Impact of Positron Emission Tomography Imaging Prior to Liver Resection for Colorectal Adenocarcinoma Metastases (PETCAM)

• proportion of patients who have a change in management resulting from PET [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  

• proportion of patients precluded from having a liver resection because of additional metastatic disease identified on PET [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• 3-year overall survival of patients who undergo surgery with curative intent [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• 3-year overall survival of all patients [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• sensitivity and specificity of PET in detecting other hepatic and extra-hepatic metastatic disease prior to a potentially curable liver resection for colorectal adenocarcinoma metastatic disease [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• economic analysis of the addition of PET in the diagnostic work-up [ Time Frame: 4 year ] [ Designated as safety issue: No ]
  
• prognostic ability of the PET standard uptake value (SUV) in predicting 3-year overall survival [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  

Colorectal cancer remains a leading cause of death in men and women. A significant number of patients with colorectal cancer will either present with, or subsequently develop, liver metastases. In contrast to many other epithelial solid tumours, resection of colorectal cancer hepatic metastases results in long-term survival and even cure. However, despite state of the art CT imaging, 60-75% of patients who appear to have limited disease amenable to surgical resection will eventually die from extra-hepatic and recurrent hepatic metastases. If occult micrometastatic disease that becomes evident after liver resection could be detected reliably during pre-operative assessment, patients harboring more widespread disease could be spared a non-curative liver resection. This is one of the present challenges of liver surgery. PET imaging has the potential to improve the detection of both hepatic and extra-hepatic metastatic disease, not detected by conventional imaging modalities.

This prospective, multicenter trial will enroll patients with colorectal cancer liver metastases considered resectable, based on CT scans of the thorax, abdomen and pelvis, which demonstrate no evidence of extra-hepatic disease. A full colonoscopy within the preceding 12 months will ensure there is no local recurrence, or other primary cancer at the time of planned liver resection. These patients will be randomized to PET scan or not.