Skip to main content
SpringerLink
Log in

Does positron emission tomography change management in primary rectal cancer? A prospective assessment

  • Original Contributions
  • Diseases of the Colon & Rectum
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose: The influence of positron emission tomography in the management of recurrent rectal cancer is well established but its role in primary rectal cancer remains uncertain. This study therefore prospectively assesses the impact of position emission tomography scanning on the management of primary rectal cancer. Methods: Forty-six patients with advanced primary rectal cancer referred for consideration of adjuvant preoperative therapy underwent position emission tomography scanning. The referring physicians prospectively recorded each patient’s stage following conventional imaging and the proposed treatment plan prior to position emission tomography scanning. This was then compared with subsequent stage and actual management implemented, and the appropriateness of position emission tomography-induced changes was noted by subsequent clinical follow-up. Results: The surgical management of 36 of 46 patients (78 percent) was unchanged as a result of position emission tomography, even though position emission tomography upstaged disease in 3 of 36 cases (8 percent) and downstaged disease in 5 of 36 cases (14 percent). In 8 of 46 cases (17 percent), management was altered because of the position emission tomography scan findings, including 6 cases (13 percent) in which surgery was cancelled and 2 other cases (4 percent) in which the radiotherapy field was changed. Where available, follow-up confirmed the appropriateness of position emission tomography-induced management change in each case. Two patients had a change in therapy independent of the position emission tomography scan due to clinical circumstances. Overall tumor stage was changed following position emission tomography in 18 of 46 patients (39 percent). Conclusion: Position emission tomography scanning appears to accurately change the stage or appropriately alter the therapy of almost a third of patients with advanced primary rectal cancer. In view of this, we suggest that position emission tomography scanning be considered part of standard workup for such patients, particularly if neoadjuvant chemoradiation is being considered as part of primary management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Thomas A, Murrey T, Thun M. Cancer Statistics. CA Cancer J Clin 2002; 52: 23–47

    Article  PubMed  Google Scholar 

  2. Jensen O, Esteve J, Moller H, Renard H. Cancer in the European community and its member states. Eur J Cancer 1990; 26: 1167–256

    Article  PubMed  CAS  Google Scholar 

  3. Myers M, Ries L. Cancer patient survival rates: SEER program results for 10 years of follow-up. CA Cancer J Clin 1989; 39: 21–32

    Article  PubMed  CAS  Google Scholar 

  4. Colorectal Cancer Collaborative Group. Adjuvant radio-therapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 2001; 358: 1291–304

    Article  Google Scholar 

  5. Gibbs P, Chao MW, Tjandra JJ. Optimizing the outcome for patients with rectal cancer. Dis Colon Rectum 2003; 46: 389–402

    Article  PubMed  Google Scholar 

  6. Saltz L, Minsky B. Adjuvant therapy of cancers of the colon and rectum. Surg Clin N Am 2002; 82: 1035–58

    Article  PubMed  Google Scholar 

  7. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Re-section of colorectal liver metastases. World J Surg 1995; 19: 59–71

    Article  PubMed  CAS  Google Scholar 

  8. Heriot A, Grundy A, Kumar D. Preoperative staging of rectal carcinoma. Br J Surg 1999; 86: 17–28

    Article  PubMed  CAS  Google Scholar 

  9. Moss A. Imaging of colorectal cancer. Radiology 1989; 170: 308–10

    PubMed  CAS  Google Scholar 

  10. Beynon J, Mortensen NJ, Rigby HS. Rectal endosonography, a new technique for the preoperative staging of rectal carcinoma. Eur J Surg Oncol 1988; 14: 297–309

    PubMed  CAS  Google Scholar 

  11. Brown G, Richards C, Dallimore N, et al. Rectal carcinoma: thin section MR imaging for staging in 28 patients. Radiology 1999; 211: 215–22

    PubMed  CAS  Google Scholar 

  12. Leen E, Angerson W, Wotherspoon H, Moule B, Cook T, McArdle C. Detection of colorectal liver metastases: comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow-up results. Radiology 1995; 195: 113–6

    PubMed  CAS  Google Scholar 

  13. Hoh C, Schiepers C, Seltzer M, et al. PET in oncology: will it replace the other modalities? Semin Nucl Med 1997; 27: 94–106

    Article  PubMed  CAS  Google Scholar 

  14. Falk PM, Gupta NC, Thorson AG, et al. Positron emission tomography for preoperative staging of colorectal carcinoma. Dis Colon Rectum 1994; 37: 153–6

    Article  PubMed  CAS  Google Scholar 

  15. Abdel-Nabi H, Doerr R, Lamonica D, et al. Staging of primary colorectal carcinomas with fluorine-18 fluoro-deoxyglucose whole-body PET: correlation with histo-pathologic and CT findings. Radiology 1998; 206: 755–60

    PubMed  CAS  Google Scholar 

  16. Ogunbiyi OA, Flanagan FL, Dehdashti F, et al. Detection of recurrent and metastatic colorectal cancer: comparison of positron emission tomography and computed tomography. Ann Surg Oncol 1997; 4: 613–20

    Article  PubMed  CAS  Google Scholar 

  17. Mukai M, Sadahiro S, Yasuda S, et al. Preoperative evaluation by whole—body 18F-fluorodeoxyglucose positron emission tomography in patients with primary colorectal cancer. Oncol Rep 2000; 7: 85–7

    PubMed  CAS  Google Scholar 

  18. 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  CAS  Google Scholar 

  19. 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  Google Scholar 

  20. Sobin L, Wittekind C. UICC International Union Against Cancer: TNM classification of malignant tumours. 5th ed. New York: John Wiley and Sons, 1997: 67–8.

