2-fluoro-2-deoxyglucose-6-phosphate and Colorectal-Neoplasms

Radiofrequency ablation (RFA) for thoracic tumours has emerged as a minimally invasive therapy option for primary and secondary lung tumours and has gained increasing acceptance for pain palliation. The procedure is well tolerated and the complication rates are low. RFA provides the opportunity for localized tissue destruction of limited tumour volumes with medium and long term follow-up data suggesting that survival figures do parallel those of non-surgical treatment modalities. The purpose of this article is to review the status of RFA in lung tumours, to emphasize its place in symptomatic palliation and to discuss its potential role in conjunction with radiation or systemic therapy.

Topics: Carcinoma, Non-Small-Cell Lung; Catheter Ablation; Colorectal Neoplasms; Combined Modality Therapy; Glucose-6-Phosphate; Hemorrhage; Humans; Lung Neoplasms; Palliative Care; Patient Selection; Pleural Effusion; Pleural Neoplasms; Pneumothorax; Prognosis; Tomography, X-Ray Computed; Treatment Outcome

We evaluated the value of Gadoxetic acid-enhanced liver MRI in the preoperative staging of colorectal cancer and estimated the clinical impact of liver MRI in the management plan of liver metastasis.. We identified 108 patients who underwent PET/CT and liver MRI as preoperative evaluation of colorectal cancer, between January 2011 and December 2013. We evaluated the per nodule sensitivity of PET/CT and liver MRI for liver metastasis. Management plan changes were estimated for patients with metastatic nodules newly detected on liver MRI, to assess the clinical impact.. We enrolled 131 metastatic nodules (mean size 1.6 cm) in 41 patients (mean age 65 years). The per nodule sensitivities of PET/CT and liver MRI were both 100% for nodules measuring 2 cm or larger but were significantly different for nodules measuring less than 2 cm (59.8% and 95.1%, resp., P = 0.0001). At least one more metastatic nodule was detected on MRI in 16 patients. Among these, 7 patients indicated changes of management plan after performing MRI.. Gadoxetic acid-enhanced liver MRI detected more metastatic nodules compared with PET/CT, especially for small (<2 cm) nodules. The newly detected nodules induced management plan change in 43.8% (7/16) of patients.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Contrast Media; Female; Gadolinium DTPA; Glucose-6-Phosphate; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Positron-Emission Tomography

Tumoral heterogeneity is a major determinant of resistance in solid tumors. FDG-PET/CT can identify early during chemotherapy non-responsive lesions within the whole body tumor load. This prospective multicentric proof-of-concept study explores intra-individual metabolic response (mR) heterogeneity as a treatment efficacy biomarker in chemorefractory metastatic colorectal cancer (mCRC).. Standardized FDG-PET/CT was performed at baseline and after the first cycle of combined sorafenib (600mg/day for 21 days, then 800mg/day) and capecitabine (1700 mg/m²/day administered D1-14 every 21 days). MR assessment was categorized according to the proportion of metabolically non-responding (non-mR) lesions (stable FDG uptake with SUVmax decrease <15%) among all measurable lesions.. Ninety-two patients were included. The median overall survival (OS) and progression-free survival (PFS) were 8.2 months (95% CI: 6.8-10.5) and 4.2 months (95% CI: 3.4-4.8) respectively. In the 79 assessable patients, early PET-CT showed no metabolically refractory lesion in 47%, a heterogeneous mR with at least one non-mR lesion in 32%, and a consistent non-mR or early disease progression in 21%. On exploratory analysis, patients without any non-mR lesion showed a significantly longer PFS (HR 0.34; 95% CI: 0.21-0.56, P-value <0.001) and OS (HR 0.58; 95% CI: 0.36-0.92, P-value 0.02) compared to the other patients. The proportion of non-mR lesions within the tumor load did not impact PFS/OS.. The presence of at least one metabolically refractory lesion is associated with a poorer outcome in advanced mCRC patients treated with combined sorafenib-capecitabine. Early detection of treatment-induced mR heterogeneity may represent an important predictive efficacy biomarker in mCRC.. ClinicalTrials.gov NCT01290926.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Colorectal Neoplasms; Disease-Free Survival; Female; Glucose-6-Phosphate; Humans; Male; Middle Aged; Neoplasm Metastasis; Niacinamide; Phenylurea Compounds; Positron-Emission Tomography; Prospective Studies; Radiography; Sorafenib; Survival Rate

Topics: Adenocarcinoma; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; Female; Glucose-6-Phosphate; Humans; Incidental Findings; Jejunal Neoplasms; Microsatellite Instability; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Positron-Emission Tomography; Tomography, X-Ray Computed

Dramatic responses are being observed in colorectal cancer liver metastases treated with newer chemotherapeutic regimens. These have been associated with normalization of [(18)F]fluoro-2-deoxy-D-glucose (FDG) uptake (complete metabolic response) on follow-up Positron Emission Tomography with [(18)F]fluoro-2-deoxy-D-glucose (FDG-PET) scans in some patients. It is unclear how often complete metabolic response is indicative of complete tumor destruction. We analyzed a subset of patients who had neoadjuvant chemotherapy for hepatic metastases from colorectal adenocarcinoma. Inclusion criteria were: (1) FDG-avid hepatic lesions before initiation of chemotherapy; (2) complete metabolic response of the same lesions after chemotherapy; and (3) histopathologic examination of hepatic lesions. Complete pathologic response was defined as no histologically identifiable viable tumor. Fourteen patients fit the inclusion criteria. All had synchronous, hepatic-only colorectal metastases. On microscopic examination, complete pathologic response to the neoadjuvant regimen was found in only 5 of 34 lesions (15%) and in only 3 of the 14 patients (21%). Seven lesions had complete metabolic response and disappeared on computed tomography (CT); of these, six still contained viable tumor. We conclude that complete metabolic response on FDG-PET after neoadjuvant chemotherapy is an unreliable indicator of complete pathologic response. Therefore, currently, curative resection of liver metastases in these patients should not be deferred on the basis of FDG-PET findings.

Topics: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Chemotherapy, Adjuvant; Colorectal Neoplasms; Drug Therapy, Combination; Female; Fluorouracil; Glucose-6-Phosphate; Humans; Leucovorin; Liver Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Organoplatinum Compounds; Positron-Emission Tomography; Treatment Outcome