Reliability of Contrast CT and Positron Emission Tomography in Post-Surgical Colorectal Cancer and Its Association with Obesity
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Open Access Maced J Med Sci electronic publication ahead of print, published on July 27, 2019 as https://doi.org/10.3889/oamjms.2019.640 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2019.640 eISSN: 1857-9655 Clinical Science Reliability of Contrast CT and Positron Emission Tomography in Post-Surgical Colorectal Cancer and Its Association with Obesity Safenaz Y. El Sherity1*, Shymaa A. Shalaby2, Nayera E. Hassan1, Sahar A. El-Masry1, Rokia A. El-Banna1 1Biological Anthropology Department, Medical Research Division, National Research Centre, Dokki, Giza, Egypt; 2Radiodiagnosis department, Faculty of Medicine, Helwan University, Cairo, Egypt Abstract Citation: El Sherity SY, Shalaby SA, Hassan NE, El- BACKGROUND: Post-surgical recurrence of cancer colon occurs in one-third of patients within the first two Masry SA, El-Banna RA. Reliability of Contrast CT and years, so early detection is important. The assessment of the therapeutic response is important to change Positron Emission Tomography in Post-Surgical Colorectal Cancer and Its Association with Obesity. Open protocol strategy. Positron emission tomography/computed tomography PET/CT, a valuable tool gives both Access Maced J Med Sci. metabolic and anatomic information for whole-body regions. Obesity is an important risk factor for colorectal https://doi.org/10.3889/oamjms.2019.640 cancer. Keywords: Post-surgical; PET/CT and colorectal cancer *Correspondence: Safenaz Y. El Sherity. Biological AIM: To evaluate post-surgical and therapeutic colorectal cancer by PET/CT and study obesity association to its Anthropology Department, Medical Research Division, prognosis. National Research Centre, Dokki, Giza, Egypt. E-mail: [email protected] METHODS: This was a prospective study involved 93 patients with, post-surgical colorectal cancer examined by Received: 25-Jun-2019; Revised: 06-Jul-2019; Accepted: 07-Jul-2019; Online first: 27-Jul-2019 PET/CT, then follow up after 4-6 months. Copyright: © 2019 Safenaz Y. El Sherity, Shymaa A. Shalaby, Nayera E. Hassan, Sahar A. El-Masry, Rokia A. RESULTS: There was a statistically significant difference between PET/CT and contrast CT. The sensitivity& the El-Banna. This is an open-access article distributed under specificity were (96.4%-100% & 92.3%-98.2%) for PET/CT and (84.2%-90.2% & 76.5%-85.4%) for contrast CT the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) respectively. Post-therapeutic follow up showed; progressive course (24.5%), stationary course (26.4%), partial regression (28.3%) and complete regression course (20.8%). Obesity is a risk factor for progression with highly Funding: This research did not receive any financial support statistically significant to treatment response. Obese patients had a progressive or stationary course of the Competing Interests: The authors have declared that no disease. Also, there was a highly statistically significant association between total abdominal fat & visceral competing interests exist abdominal fat areas with good response of treatment. CONCLUSION: PET/CT is the most appropriate imaging technique to detect any recurrence or metastases in post-surgical colorectal cancer with high sensitivity and specificity comparing to CT. Obesity is a predictor risk factor for prognosis of the disease, as generally and abdominally (total & visceral fat) had an association with therapeutic response. Introduction Post-surgical recurrence of cancer colon occurs within the first two years. It can recur loco- regionally or at distant sites [4]. In therapy, resection Worldwide more than one million people get of one metastasis is associated with good survival colorectal cancer yearly [1]. Also, it is the third most rate while multifocal metastatic lesions give a less commonly diagnosed cancer in males and the second favourable prognosis [5]. Also, the assessment of the in females, with 1.8 million new cases and almost therapeutic response (chemo-radiotherapy) is 861,000 deaths in 2018, according to GLOBOCAN important for change protocol strategy of ineffective database. The highest incidence rates are in Europe, and toxic chemotherapy [6]. So, early detection helps North America, Australia, and New Zealand, while the design the clinical therapeutic guidelines; secondary lowest rates are in South-Central Asia and Africa [2]. operation, radiotherapy or chemotherapy. Colorectal cancer is the 7th commonest cancer in Serum carcinoembryonic antigen (CEA) and Egypt; it represents 3.5% of male cancers and 3% of contrast computed tomography (CT) are conventional female cancers [3]. The estimated