Positron Emission Tomography /Computed Tomography Follow-Up in Patients with Gastrointestinal Tract Malignancies

Main Article Content

Abdellatief Mohammed Khairy Eltahan
Mohamad Abd El-Hamid Alm El- Din
Alsiagy Ali Abdel- Aziz
Emad Mohamad Mashaly


Background: PET/CT has an increasing role in the oncology field, including GIT. The role of PET/CT is more significant in the follow-up than initial staging and diagnosis as it helps in therapy assessment and detects recurrence and metastasis. In esophageal cancer, it helps by detecting the distant metastasis and discover synchronous neoplasm. Also, it is acclaimed to help in early detection of the response of the patient to chemo and radiotherapy. In the follow-up, it may be useful to detect recurrence. PET/CT has a minimal role in gastric cancer, as it shows no superiority over C.T. alone. For Colorectal Cancer, PET/CT has a good value in cases of suspected liver or lung metastasis and local recurrence after surgery. This study aimed to evaluate the impact of PET/CT on treatment decision & follow-up of patients with gastrointestinal tract malignancies.

Methods: This study is a cross-sectional study and was done retrospectively by collecting data and records of 47 GIT malignancy patients who underwent PET/CT during or after treatment. At PET/CT unit, Diagnostic Radiology Department in Educational hospitals - Tanta University between July 2015 and December 2017.

Results: The patients were mainly colorectal in the site and primarily adenocarcinoma in type. We found that 27.7% of cases treatment plans were influenced by the PET/CT results, the percentage is highest with colon cancer (40%) then rectal cancer (25%), and our few esophageal, gastric, intestinal malignancies cases have shown no influence which is due to a small number of cases. PET/CT seems to have the best add value in patients with colorectal cancer with metastasis with a 66.7% change in treatment plans. Six patients had inconclusive results of PET/CT due to scan limitations.

Conclusion: Relying on PET/CT in clinical decisions in esophageal or gastric cancer is not encouraged unless in case of clinical or imaging suspicion of recurrence. On the other hand, PET/CT is useful in detecting post-treatment metastasis and local recurrence in colorectal cancer.

Positron emission tomography, computed tomography, follow-up, gastrointestinal, malignancies.

Article Details

How to Cite
Eltahan, A. M. K., Din, M. A. E.-H. A. E.-, Aziz, A. A. A.-, & Mashaly, E. M. (2020). Positron Emission Tomography /Computed Tomography Follow-Up in Patients with Gastrointestinal Tract Malignancies. Journal of Advances in Medicine and Medical Research, 32(21), 77-87. https://doi.org/10.9734/jammr/2020/v32i2130698
Original Research Article


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. C.A. Cancer J Clin. 2018;68(6):394–424.

International Agency for Research on Cancer. Population fact sheets: World [Internet]. GLOBACAN 2018. 2018;876:1–2. Available:http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf

Eaa E, Anan I, Aamm E, Das AG, Mm H, Abs M. The National Cancer Registry in Egypt A retrospective Cross Sectional Epidemiological Study; 2015.

International Agency for Research on Cancer. Egypt, Globocan [Internet]. 2018;399:19–20.

Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve J-L, Mitry E, et al. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis. 2015;47(6):443–54.

Sonnenberg WR. Gastrointestinal Malignancies. Prim Care - Clin Off Prac. 2017;44(4):721–32.

Gong J, Cao W, Zhang Z, Deng Y, Kang L, Zhu P, et al. Diagnostic efficacy of whole-body diffusion-weighted imaging in the detection of tumour recurrence and metastasis by comparison with 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography or computed tomography in patients with gastrointestinal cance. Gastroenterol Rep. 2015;3(2):128–35.

Banks KP, Song W.S. Role of positron emission tomography-computed tomography in gastrointestinal malignancies. Radiol Clin North Am. 2013;51(5):799–831.

Donswijk ML, Hess S, Mulders T, Lam MGEH. [18F]fluorodeoxyglucose PET/ computed tomography in gastrointestinal malignancies. PET Clin. 2014;9(4):421–41.

Malik V, Lucey JA, Duffy GJ, Wilson L, McNamara L, Keogan M, et al. Early Repeated 18F-FDG PET Scans During Neoadjuvant Chemoradiation Fail to Predict Histopathologic Response or Survival Benefit in Adenocarcinoma of the Esophagus. J Nucl Med. 2010;(12):1863–9.

Elliott JA, Farrell NJO, King S, Halpenny D, Malik V, Muldoon C, et al. Value of C.T. – PET after neoadjuvant chemoradiation in the prediction of histological tumour regression , nodal status and survival in oesophageal adenocarcinoma. Br J Surg. 2014;1702–11.

Dai T, Popa E, Shah MA. The role of 18F-FDG PET imaging in upper gastrointestinal malignancies. Curr Treat Options Oncol. 2014;15(3):351–64.

Kroese TE, Goense L, Van Hillegersberg R, De Keizer B, Mook S, Ruurda JP, et al. Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18 F-FDG PET(/CT): A systematic review and meta-analysis. Dis Esophagus. 2018;31(12):1–9.

