Skip to main content
Erschienen in: Diseases of the Colon & Rectum 7/2008

01.07.2008 | Original Contribution

The Impact of 18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography on the Staging and Management of Primary Rectal Cancer

verfasst von: K. Davey, F.R.A.C.S., A. G. Heriot, M.D., F.R.C.S., F.R.A.C.S., J. Mackay, F.R.A.C.S., E. Drummond, M.Sc., A. Hogg, Ph.D., S. Ngan, F.R.A.N.Z.C.R., A. D. Milner, Ph.D., R. J. Hicks, M.D., F.R.A.C.P.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 7/2008

Einloggen, um Zugang zu erhalten

Abstract

Purpose

18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) has a role in recurrent colorectal cancer. This study was designed to assess the impact of PET-CT on management of primary rectal cancer.

Methods

Eighty-three patients with rectal cancer underwent PET-CT scan between 2002 and 2005. Referring physicians prospectively recorded stage and management plan after conventional imaging before PET-CT scan, which were compared to subsequent stage and management after PET-CT.

Results

Staging PET-CT caused a change in stage from conventional imaging in 26 patients (31 percent). Twelve (14 percent) were upstaged (7 change in N stage; 4 change in M stage; 1 change in N and M stage), and 14 (17 percent) were downstaged (10 change in N stage; 3 change in M stage; 1 change in N and M stage). PET-CT scan altered management intent in seven patients (8 percent) (curative to palliative 6 patients; palliative to curative 1 patient). Management was altered in ten patients (12 percent). There was no difference in impact with respect to tumor height.

