Positron emission tomography detection of distant metastatic or synchronous disease in patients with locally advanced rectal cancer receiving preoperative chemoradiation Journal Article
| Authors: | Nahas, C. S. R.; Akhurst, T.; Yeung, H.; Riedel, E.; Markowitz, A. J.; Minsky, B. D.; Paty, P. B.; Weiser, M. R.; Temple, L. K.; Wong, W. D.; Larson, S. M.; Guillem, J. G.; Leibold, T. |
| Article Title: | Positron emission tomography detection of distant metastatic or synchronous disease in patients with locally advanced rectal cancer receiving preoperative chemoradiation |
| Abstract: | Background: Patients with locally advanced rectal cancer may present with synchronous distant metastases. Choice of optimal treatment-neoadjuvant chemoradiation versus systemic chemotherapy alone-depends on accurate assessment of distant disease. We prospectively evaluated the ability of [ 18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) to detect distant disease in patients with locally advanced rectal cancer who were otherwise eligible for combined modality therapy (CMT). Methods: Ninety-three patients with locally advanced rectal cancer underwent whole-body [18F]FDG PET scanning 2-3 weeks before starting CMT. Sites other than the rectum, mesorectum, or the area along the inferior mesenteric artery were considered distant and were divided into nine groups: neck, lung, mediastinal lymph node (LN), abdomen, liver, colon, pelvis, peripheral LN, and soft tissue. Two nuclear medicine physicians blinded to clinical information used PET images and a five-point scale (0-4) to determine certainty of disease. A score greater than 3 was considered malignant. Confirmation was based on tissue diagnosis, surgical exploration, and subsequent imaging. Results: At a median follow-up of 34 months, the overall accuracy, sensitivity, and specificity of PET in detecting distant disease were 93.7%, 77.8%, and 98.7% respectively. Greatest accuracy was demonstrated in detection of liver (accuracy = 99.9%, sensitivity = 100%, specificity = 98.8%) and lung (accuracy = 99.9%, sensitivity = 80%, specificity = 100%) disease; PET detected 11/12 confirmed malignant sites in liver and lung. A total of 10 patients were confirmed to have M1 stage disease. All 10 were correctly staged by pre-CMT PET; abdominopelvic computed tomography (CT) scans accurately detected nine of them. Conclusion: Baseline PET in patients with locally advanced rectal cancer reliably detects metastatic disease in liver and lung. PET may play a significant role in defining extent of distant disease in selected cases, thus impacting the choice of neoadjuvant therapy. © 2007 Society of Surgical Oncology. |
| Keywords: | adult; cancer chemotherapy; controlled study; middle aged; surgical technique; major clinical study; clinical trial; cancer localization; advanced cancer; cancer adjuvant therapy; cancer patient; cancer radiotherapy; combined modality therapy; neoadjuvant therapy; positron emission tomography; follow up; lymph node metastasis; antineoplastic agent; cancer diagnosis; neoplasm staging; pelvis; diagnostic accuracy; prospective study; sensitivity and specificity; prospective studies; metastasis; computer assisted tomography; controlled clinical trial; diagnostic imaging; distant metastasis; liver metastasis; lung metastasis; disease severity; medical information; abdomen; diagnostic value; fluorodeoxyglucose f 18; positron-emission tomography; neoplasm metastasis; physician; rating scale; metastases; rectal neoplasms; pet; rectum cancer; neoplasms, multiple primary; iodinated contrast medium; rectal cancer; rectum; soft tissue metastasis; single blind procedure; single-blind method; neck metastasis; preoperative radiotherapy; pelvis metastasis; synchronous disease; abdominal metastasis; colon metastasis; inferior mesenteric artery; mediastinum lymph node metastasis |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 15 |
| Issue: | 3 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2008-03-01 |
| Start Page: | 704 |
| End Page: | 711 |
| Language: | English |
| DOI: | 10.1245/s10434-007-9626-y |
| PUBMED: | 17882490 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 16" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus" |
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