Healy MA, Yin H, Reddy RM, Wong SL. Use of positron emission tomography to detect recurrence and associations with survival in patients with lung and esophageal cancers. J Natl Cancer Inst. 2016;108(7):1–8.

Kim TJ, Kim HY, Lee KW, Kim MS. Multimodality assessment of esophageal cancer: Preoperative staging and monitoring of response to therapy. Radiographics. 2009;29(2):403–21.

Flamen P, Lerut A, Cutsem E Van, Cambier JP, Maes A, Wever W De, et al. The Utility Of Positron Emission Tomography For The Diagnosis And Staging Of Recurrent Esophageal Cancer. J Thorac Cardiovasc Surg. 2000;1085–92.

Tamandl D, Fueger B, Haug A, Schmid R, Stift J, Schoppmann SF, et al. A diagnostic algorithm that combines quantitative 18 F-FDG PET parameters and contrast-enhanced C.T. improves posttherapeutic locoregional restaging and prognostication of survival in patients with esophageal cancer. Clin Nucl Med. 2019;44(1):e13–21.

Goense L, Van Rossum PSN, Reitsma JB, Lam MGEH, Meijer GJ, Van Vulpen M, et al. Diagnostic performance of 18F-FDG PET and PET/CT for the detection of recurrent esophageal cancer after treatment with curative intent: A systematic review and meta-analysis. J Nucl Med. 2015;56(7):995–1002.

Cremonesi M, Garibaldi C, Timmerman R, Ferrari M, Ronchi S, Grana CM, et al. Interim 18F-FDG-PET/C.T. during chemo-radiotherapy in the management of oesophageal cancer patients. A systematic review. Radiother Oncol. 2017;125(2):200–12.

Zou H, Zhao Y. 18FDG PET-CT for detecting gastric cancer recurrence after surgical resection: A meta-analysis. Surg Oncol [Internet]. 2013;22(3):162–6. Available:http://dx.doi.org/10.1016/j.suronc.2013.05.001

Lee JE, Hong SP, Ahn DH, Jeon TJ, Kang MK, Kwon C Il, et al. The role of 18F-FDG PET/CT in the evaluation of gastric cancer recurrence after curative gastrectomy. Yonsei Med J. 2011;52(1): 81–8.

Kim DW, Park SA, Kim CG. Detecting the recurrence of gastric cancer after curative resection: Comparison of FDG PET/CT and contrast-enhanced abdominal C.T. J Korean Med Sci; 2011.

Li P, Liu Q, Wang C, Wang T, Liu J, Huang G, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer after surgical resection: a systematic review and meta-analysis. Ann Nucl Med [Internet]. 2016;30(3):179–87. Available:http://link.springer.com/10.1007/s12149-016-1058-y

Park MJ, Lee WJ, Lim HK, Park KW, Choi JY, Kim BT. Detecting recurrence of gastric cancer: The value of FDG PET/CT. Abdom Imaging. 2009;34(4):441–7.

Cayvarlı H, Bekiş R, Akman T, Altun D. The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence. Malecular Imaging Radionucl Ther. 2014;23(3):76–83.

Bilici A, Ustaalioglu BBO, Şeker M, Kefeli U, Canpolat N, Tekinsoy B, et al. The role of 18F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: Can the results of FDG PET/CT influence patients’ treatment decision making? Eur J Nucl Med Mol Imaging; 2011

Sim SH, Kim YJ, Oh DY, Lee SH, Kim DW, Kang WJ, et al. The role of PET/CT in detection of gastric cancer recurrence. BMC Cancer. 2009;9:1–7.

Blencowe NS, Whistance RN, Strong S, Hotton EJ, Ganesh S, Roach H, et al. Evaluating the role of fluorodeoxyglucose positron emission tomography-computed tomography in multi-disciplinary team recommendations for oesophago-gastric cancer. Br J Cancer; 2013.

Marcus C, Marashdeh W, Ahn SJ, Taghipour M, Subramaniam RM. 18F-FDG PET/CT and Colorectal Cancer: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management. J Nucl Med [Internet]. 2015 Jul 1;56(7):989–94. Available:http://jnm.snmjournals.org/cgi/doi/10.2967/jnumed.115.156240

Artiko V, Odalovic S, Sobic-Saranovic D, Petrovic M, Stojiljkovic M, Petrovic N, et al. Can 18F-FDG PET/CT scan change treatment planning and be prognostic in recurrent colorectal carcinoma? A prospective and follow-up study. Hell J Nucl Med. 2015;18(1):35–41.

Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of 18F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging [Internet]. 2015;42(1):152–63. Available:http://link.springer.com/10.1007/s00259-014-2930-4

Georgakopoulos A, Pianou N, Kelekis N, Chatziioannou S. Impact of 18F-FDG PET/CT on therapeutic decisions in patients with colorectal cancer and liver metastases. Clin Imaging [Internet]. 2013;37(3):536–41. Available:http://dx.doi.org/10.1016/j.clinimag.2012.09.011

Kochhar R, Liong S, Manoharan P. The role of FDG PET/CT in patients with colorectal cancer metastases. Cancer Biomarkers. 2010;7(4–5):235– 48.