Abstract
Globally, colorectal cancer is a common medical problem and improvement of survival in patients with colorectal carcinoma could be achieved by identifying disease recurrence and progression, as well as by specifying their treatment planning. The use of various biomarkers associated with radio diagnosis techniques is not common in daily clinical practice. The aim of the present study was to evaluate the usefulness of dual assessment of FDG-PET and CEA in detecting recurrence of colorectal carcinoma in patients subsequent to colonic resection or rectal amputation. One hundred sixty patients, 99 males and 61 females, the mean of their age was 55.76 ± 12.25 years with suspected recurrent colonrectal cancer (CRC) after previous colonic resection or rectal amputation for CRC were included in this prospective study from February 2011 to March 2015. The inclusion criteria were: histopathologically confirmed colorectal adenocarcinoma, curative resection of the primary tumor, at least 3 months before and availability for follow-up after 18F-FDG PET/CT and CEA for at least 12 months. The CEA levels were measured within the time of the FDG PET/CT study. Only 132 patients were confirmed by histopathology or 6 month clinical follow up had local recurrence or metastasis (47 patients were confirmed had Intra-abdominal extra-hepatic recurrence , 80 patients had extra-abdominal and/or hepatic recurrence , 30 patients had other form of recurrence (17 patients had metastasis at other sites as the neck, long bones , mediastinal lymph nodes and multiple metastases) .The PET/CT diagnosis of recurrence and metastasis in CRC patients included in the study. Out of 160 patients after CRC resection, 126 patients were diagnosed by PET/CT as true-positive cases (25.62% Stage II /53.13% and I Stage III/IV) and 34 patients as negative cases (21.25 %). The sensitivity of monitoring the recurrence and metastasis of patients with CRC by PET/CT was 95.45 %. However, the diagnostic value of CEA levels for recurrence and metastasis in CRC patients included in the study proved that 102 patients had increased value of CEA (63.8%) and 58 patients (36.2%) had normal CEA value. The sensitivity of the CEA levels for monitoring the recurrence of the patients with CRC was 77.27 %. The sensitivity of the 18F-FDG PET/CT scan is superior to CEA in detection of colorectal cancer recurrence and dual assessment is important in treatment planning.
Highlights
Colorectal cancer (CRC) is a major cause of cancer-related mortality in Western countries
The aim of the present study was to evaluate the usefulness of dual assessment of FDG-Positron emission tomography (PET) and Carcinoembryonic Antigen (CEA) in detecting recurrence of colorectal carcinoma in patients subsequent to colonic resection or rectal amputation
The main findings in the present study indicated that the sensitivity of monitoring the recurrence and metastasis of patients with CRC by PET/CT was 95.45 %
Summary
Colorectal cancer (CRC) is a major cause of cancer-related mortality in Western countries. It is the third most commonly diagnosed cancer, with an estimated 146, 970 new cases diagnosed in the USA during 2009 [1]. 80% of patients present with local/regional disease and 20% with metastatic disease [2]. ~30-50% of patients undergoing a curative resection will have recurrent disease, optimizing the surveillance strategy is paramount [3]. Despite the advances in surgical treatment and introduction of combined therapeutic modalities, 5 years survival rarely exceeds 60%, varying from 90% in localized disease to 11% in patients with spread to distant organs [6]
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