Impact of F-18-FDG PET on managing patients with colorectal cancer: The referring physician's perspective

Whole-body PET imaging with F-18-FDG has been used successfully to stage co lorectal cancer. However, the impact of FDG PET on patient management from the referring physician's point of view has not been determined. Methods: A questionnaire was sent to referring physicians to determine whether and ho w PET altered the management of colorectal cancer patients. Management chan ges, when present, were classified as intermodality (e.g., medical to surgi cal, surgical to radiation, medical ton treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach). Results: Of 60 respon ses from referring physicians, changes in clinical stage were reported for 25 patients (42%). Among these, the disease was upstaged in 20 patients (80 %) and downstaged in 5 patients (20%). The PET findings contributed to inte rmodality management changes in 22 of the 60 patients (37%), intramodality changes in 11 patients (18%),a combination of management changes in 4 patie nts (7%), and no change in 19 patients (32%). Two of the 60 patients (3%) h ad other changes, and no response to this question was received for the rem aining 2 patients (3%). As a result of PET findings, physicians avoided maj or surgery in 41% of patients for whom surgery was the intended treatment. Conclusion: This survey-based study of referring physicians shows that FDG PET had a major impact on the management of colorectal cancer patients and contributed to changes in clinical stage and major management decisions in >40% of patients.