Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution’s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824–0.946; p < 0.001), 0.844 (95% CI: 0.772–0.916; p < 0.001), 0.753 (95% CI: 0.612–0.844; p < 0.001), and 0.547 (95% CI: 0.442–0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers.

Bacground/Aim. Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. Methods. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. Results. A total of 48 (24.9%) patients did not use any type of alternative therapy; 145 (75.1%) patients used at least one product and 124 (64.25%) patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients); 136 (70.5%) patients were informed about alternative therapies by other patients.; 145 (75.1% ) used alternative medicine to increase the chances for cure; 88 (45.6%) of interviewed patients would like to participate in future research in this field. Conclusion. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.

Introduction. Breast cancer is one of the most common malignancies in women and the main leading cause of cancer death. The most frequent sites of metastases from breast cancer are bones, lungs, the central nervous system, the liver and soft tissue. Colonic metastases from breast cancer are rare. Case report. We presented a 70-year-old woman with bulky obstructing lesion of sigmoid colon. A physician in charge on our department examined the patient and past history of breast cancer was found up. Surgery was performed with removal of sigmoid colon and three of six lymph nodes were positive. Pathological examination, including immunohistochemical stains, confirmed the diagnosis of metastatic breast cancer to sigmoid colon. The multidisciplinary oncology team suggested postoperative chemotherapy. The patient received four cycles of chemotherapy with paclitaxel followed by anastrozole. On the first control visit no disease activity was detected. Conclusion. In patients with the past history of breast cancer the symptoms of hematochezia or anemia may indicate colonic metastases.

Bone metastases from colorectal cancer are not common and most frequently are manifesting in late history of metastatic disease. We present a 67-old man who had first symptoms of metastatic disease manifested with edema and decreased mobility of thumb of right hand. Radiography showed complete osteolysis of proximal phalanx of thumb, which appeared 30 months after primary surgery for colorectal cancer. Histopathologic analysis of amputated thumb confirmed diagnosis of metastatic colorectal carcinoma and excluded osteolysis of other reasons. Metastatic changes in the first and second lumbar vertebra, which were treated with palliative radiotherapy, were confirmed by additional diagnostics.

Background/Objectives: The treatment goal for patients with unresectable liver-limited metastatic colorectal cancer (mCRC) is resection. Biological agents directed to vascular endothelial growth factor (anti-VEGF) and epidermal growth factor receptor (anti-EGFR) are effective in RAS wild type mCRC. We aimed to investigate which type of biological therapy is more efficient and tolerable in the first line treatment of patients with RAS wild type mCRC and unresectable liver metastases. Methods: This was a prospective, single-centre cohort analysis that included patients with mCRC and unresectable liver metastases, without mutations in the KRAS and NRAS genes (exons 2, 3 and 4), treated at the University Clinical Centre of Nis, Serbia. The overall response rate (ORR), depth of response (DoR), resection rate (RR), progression-free survival (PFS) and overall survival (OS) were compared between patients treated with the anti-EGFR antibody cetuximab/panitumumab and those treated with the anti-VEGF antibody bevacizumab, each in combination with the chemotherapy doublet FOLFOX/FOLFIRI. Results: Fifty-one patients were treated with anti-EGFR antibodies and 50 patients received bevacizumab. Anti-EGFR treatment provided better ORR (70.6% vs. 50%; p = 0.034), deeper response (47.2% vs. 33.67%; p = 0.004) and higher RR (66.7% vs. 46%; p=0.036). Median PFS was significantly better in the anti-EGFR treated group (12.1 vs. 8.5 months; p=0.016). Median OS tended to be better in anti-EGFR-treated patients, but the difference was not significant (30.4 vs. 25.5 months; p=0.221). Both treatments had comparable rates of grade 3/4 toxicity (37.2% vs. 28%; p=0.32). Conclusion: Patients with RAS wild-type, unresectable mCRC should be treated with anti-EGFR therapy when aiming for conversion.

Background/Objectives: Resection is the treatment goal in unresectable liver-limited metastatic colorectal cancer (mCRC). Anti-VEGF and anti-EGFR antibodies are effective in RAS wild-type mCRC, but the better option for conversion is unclear. We compared their efficacy and tolerability as first-line treatment. Methods: In this prospective, single-centre cohort study, patients with RAS-wild-type mCRC and unresectable liver metastases received cetuximab or panitumumab (anti-EGFR) or bevacizumab (anti-VEGF) with FOLFOX or FOLFIRI. We compared the overall response rate (ORR), depth of response (DoR), resection rate (RR), progression-free survival (PFS), overall survival (OS) and toxicity, using Cox regression adjusted for baseline covariates. Results: Of 101 patients, 51 received anti-EGFR therapy and 50 bevacizumab. Anti-EGFR therapy achieved a higher ORR (70.6% vs. 50.0%; p = 0.034), deeper response (47.2% vs. 33.7%; p = 0.004) and higher RR (66.7% vs. 46.0%; p = 0.036). The median PFS was longer (12.1 vs. 8.5 months; adjusted HR 0.48, 95% CI 0.29–0.78; p = 0.003), whereas the median OS did not differ significantly (30.4 vs. 25.5 months; p = 0.382). Grade 3/4 toxicity was similar (35.3% vs. 22.0%; p = 0.187). Conclusions: Anti-EGFR therapy was associated with higher response and resection rates and longer PFS and may be considered when conversion is the aim; these single-centre, non-randomised findings require confirmation in randomised studies.