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Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer.

Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, Vaylet C, Rougier P, André T, Gornet JM, Cherqui D, Delbaldo C, Panis Y, Talbot JN, Meignan M, Le Guludec D - Br. J. Cancer (2008)

Bottom Line: In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers).The overall time in detecting a recurrence from the baseline was not significantly different in the two groups.However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P=0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0).

View Article: PubMed Central - PubMed

Affiliation: Université Paris 12 et Hôpital Henri Mondor, 51 Av du Mal de Lattre de Tassigny, Créteil 94100, France. iradj.sobhani@hmn.aphp.fr

ABSTRACT
We assessed the potential benefits of including systematic 18fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting tumour recurrence in a prospective randomised trial. Patients (N=130) who had undergone curative therapy were randomised to undergo either conventional (Con) or FDG-PET procedures during follow-up. The two groups were matched at baseline. Recurrence was confirmed histologically. 'Intention-to-treat' analysis revealed a recurrence in 46 patients (25 in the FDG-PET group, and 21 in the Con group; P=0.50), whereas per protocol analysis revealed a recurrence in 44 out of 125 patients (23 and 21, respectively; P=0.60). In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers). Three false-positive cases of FDG-PET led to no beneficial procedures (two laparoscopies and one liver MRI that were normal). We failed to identify peritoneal carcinomatosis in two of the patients undergoing FDG-PET. The overall time in detecting a recurrence from the baseline was not significantly different in the two groups. However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P=0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0). Regular FDG-PET monitoring in the follow up of colorectal cancer patients may permit the earlier detection of recurrence, and influence therapy strategies.

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Kaplan–Meier curve for time to recurrence detected in patients with curative therapy for colon or rectal cancer.
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fig2: Kaplan–Meier curve for time to recurrence detected in patients with curative therapy for colon or rectal cancer.

Mentions: One hundred thirty patients (65 in each group) were evaluated in an ITT analysis; five were excluded from the PP analysis because of missing data. The two arms were matched with regard to the characteristics of both the patients and tumours (Table 1). Overall, the number of patients with a detected recurrence was 44 (23 in the PET group and 21 the Con group; P=0.60). Recurrence was confirmed either by biopsies or surgery in 27 (21.6% in the PP analysis) of these 44 patients: 15 out of the 60 (25%) patients in the PET-group, and 12 out of the 65 (18.5%) patients in the Con group (P=0.19). Kaplan–Meier curves for the time from baseline until the detection of a recurrence of the disease during follow-up were obtained, and ITT analysis performed (Figure 2). There was no significant difference between the PET and Con groups with regard to actuarial curves of recurrence (log-rank, P=0.55); however, for all the patients with a recurrence, the time from baseline until detection of the recurrence was significantly shorter (P=0.01) in the PET group (12.1±3.6 months) than in the Con group (15.4±4.9 months). However, if we consider only asymptomatic patients without elevated serum tumour markers, then a recurrence was detected in 34 patients (20 PET group patients and 14 in the Con group) by imaging procedures (CT, PET, Chest X-Ray, US). In this case, the time from baseline until the detection of a recurrence was shorter (although not significantly so) in the PET group than in the Con group (log-rank test, P=0.25) (Figure 3).


Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer.

Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, Vaylet C, Rougier P, André T, Gornet JM, Cherqui D, Delbaldo C, Panis Y, Talbot JN, Meignan M, Le Guludec D - Br. J. Cancer (2008)

Kaplan–Meier curve for time to recurrence detected in patients with curative therapy for colon or rectal cancer.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2266857&req=5

fig2: Kaplan–Meier curve for time to recurrence detected in patients with curative therapy for colon or rectal cancer.
Mentions: One hundred thirty patients (65 in each group) were evaluated in an ITT analysis; five were excluded from the PP analysis because of missing data. The two arms were matched with regard to the characteristics of both the patients and tumours (Table 1). Overall, the number of patients with a detected recurrence was 44 (23 in the PET group and 21 the Con group; P=0.60). Recurrence was confirmed either by biopsies or surgery in 27 (21.6% in the PP analysis) of these 44 patients: 15 out of the 60 (25%) patients in the PET-group, and 12 out of the 65 (18.5%) patients in the Con group (P=0.19). Kaplan–Meier curves for the time from baseline until the detection of a recurrence of the disease during follow-up were obtained, and ITT analysis performed (Figure 2). There was no significant difference between the PET and Con groups with regard to actuarial curves of recurrence (log-rank, P=0.55); however, for all the patients with a recurrence, the time from baseline until detection of the recurrence was significantly shorter (P=0.01) in the PET group (12.1±3.6 months) than in the Con group (15.4±4.9 months). However, if we consider only asymptomatic patients without elevated serum tumour markers, then a recurrence was detected in 34 patients (20 PET group patients and 14 in the Con group) by imaging procedures (CT, PET, Chest X-Ray, US). In this case, the time from baseline until the detection of a recurrence was shorter (although not significantly so) in the PET group than in the Con group (log-rank test, P=0.25) (Figure 3).

Bottom Line: In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers).The overall time in detecting a recurrence from the baseline was not significantly different in the two groups.However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P=0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0).

View Article: PubMed Central - PubMed

Affiliation: Université Paris 12 et Hôpital Henri Mondor, 51 Av du Mal de Lattre de Tassigny, Créteil 94100, France. iradj.sobhani@hmn.aphp.fr

ABSTRACT
We assessed the potential benefits of including systematic 18fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting tumour recurrence in a prospective randomised trial. Patients (N=130) who had undergone curative therapy were randomised to undergo either conventional (Con) or FDG-PET procedures during follow-up. The two groups were matched at baseline. Recurrence was confirmed histologically. 'Intention-to-treat' analysis revealed a recurrence in 46 patients (25 in the FDG-PET group, and 21 in the Con group; P=0.50), whereas per protocol analysis revealed a recurrence in 44 out of 125 patients (23 and 21, respectively; P=0.60). In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers). Three false-positive cases of FDG-PET led to no beneficial procedures (two laparoscopies and one liver MRI that were normal). We failed to identify peritoneal carcinomatosis in two of the patients undergoing FDG-PET. The overall time in detecting a recurrence from the baseline was not significantly different in the two groups. However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P=0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0). Regular FDG-PET monitoring in the follow up of colorectal cancer patients may permit the earlier detection of recurrence, and influence therapy strategies.

Show MeSH
Related in: MedlinePlus