Evaluation of patients with liver metastases from colorectal cancer for locally ablative treatment with laser induced thermotherapy

H. Amthauer; T. Denecke; B. Hildebrandt; R. Rühl; A. Miersch; A. Nicolaou; J. Ruf; M. Plotkin; E. L. Hänninen; C. Stroszczynski; M. Gutberlet; J. Langrehr; H. Riess; J. Ricke

doi:10.1055/s-0038-1625115

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2006; 45(04): 177-184
DOI: 10.1055/s-0038-1625115

Original Articles

Schattauer GmbH

Evaluation of patients with liver metastases from colorectal cancer for locally ablative treatment with laser induced thermotherapy

Impact of PET with ¹⁸F-fluorodeoxyglucose on therapeutic decisionsEvaluation von Patienten mit Lebermetastasen kolorektaler Karzinome vor lokalablativer Therapie mittels Laser-induzierter ThermotherapieWertigkeit der FDGPET bei der Therapieentscheidung

Authors

H. Amthauer^*

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
T. Denecke^*

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
B. Hildebrandt

²Medizinische Klinik für Hämatologie Onkologie (Direktor: Univ.-Prof. Dr. med. Bernd Dörken)
R. Rühl

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
A. Miersch

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
A. Nicolaou

²Medizinische Klinik für Hämatologie Onkologie (Direktor: Univ.-Prof. Dr. med. Bernd Dörken)
J. Ruf

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
M. Plotkin

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
E. L. Hänninen

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
C. Stroszczynski

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
M. Gutberlet

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)
J. Langrehr

³Klinik für Allgemein-, Viszeral- und Transplantationschirurgie (Direktor: Univ.-Prof. Dr. med. Peter Neuhaus), Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin
H. Riess

²Medizinische Klinik für Hämatologie Onkologie (Direktor: Univ.-Prof. Dr. med. Bernd Dörken)
J. Ricke

¹Klinik für Strahlenheilkunde und PET-Zentrum (Direktor: Univ.-Prof. Dr. med. Dr. h.c. Roland Felix)

Abstract

Summary

Purpose: Before locally ablative treatment of colorectal liver metastases, patients have to be carefully evaluated to decide whether this is the adequate therapy. In this study we determined the value of FDG-PET in comparison to conventional staging procedures. Patients, methods: In 68 consecutive patients referred for laser induced thermotherapy (LITT) of liver metastases from colorectal cancer, pretherapeutic staging with conventional imaging (thoracic and abdominal CT, liver MRI, chest X-ray) and FDG-PET was performed. The examinations were analysed separately and blinded. Based on the staging information, therapeutic decisions were made by an interdisciplinary review board according to a standardized algorithm. The results were compared between conventional imaging and FDG-PET, and were validated by clinical follow up data and histopathology, respectively. Results: On FDG-PET 210 lesions were interpreted as tumour manifestations. 48 of these were not seen on conventional imaging (true positive, n=46). In contrast, 24 lesions were visualized by conventional imaging only (true positive, n=12). Compared to conventional imaging, discrepant findings on FDG-PET led to treatment modifications in 25 patients (37%); these were correct in 20/25 patients. According to the actual treatment course, the inadequate treatment modifications in the remaining 5 patients were avoided by further diagnostic procedures (i.e. biopsies). Conclusion: In the evaluation of patients with known liver metastases from colorectal cancer before LITT, FDG-PET depicts relevant findings subsidiary to conventional imaging and thus is of high value for therapeutic decision making.

Zusammenfassung

Ziel: Vor lokalablativer Therapie kolorektaler Lebermetastasen müssen die Patienten sorgfältig evaluiert werden, um adäquate Therapieentscheidung treffen zu können. Die Wertigkeit der FDG-PET sollte bestimmt und mit dem konventionellen Staging verglichen werden. Patienten, Methoden: Bei 68 konsekutiven Patienten, die sich zur Laserinduzierten Thermotherapie (LITT) von kolorektalen Lebermetastasen vorstellten, erfolgte ein präinterventionelles Staging mit konventioneller Bildgebung (Thorax/Abdomen- CT, Leber-MRT und Röntgen-Thorax) und einer FDGPET. Das Bildmaterial wurde separat verblindet analysiert. Mit den Ergebnissen des Stagings wurden Therapieentscheidungen in einer interdisziplinären Expertenrunde, anhand eines standardisierten Algorithmus getroffen. Die Resultate der konventionellen Bildgebung und der FDG-PET wurden verglichen und mit dem klinischen Verlauf sowie den histopathologischen Ergebnissen validiert. Ergebnisse: Die FDG-PET detektierte 210 tumorsuspekte Läsionen; davon waren 48 mit der konventionellen Bildgebung nicht erfasst worden (richtig positiv: 46/48). Demgegenüber waren 24 Läsionen nur mit der konventionellen Bildgebung erfasst worden (richtig positiv: 12/24). Im Vergleich zur konventionellen Bildgebung führten diskrepante Befunde in der FDG-PET bei 25 Patienten (37%) zu Therapieänderungen, die in 20/25 Fällen korrekt waren. In den übrigen 5 Fällen zeigte der klinische Verlauf, dass eine inadäquate Therapieänderung durch nachgeschaltete Biopsien vermieden werden konnte. Schlussfolgerung: Bei der Evaluation von Patienten mit Lebermetastasen kolorektaler Karzinome vor LITT erfasst die FDG-PET, ergänzend zur konventionellen Bildgebung, relevante Befunde und ist damit für die Therapieentscheidung von hohem Wert.

Keywords

Colorectal cancer - laser induced thermotherapy - liver metastases - positron emission tomography

Schlüsselwörter

Kolorektales Karzinom - Laser-induzierte Thermotherapie - Lebermetastasen - FDG-PET

Full Text

References

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