Monitoring Therapy

The ability of PET to differentiate scar tissue from recurrent tumor in the pelvis was recognized very early.288,289 Increased FDG uptake can be present immediately after radiation because of inflammatory changes, and this is not always associated with residual tumor. Moore et al.290 found a sensitivity of 84% and specificity of 88% for the detection of local pelvic recurrence 6 months after external-beam radiation therapy for rectal cancer. In contrast, Schiepers et al.291 concluded that there was no correlation between FDG uptake and cell kinetics in patients with primary rectal cancer treated by irradiation. Guillem et al.292 demonstrated in a study of 15 patients treated with combined chemoradiation that FDG-PET added useful information. In a study of 25 patients with rectal cancer, Calvo et al.293 described SUVs that were significantly decreased after treatment, but no correlation was found between postradiation metabolic activity and the 3-year survival rate.

Hepatic metastases can be treated with either systemic chemotherapy or regional therapy to the liver. A variety of

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TABLE 33.12. FDG-PET results in detection and staging recurrent colorectal carcinoma.

Author

Year of patients

Sens

Spec

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