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Positron Emission Tomography Detection of Distant Metastatic or Synchronous Disease in Patients with Locally Advanced Rectal Cancer Receiving Preoperative Chemoradiation

  • Gastrointestinal Oncology
  • Original Paper
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 23 January 2008

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.

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Acknowledgements

This study was supported by a grant from the National Cancer Institute (RO1 82534-01) awarded to José G. Guillem.

Presented at the Annual Meeting of the Society of Surgical Oncology, March 15–18, 2007, Washington, DC.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Caio S. R. Nahas MD, Philip B. Paty MD, Martin R. Weiser MD, Larissa K. Temple MD, W. Douglas Wong MD & José G. Guillem MD

  2. Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Timothy Akhurst MD & Henry Yeung MD

  3. Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ellen Riedel MA

  4. Department of Gastroenterology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Arnold J. Markowitz MD

  5. Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Bruce D. Minsky MD

  6. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Steven M. Larson MD

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  1. Caio S. R. Nahas MD
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  2. Timothy Akhurst MD
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  3. Henry Yeung MD
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  12. José G. Guillem MD
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Corresponding author

Correspondence to José G. Guillem MD.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1245/s10434-007-9710-3

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Nahas, C.S.R., Akhurst, T., Yeung, H. et al. Positron Emission Tomography Detection of Distant Metastatic or Synchronous Disease in Patients with Locally Advanced Rectal Cancer Receiving Preoperative Chemoradiation. Ann Surg Oncol 15, 704–711 (2008). https://doi.org/10.1245/s10434-007-9626-y

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  • DOI: https://doi.org/10.1245/s10434-007-9626-y

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