference in detection of EHD on PET-L (7/37;18.9%), PET-C (7/37;18.9%), and CT (4/37;10.8%) for Group R (p = 0.375), but in Group O more EHD was detected on both PET-L (15/83;18.1%) and PET-C (22/83;26.5%) than CT (8/83;9.6%); p = 0.039 and p < 0.001, respectively. For the entire cohort, PET-L and PET-C detected EHD and/or SALM not reported on CT in 14 (11.7%) and 22 (18.3%) patients. CONCLUSION The impact of recent chemotherapy on detection of colorectal metastases with PET suggests that the utility of PET in patient selection for liver resection in the prior PET-CAM-RCT may have been underestimated.
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Affiliation(s)
- Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Deanna Langer
- Department of Clinical Programs, Cancer Imaging Program, Cancer Care Ontario, Toronto, ON, Canada
| | - Ravi Mohan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Douglas Hussey
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Moshonov Hadas
- Office of Research and Development, Joint Department of Medical Imaging, UHN, MSH, WCH, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shlomit Tamir
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
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Ronot M, Clift AK, Vilgrain V, Frilling A. Functional imaging in liver tumours. J Hepatol 2016; 65:1017-1030. [PMID: 27395013 DOI: 10.1016/j.jhep.2016.06.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/08/2023]
Abstract
Functional imaging encompasses techniques capable of assessing physiological parameters of tissues, and offers useful clinical information in addition to that obtained from morphological imaging. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. The liver is of major importance in oncological practice; not only is hepatocellular carcinoma one of the malignancies with steadily rising incidence worldwide, but hepatic metastases are regularly observed with a range of solid neoplasms. Within the realm of hepatic oncology, different functional imaging modalities may occupy pivotal roles in lesion characterisation, treatment selection and follow-up, depending on tumour size and type. In this review, we characterise the major forms of functional imaging, discuss their current application to the management of patients with common primary and secondary liver tumours, and anticipate future developments within this field.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | | | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
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Araujo RLC, Riechelmann RP, Fong Y. Patient selection for the surgical treatment of resectable colorectal liver metastases. J Surg Oncol 2016; 115:213-220. [PMID: 27778357 DOI: 10.1002/jso.24482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/30/2016] [Indexed: 12/14/2022]
Abstract
Advances in surgery and chemotherapy regimens have increased the long-term survival of patients with colorectal liver metastases (CRLM). Although liver resection remains an essential part of any curative strategy for resectable CRLM, chemotherapy regimens have also improved the long-term outcomes. However, the optimal timing for chemotherapy regimens remains unclear. Thus, this review addressed key points to aid the decision-making process regarding the timing of chemotherapy and surgery for patients with resectable CRLM. J. Surg. Oncol. 2017;115:213-220. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Raphael L C Araujo
- Department of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Rachel P Riechelmann
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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39
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Franklin JM, Sharma RA, Harris AL, Gleeson FV. Imaging oligometastatic cancer before local treatment. Lancet Oncol 2016; 17:e406-14. [PMID: 27599145 DOI: 10.1016/s1470-2045(16)30277-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/21/2022]
Abstract
With the advent of novel treatment strategies to help widen the therapeutic window for patients with oligometastatic cancer, improved biomarkers are needed to reliably define patients who can benefit from these treatments. Multimodal imaging is one such option and should be optimised to comprehensively assess metastatic sites, disease burden, and response to neoadjuvant treatment in each disease setting. These features will probably remain important prognostic biomarkers, and are crucial in planning multidisciplinary treatment. There are opportunities to extract additional phenotypic information from conventional imaging, while novel imaging techniques can also reveal specific aspects of tumour biology. Imaging can both characterise and localise the phenotypic heterogeneity of multiple tumour sites. Novel approaches to existing imaging datasets and correlation with tumour biology will be important in realising the potential of imaging to guide treatment in the oligometastatic setting. In this Personal View, we discuss the current status and future directions of imaging before treatment in patients with extracranial oligometastases.
