PET changes management and improves prognostic stratification in patients with recurrent colorectal cancer: results of a multicenter prospective study.
The aims of our study were to examine the impact of PET in changing management in patients with proven or suspected colorectal cancer recurrence and to assess the impact of management change on disease-free survival.


METHODS
Symptomatic patients with a residual structural lesion suggestive of recurrent tumor (group A) or patients with pulmonary or hepatic metastases considered to be potentially resectable (group B) underwent PET scans. Pre-PET management plans were documented by referring clinicians unaware of the PET results, and follow-up to 12 mo was performed to determine actual management and clinical outcomes.


RESULTS
A total of 191 patients (118 men and 73 women; mean age, 66 y) were studied. PET detected additional sites of disease in 48.4% of patients in group A and in 43.9% of patients in group B. A change in planned management was documented in 65.6% of group A and in 49.0% of group B patients. These management plans were implemented in 96% of patients. Follow-up data in group A showed progressive disease in 60.5% of patients with additional lesions detected by PET, compared with conventional imaging, and in 36.2% of patients with no additional lesions detected by PET (P=0.04). In group B, progressive disease was identified in 65.9% of patients with additional lesions detected by PET and in 39.2% of patients with no additional lesions detected by PET (P=0.01). PET also provided valuable prognostic information on patients stratified into curative- or palliative-intent groups.


CONCLUSIONS
These data demonstrate the significant impact of PET on management and outcomes in patients with suspected recurrent colorectal cancer.
Scott
Andrew M
AM
Centre for PET, Austin Hospital, Melbourne, Australia. andrew.scott@ludwig.edu.au
Gunawardana
Dishan H
DH
Kelley
Ben
B
Stuckey
John G
JG
Byrne
Amanda J
AJ
Ramshaw
Jayne E
JE
Fulham
Michael J
MJ
D001315:Australia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000379:methods; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome