Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the postoperative clinical management of patients with colorectal cancer

Year 2022, Volume: 13 Issue: 46, 138 - 143, 01.08.2022

Alev Çınar , Engin Alagöz Aslı Ayan , Aybüke Uçgun

https://doi.org/10.17944/mkutfd.969726

Abstract

Objective: Colorectal cancer (CRC) is a well-known, surgically curable type of cancer if detected early. Survival rate increase depends on the early detection of the recurrent lesions. In this present study, we aimed to emphasize the value of the F-18 FDG PET/CT imaging modality to evaluate the postoperative treatment response of patients with CRC, based on our clinical experience.
Methods: Between January 2016 and January 2020, 168 colorectal cancer patients underwent F-18 FDG PET/CT to evaluate residue/recurrence cancer in our institution. Patients enrolled in this study were operated on for primary colon tumors. Before and after systemic therapy, all patients underwent pre and post-treatment F-18 FDG PET/CT to assess treatment response. The images were analyzed retrospectively.
Results: Patients were classified according to primary tumor localization. Of 168 patients, the primary tumor localized in the ascending colon (n=55), the descending colon (n=33), the transverse colon (n=14), the rectosigmoid (n=61), and the caecum in the other five patients. Recurrence of primary tumor site was detected in 57 patients; 33 of them were male (57.9%) and 24 female (42.1%). The mean SUVmax of the local recurrent lesion was 8.97 ± 3.42 g/ml. In addition, from the ascending colon group, two patients had new foci of tumoral lesions (1.20%).
Conclusion: Resection of the colonic segments with tumor, if possible, is the first step in the treatment of patients with colorectal cancer. After the curative operation, recurrence can be seen in approximately 40% of patients within the first two years. Early detection of recurrence improves the survival rate.

Keywords

Colorectal Cancer, Treatment Response, Fluorodeoxyglucose Positron Emission Tomography

Kolorektal kanseri olan hastaların ameliyat sonrası klinik yönetiminde fluorine-18 fluorodeoxyglucose pozitron emisyon tomografisi/bilgisayarlı tomografi’nin tanısal önemi

Abstract

Amaç: Kolorektal kanser, erken tespitinde cerrahi kür sağlanabilen yaygın bir kanser türüdür. Bu kanser tipinde tedaviye yanıtın erken belirlenmesi yaşam süresini olumlu etkilemektedir. Çalışmamızda kolorektal kanseri olan hastaların, ameliyat sonrasındaki klinik yönetimlerinde F-18 FDG PET/BT’nin tanısal önemini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Haziran 2016 ve Ocak 2020 tarihleri arasında 168 hasta kolorektal kanser yönetimi amacıyla bölümümüze yönlendirilmiştir. Bu hastaların hepsi primer kolon tümörleri için ameliyat edilmişlerdi. Sistemik tedavi öncesinde ve sonrasında tedavi yanıtının değerlendirilmesi amacıyla bazal ve ardışık F-18 FDG PET/BT incelemesi yapılmıştır. F-18 FDG PET/BT taramaları sırasıyla analiz edilmiştir.
Bulgular: Hastalar primer tümör lokalizasyonlarına göre gruplandırıldı. Toplam 168 hastanın 55’inde sağ kolonda, 33’ünde sol kolonda, 14’ünde transvers kolonda, 61’inde rektosigmoid kolonda ve 5’inde çekumda primer tümör saptandı. Lokal rekürrens 57 hastada saptanmış olup 33’ü erkek (%57.9) ve 24’ü (%42.1) kadındı. Lokal rekürrense ait ortalama SUVmaks 8.97±3.42 g/ml olarak saptandı. Ek olarak çıkan kolon grubunda 2 hastada (%1.20) yeni tümöral odak gözlendi.
Sonuç: Kolorektal kanserli hastalarda, yapılabiliyorsa kolon rezeksiyonu tedavide ilk aşamadır. Küratif cerrahi sonrası ilk iki yıl içinde, hastaların yaklaşık %40’ında rekürrens görülebilmektedir. Rekürrensin erken tespiti, hastaların yaşam süresini iyileştirmektedir.

