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Positron Emission Tomography Affects Surgical Management in Recurrent Colorectal Cancer Patients

From the Division of Surgical Oncology (DCD, MWA, WEB, EWM), Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, Ohio; Digestive Disorders Center (EEZ), University of South Florida, Tampa, Florida; and Department of Nuclear Medicine/PET (JM), Kettering Memorial Hospital, Dayton, Ohio.

Correspondence: Address correspondence and reprint requests to: Darius C. Desai, MD, St. Luke’s Hospital, 801 Ostrum St., Bethlehem, PA 18015; Fax: 610-954-6055; E-mail: desaid{at}slhn.org

Background: We determined the effect of positron emission tomography (PET) on surgical decision-making in patients with metastatic or recurrent colorectal cancer.

Methods: A total of 114 patients with advanced colorectal cancer were imaged with computed tomography (CT) and PET scans. The PET and CT scans were independently interpreted before surgery and recorded.

Results: Forty-two of the 114 patients had resectable disease on the basis of CT. PET altered therapy in 17 (40%) of these 42 patients on the basis of the following results: extrahepatic disease (n = 9), bilobar involvement (n = 3), thoracic involvement (n = 5), retroperitoneal lymphadenopathy (n = 2), bone involvement (n = 1), and supraclavicular disease (n = 1). In 25 patients with liver metastases only, PET found additional disease in 18 (72%), extrahepatic disease in 11, chest disease in 13, retroperitoneal lymphadenopathy in 4, and bone disease in 3. In five patients, both scans underestimated small-volume peritoneal metastases discovered at laparotomy.

Conclusions: PET altered therapy in 40% of patients. In patients with isolated liver involvement, 72% had more extensive disease that precluded surgical resection. PET scans should be used in the management of patients with recurrent colorectal cancer who are being considered for potentially curative surgery.

Key Words: PET • Colon cancer • Surgery • Recurrence

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