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Affiliation(s)
- James M Franklin
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, University of Oxford, UK.
| | | | - Adrian L Harris
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, University of Oxford, UK
| | - Fergus V Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, University of Oxford, UK
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40
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Wartski M. La tomographie par émission de positons (TEP) en oncologie digestive. Presse Med 2016; 45:734-41. [DOI: 10.1016/j.lpm.2016.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022] Open
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41
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Van Cutsem E, Verheul HMW, Flamen P, Rougier P, Beets-Tan R, Glynne-Jones R, Seufferlein T. Imaging in Colorectal Cancer: Progress and Challenges for the Clinicians. Cancers (Basel) 2016; 8:cancers8090081. [PMID: 27589804 PMCID: PMC5040983 DOI: 10.3390/cancers8090081] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023] Open
Abstract
The use of imaging in colorectal cancer (CRC) has significantly evolved over the last twenty years, establishing important roles in surveillance, diagnosis, staging, treatment selection and follow up. The range of modalities has broadened with the development of novel tracer and contrast agents, and the fusion of technologies such as positron emission tomography (PET) and computed tomography (CT). Traditionally, the most widely used modality for assessing treatment response in metastasised colon and rectal tumours is CT, combined with use of the RECIST guidelines. However, a growing body of evidence suggests that tumour size does not always adequately correlate with clinical outcomes. Magnetic resonance imaging (MRI) is a more versatile technique and dynamic contrast-enhanced (DCE)-MRI and diffusion-weighted (DW)-MRI may be used to evaluate biological and functional effects of treatment. Integrated fluorodeoxyglucose (FDG)-PET/CT combines metabolic and anatomical imaging to improve sensitivity and specificity of tumour detection, and a number of studies have demonstrated improved diagnostic accuracy of this modality in a variety of tumour types, including CRC. These developments have enabled the progression of treatment strategies in rectal cancer and improved the detection of hepatic metastatic disease, yet are not without their limitations. These include technical, economical and logistical challenges, along with a lack of robust evidence for standardisation and formal guidance. In order to successfully apply these novel imaging techniques and utilise their benefit to provide truly personalised cancer care, advances need to be clinically realised in a routine and robust manner.
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Affiliation(s)
- Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium.
| | - Henk M W Verheul
- Division of Medical Oncology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands.
| | - Patrik Flamen
- Nuclear Medicine Imaging and Therapy Department, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
| | - Philippe Rougier
- Gastroenterology and Digestive Oncology Department, European Hospital, Georges Pompidou, 75015 Paris, France.
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Rob Glynne-Jones
- Department of Medical Oncology, Mount Vernon Centre for Cancer Treatment, HA6 2RN Middlesex, UK.
| | - Thomas Seufferlein
- Clinic of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
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Huang YTT, Park J, Chong S, Hugh TJ, Ng WL, Lin M. The prognostic value of fluorodeoxyglucose positron emission tomography metabolic tumor volume in solitary colorectal liver metastasis. Asia Pac J Clin Oncol 2016; 13:e262-e270. [DOI: 10.1111/ajco.12568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Yi-Tung T Huang
- Department of Nuclear Medicine and PET; Sydney Australia
- University of New South Wales; Kensington Sydney Australia
| | - Joomann Park
- University of New South Wales; Kensington Sydney Australia
| | - Shanley Chong
- University of New South Wales; Kensington Sydney Australia
- Epidemiology, Healthy People and Places Unit; Southwestern Sydney Local Health District; Sydney Australia
| | - Thomas J Hugh
- Upper GI Surgical Unit; Royal North Shore Hospital and North Shore Private Hospital; St. Leonards Sydney Australia
- University of Sydney; Sydney Australia
| | - Weng Leong Ng
- University of New South Wales; Kensington Sydney Australia
- Medical Oncology, Liverpool Hospital; Sydney Australia
- Ingham Institute for Applied Medical Research; Liverpool; Sydney Australia
- University of Western Sydney; Sydney Australia
| | - Michael Lin
- Department of Nuclear Medicine and PET; Sydney Australia
- University of New South Wales; Kensington Sydney Australia
- University of Western Sydney; Sydney Australia
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Serrano PE, Gafni A, Gu CS, Gulenchyn KY, Julian JA, Law C, Hendler AL, Moulton CA, Gallinger S, Levine MN. Positron Emission Tomography–Computed Tomography (PET-CT) Versus No PET-CT in the Management of Potentially Resectable Colorectal Cancer Liver Metastases: Cost Implications of a Randomized Controlled Trial. J Oncol Pract 2016; 12:e765-74. [DOI: 10.1200/jop.2016.011676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: To evaluate whether positron emission tomography (PET) combined with computed tomography (PET-CT) is cost saving, or cost neutral, compared with conventional imaging in management of patients with resectable colorectal cancer liver metastases. Methods: Cost evaluation of a randomized trial that compared the effect of PET-CT on surgical management of patients with resectable colorectal cancer liver metastases. Health care use data ≤ 1 year after random assignment was obtained from administrative databases. Cost analysis was undertaken from the perspective of a third-party payer (ie, Ministry of Health). Mean costs with 95% credible intervals (CrI) were estimated by using a Bayesian approach. Results: The estimated mean cost per patient in the 263 patients who underwent PET-CT was $45,454 CAD (range, $1,340 to $181,420) and in the 134 control patients, $40,859 CAD (range, $279 to $293,558), with a net difference of $4,327 CAD (95% CrI, −$2,207 to $10,614). The primary cost driver was hospitalization for liver surgery (difference of $2,997 CAD for PET-CT; 95% CrI, −$2,144 to $8,010), which was mainly a result of a longer length of hospital stay for the PET-CT arm (median, 7 v 6 days; P = .03) and a higher postoperative complication rate (20% v 10%; P = .01). Baseline characteristics were similar between groups, including the number of liver segments involved with cancer, number of segments resected, and type of liver resection performed. No difference in survival was detected between arms. Conclusion: PET-CT was associated with limited clinical benefit and a nonsignificant increased cost. Universal funding of PET-CT in the management of patients with resectable colorectal cancer liver metastases does not seem justified.
