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Diagnostic Applications of Nuclear Medicine: Colorectal Cancer

Nuclear Oncology

Abstract

Colorectal cancer is the fourth most common neoplastic disease (50–60% overall survival at 5 years); 90–95% of colorectal cancers are adenocarcinoma. Important prognostic factors include: whether the tumor is well differentiated, the extent of the primary tumor, and the presence of local and/or lymph node invasion. Two staging classifications for colorectal cancer are available: Dukes’ classification and the TNM stage system by the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC).

Contrast-enhanced computed tomography (CECT) of the chest, abdomen, and pelvis is used in pretreatment staging. Because of the high incidence of disease recurrence (30–40%), morphological imaging (CT, abdominal ultrasound) and serial measurements of serum markers (carcinoembryonic antigen, or CEA) are used in the follow-up. The use of [18F]FDG-PET for early detection of primary colorectal cancer is limited due to the low sensitivity for small tumors as well as for mucinous lesions. False-positive PET findings are also reported in patients with inflammatory bowel disease (IBD) or previous diagnostic polipectomy. Although [18F]FDG PET is more sensitive than CT in detecting regional lymph node involvement, CT is better at detecting liver metastases. As a result, the role of [18F]FDG PET-CT for presurgical staging is unclear. [18F]FDG-PET is useful as a complementary exam in selected patients with a high metastatic potential.

During restaging and follow-up, whole-body [18F]FDG-PET/CT is recommended to localize recurrent disease in cases of elevated serum CEA and negative morphological imaging findings or indeterminate lesions. Combined PET/CT tomography improves the accuracy of the evaluation of colorectal cancer, especially in the visualization of abdomino-pelvic extrahepatic disease.

[18F]FDG-PET may be useful to evaluate response to chemotherapy, although the optimum timing of the assessment of metabolic response remains unsettled. Moreover, new drugs targeted to angiogenesis or tyrosine kinase have opened new frontiers to the use of [18F]FDG-PET in evaluating response because of their cytostatic rather than cytoreductive effect. In rectal cancer it is often difficult to evaluate response to radiotherapy by anatomic imaging due to residual tissue mass, but [18F]FDG-PET/CT can detect residual tumor by the metabolic activity. Finally, [18F]FDG-PET has been proposed in the evaluation of response to local treatment of liver and lung metastases by radiofrequency ablation (RFA). In patients with unresectable liver metastases and/or advanced burden of liver disease, transarterial radioembolization with microspheres labeled with 90Y is becoming a valid therapeutic alternative to chemoembolization and RFA.

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Abbreviations

[18F]FDG:

2-deoxy-2-[18F]fluoro-d-glucose

99mTc-HDP:

99mTc-hydroxyethylenediphosphonate

AJCC:

American Joint Committee on Cancer

BOmR:

Best overall metabolic response

CEA:

Carcinoembryonic antigen

CECT:

Contrast-enhanced computed tomography

CI:

Confidence interval

CMR:

Complete metabolic response

CRC:

Colorectal cancer

CRT:

Chemoradiotherapy

CT:

X-ray computed tomography

DOTA:

1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid

EORTC:

European Organization for Research and Treatment of Cancer

GI:

Gastrointestinal

IBD:

Inflammatory bowel disease

M:

Metastasis status according to the AJCC/UICC TNM staging system

MRI:

Magnetic resonance imaging

N:

Lymph node status according to the AJCC/UICC TNM staging system

NOC:

1-Nal3-octreotide

NPV:

Negative predictive value

PERCIST:

Positron emission tomography response criteria in solid tumors

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PET/MRI:

Positron emission tomography/magnetic resonance imaging

PMD:

Progressive metabolic disease

PMR:

Partial metabolic response

PPV:

Positive predictive value

PREDIST:

PET residual disease in solid tumor

PTV:

Radiotherapy planning target volume

RECIST:

Response evaluation criteria in solid tumors

RFA:

Radiofrequency ablation

ROI:

Region of interest

SMD:

Stable metabolic disease

SN:

Sensitivity

SP:

Specificity

SUV:

Standardized uptake value

T:

Tumor status according to the AJCC/UICC TNM staging system

TLG:

Total lesion glycolysis

TOC:

Octreotide

TREUS:

Transrectal ultrasound

TRG:

Tumor regression grade

UICC:

Union Internationale Contre le Cancer (International Union Against Cancer)

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Authors and Affiliations

  1. PET Center, Affidea IRMET, Via Onorato Vigliani 89/A, I-10126, Torino, Italy

    Ettore Pelosi & Daniele Penna

  2. Department of Medical Sciences Nuclear medicine, University of Torino, Torino, Italy

    Désirée Deandreis

  3. Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy

    Laura Cassalia

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  1. Ettore Pelosi
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  2. Désirée Deandreis
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  3. Laura Cassalia
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  4. Daniele Penna
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Correspondence to Ettore Pelosi .

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Editors and Affiliations

  1. Attending Emeritus, Memorial Sloan-Kettering Cancer Center Dept. Radiology, New York, New York, USA

    H. William Strauss

  2. Professor Emeritus, University of Pisa, Pisa, Italy

    Giuliano Mariani

  3. Associate Professor and Director of Nuclear Medicine, University of Pisa, Pisa, Italy

    Duccio Volterrani

  4. Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Pelosi, E., Deandreis, D., Cassalia, L., Penna, D. (2016). Diagnostic Applications of Nuclear Medicine: Colorectal Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_19-1

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  • DOI: https://doi.org/10.1007/978-3-319-26067-9_19-1

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  1. Latest

    Diagnostic Applications of Nuclear Medicine: Colorectal Cancer
    Published:
    20 May 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_19-3

  2. Diagnostic Applications of Nuclear Medicine: Colorectal Cancer
    Published:
    09 April 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_19-2

  3. Original

    Diagnostic Applications of Nuclear Medicine: Colorectal Cancer
    Published:
    07 October 2016

    DOI: https://doi.org/10.1007/978-3-319-26067-9_19-1

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