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Is PET Useful in Management of Colorectal Metastases?

May 16, 2014

Is PET Useful in Management of Colorectal Metastases?

  1. Henry Mark Kuerer, MD, PhD, FACS

Combining PET with CT does not provide additional benefit for most patients with liver-only metastases.

  1. Henry Mark Kuerer, MD, PhD, FACS

The use of additional advanced imaging technology is thought to provide additional clinical information that aids clinical decision making. To test whether adding PET (positron emission tomography) to CT (computed tomography) improves the management of patients with metastatic cancer, investigators in Canada conducted a randomized multicenter study of 404 patients with potentially resectable liver-only metastases, as identified by CT scans of the chest, abdomen, and pelvis. Patients also had clear colonoscopy.

Patients were randomized 2 to 1 to receive PET-CT versus no PET-CT (controls). Outcomes included a change in management of hepatic and other surgery and overall survival (OS).

Liver resection was completed in 91% of patients in the PET-CT group and 92% in controls. Among those who underwent PET-CT, 8% had a change in surgical management (95% confidence interval, 5.0%–11.9%); a total of 2.7% avoided what would have been considered noncurative-intent hepatic surgery. At a median follow-up of 36 months, OS was similar between groups.

Comment

Based on the results of this study, experienced hepatobiliary surgeons stress that PET-CT has no essential role in the routine management of stage IV colorectal cancer patients with liver-only metastasis. PET-CT is potentially useful in other specific indications, such as diagnosing rare indeterminate lesions or locating lesions in a liver with advanced steatosis. Further areas of research are needed to assess whether combining PET with CT adds value to standard CT imaging when assessing response and determining prognosis in patients treated with neoadjuvant chemotherapy.

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Speaker's bureau Physicians’ Education Resource, LLC Grant / Research support Susan G. Komen Breast Cancer Foundation Editorial boards Annals of Surgical Oncology Leadership positions in professional societies Alliance for Clinical Trials in Oncology (Chair, Education Committee); Society of Surgical Oncology (Chair, Curriculum Ad Hoc Committee, Breast Program Directors

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