Worldwide almost 700000 patients are diagnosed with colorectal cancer each year. Of all colorectal cancer patients more than 40% die as a consequence of metastases, of which the majority is located in the liver. Resection of the affected liver segments is considered to be the only curative treatment and although patient selection for hepatectomy by current diagnostic tools (e.g. [18F]FDG PET) has significantly reduced futile surgery 1 , still 70% of all operated patients die within 5 years after hepatic resection. To improve prediction of patient outcome, novel PET tracers with better prognostic value are needed.
The PICO trial, which stands for “Prognostic Imaging COlorectal cancer”, investigates the prognostic relevance of the positron emission tomography (PET) tracer 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) in patients with liver metastases of colorectal cancer. In a multiclinical trial, in which 17 Dutch (medical) institutes participate, patients that have been selected for hepatectomy by conventional imaging techniques will undergo one additional (PET) scan using [18F]FLT as a tracer. Resected material will be investigated by standard immunohistochemical techniques and standard uptake values (SUVs) of [18F]FLT and [18F]FDG, which generally is used for staging, will be compared and related to tissue parameters. Follow-up period after resection will be approximately two years.
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Theo J.M. Ruers, Bastiaan Wiering, Joost R.M. van der Sijp, Rudi M. Roumen, Koert P. de Jong, Emile F.I. Comans, Jan Pruim, Helena M. Dekker, Paul F.M. Krabbe, and Wim J.G. Oyen, J Nucl Med 2009 , vol. 50, p. 1036-1041
The following patients are eligable for the PICO trial:
- technically resectable liver metastases of colorectal cancer
- at least one metastatic lesion with a maximal diameter larger than 2 cm
- signed informed consent
The following patients should be excluded from the PICO trial:
- chemotherapy within 3 months before [18F]FLT PET
- extrahepatic metastases
- radiofrequency abblation (RFA) only (no resection)
- claustrophobia, prohibiting PET scanning
- pregnant or lactating, prohibiting PET scanning.
All participants in the study are included in the “DeCoDe PET” group and can be found here .
Jeroen A.C.M. Goos (PhD student)
Dr. Remond J.A. Fijneman (supervisor)
Dr. Ab A. Geldof (supervisor)
Prof. Dr. Gerrit A. Meijer (project leader)
Prof. Dr. Otto S. Hoekstra (project leader)
Email: ja.goos@vumc.nl
Telephone number: +31 (0)20 44 42395 / +31 (0)6 12102598