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Affiliation(s)
- Pablo E. Serrano
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Amiram Gafni
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Chu-Shu Gu
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Karen Y. Gulenchyn
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Jim A. Julian
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Calvin Law
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Aaron L. Hendler
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Carol-Anne Moulton
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Steven Gallinger
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
| | - Mark N. Levine
- McMaster University, Hamilton, Ontario; and University of Toronto, Toronto, Ontario, Canada
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Abstract
Gastrointestinal malignancies comprise a heterogeneous group of diseases that include both common and rare diseases with very different presentations and prognoses. The mainstay of treatment is surgery in combination with preoperative and adjuvant chemotherapy depending on clinical presentation and initial stages. This article outlines the potential use of fluorodeoxyglucose-PET/CT in clinical decision making with special regard to preoperative evaluation and response assessment in gastric cancer (including the gastroesophageal junction), pancreatic cancer (excluding neuroendocrine tumors), colorectal cancer, and gastrointestinal stromal tumors.
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de Galiza Barbosa F, Delso G, Ter Voert EEGW, Huellner MW, Herrmann K, Veit-Haibach P. Multi-technique hybrid imaging in PET/CT and PET/MR: what does the future hold? Clin Radiol 2016; 71:660-72. [PMID: 27108800 DOI: 10.1016/j.crad.2016.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 12/19/2022]
Abstract
Integrated positron-emission tomography and computed tomography (PET/CT) is one of the most important imaging techniques to have emerged in oncological practice in the last decade. Hybrid imaging, in general, remains a rapidly growing field, not only in developing countries, but also in western industrialised healthcare systems. A great deal of technological development and research is focused on improving hybrid imaging technology further and introducing new techniques, e.g., integrated PET and magnetic resonance imaging (PET/MRI). Additionally, there are several new PET tracers on the horizon, which have the potential to broaden clinical applications in hybrid imaging for diagnosis as well as therapy. This article aims to highlight some of the major technical and clinical advances that are currently taking place in PET/CT and PET/MRI that will potentially maintain the position of hybrid techniques at the forefront of medical imaging technologies.
