PET-CT no better than CT for pre-op planning in liver metastases of colorectal cancer

Image: PD 

1. Individuals with colorectal cancer and liver metastases in this study undergoing PET-CT had a change in surgical intervention 8.0% of the time. 

2. The disease-free and overall survival in individuals in this study with colorectal cancer and liver metastases was no different based on whether the individual underwent PET-CT or CT imaging. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Colorectal cancer is a leading cause of morbidity and mortality in the United States.  Approximately half of patients have liver metastases and surgical intervention is an important component of treatment.  Surgical planning involves imaging studies and both CT and PET-CT have been used.  This study randomly assigned 404 individuals with colorectal cancer and liver metastases to either have CT imaging or PET-CT imaging to see if PET-CT imaging altered treatment plans.  Surgeons reviewing the cases indicated that they would change surgical management based on PET-CT imaging in 8.7% of patients, though only 8.0% of individuals in the PET-CT group had a change in surgical management.  There was no difference in disease-free or overall survival between the two groups.  Strengths of this study include a randomized design and careful review of the included patients.  A weakness of this study is the homogeneous nature of the individuals included.  Additionally, most people had moderate to intermediate tumor grade at diagnosis, so these results may not apply to people with higher-grade tumors.  While this study suggests that PET-CT may not change management when compared to CT imaging alone, more data will be needed before recommendations for use of PET-CT can be made.

Click to read the study, published today in JAMA

Relevant Reading: Evidence-based approach to the introduction of positron emission tomography in Ontario, Canada

In-Depth [randomized controlled trial]: This study randomized 404 individuals with colorectal cancer and liver metastases to have PET-CT or CT imaging before surgical resection to see how frequently PET-CT alters management and survival.  Of the 111 PET-CT scans, 55% (62) were considered negative when compared to previous CT. Surgeons reviewed the cases and determined that they would change surgical management in 8.7% (95% CI 5.6%-12.8%) of those undergoing PET-CT.  Eight percent (95% CI 5.0%-11.9%) of patients in the PET-CT group actually had a change in management based on the PET-CT results.  Changes in management included no surgery, more extensive surgery, and more extensive non-hepatic surgery.  Overall survival was the same in the PET-CT and CT groups (HR 0.86, 95% CI 0.60-1.21, p=0.38).  Disease-free survival was no different between the CT and PET-CT groups (HR 0.81, 95% CI 0.56-1.18, p=0.28).

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