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Increased Metabolic Activity of Indolent Liver Metastases After Resection of a Primary Colorectal Tumor

¹ Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; ² Department of Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; and ³ Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

Correspondence: For correspondence or reprints contact: Marian G.W. Scheer, Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: M.Scheer{at}chir.umcn.nl

In murine models, resection of a primary tumor leads to increased vascularization and accelerated growth of metastases that previously had remained microscopic. To study such a potentially inhibitory effect of primary tumors on the outgrowth of distant metastases in humans, we assessed the metabolic activity of liver metastases by ¹⁸F-FDG PET before and after resection of primary colorectal tumors. Methods: Group A consisted of 8 patients with synchronous colorectal liver metastases who were scheduled for resection of their primary tumor. These patients underwent an ¹⁸F-FDG PET scan shortly before resection and 2–3 wk after resection of the primary tumor. The patients in a control group (group B, n = 9) underwent an ¹⁸F-FDG PET scan at the time of diagnosis of the liver metastases and a second scan several weeks later, before initiating treatment. There was no surgical intervention between the two ¹⁸F-FDG PET scans in this group. Results: In group A, the maximum and mean standardized uptake values of the liver metastases clearly increased after resection of the primary tumor, by 38% ± 55% and 42% ± 52%, respectively, as compared with the first ¹⁸F-FDG PET scan. In group B, the maximum and mean standardized uptake values of the second ¹⁸F-FDG PET scan were not significantly higher than those of the first ¹⁸F-FDG PET scan; –11% ± 23% and 1% ± 29%, respectively. The difference in standardized uptake value increase between the 2 groups was statistically significant (P < 0.05). Conclusion: Our data cannot differentiate between the immunologic sequels caused by the surgical trauma itself and those caused by removal of the primary tumor. The observation itself, however, of increased metabolic activity after surgical resection of the primary tumor may have direct clinical applications and suggests the administration of antiangiogenic therapy after surgery of the primary tumor.

Key Words: colorectal cancer • liver metastases • ¹⁸F-FDG PET

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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				M. G.W. Scheer, W. J.G. Oyen, and T. J.M. Ruers Reply: Increased Metabolic Activity of Indolent Liver Metastases After Resection of a Primary Colorectal Tumor J. Nucl. Med., January 1, 2009; 50(1): 168 - 168. [Full Text] [PDF]

				J. Seto Increased Metabolic Activity of Indolent Liver Metastases After Resection of a Primary Colorectal Tumor J. Nucl. Med., January 1, 2009; 50(1): 167 - 167. [Full Text] [PDF]