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Affiliation(s)
- F de Galiza Barbosa
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; University of Zurich, Switzerland
| | - G Delso
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; GE Healthcare, Waukesha, WI, USA
| | - E E G W Ter Voert
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; University of Zurich, Switzerland
| | - M W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; University of Zurich, Switzerland; Department of Neuroradiology, University Hospital Zurich, Switzerland
| | - K Herrmann
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, United States; Department of Nuclear Medicine, Universitätsklinikum Würzburg, Oberdürrbacher, Str. 6, Würzburg, Germany
| | - P Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich, Switzerland; University of Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
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Glucose Transporter 1 (SLC2A1) and Vascular Endothelial Growth Factor A (VEGFA) Predict Survival After Resection of Colorectal Cancer Liver Metastasis. Ann Surg 2016; 263:138-45. [PMID: 25563886 DOI: 10.1097/sla.0000000000001109] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the individual and combined prognostic value of HIF1α, SLC2A1, and vascular endothelial growth factor A (VEGFA) in a multi-institutional cohort of patients with resected colorectal cancer liver metastasis (CRCLM). BACKGROUND In the majority of patients with CRCLM, resection seems not to be curative, despite its curative intent. Overexpression of hypoxia-inducible factor 1α (HIF1α), glucose transporter 1 (SLC2A1; also known as GLUT1), and VEGFA has been associated with tumor progression and poor prognosis of patients with colorectal cancer (CRC). METHODS Tissue microarrays were generated using CRCLM and patient-matched primary CRC from patients who underwent CRCLM resection between 1990 and 2010. Prognostic value of HIF1α, SLC2A1, and VEGFA was determined by immunohistochemistry. A 500-fold cross-validated hazard rate ratio (HRRav) for overall survival was calculated. RESULTS HIF1α, SLC2A1, and VEGFA expression could be evaluated in 328, 350, and 335 patients, respectively. High SLC2A1 expression was associated with good prognosis (HRRav, 0.67; P (HRR >1) < 0.01) and high VEGFA expression to poor prognosis (HRRav, 1.84; P (HRR < 1) = 0.02), also after multivariate analysis including established clinicopathological prognostic variables (HRRav, 0.67; P (HRR > 1) < 0.01 and HRRav, 1.50; P (HRR < 1) = 0.02, respectively). SLC2A1 showed prognostic value particularly in patients treated with systemic therapy (P < 0.01), whereas the prognostic value of VEGFA expression was mainly observed in patients not treated with systemic therapy (P < 0.01). Prognosis was especially poor in patients with both low SLC2A1 and high VEGFA expression (P < 0.01). HIF1α expression was not associated with survival. CONCLUSIONS SLC2A1 and VEGFA expression are prognostic molecular biomarkers for patients with CRCLM with added value to established clinicopathological variables.
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Achiam MP, Løgager VB, Skjoldbye B, Møller JM, Lorenzen T, Rasmussen VL, Thomsen HS, Mollerup TH, Okholm C, Rosenberg J. Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial. PeerJ 2016; 4:e1532. [PMID: 26793420 PMCID: PMC4715462 DOI: 10.7717/peerj.1532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/03/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT. Methods. Consecutive patients diagnosed with rectal cancers were asked to participate in the study. Preoperative CT and diffusion weighted MR (DWMR) were compared to contrast enhanced laparoscopic ultrasound (CELUS). Results. A total of 35 patients were included, 15 patients in Group-1 having the standard CT evaluation of the liver and 20 patients in Group-2 having the standard CT evaluation of the liver and DWMR of the liver. Compared with CELUS, the per-patient sensitivity/specificity was 50/100% for CT, and for DWMR: 100/94% and 100/100% for Reader 1 and 2, respectively. The per-lesion sensitivity of CT and DWMR were 17% and 89%, respectively compared with CELUS. Furthermore, one patient had non-resectable metastases after DWMR despite being diagnosed with resectable metastases after CT. Another patient was diagnosed with multiple liver metastases during CELUS, despite a negative CT-scan. Discussion. DWMR is feasible for preoperative evaluation of liver metastases. The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time.
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Affiliation(s)
- Michael P Achiam
- Department of Surgical Gastroenterology, Abdominal Centret, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Vibeke B Løgager
- Department of Radiology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Bjørn Skjoldbye
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Jakob M Møller
- Department of Radiology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Torben Lorenzen
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Vera L Rasmussen
- Department of Radiology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Talie H Mollerup
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Cecilie Okholm
- Department of Surgical Gastroenterology, Abdominal Centret, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen , Herlev , Denmark
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Kim R, Prithviraj G, Kothari N, Springett G, Malafa M, Hodul P, Kim J, Yue B, Morse B, Mahipal A. PET/CT Fusion Scan Prevents Futile Laparotomy in Early Stage Pancreatic Cancer. Clin Nucl Med 2015; 40:e501-5. [PMID: 26053713 PMCID: PMC4813735 DOI: 10.1097/rlu.0000000000000837] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Surgical resection with negative margins is the only curative approach for pancreatic cancer. A paucity of data exists in using PET/CT scan as staging workup in resectable pancreatic cancer. The aim of this study is to determine if PET/CT prevents futile laparotomy by detecting occult metastatic disease in patients with resectable or borderline resectable pancreatic cancer. METHODS Patients were included using institutional PET/CT data base incorporating National Oncologic PET Registry with diagnosis of resectable or borderline resectable pancreatic cancer from 2005 to 2012. Clinical, radiographic, and pathologic characteristics were evaluated. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered secondary to PET/CT. RESULTS We identified 285 patients with early stage pancreatic cancer who received PET/CT as part of initial staging workup. Upon initial workup (CT + EUS), 62% of patients were considered resectable, and 38% were borderline resectable. Addition of PET/CT scan changed the management in 10.9% (n = 31) of the patients (95% CI, 8%-15%). Metastatic lesions were confirmed with biopsy in 19 patients (61%). The proportion of change in treatment plan was significantly higher in patients who were initially considered to have borderline resectable compared with resectable malignancy (17% vs 7%, P = 0.019). In 199 patients who underwent surgery, 18.1% (n = 36) were found to have metastatic disease intraoperatively. CONCLUSIONS PET/CT helped improve detection of occult metastases, ultimately sparing these patients a potentially unnecessary surgery. The role of PET/CT scan should be validated in prospective study.
