Ann Surg 1997 Nov;226(5):621-31
Use of carcinoembryonic antigen radioimmunodetection and computed tomography
for predicting the resectability of recurrent colorectal cancer.
Hughes K, Pinsky CM, Petrelli NJ, Moffat FL, Patt YZ, Hammershaimb L, Goldenberg
DM.
OBJECTIVE: The objective was to determine the role of arcitumomab (CEA-Scan;
Immunomedics, Morris Plains, NJ), an anticarcinoembryonic antigen (CEA) Fab'
labeled with technetium-99m, in the presurgical evaluation of patients with
recurrent or metastatic colorectal carcinoma. SUMMARY BACKGROUND DATA: Surgical
resection is the only method known to cure recurrent or metastatic colorectal
carcinoma. The location and extent of disease must be determined before surgery.
The role of antibody imaging, a new cancer detection modality, in preoperative
evaluation for resection of locally recurrent or metastatic colorectal cancer
has not been established, either alone or in combination with standard
diagnostic modalities. METHODS: In a blinded analysis of 209 patients with known
or suspected colorectal cancer, the accuracy of arcitumomab, alone and combined
with computed tomography (CT), was compared to that of CT for predicting
abdominopelvic tumor resectability by correlating the results with surgical and
histopathologic findings. RESULTS: Arcitumomab alone or combined with CT was
found to be significantly more accurate for predicting surgical outcome than CT
alone. When the results of CT and arcitumomab were concordant for abdominopelvic
resectability, nonresectability, or absence of disease, the prediction was
accurate in 67%, 100%, and 64%, respectively. Thus, the concordance for
nonresectability (100% correct) may obviate the need for other diagnostic
modalities or exploratory surgery. When the two tests were discordant,
arcitumomab was correct substantially more often than CT. Because the liver is
the most common site of distant metastasis in colorectal cancer, a subset of
patients with hepatic disease was also analyzed; findings were similar to the
overall resectability results. The product's safety profile was excellent: the
incidence of induction of an immune response against arcitumomab was <1% and
that of potentially adverse events was 1.2%. CONCLUSIONS: The accuracy of
arcitumomab for assessing resectability status is greater than that of CT, both
in all patients undergoing evaluation for curative abdominopelvic resection of
colorectal cancer and in the subset of patients with suspected or proven liver
metastases. The additional use of arcitumomab with CT potentially doubles the
number of patients who could be saved the cost, morbidity, and mortality of
unnecessary abdominopelvic surgery and increases those who are potentially
resectable for cure by 40%.
Publication Types:
- Multicenter study
