FDG-PET Scans Reduce Number of Futile Surgeries for Hepatic Colorectal Metastases

Researchers from the Netherlands have reported that the use 18F-FDG PET scans reduced the number of futile surgeries for hepatic metastases from 45% to 28%. The details of this study appeared in the July 2009 issue of the Journal of Nuclear Medicine.[1]

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Liver metastases are common among patients with advanced disease, and optimal approaches for patients with liver metastases that are resectable continue to be evaluated. For patients with colorectal cancer with a single metastasis to the liver, surgical resection is the optimal treatment. However, it is important to determine the extent of hepatic metastases before patients are subjected to a laparotomy.

The usual method of determining operability of hepatic metastases is a CT scan. In the current study researcher sought to determine the added value of FDG-PET to CT for determining operability of patients considered for surgical resection of colorectal metastases to the liver. This study included 150 patients with colorectal liver metastases who were randomly allocated to pre-surgical testing with CT alone or CT plus FDG-PET. Futile laparotomy was defined as any laparatomy that did not result in complete tumor resection, one that detected benign disease, or a disease-free survival of less than six months. Forty-five percent of the control group had a futile laparotomy compared with 28% in the CT plus FDG-PET group. This translated into a risk reduction of 38%. These authors concluded that FDG-PET prevented unnecessary surgery in one of six patients.

Comments: These data clearly show the benefit of FDG-PET scanning as part of the pre-op evaluation of patients with hepatic metastases form colorectal cancer.

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