Clinical Value of18F-FDG- PET-CT in the Preoperative Staging of Peritoneal Carcinomatosis from Colorectal Origin
19
Citation
13
Reference
10
Related Paper
Citation Trend
Abstract:
dequate staging is essential in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who are candidates for cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Metabolic imaging using (18)F-FDG-PET-CT is commonly used to exclude distant metastasis in these patients. Here, we aimed to assess the performance of (18)F-FDG-PET-CT in locoregional staging of the extent of PC.Patients with PC from CRC underwent staging including 18F-FDG-PET-CT. In the absence of systemic -dissemination, CRS and oxaliplatin based HIPEC were performed. The extent of PC was quantified during surgery using the modified 7 region count (7RC). The correlation between imaging based estimation of PC extent and surgical 7RC was analyzed using Pearson correlation using both patient based and region based analyses.Fifty-five patients were included between February 2005 and October 2018. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 57%, 98%, 95%, 78% and 82% respectively for non-mucinous tumors and 32%, 100%, 100%, 55% and 63% respectively. (18)F-FDG-PET-CT detected the presence of colorectal PC in 96% of patients suffering from PC with nonmucinous histology and in 60% of patients suffering from PC with mucinous histology. Correlation between imaging 7RC and surgical 7RC was better for PC with nonmucinous histology (r = 0.623) than for PC with mucinous histology (r = -0.180).Despite of underestimating the exact extent of disease involvement, (18)F-FDG-PET-CT shows good performance in detecting colorectal PC with nonmucinous histology. For colorectal PC with mucinous histology, (18)F-FDG-PET-CT, however, shows poor performance. Since (18)F-FDG-PET-CT did not detect the presence of colorectal PC in all patients in whom long-term survival could be achieved, (18)F-FDG-PET-CT should be implemented into a broad pre-operative assessment strategy.Keywords:
Histology
Hyperthermic Intraperitoneal Chemotherapy
Hyperthermic Intraperitoneal Chemotherapy
Intraperitoneal Chemotherapy
Mitomycin C
Cite
Citations (54)
Premedication
Hypersensitivity reaction
Cite
Citations (4)
Hyperthermic Intraperitoneal Chemotherapy
Bolus (digestion)
Peritoneal cavity
Cite
Citations (1)
背景・目的: oxaliplatin base の化学療法が大腸癌腹膜播種症例に与える影響について検討した。対象・方法: 2006 年1月～2012 年11 月の間に，腹膜播種陽性Stage IV 大腸癌と診断され，oxaliplatin base の化学療法を導入した49 例（oxaliplatin施行群）と，それ以前に5─FU 系の全身化学療法を施行した26 例（control 群）を対象。oxaliplatin 導入前後のoverall survival（OS）を比較。また，oxaliplatin 施行群のOS に関して臨床病理学的因子を共変量とし，単変量，多変量解析を行い，予後因子を検討した。結果: oxalplatin 施行群はcontrol 群より有意に生存期間が延長していた（中央値 20.5 か月 vs 11.7 か月，p＝0.04）。oxaliplatin 施行群におけるOS に対するfavorable factor として，70 歳以下（p＝0.03），原発巣切除（p＝0.02）が同定された。結語: oxaliplatin base の化学療法は大腸癌腹膜播種症例においても生存期間を改善させた。腹膜播種の程度に関係なく原発巣切除を70 歳以下の症例に行い，速やかにoxaliplatin base の化学療法を導入することが予後向上につながることが示唆された。
Base (topology)
Cite
Citations (0)
Cite
Citations (0)
Hyperthermic Intraperitoneal Chemotherapy
Mitomycin C
Cite
Citations (62)
Hyperthermic Intraperitoneal Chemotherapy
Mitomycin C
Intraperitoneal Chemotherapy
Cite
Citations (28)
We agree with Julianov and Saroglu that data on safety and efficacy are of utmost importance when critically reviewing the value of HIPEC treatment.1 Nevertheless, this topic is beyond the scope of the review we wrote which exclusively focussed on pharmacology of oxaliplatin-based HIPEC and the implications for clinical practice.2 Julianov and Saroglu refer to the study of Levine et al regarding haematologic toxicity of HIPEC in patients with peritoneal metastases of appendiceal origin.3 Our review was focussed on peritoneal carcinomatosis (PC) of colorectal origin. Levine et al describes a fixed Mitomycin C (MMC) dose of 40 mg and an oxaliplatin dose of 200 mg/m2 administered during 120 minutes using a closed abdominal technique.3 This differs from the most often used HIPEC protocol for PC of colorectal origin describing a dose of 35 mg/m2 for MMC