The Role and Limitations of 18-Fluoro-2-deoxy-<Emphasis Type="SmallCaps">d</Emphasis>-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings |
| |
Authors: | Nir Lubezky Ur Metser Ravit Geva Richard Nakache Einat Shmueli Joseph M Klausner Einat Even-Sapir Arie Figer Menahem Ben-Haim |
| |
Institution: | (1) Liver Surgery Unit of The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;(2) Department of Surgery B, The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv, 64239, Israel;(3) Department of Oncology of The Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;(4) Institute of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel |
| |
Abstract: | Background Recent data confirmed the importance of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the selection of patients with colorectal hepatic metastases for surgery.
Neoadjuvant chemotherapy before hepatic resection in selected cases may improve outcome. The influence of chemotherapy on
the sensitivity of FDG-PET and CT in detecting liver metastases is not known.
Methods Patients were assigned to either neoadjuvant treatment or immediate hepatic resection according to resectability, risk of
recurrence, extrahepatic disease, and patient preference. Two-thirds of them underwent FDG-PET/CT before chemotherapy; all
underwent preoperative contrast-enhanced CT and FDG-PET/CT. Those without extensive extrahepatic disease underwent open exploration
and resection of all the metastases according to original imaging findings. Operative and pathological findings were compared
to imaging results.
Results Twenty-seven patients (33 lesions) underwent immediate hepatic resection (group 1), and 48 patients (122 lesions) received
preoperative neoadjuvant chemotherapy (group 2). Sensitivity of FDG-PET and CT in detecting colorectal (CR) metastases was
significantly higher in group 1 than in group 2 (FDG-PET: 93.3 vs 49%, P < 0.0001; CT: 87.5 vs 65.3, P = 0.038). CT had a higher sensitivity than FDG-PET in detecting CR metastases following neoadjuvant therapy (65.3 vs 49%,
P < 0.0001). Sensitivity of FDG-PET, but not of CT, was lower in group 2 patients whose chemotherapy included bevacizumab compared
to patients who did not receive bevacizumab (39 vs 59%, P = 0.068).
Conclusions FDG-PET/CT sensitivity is lowered by neoadjuvant chemotherapy. CT is more sensitive than FDG-PET in detecting CR metastases
following neoadjuvant therapy. Surgical decision-making requires information from multiple imaging modalities and pretreatment
findings. Baseline FDG-PET and CT before neoadjuvant therapy are mandatory.
The abstract was presented before the 58th Cancer Symposium of the Society of Surgical Oncology, Atlanta, GA, USA, 2005, and
before the 2005 Congress of the American Hepato-Pancreato-Biliary Association, Fort-Lauderdale, FL, USA. |
| |
Keywords: | Colorectal liver metastases FDG-PET Neoadjuvant chemotherapy |
本文献已被 SpringerLink 等数据库收录! |
|