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Affiliation(s)
- Richard Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Gopi Prithviraj
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Nishi Kothari
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Greg Springett
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Pamela Hodul
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Binglin Yue
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Brian Morse
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Amit Mahipal
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
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A General Cutoff Level Combined With Personalized Dynamic Change of Serum Carcinoembryonic Antigen Can Suggest Timely Use of FDG PET for Early Detection of Recurrent Colorectal Cancer. Clin Nucl Med 2015. [DOI: 10.1097/rlu.0000000000000900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Goos JACM, Verbeek J, Geldof AA, Hiemstra AC, van de Wiel MA, Adamzek KA, Delis-Van Diemen PM, Stroud SG, Bradley DP, Meijer GA, Hoekstra OS, Fijneman RJA, Windhorst AD. Molecular imaging of aurora kinase A (AURKA) expression: Synthesis and preclinical evaluation of radiolabeled alisertib (MLN8237). Nucl Med Biol 2015; 43:63-72. [PMID: 26432753 DOI: 10.1016/j.nucmedbio.2015.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Survival of patients after resection of colorectal cancer liver metastasis (CRCLM) is 36%-58%. Positron emission tomography (PET) tracers, imaging the expression of prognostic biomarkers, may contribute to assign appropriate management to individual patients. Aurora kinase A (AURKA) expression is associated with survival of patients after CRCLM resection. METHODS We synthesized [(3)H]alisertib and [(11)C]alisertib, starting from [(3)H]methyl nosylate and [(11)C]methyl iodide, respectively. We measured in vitro uptake of [(3)H]alisertib in cancer cells with high (Caco2), moderate (A431, HCT116, SW480) and low (MKN45) AURKA expression, before and after siRNA-mediated AURKA downmodulation, as well as after inhibition of P-glycoprotein (P-gp) activity. We measured in vivo uptake and biodistribution of [(11)C]alisertib in nude mice, xenografted with A431, HCT116 or MKN45 cells, or P-gp knockout mice. RESULTS [(3)H]Alisertib was synthesized with an overall yield of 42% and [(11)C]alisertib with an overall yield of 23%±9% (radiochemical purity ≥99%). Uptake of [(3)H]alisertib in Caco2 cells was higher than in A431 cells (P=.02) and higher than in SW480, HCT116 and MKN45 cells (P<.01). Uptake in A431 cells was higher than in SW480, HCT116 and MKN45 cells (P<.01). Downmodulation of AURKA expression reduced [(3)H]alisertib uptake in Caco2 cells (P<.01). P-gp inhibition increased [(3)H]alisertib uptake in Caco2 (P<.01) and MKN45 (P<.01) cells. In vivo stability of [(11)C]alisertib 90min post-injection was 94.7%±1.3% and tumor-to-background ratios were 2.3±0.8 (A431), 1.6±0.5 (HCT116) and 1.9±0.5 (MKN45). In brains of P-gp knockout mice [(11)C]alisertib uptake was increased compared to uptake in wild-type mice (P<.01) CONCLUSIONS: Radiolabeled alisertib can be synthesized and may have potential for the imaging of AURKA, particularly when AURKA expression is high. However, the exact mechanisms underlying alisertib accumulation need further investigation. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Radiolabeled alisertib may be used for non-invasively measuring AURKA protein expression and to stratify patients for treatment accordingly.
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Affiliation(s)
- Jeroen A C M Goos
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Joost Verbeek
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert A Geldof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke C Hiemstra
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark A van de Wiel
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Kevin A Adamzek
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Gerrit A Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Remond J A Fijneman
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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