    Google Scholar 

  21. Crippa F, Gavazzi C, Bozzetti F, et al. The influence of blood glucose levels on [18F]fluorodeoxyglucose (FDG) uptake in cancer: a PET study in liver metastases from colorectal carcinomas. Tumori 1997; 83: 748–52

    PubMed  CAS  Google Scholar 

  22. Miraldi F, Vesselle H, Faulhaber P, Adler L, Leisure G. Elimination of artifactual accumulation of FDG in PET imaging of colorectal cancer. Clin Nucl Med 1998; 23: 3–7

    Article  PubMed  CAS  Google Scholar 

  23. Karp JS, Muehllehner G, Mankoff DA, et al. Continuous-slice PENN-PET: a positron tomograph with volume imaging capacity. J Nucl Med 1990; 31: 617–27

    PubMed  CAS  Google Scholar 

  24. Fulham M, Meikle S, Hooper P, Silver K. Lesion detection in whole body FDG PET using simultaneous emission transmission acquisition and OSEM reconstruction (SET-OSEM) versus emission only (OE) and FBP reconstruction: an ROC study. J Nucl Med 1997; 37: 78P

    Google Scholar 

  25. Benard F, Smith R, Hustinx P, Karp K, Alavi A. Clinical evaluation of processing techniques for attenuation correction with 137-Cs in whole-body PET imaging. J Nucl Med 1999; 40: 1257–63

    PubMed  CAS  Google Scholar 

  26. Arulampalam T, Costa D, Loizidou M, Visvikis D, Ell P, Taylor I. Positron emission tomography and colorectal cancer. Br J Surg 2001; 88: 176–89

    Article  PubMed  CAS  Google Scholar 

  27. Boykin KN, Zibari GB, Lilien DB, McMillan R, Aultman D, McDonald J. The use of FDG-positron emission tomography for the evaluation of colorectal metastases of the liver. Am Surg 1999; 65: 1183–5

    PubMed  CAS  Google Scholar 

  28. Fong Y, Saldinger P, Akhurst T, et al. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am J Surg 1999; 178: 282–7

    Article  PubMed  CAS  Google Scholar 

  29. Lai D, Fulham M, Stephens M, et al. The role of whole-body positron emission tomography with F-18 fluoro-deoxyglucose in recurrent colorectal cancer metastases to the liver. Arch Surg 1996; 131: 703–7

    PubMed  CAS  Google Scholar 

  30. Valk PE, 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

    Article  PubMed  CAS  Google Scholar 

  31. Imdahl A, Reinhardt M, Nitzsche E, et al. Impact of 18F-FDG positron emission tomography for decision making in colorectal cancer recurrences. Langenbecks Arch Surg 2000; 385: 129–34

    Article  PubMed  CAS  Google Scholar 

  32. Delbeke D, Vitola J, Sandier M, et al. Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver. Am J Surg 1996; 171: 21–6

    Article  PubMed  Google Scholar 

  33. Beyer T, Townsend D, Brun T, et al. A combined PET/ CT scanner for clinical oncology. J Nucl Med 2000; 41: 1369–79

    PubMed  CAS  Google Scholar 

  34. Freeny P. Helical computed tomography of the liver: techniques, applications and pitfalls. Endoscopy 1997; 29: 515–23

    Article  PubMed  CAS  Google Scholar 

  35. Vitola J, Delbeke D, Sandler M, et al. Positron emission tomography to stage suspected metastatic colorectal carcinoma to the liver. Am J Surg 1996; 171: 21–6

    Article  PubMed  CAS  Google Scholar 

  36. Delbeke D, Vitola JV, Sandler MP, et al. Staging recurrent metastatic colorectal carcinoma with PET. J Nucl Med 1997; 38: 1196–2001

    PubMed  CAS  Google Scholar 

  37. MacManus MP, Hicks RJ, Mathews J, et al. High rate of detection of unsuspected distant metastases by PET in apparant stage III non-small cell lung cancer: implications for radical radiotherapy. Int J Radiat Oncol Biol Phys 2001; 50: 287–93

    Article  PubMed  CAS  Google Scholar 

  38. Brennan M. PET scanning in malignancy: infant, adolescent, or mature citizen? Ann Surg 2001; 233: 320–1

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, St. Vincent’s Hospital, Melbourne, Australia

    Alexander G. Heriot, Jamie Keck & John Mackay

  2. Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia

    Rodney J. Hicks, Elizabeth G. P. Drummond, John Mackay & Victor Kalff

  3. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    John Mackay

  4. Department of Surgery, Box Hill Hospital, Melbourne, Australia

    John Mackay & Frank Chen

Authors
  1. Alexander G. Heriot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodney J. Hicks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth G. P. Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jamie Keck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Mackay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victor Kalff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rodney J. Hicks.

About this article

Cite this article

Heriot, A.G., Hicks, R.J., Drummond, E.G.P. et al. Does positron emission tomography change management in primary rectal cancer? A prospective assessment. Dis Colon Rectum 47, 451–458 (2004). https://doi.org/10.1007/s10350-003-0089-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-003-0089-3

Key words

Search

Navigation