Kalff Victor, Hicks Rodney J, Ware Robert E, Hogg Annette, Binns David, McKenzie Allan F
Department of Diagnostic Imaging, Peter MacCallum Cancer Institute, 12 Cathedral Place, East Melbourne, Victoria 3002, Australia.
J Nucl Med. 2002 Apr;43(4):492-9.
This prospective study aimed to confirm, in a clinical setting, the benefits suggested by earlier retrospective studies of (18)F-FDG PET scanning for the evaluation of patients with suspected recurrence of colorectal cancer.
The referring oncologist was asked to prospectively assign a treatment plan for 102 consecutive patients being evaluated by (18)F-FDG PET for suspected or confirmed recurrence of colorectal cancer and without evidence of unresectable disease on conventional staging investigations, including CT. This treatment plan was then compared with that based on incremental information supplied by PET. Management changes were validated by follow-up.
For 6 patients, the oncologist would not commit to a management plan without access to PET information, and for all these patients, PET correctly guided management. Of the remaining 96 patients, the management plan for 54 (56%) was altered as a direct result of unexpected PET findings. Thus, PET directly influenced management in 60 (59%) of 102 patients. The discrepant PET results could be validated in 57 patients and were correct for both the presence and the extent of malignant disease in 52 (91%) of these patients but were false-positive in 1 patient because of a pelvic abscess and underestimated the extent of metastatic disease in 4 (7%). Relapse was confirmed in 49 (98%) of 50 evaluable patients with positive PET findings. Significantly, planned surgery was abandoned in 26 (60%) of 43 patients because of incremental PET findings. Of the 42 patients for whom management was not changed by PET findings, false-negative PET findings were documented for 5 (4 with metastases < 1 cm), and the PET findings for 1 were presumed to be false-positive because of sarcoidosis.
This prospective study confirms the high impact, suggested by previous retrospective analyses, of (18)F-FDG PET on management of patients with suspected recurrent colorectal cancer. The major benefit of PET is avoidance of inappropriate local therapies by documentation of widespread disease.
本前瞻性研究旨在在临床环境中证实早期回顾性研究提出的¹⁸F - FDG PET扫描对评估疑似结直肠癌复发患者的益处。
要求转诊的肿瘤内科医生为102例连续接受¹⁸F - FDG PET检查以评估疑似或确诊结直肠癌复发且在包括CT在内的传统分期检查中无不可切除疾病证据的患者前瞻性地制定治疗计划。然后将该治疗计划与基于PET提供的增量信息制定的计划进行比较。管理变化通过随访进行验证。
对于6例患者，肿瘤内科医生在无法获得PET信息时不会做出管理计划，而对于所有这些患者，PET正确地指导了管理。在其余96例患者中，54例（56%）的管理计划因PET意外发现而直接改变。因此，PET直接影响了102例患者中60例（59%）的管理。57例患者的PET结果差异可得到验证，其中52例（91%）患者的恶性疾病存在和范围均正确，但1例因盆腔脓肿出现假阳性，4例（7%）低估了转移疾病的范围。50例PET检查结果阳性的可评估患者中有49例（98%）复发得到证实。值得注意的是，43例患者中有26例（60%）由于PET的增量发现而放弃了计划中的手术。在42例管理未因PET发现而改变的患者中，记录到5例假阴性PET结果（4例转移灶<1 cm），1例患者的PET结果因结节病被认为是假阳性。
这项前瞻性研究证实了先前回顾性分析所表明的¹⁸F - FDG PET对疑似复发性结直肠癌患者管理的重大影响。PET的主要益处是通过记录广泛疾病避免不适当的局部治疗。
