ColorectalCancer (CRC) Pre and Pos Chemotherapy

 

 

 

 

 

 

 

 

 

 

 

        Male, 46 year old, presented with rectal bleeding  and constipation.  Colonoscopy, depicted a stenosing tumor at 10 to 15 cm from the anal margin. Biopsy poorly differentiated tubular adenocarcinoma with signet ring cells. CT  and MRI of the abdomen and pelvis:  wall thickening of recto-sigmoid, associated with a higher density in the adjacent fat planes, without retroperitoneal lymphadenopathy, or lung or liver metastases, but with peritoneal implants. PET-CT, 2 pictures at left show a supra and retro vesical mass and peritoneal nodules. Underwent chemo (oxaliplatino, xeloda and folfox) and radiation therapy. At right followup PET-CT after 2 months treatment, shows a significant tumor decrease (SUV pre, 18 and pos 6) and no peritoneal nodes. Surgery was indicated.

            According to Culverwell et al. in review, "(18)Fluorine 2-fluoro-2-deoxy-D: -glucose positron emission tomography-computed tomography (PET-CT) has a firmly established role in staging, restaging, and recurrence detection of a range of tumors" (3). On the other hand Ozkan  et al after assessing 69 patients, concludes that "FDG PET/CT is a safe imaging method that can be used in the determination of CRC recurrence in patients with elevated CEA levels, regardless of the CEA level" (4).

References:

1  Simo M. Utilidad de la Tomografia PET en cancer de mama, p: 535-541 and Setoain X. PET en los linfomas, p: 543-547. En Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.

2  Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004 May; 231(2): 305-32.

3   Culverwell AD, Chowdhury FU, Scarsbrook AF. Optimizing the role of FDG PET-CT for potentially operable metastatic colorectal
cancer.Abdom Imaging. 2012 Feb 28.

4   Ozkan E, Soydal C, Araz M, Kir KM, Ibis E. The role of 18F-FDG PET/CT in detecting colorectal cancer recurrence in patients
with elevated CEA levels. Nucl Med Commun. 2012 Apr;33(4):395-402.

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