Study findings question benefit of additional imaging before cancer surgery

May 13, 2014

Among patients with a certain type of colorectal cancer with limited spread to the liver, imaging using positron emission tomography and computed tomography (CT) before surgery did not significantly change the surgical treatment of the cancer, compared with CT alone, according to a study in the May 14 issue of JAMA.

Colorectal cancer is a leading cause of cancer death. Approximately 50 percent of patients present with or subsequently develop cancer that has spread (metastases) to the liver. Some patients with liver metastases are candidates for surgery to have the cancer removed. However, unidentified occult (hidden) metastases at the time of surgery can render the operation noncurative. Thus, long-term survival following surgical resection (removal) for is only about 50 percent. Positron emission tomography combined with computed tomography (PET-CT) could help avoid noncurative surgery by identifying patients with occult metastases, according to background information in the article.

Carol-Anne Moulton, M.B., B.S., of the University Health Network, Toronto, Canada, and colleagues randomly assigned patients with colorectal cancer treated by surgery with resectable (surgically removable) metastases based on CT scans to PET-CT (n = 270) or CT only (n = 134) to determine the effect on the surgical management of these patients. The study, conducted between 2005 and 2013, involved 21 surgeons at 9 hospitals in Ontario.

Of the 263 patients who received PET-CT scans, 111 provided new information: 62 were classified as negative and 49 had abnormal or suspicious lesions. Change in management (canceled, more extensive liver surgery, or surgery performed on additional organs) as a result of the PET-CT findings occurred in 8.7 percent of cases; 2.7 percent avoided noncurative liver surgery. Overall, liver resection was performed on 91 percent of patients in the PET-CT group and 92 percent of the .

The median (midpoint) follow-up was three years. The researchers found no significant difference in survival or disease-free survival between patients in the PET-CT group vs the control group.

"Many countries struggle to maintain quality health care within existing budgets. This is difficult because of increasing as a result of an aging population and the expense of new therapies and technologies, including diagnostic and functional imaging," the authors write.

"Among with potentially resectable hepatic metastases of colorectal adenocarcinoma, the use of PET-CT compared with CT alone did not result in frequent change in surgical management. These findings raise questions about the value of PET-CT scans in this setting."

Explore further: PET/CT shows clear advantages over conventional staging for breast cancer patients

More information: DOI: 10.1001/jama.2014.3740

Related Stories

PET/CT shows clear advantages over conventional staging for breast cancer patients

January 2, 2013
New research published in the January issue of The Journal of Nuclear Medicine shows that 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging offers significant prognostic stratification ...

PET/MR effective for imaging recurrent prostate cancer

June 11, 2013
When prostate cancer makes a comeback, it becomes increasingly important to have exceptional imaging available to find all possible regions where cancer has spread to other parts of the body, or metastasized, in order to ...

Follow-up tests improve colorectal cancer recurrence detection

January 14, 2014
Among patients who had undergone curative surgery for primary colorectal cancer, the screening methods of computed tomography and carcinoembryonic antigen each provided an improved rate of surgical treatment of cancer recurrence ...

Long term results of EORTC trial for patients with resectable liver metastases from colorectal cancer

November 6, 2013
Long term results of the randomized phase III EORTC intergroup trial 40983 were recently reported in The Lancet Oncology. The observed 4.1% difference in overall survival at five years for patients with initially resectable ...

PET-CT improves care of limited-stage small-cell lung cancer patients

June 25, 2013
Each year, 13 percent of all newly diagnosed lung cancer patients are diagnosed with small-cell lung cancer (SCLC). Approximately 39 percent of patients with SCLC are diagnosed with limited-stage disease, meaning the cancer ...

Recommended for you

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.