numbers of colon methods. As serum CEA levels are used for cancer patients were more than three thousand in recurrence monitoring, with its high-level imaging 2015 [3]. modality will be necessary to localise the site of recurrence and metastases [7]. Regarding changes of _______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 1 Clinical Image _______________________________________________________________________________________________________________________________ anatomical structures and fibrous tissue in the Location: Misr Radiology center (MRC), Cairo, operative region, contrast CT is likely unable to Egypt. differentiate postsurgical changes from recurrence and may miss metastatic deposits. While the functional imaging; Fluorine-18 fluoro-D-glucose positron emission tomography / computed Methods tomography (18F-FDG PET/CT) scan can be greatly used to recognise the metabolic characteristics of the lesions and detect any active cells [8]. The integrated Patient preparation: allow low carbohydrate PET/CT gives both metabolic and anatomic and high protein diets with liquids (24 hours before), information with a single device at one diagnostic then fasting 6 hours before the examination. session for the whole-body regions to detect any The day of examination: complete history was recurrence and metastases [9]. taken and indication (High tumour marker CEA and Several studies reported that obesity is an previous PET/CT scan for follow up), then important risk factor for colorectal cancer [10], [11], measurements were taken before starting the [12], [13], while Scarpa et al., showed the role of examination: Fasting blood sugar, body height and obesity in postoperative recurrence and multifocal weight (using a Seca scale balance and disease [14]. anthropometer with light clothes and no shoes, the measure was taken to nearest 0.1 cm and 0.01 kg The aims of this study; to evaluate post- respectively) [15]. The Body mass index (BMI) was surgical and therapeutic colorectal cancer by PET/CT calculated as; the weight (kg)/ height (m2) and for proper management, also predict the effect of classified into; (18.5 ≥ normal weight < 25), (≥ 25 obesity as a risk factor in prognosis among a sample overweight < 30) and obese (≥ 30) [16]. of Egyptian patients. Examinations: Intravenous injection of 5 – 10 mCi as an average dose of 18F-FDG (0.1 mCi/Kg) one Sample size estimation hour before starting the scan. Each patient was examined by PET/CT using Phillips Ingenuity TF, 128 The sample size was calculated using PASS slice machines (Cleveland, OH, USA) as the following 11 (USA), regarding the proportional of PET/CT A low-dose non-contrast CT for attenuation correction sensitivity at the previous study; 90 subjects were followed by PET scan from the skull to the mid-thigh, adequate with power 90.0%, α = 0.05, and B = 0.1 then a diagnostic post-contrast CT using nonionic contrast medium. Those PET images were assessed by both visually & semi-quantitatively for the regions with pathologic tracer accumulation using maximum standardized uptake value (SUVmax); loco-regional Patients and Methods lesion (recurrent) was identified by presence of metabolically active tumour tissue with high FDG accumulation and correlated this activity to its Design: A prospective study anatomical site in the combined PET/CT images, the Ethics: This study was approved by the lymph nodes and distant metastases (lung, liver, research ethics committee, faculty of medicine, bone, brain, and others) were evaluated as well. The Helwan University (FMHU 1-2019) and informed comparison between the recent scan and the previous written consent were signed by each patient. one in follow up cases was made to evaluate the response of treatment (Fig. 1). Participants: Ninety-four Egyptian’s patients with post-surgical cancer colon, examined for follow The assessment of therapeutic response up after 4-6 months by PET/CT, both genders were evaluated by PET/CT according to RECIST criteria included in this study (55 males and 39 females); their [17]: ages were ranged from 38 to 75 years. They were - Complete response (CR): The referred from clinical oncology and surgery disappearance of FDG uptake at the target tumour departments due to elevated CEA or follow up to lesion.no new FDG avid lesion. assess the effect of treatment. The inclusion criteria: pathologically proven colorectal carcinoma and - Partial response (PR): reduction at least a underwent appropriate therapy for 4-6 months. 30% in target measurable tumour FDG uptake, taking Exclusion criteria included those who had a bad the baseline lesion as a reference. general condition, impaired renal function, allergy to - Progressive disease (PD): at least a 25% intravenous contrast material