Conclusions

PET-CT scan impacts the management of patients with primary rectal cancer and influences staging/therapy in a third of patients and should be a component of rectal cancer workup.
Literatur
1.
Zurück zum Zitat Ruo L, Guillem J. Major 20th-Century advances in the management of rectal cancer. Dis Colon Rectum 1999;42:563–78.PubMedCrossRef Ruo L, Guillem J. Major 20th-Century advances in the management of rectal cancer. Dis Colon Rectum 1999;42:563–78.PubMedCrossRef
2.
Zurück zum Zitat Martling A, Holm T, Rutqvist L-E, Moran B, Heald R, Cedermark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group. Basingstoke Bowel Cancer Research Project. Lancet 2000;356:93–6.PubMedCrossRef Martling A, Holm T, Rutqvist L-E, Moran B, Heald R, Cedermark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group. Basingstoke Bowel Cancer Research Project. Lancet 2000;356:93–6.PubMedCrossRef
3.
Zurück zum Zitat Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291–304.CrossRef Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291–304.CrossRef
4.
Zurück zum Zitat Gibbs P, Chao M, Tjandra J. Optimizing the outcome for patients with rectal cancer. Dis Colon Rectum 2003;46:389–402.PubMedCrossRef Gibbs P, Chao M, Tjandra J. Optimizing the outcome for patients with rectal cancer. Dis Colon Rectum 2003;46:389–402.PubMedCrossRef
5.
Zurück zum Zitat Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRef Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRef
6.
Zurück zum Zitat Nicholls RJ, Galloway DJ, Mason AY, Boyle P. Clinical local staging of rectal cancer. Br J Surg 1985;72(Suppl):S51–2.PubMedCrossRef Nicholls RJ, Galloway DJ, Mason AY, Boyle P. Clinical local staging of rectal cancer. Br J Surg 1985;72(Suppl):S51–2.PubMedCrossRef
7.
Zurück zum Zitat Schaffzin D, Wong W. Endorectal ultrasound in the preoperative evaluation of rectal cancer. Clin Colorectal Cancer 2004;4:124–32.PubMedCrossRef Schaffzin D, Wong W. Endorectal ultrasound in the preoperative evaluation of rectal cancer. Clin Colorectal Cancer 2004;4:124–32.PubMedCrossRef
8.
Zurück zum Zitat Heriot A, Grundy A, Kumar D. Preoperative staging of rectal carcinoma. Br J Surg 1999;86:17–28.PubMedCrossRef Heriot A, Grundy A, Kumar D. Preoperative staging of rectal carcinoma. Br J Surg 1999;86:17–28.PubMedCrossRef
9.
Zurück zum Zitat Beets-Tan R, Beets G, Vliegen R, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer. Lancet 2001;357:497–504.PubMedCrossRef Beets-Tan R, Beets G, Vliegen R, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer. Lancet 2001;357:497–504.PubMedCrossRef
10.
Zurück zum Zitat Brown G, Kirkham A, Williams GT, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 2004;182:431–9.PubMed Brown G, Kirkham A, Williams GT, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 2004;182:431–9.PubMed
11.
Zurück zum Zitat MacManus M, Hicks R, Mathews J, et al. High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small cell lung cancer: implications for radical radiotherapy. Int J Radiat Oncol Biol Phys 2001;50:287–93.PubMedCrossRef MacManus M, Hicks R, Mathews J, et al. High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small cell lung cancer: implications for radical radiotherapy. Int J Radiat Oncol Biol Phys 2001;50:287–93.PubMedCrossRef
12.
Zurück zum Zitat Blum R, Seymour J, Wirth A, et al. Frequent impact of (18F) fluorodeoxyglucose positron emission tomography on the staging and management of patients with indolent non-Hodgkin’s lymphoma. Clin Lymphoma 2003;4:43–9.PubMedCrossRef Blum R, Seymour J, Wirth A, et al. Frequent impact of (18F) fluorodeoxyglucose positron emission tomography on the staging and management of patients with indolent non-Hodgkin’s lymphoma. Clin Lymphoma 2003;4:43–9.PubMedCrossRef
13.
Zurück zum Zitat Leong T, Everitt C, Hichs R, et al. A prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Radiother Oncol 2006;78:254–61.PubMedCrossRef Leong T, Everitt C, Hichs R, et al. A prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Radiother Oncol 2006;78:254–61.PubMedCrossRef
14.
Zurück zum Zitat Meta J, Seltzer M, Schiepers C, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician's perspective. J Nucl Med 2001;42:586–90.PubMed Meta J, Seltzer M, Schiepers C, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician's perspective. J Nucl Med 2001;42:586–90.PubMed
15.
Zurück zum Zitat Kalff V, Hicks R, Ware R, Hogg A, Binns D, McKenzie A. The clinical impact of 18F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492–9.PubMed Kalff V, Hicks R, Ware R, Hogg A, Binns D, McKenzie A. The clinical impact of 18F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492–9.PubMed
16.
Zurück zum Zitat Heriot A, Keck J, Mackay J, et al. A prospective assessment of the impact of PET in primary rectal cancer: does it change management? Dis Colon Rectum 2004;47:451–8.PubMedCrossRef Heriot A, Keck J, Mackay J, et al. A prospective assessment of the impact of PET in primary rectal cancer: does it change management? Dis Colon Rectum 2004;47:451–8.PubMedCrossRef
