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Evaluation of 18F-FDG-PET for Early Detection of Suboptimal Response of Rectal Cancer to Preoperative Chemoradiotherapy: A Prospective Analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Early identification of inadequate response to preoperative chemoradiotherapy (CRT) may spare rectal cancer patients the toxicity of ineffective treatment. We prospectively evaluated tumor response with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) early in the course of preoperative CRT.

Methods

A total of 27 prospectively accrued patients with locally advanced rectal cancer (T3–4/N1) received preoperative CRT (5040 cGy + 5FU-based chemotherapy). Patients underwent PET scanning before and 8–14 days after commencement of CRT. Scans were interpreted using 3 standard parameters: SUVmax, SUVavg, and total lesion glycolysis (TLG) as well as an investigational parameter: visual response score (VRS). Percent pathologic response was quantified as a continuous variable. All PET parameters were correlated with pathology. Pathologic complete/near-complete response was defined as ≥95% tumor destruction, suboptimal response as <95%. Statistical analysis was performed using the Wilcoxon rank sum test and receiver operating characteristic (ROC) curve analysis.

Results

Of the 27 patients, 11 (41%) had pathologic complete/near-complete response; 16 (59%) had suboptimal response. SUVmax, SUVavg, and TLG did not discriminate between responders and nonresponders. Visual response score (VRS) was statistically significantly higher for complete/near-complete responders than for suboptimal responders (65 vs. 33%, P = 0.02). Suboptimal responders were identified with 94% sensitivity and 78% accuracy using a VRS cut-off of 50%.

Conclusions

In this pilot study, FDG-PET at 8–14 days after the beginning of preoperative CRT was unsuccessful at predicting pathological response with enough accuracy to justify an early change in therapy.

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Acknowledgment

This work was supported in part by National Cancer Institute Grant R01 82534-01, awarded to José G. Guillem, MD, MPH.

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Authors and Affiliations

  1. Department of Surgery (Colorectal Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Tobias Leibold MD, David B. Chessin MD, Philip B. Paty MD, Martin R. Weiser MD, W. Douglas Wong MD & José G. Guillem MD, MPH

  2. Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Timothy J. Akhurst MD, Henry W. Yeung MD, Homer Macapinlac MD & Steven M. Larson MD

  3. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jinru Shia MD

  4. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Bruce D. Minsky MD

  5. Department of Medicine (Gastrointestinal Oncology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Leonard B. Saltz MD

  6. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Elyn Riedel MA & Madhu Mazumdar PhD

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  1. Tobias Leibold MD
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Correspondence to José G. Guillem MD, MPH.

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Leibold, T., Akhurst, T.J., Chessin, D.B. et al. Evaluation of 18F-FDG-PET for Early Detection of Suboptimal Response of Rectal Cancer to Preoperative Chemoradiotherapy: A Prospective Analysis. Ann Surg Oncol 18, 2783–2789 (2011). https://doi.org/10.1245/s10434-011-1634-2

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