Positron Emission Tomography-Computed Tomography for Patients with Recurrent Colorectal Liver Metastases: Impact on Restaging and Treatment Planning.
BACKGROUND
The impact of fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for patients with colorectal liver metastases (CLM) still is debated. Its relevance could be enhanced in the case of recurrent disease. The current study aimed to elucidate the role of PET-CT in restaging and treatment planning for recurrent CLM.


METHODS
A series of 352 consecutive patients undergoing their first liver resection for CLM between 2005 and 2014 was reviewed. Of these patients, 224 (63.6 %) had a recurrence. The 107 patients who had received PET-CT at diagnosis of recurrence before chemotherapy were analyzed. CT was available in all cases, and magnetic resonance imaging (MRI) was available in 64 cases.


RESULTS
Extrahepatic lesions were found in 59 patients. Liver and lung recurrences were detected with excellent sensitivity by CT/MRI and PET-CT (liver: 100 vs. 96.7 %; lung: 95.8 vs. 95.8 %). In detecting other recurrence sites, PET-CT had higher sensitivity than CT/MRI (91.5 vs. 54.2 %, p < 0.01; lymph nodes: 93.5 vs. 64.5 %, p = 0.011; peritoneum: 80 vs. 20 %, p = 0.023; bones: 87.5 vs. 37.5 %, nonsignificant difference). For 28.8 % (17/59) of the patients, the diagnosis of extrahepatic disease was obtained thanks to PET-CT (39.5 % considering nonpulmonary lesions). PET-CT modified treatment strategy in 16 (14.9 %) patients, excluding from surgery 15 (20.3 %) of 74 patients resectable at CT/MRI. This latter subgroup had a lower survival rate than the patients resectable after PET-CT (2-year survival, 22.7 vs. 77.8 %; p = 0.004), similar to the patients unresectable at CT/MRI (57.6 %).


CONCLUSIONS
In the authors' experience, PET-CT has offered a relevant contribution to restaging of recurrent CLM. It disclosed one fourth of extrahepatic lesions and prevented worthless surgery for about 20 % of patients.
Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Luca
L
Viganò
Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Egesta
E
Lopci
Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Guido
G
Costa
Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Marcello
M
Rodari
Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Dario
D
Poretti
Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Vittorio
V
Pedicini
Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Luigi
L
Solbiati
Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
Arturo
A
Chiti
Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy. guido.torzilli@hunimed.eu.
Guido
G
Torzilli
D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D015179:Colorectal Neoplasms / Q000473:pathology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D010347:Patient Care Planning; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals; D012008:Recurrence; D012680:Sensitivity and Specificity; D015996:Survival Rate
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18