administered during 90 minutes and a dose of 460 mg/m2 for oxaliplatin administered during 30 minutes, both using an open HIPEC technique.4 Although haematologic toxicity of HIPEC might be independent of tumour origin, differences in protocols will affect systemic exposure of the cytotoxic drug and thereby the haematologic toxicity profile. Therefore, we do not agree with the statement of Julianov and Saroglu that patients with leukopenia should be treated with oxaliplatin-based HIPEC and patients with thrombocytopenia should be treated with MMC-based HIPEC. Moreover, most patients usually have neither thrombocytopenia nor leukopenia prior to HIPEC treatment. We do agree with Julianov and Saroglu that the use of oxaliplatin-based HIPEC is subject to debate after the results of the PRODIGE 7 trial. Nevertheless, it should be mentioned that most of the patients enrolled in this trial received systemic therapy pre- and/or post-surgery. In the Netherlands, the majority of patients who are treated with HIPEC for PC of colorectal origin are chemotherapy-naive.5 The use of systemic therapy might distort a potential effect of intraperitoneal administered oxaliplatin. Although Verwaal et al demonstrated a survival benefit of cytoreductive surgery combined with MMC-based HIPEC,6 it remains unknown what part of the survival benefit can be contributed to HIPEC on top of the cytoreductive surgery. Retrospective comparisons between oxaliplatin and MMC does not show statistically significant differences in survival and postoperative morbidity7, 8 or are contradictory; one study favoured MMC,9 and another study showed a survival benefit of oxaliplatin.10 Therefore, one should be extremely cautious when advising one drug over another in HIPEC for PC of colorectal origin. Given the great variety in HIPEC protocols and the potential impact this might have on clinical outcome, it is important to standardize the HIPEC procedure in order to be able to compare the outcomes of different studies. Future studies should focus on the value of oxaliplatin-based HIPEC in chemotherapy-naive patients and on optimal patient selection, which still remains one of the most challenging issues. There are no competing interests to declare.
Hyperthermic Intraperitoneal Chemotherapy
Leukopenia
Cite
Citations (0)
oxaliplatin を含む化学療法により肝類洞障害が生じ，その結果，門脈圧が亢進し脾腫が生じる例があることが知られている。今回われわれは，oxaliplatin を含む化学療法により脾臓が増大し，oxaliplatin の休薬により縮小した大腸癌の2 例を報告する。なお脾臓体積の測定には医用画像処理ワークステーションZIOSTATION を用いた。ZIOSTATION 上で脾臓の3D 画像を作成し，その体積を測定した。症例1: 治療開始前137.82 mL であった脾臓はmFOLFOX6/bevacizumab による治療開始2 か月後160.96 mL に増大した。6 コース終了後神経障害のためoxaliplatin のみを休薬したところ151.58 mLに縮小した。神経障害改善後にoxaliplatin を再導入したところ脾臓は177.48 mL に増大したものの，再びoxaliplatin のみを休薬したところ158.52 mLに縮小した。症例2: 治療開始前105.84 mL であった脾臓はmFOLFOX6/bevacizumabによる治療開始10 か月後に228.54 mL に増大した。その後sLV5FU2/bevacizumab，さらにirinotecan 単剤へと移行したところ197.06 mL に縮小した。oxaliplatin 投与によって脾臓は増大するものの，oxaliplatin を休薬すれば脾臓の増大は可逆的である可能性がある。
Cite
Citations (0)
Aim: Cisplatin plus 5-fluorouracil (5-FU) or S-1 is a standard therapy for gastric cancer (GC). However, cisplatin is emetic and potentially nephrotoxic. Oxaliplatin may be less toxic, but few basic data are available for this setting. Here, we evaluated oxaliplatin for GC, by testing surgical specimens. Materials and Methods: We evaluated effects of oxaliplatin and 5-FU, alone and in combination, on surgical specimens from 11 patients with GC, using collagen gel droplet embedded culture drug tests. Results: Oxaliplatin was less efficacious than 5-FU, and its synergistic effect was less in tumors highly sensitive to 5-FU than in those with low sensitivity. Tumor differentiation and drug sensitivity were not correlated. Conclusion: Although oxaliplatin monotherapy had little effect on GC, we saw a limited synergistic effect of oxaliplatin with 5-FU in 5-FU-sensitive patients. Collagen gel droplet embedded culture drug tests may predict this synergistic effect, and help select candidates for this or other regimens.
Nephrotoxicity
Cite
Citations (7)