Abstract
Purpose
In recent years, combined modality therapy (CMT) with chemotherapy and radiation has replaced surgery as the preferred treatment for cancer of the anal canal. Clinical staging with computed tomography (CT) scan alone may underestimate the extent of disease. We investigated the utility of positron emission tomography (PET) with 2-deoxy-2[F-18]fluoro-d-glucose (FDG) in the staging and determination of response to CMT.
Patients and Methods
From September 1999 to August 2002, 21 patients with cancer of the anal canal were studied prospectively. All patients underwent pretreatment PET, in addition to standard clinical evaluation that included CT scanning. Follow-up PET studies were ordered one month after completion of CMT.
Results
Sites of metastases not observed on CT scan were identified in five of 21 patients (24%). These sites included pelvic lymph nodes (four patients) and distant omental metastasis (one patient). In another patient, PET confirmed the presence of suspected M1 disease in the liver. Posttreatment PET imaging was less useful. Nine patients had minimal residual PET activity at the primary site on the one-month follow-up PET study, but only three of these subsequently developed local recurrence. In addition, recurrences occurred in three patients (two local, one distant) of the six who had negative posttreatment PET studies.
Conclusions
FDG-PET, in conjunction with CT scanning, provides additional staging information in cancer of the anal canal. This information may have implications for prognosis and radiotherapy planning. Posttreatment PET scans appear to be of little value in predicting durability of response.
Similar content being viewed by others
References
Centers for Medicare and Medicaid Services, Coverage Issues Manual; Program Memorandum Intermediaries/Carriers Transmittal AB-03-092, June 20, 2003
Bastiaannet E, Groen H, Jager PL, et al. (2004) The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas: A systematic review and meta-analysis. Cancer Treat Rev 30:83–101
Rose PG, Adler LP, Rodriguez M, et al. (1999) Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: A surgicopathologic study. J Clin Oncol 17:41–45
Hain SF, O'Doherty MJ, Timothy AR, et al. (2000) Fluorodeoxyglucose PET in the initial staging of germ cell tumours. Eur J Nucl Med 27:590–594
DeSantis M, Becherer A, Bokemeyer C, et al. (2004) 2-[18]Fluorodeoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: An update of the prospective multicentric SEMPET trial. J Clin Oncol 22:1034–1039
Haustermans KM, Vrieze O, DeWever W, et al. (2002) The role of FDG-PET in the design of the radiation fields for patients with advanced esophageal cancer. Int J Radiat Biol Phys 54(2s):249 (Abstract)
Majhail NS, Urbain J, Albani JM, et al. (2003) F-18 fluorodeoxyglucose positron emission tomography in the evaluation of distant metastases from renal cell carcinoma. J Clin Oncol 21:3995–4000
Nigro ND, Vaitkevicius VK, Considine B (1974) Combined therapy for cancer of the anal canal: A preliminary report. Dis Colon Rectum 17:354–356
Flam M, John M, Pajak TF, et al. (1996) Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: Results of a phase III randomized intergroup study. J Clin Oncol 14:2527–2539
Cummings BJ, Keane TJ, O'Sullivan B, et al. (1991) Epidermoid anal cancer: Treatment by radiation alone or by 5-fluorouracil with and without mitomycin-C. Int J Radiat Biol Phys 21:1115–1125
DeVita VT, Hellman S, Rosenberg SA (2001) Cancer: Principles & Practice of Oncology. Philadelphia, PA: Lippincott Williams & Wilkins, pp 1337–1338
Ogunbiyi OA, Flanagan FL, Dehdashti F, et al. (1997) Detection of recurrent and metastatic colorectal cancer: Comparison of positron emission tomography and computed tomography. Ann Surg Oncol 4:613–620
Kubota R, Yamada S, Kubota K, et al. (1992) Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo—high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 33:1972–1980
Hu K, Minsky BD, Cohen AM, et al. (1999) 30 Gy may be an adequate dose in patients with anal cancer treated with excisional biopsy followed by combined-modality therapy. J Surg Oncol 70:71–77
Ciernik IF, Dizendorf E, Baumert BG, et al. (2003) Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): A feasibility study. Int J Radiat Oncol Biol Phys 57:853–863
Intensity Modulated Radiation Therapy Collaborative Working Group (2001) Intensity-modulated radiotherapy: Current status and issues of interest. Int J Radiat Oncol Biol Phys 51:880–914
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trautmann, T.G., Zuger, J.H. Positron Emission Tomography for Pretreatment Staging and Posttreatment Evaluation in Cancer of the Anal Canal. Mol Imaging Biol 7, 309–313 (2005). https://doi.org/10.1007/s11307-005-0003-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11307-005-0003-6