1. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases.
- Author
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, and Serrano PE
- Subjects
- Canada, Cause of Death, Colectomy methods, Colectomy mortality, Colorectal Neoplasms mortality, Colorectal Neoplasms surgery, Controlled Clinical Trials as Topic, Disease-Free Survival, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Neoplasm Invasiveness pathology, Neoplasm Staging, Positron Emission Tomography Computed Tomography methods, Preoperative Care methods, Prognosis, Randomized Controlled Trials as Topic, Risk Assessment, Role, Survival Analysis, Treatment Outcome, Colorectal Neoplasms pathology, Hepatectomy methods, Liver Neoplasms diagnostic imaging, Liver Neoplasms secondary, Positron-Emission Tomography methods
- Abstract
Background: Positron emission tomography (PET), alone or combined with computed tomography (CT), potentially enhances detection of occult metastatic colorectal cancer., Methods: We compared the impact of PET/PET-CT with conventional imaging, versus conventional imaging alone, in patients with potentially resectable colorectal cancer liver metastases. MEDLINE, EMBASE, and CENTRAL were searched for studies investigating PET/PET-CT to determine resectability. Outcomes included overall (OS), disease-free survival (DFS), change in surgical management, and futile laparotomy. Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A pre-specified protocol was registered in PROSPERO., Results: Of 4034 articles, two randomized trials (n = 554), and 11 non-randomized studies (n = 2251) were included. PET/PET-CT did not improve OS (hazard ratio [HR] 0.94, 95% CI 0.69-1.26, moderate quality) or DFS (HR 1.01, 95% CI 0.82-1.26, moderate quality). In the two trials, PET/PET-CT changed surgical management in 8% of cases (95% CI 5-11%, high quality), and did not significantly reduce futile laparotomies (risk ratio 0.59, 95% CI 0.24-1.47, low quality). Among non-randomized studies, PET/PET-CT changed surgical management in 20% of cases (95% CI 17-22%, very low quality) and reduced futile laparotomies (odds ratio 0.51, 95% CI 0.32-0.81, very low quality)., Conclusions: Moderate-quality evidence suggests that preoperative PET/PET-CT does not improve OS or DFS in patients with colorectal cancer liver metastases. These results do not support routine use of PET/PET-CT in patients with potentially resectable disease. The main limitation of this study was the lack of randomized studies., (Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
- Published
- 2019
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