Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer

Journal Article · Sat Sep 01 00:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.10.048· OSTI ID:22149442

Mistrangelo, Massimiliano ^[1]; Pelosi, Ettore ^[2]; Bello, Marilena ^[3]; Ricardi, Umberto ^[4]; Milanesi, Enrica ^[5]; Cassoni, Paola ^[6]; Baccega, Massimo ^[7]; Filippini, Claudia ^[8]; Racca, Patrizia ^[5]; Lesca, Adriana ^[7]; Munoz, Fernando H. ^[4]; Fora, Gianluca ^[5]; Skanjeti, Andrea ^[3]; Cravero, Francesca; Morino, Mario ^[1]

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1. Digestive and Colorectal Surgical Department, Centre of Minimal Invasive Surgery, University of Turin, Molinette Hospital, Turin (Italy)
2. PET Center IRMET spa, Turin (Italy)
3. Department of Nuclear Medicine, University of Turin, Molinette Hospital (Italy)
4. Department of Radiotherapy, University of Turin, Molinette Hospital (Italy)
5. Oncological Centre for Gastrointestinal Neoplasms, University of Turin, Molinette Hospital (Italy)
6. Department of Biomedical Sciences and Human Oncology, University of Turin, Molinette Hospital (Italy)
7. Department of Nuclear Medicine, Molinette Hospital (Italy)
8. Anaesthesia and Intensive Care Unit, University of Turin, Molinette Hospital (Italy)

Purpose: Pre- and post-treatment staging of anal cancer are often inaccurate. The role of positron emission tomograpy-computed tomography (PET-CT) in anal cancer is yet to be defined. The aim of the study was to compare PET-CT with CT scan, sentinel node biopsy results of inguinal lymph nodes, and anal biopsy results in staging and in follow-up of anal cancer. Methods and Materials: Fifty-three consecutive patients diagnosed with anal cancer underwent PET-CT. Results were compared with computed tomography (CT), performed in 40 patients, and with sentinel node biopsy (SNB) (41 patients) at pretreatment workup. Early follow-up consisted of a digital rectal examination, an anoscopy, a PET-CT scan, and anal biopsies performed at 1 and 3 months after the end of treatment. Data sets were then compared. Results: At pretreatment assessment, anal cancer was identified by PET-CT in 47 patients (88.7%) and by CT in 30 patients (75%). The detection rates rose to 97.9% with PET-CT and to 82.9% with CT (P=.042) when the 5 patients who had undergone surgery prior to this assessment and whose margins were positive at histological examination were censored. Perirectal and/or pelvic nodes were considered metastatic by PET-CT in 14 of 53 patients (26.4%) and by CT in 7 of 40 patients (17.5%). SNB was superior to both PET-CT and CT in detecting inguinal lymph nodes. PET-CT upstaged 37.5% of patients and downstaged 25% of patients. Radiation fields were changed in 12.6% of patients. PET-CT at 3 months was more accurate than PET-CT at 1 month in evaluating outcomes after chemoradiation therapy treatment: sensitivity was 100% vs 66.6%, and specificity was 97.4% vs 92.5%, respectively. Median follow-up was 20.3 months. Conclusions: In this series, PET-CT detected the primary tumor more often than CT. Staging of perirectal/pelvic or inguinal lymph nodes was better with PET-CT. SNB was more accurate in staging inguinal lymph nodes.

• OSTI ID: 22149442
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 84; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIOPSY
CAT SCANNING
COMBINED THERAPY
COMPARATIVE EVALUATIONS
LYMPH NODES
METASTASES
NEOPLASMS
PATIENTS
POSITRON COMPUTED TOMOGRAPHY
RECTUM
SENSITIVITY
SPECIFICITY
SURGERY