FDG-PET/CT in der Nachsorge von kolorektalen Karzinomen

 

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Zusammenfassung

Nach Einführung des Koloskopie-Screenings hat sich in den letzten Jahren die Mortalität durch Darmkrebs deutlich verringert. Auch wenn jetzt häufiger frühe Erkrankungsstadien erkannt werden, erleidet immer noch ein beträchtlicher Teil der Patienten Rezidive und Metastasierungen. Die FDG-PET/CT zeigt eine hohe Treffsicherheit beim Nachweis und der Lokalisation von Darmkrebs-Rezidiven. Man weiß, dass nach R0-Resektionen von Metastasen oder Rezidiven eine realistische Chance auf Langzeitüberleben besteht. Daher ist es als ein starker Hinweis auf einen patientenrelevanten Nutzen anzusehen, dass man – wie eine randomisierte Studie zeigte – mit dem Einsatz der FDG-PET/CT in der Nachsorge signifikant häufiger Rezidive fand als bei der herkömmlichen Diagnostik und dann meistens eine R0-Resektion zu erreichen war. Aktuelle Leitlinien empfehlen mittlerweile den Einsatz der FDG-PET/CT zur Rezidiv-Diagnostik bei steigenden CEA-Werten oder unklaren Befunden der morphologischen Diagnostik.

Abstract

With the introduction of screening for colorectal cancer by colonoscopy, the mortality related to colorectal cancer was significantly reduced in recent years. Although now more early stages of the disease are detected, still a significant proportion of patients experiences relapse and metastatic spread. FDG-PET/CT shows a high accuracy in the detection and localization of recurrences of colorectal cancer. We know that R0 resections of metastases or recurrences improve long-term survival. Thus, it can be regarded as a strong indication of a benefit that a randomized trial demonstrated the detection of significantly more recurrences with subsequent R0 resection by FDG-PET/CT as compared to the surveillance with conventional imaging only. Current guidelines recommend the use of FDG-PET/CT to determine the site of recurrence in the setting of rising CEA when conventional work-up fails to unequivocally identify metastatic disease.

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