Apport de la tomographie par émission de positons au 18F-fluorodéoxyglucose (TEP-FDG) dans la prise en charge du cancer du canal anal

Abstract

Objective To evaluate the contribution of FDG-PET in the management of anal carcinoma, with special emphasis on its impact on therapeutic strategy. Materials and methods From March 2005 to August 2008, 48 PET were performed on 43 patients with anal epidermoid carcinoma, in initial staging (IS: 20 exams), therapeutic response assessment (TRA: 11), and recurrence assessment (RA: 17). We compared initial therapeutic strategies defined on conventional assessment results, to final ones chosen after PET. Results PET revealed lesions that were undetected by conventional investigation in 23% of cases (IS: 25%; TRA: 18%; RA: 23%) and cleared suspicious lesions in 21% of cases (IS: 10%; TRA: 18%; RA: 35%). It influenced the therapeutic strategy, and sometimes even modified it radically, in 44% of cases (IS: 35%; TRA: 54%; RA: 47%). This therapeutic impact was stronger in settings with diagnostic ambiguity, in which PET allowed to specify the diagnosis and to orientate consequently the therapeutic choice. Conclusion PET is interesting in the management of anal carcinoma, especially in uncertain diagnostic settings, in which the metabolic information brought allows to influence the therapeutic choice in almost half of the cases.