17.
Zurück zum Zitat Even-Sapir E, Parag Y, Lerman H, et al. Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 2004;232:815–22.PubMedCrossRef Even-Sapir E, Parag Y, Lerman H, et al. Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 2004;232:815–22.PubMedCrossRef
18.
Zurück zum Zitat Gearhart S, Frassica D, Rosen R, Choti M, Schulick R, Wahl R. Improved staging with pretreatment positron emission tomography/computed tomography in low rectal cancer. Ann Surg Oncol 2006;13:397–404.PubMedCrossRef Gearhart S, Frassica D, Rosen R, Choti M, Schulick R, Wahl R. Improved staging with pretreatment positron emission tomography/computed tomography in low rectal cancer. Ann Surg Oncol 2006;13:397–404.PubMedCrossRef
19.
Zurück zum Zitat Balch G, De Meo A, Guillem J. Modern management of rectal cancer: a 2006 update. World J Gastroenterol 2006;12:3186–95.PubMed Balch G, De Meo A, Guillem J. Modern management of rectal cancer: a 2006 update. World J Gastroenterol 2006;12:3186–95.PubMed
20.
Zurück zum Zitat Heriot A, Kumar D. Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2000;2:126–37.CrossRef Heriot A, Kumar D. Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2000;2:126–37.CrossRef
21.
Zurück zum Zitat Weber W, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001;19:3058–65.PubMed Weber W, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001;19:3058–65.PubMed
22.
Zurück zum Zitat Guillem J, Puig-La Calle JJ, Akhurst T, et al. Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography. Dis Colon Rectum 2000;43:18–24.PubMedCrossRef Guillem J, Puig-La Calle JJ, Akhurst T, et al. Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography. Dis Colon Rectum 2000;43:18–24.PubMedCrossRef
23.
Zurück zum Zitat Calvo F, Domper M, Matute R, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004;58:528–35.PubMed Calvo F, Domper M, Matute R, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004;58:528–35.PubMed
24.
Zurück zum Zitat Chessin D, Kiran R, Akhurst T, Guillem J. The emerging role of 18F-fluorodeoxyglucose positron emission tomography in the management of primary and recurrent rectal cancer. J Am Coll Surg 2005;201:948–56.PubMedCrossRef Chessin D, Kiran R, Akhurst T, Guillem J. The emerging role of 18F-fluorodeoxyglucose positron emission tomography in the management of primary and recurrent rectal cancer. J Am Coll Surg 2005;201:948–56.PubMedCrossRef
25.
Zurück zum Zitat Garcia-Aguilar J, Hernandez De Anda E, Sirivongs P, et al. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003;46:298–304.PubMedCrossRef Garcia-Aguilar J, Hernandez De Anda E, Sirivongs P, et al. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003;46:298–304.PubMedCrossRef
26.
Zurück zum Zitat Guillem J, Moore H, Akhurst T, et al. Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining long-term outcomes of rectal cancer. J Am Coll Surg 2004;199:1–7.PubMedCrossRef Guillem J, Moore H, Akhurst T, et al. Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining long-term outcomes of rectal cancer. J Am Coll Surg 2004;199:1–7.PubMedCrossRef
27.
Zurück zum Zitat Kalff V, Duong C, Drummond E, Mathews J, Hicks R. Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med 2006;47:14–22.PubMed Kalff V, Duong C, Drummond E, Mathews J, Hicks R. Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med 2006;47:14–22.PubMed
28.
Zurück zum Zitat Brennan M. PET scanning in malignancy: infant, adolescent, or mature citizen? Ann Surg 2001;233:320–1.PubMedCrossRef Brennan M. PET scanning in malignancy: infant, adolescent, or mature citizen? Ann Surg 2001;233:320–1.PubMedCrossRef
29.
Zurück zum Zitat Valk P, Abella-Columna E, Hasemann M, et al. Whole body PET imaging with 18-F fluorodeoxyglucose in management of recurrent colorectal cancer. Arch Surg 1999;134:503–11.PubMedCrossRef Valk P, Abella-Columna E, Hasemann M, et al. Whole body PET imaging with 18-F fluorodeoxyglucose in management of recurrent colorectal cancer. Arch Surg 1999;134:503–11.PubMedCrossRef
Metadaten
Titel
The Impact of 18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography on the Staging and Management of Primary Rectal Cancer
verfasst von
K. Davey, F.R.A.C.S.
A. G. Heriot, M.D., F.R.C.S., F.R.A.C.S.
J. Mackay, F.R.A.C.S.
E. Drummond, M.Sc.
A. Hogg, Ph.D.
S. Ngan, F.R.A.N.Z.C.R.
A. D. Milner, Ph.D.
R. J. Hicks, M.D., F.R.A.C.P.
Publikationsdatum
01.07.2008
Verlag
Springer-Verlag
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 7/2008
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-008-9244-1

Weitere Artikel der Ausgabe 7/2008

Diseases of the Colon & Rectum 7/2008 Zur Ausgabe

Letter to the Editor

The Author Replies

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.