Keywords

Kolorektal Kanser, Tedavi Yanıtı, Fluorodeoksiglukoz Pozitron Emisyon Tomografisi

References

• Agarwal A, Marcus C, Xiao J, Nene P, Kachnic LA, Subramaniam RM. FDG PET/CT in the management of colorectal and anal cancers. AJR. American Journal of roentgenology 2014;203(5):1109-1119. https://doi.org/10.2214/AJR.13.12256
• Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake− the role of PET/CT. European Radiology 2006;16(5):1054-1065. https://doi.org/10.1007/s00330-005-0088-y.
• Kyoto Y, Momose M, Kondo C, Itabashi M, Kameoka S, Kusakabe K. Ability of 18 F-FDG PET/CT to diagnose recurrent colorectal cancer in patients with elevated CEA concentrations. Annals of nuclear medicine 2010;24(5):395-401. Doi:10.1007/s12149-010-0372-z.
• O’Connor OJ, McDermott S, Slattery J, Sahani D, Blake MA. The use of PET-CT in the assessment of patients with colorectal carcinoma. International Journal of surgical oncology 2011;2011. https://doi.org/10.1155/2011/846512.
• Mittal BR, Senthil R, Kashyap R, Bhattacharya A, Singh B, Kapoor R, vd. 18F-FDG PET-CT in evaluation of postoperative colorectal cancer patients with rising CEA level. Nuclear medicine communications 2011;32(9):789-793. https://doi.org/10.1097/MNM.0B013e3283477dd7.
• van de Velde CJH, Boelens PG, Borras JM, Coebergh J-W, Cervantes A, Blomqvist L, vd. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 2014;50(1):1.e1-1.e34. https://doi.org/10.1016/j.ejca.2013.06.048.
• Uzun AK, Guveli TK, Ozulker F, Ozulker T. The Efficacy of F-FDG PET/CT in Detecting Colorectal Cancer Recurrences. European Archives of Medical Research 2021;37(4):236-244. https://doi.org/10.4274/eamr.galenos.2021.52533.
• Chen SH, Miles K, Taylor SA, Ganeshan B, Rodriquez M, Fraioli F,vd. FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis. European journal of nuclear medicine and molecular imaging 2021;49(1):371-384. https://doi.org/10.1007/s00259-021-055462.
• Elia RZ, Elbastawessy RA, Abdelmgeguid HA, Bassiouny AM. (2021). FDG PET/CT in follow UP patients with colorectal carcinoma after adjuvant chemotherapy. Egyptian Journal of Radiology and Nuclear Medicine 2021;52(1);1-10. https://doi.org/10.1186/s43055-021-00655-2.
• Expert Panel on Gastrointestinal Imaging:, Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, vd. ACR Appropriateness Criteria® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2017;14(5S):S234-S244. https://doi.org/10.1016/J.Jacr.2017.02.012.
• Peng J, Ding Y, Tu S, Shi D, Sun L, Li X, vd. Prognostic nomograms for predicting survival and distant metastases in locally advanced rectal cancers. PLoS ONE 2014;9(8):e106344. https://doi.org/10.1371/Journal.pone.0106344.
• Pfannschmidt J, Muley T, Hoffmann H, Dienemann H. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. The Journal of thoracic and cardiovascular surgery 2003;126(3):732-739. https://doi.org/10.16./s0022-5223(03)00587-7.
• Cho JH, Kim S, Namgung M, Choi YS, Kim HK, Zo JI, vd. The prognostic importance of the number of metastases in pulmonary metastasectomy of colorectal cancer. World journal of surgical oncology 2015;13(1):222. https://doi.org/10.1186./s12957-015-0621-7.
• Luboldt W, Volker T, Wiedemann B, Zöphel K, Wehrmann U, Koch A, vd. Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off. European Radiology 2010;20(9):2274-2285. https://doi.org/10.1007/s00330-010—1772-0.
• Borasio P, Gisabella M, Billé A, Righi L, Longo M, Tampellini M, vd. Role of surgical resection in colorectal lung metastases: analysis of 137 patients. International Journal of colorectal disease 2011;26(2):183-190. https://doi.org/10.1007/s00384-010-1075-6.
• Sundermeyer ML, Meropol NJ, Rogatko A, Wang H, Cohen SJ. Changing patterns of bone and brain metastases in patients with colorectal cancer. Clinical colorectal cancer 2005;5(2):108-113. https://doi.org/10.3816/ccc.2005.n.022.
• Davey K, Heriot AG, Mackay J, Drummond E, Hogg A, Ngan S, vd. The impact of 18-fluorodeoxyglucose positron emission tomography-computed tomography on the staging and management of primary rectal cancer. Diseases of the Colon & rectum 2008;51(7):997. https://doi.org/10.1007/s10350-008-9244-1.
• Penna C, Nordlinger B. Colorectal metastasis (liver and lung). Surgical Clinics 2002;82(5):1075-1090. https://doi.org/10.1016/s0039-6109(02)00051-8.
• Kochhar R, Liong S, Manoharan P. The role of FDG PET/CT in patients with colorectal cancer metastases. Cancer Biomarkers 2010;7(4-5):235-248. https://doi.org/10.3233/CBM-2010-0201.