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Clinical implications of initial FDG-PET/CT in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

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Abstract

Purpose

The present study evaluated the predictive and prognostic impact of initial fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in patients with locally advanced rectal cancer treated with neoadjuvant concurrent chemoradiotherapy (CCRT).

Methods

Eighty-one consecutive patients with locally advanced rectal cancer (cT3-T4 N−/N+) treated with neoadjuvant CCRT were enrolled. The FDG-PET/CT parameters, including the SUVmax, metabolic tumor volume (MTV, 50 % of SUVmax), and multiplication of the SUVmean and MTV (total lesion glycolysis, TLG), were analyzed in relation to the pathologic response and disease recurrence.

Results

Five patients (6.2 %) achieved a pathologic complete response (pCR) after CCRT followed by surgery. None of the FDG-PET/CT parameters was identified as a predictive factor for pCR. After a median follow-up period of 26.7 (range 10.9–63.3) months, 19 patients (23.5 %) presented a local and/or distant recurrence. In a multivariate analysis including the clinicopathologic parameters, the TLG of the primary tumor was associated with a worse disease-free survival after neoadjuvant CCRT (HR 20.035, 95 % CI 1.726–232.559; P = 00.017).

Conclusions

The TLG of the primary tumor in the initial FDG-PET/CT can be considered as a prognostic factor for patients with locally advanced rectal cancer treated with neoadjuvant CCRT.

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References

  1. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  2. Pucciarelli S, Toppan P, Friso ML, Russo V, Pasetto L, Urso E, Marino F, Ambrosi A, Lise M (2004) Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 47:1798–1807

    Article  PubMed  Google Scholar 

  3. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696

    Article  PubMed  Google Scholar 

  4. Valentini V, Coco C, Picciocchi A, Morganti AG, Trodella L, Ciabattoni A, Cellini F, Barbaro B, Cogliandolo S, Nuzzo G, Doglietto GB, Ambesi-Impiombato F, Cosimelli M (2002) Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 53:664–674

    Article  PubMed  Google Scholar 

  5. Rau B, Hunerbein M, Barth C, Wust P, Haensch W, Riess H, Felix R, Schlag PM (1999) Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer. Surg Endosc 13:980–984

    Article  PubMed  CAS  Google Scholar 

  6. Chen CC, Lee RC, Lin JK, Wang LW, Yang SH (2005) How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 48:722–728

    Article  PubMed  Google Scholar 

  7. Weber WA, Ott K, Becker K, Dittler HJ, Helmberger H, Avril NE, Meisetschlager G, Busch R, Siewert JR, Schwaiger M, Fink U (2001) Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19:3058–3065

    PubMed  CAS  Google Scholar 

  8. Mac Manus MP, Hicks RJ, Matthews JP, McKenzie A, Rischin D, Salminen EK, Ball DL (2003) Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 21:1285–1292

    Article  PubMed  Google Scholar 

  9. Martoni AA, Zamagni C, Quercia S, Rosati M, Cacciari N, Bernardi A, Musto A, Fanti S, Santini D, Taffurelli M (2010) Early (18)F-2-fluoro-2-deoxy-d-glucose positron emission tomography may identify a subset of patients with estrogen receptor-positive breast cancer who will not respond optimally to preoperative chemotherapy. Cancer 116:805–813

    Article  PubMed  Google Scholar 

  10. Denecke T, Rau B, Hoffmann KT, Hildebrandt B, Ruf J, Gutberlet M, Hunerbein M, Felix R, Wust P, Amthauer H (2005) Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging? Eur Radiol 15:1658–1666

    Article  PubMed  CAS  Google Scholar 

  11. Amthauer H, Denecke T, Rau B, Hildebrandt B, Hunerbein M, Ruf J, Schneider U, Gutberlet M, Schlag PM, Felix R, Wust P (2004) Response prediction by FDG-PET after neoadjuvant radiochemotherapy and combined regional hyperthermia of rectal cancer: correlation with endorectal ultrasound and histopathology. Eur J Nucl Med Mol Imaging 31:811–819

    Article  PubMed  Google Scholar 

  12. Calvo FA, Domper M, Matute R, Martinez-Lazaro R, Arranz JA, Desco M, Alvarez E, Carreras JL (2004) 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 58:528–535

    Article  PubMed  Google Scholar 

  13. Erdi YE, Macapinlac H, Rosenzweig KE, Humm JL, Larson SM, Erdi AK, Yorke ED (2000) Use of PET to monitor the response of lung cancer to radiation treatment. Eur J Nucl Med 27:861–866

    Article  PubMed  CAS  Google Scholar 

  14. Hamilton SRAL (2000) WHO classification. IARC Press, Lyon

    Google Scholar 

  15. Greene FLPD, Fleming ID (2002) The AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  16. Brierley JD, Greene FL, Sobin LH, Wittekind C (2006) The “y” symbol: an important classification tool for neoadjuvant cancer treatment. Cancer 106:2526–2527

    Article  PubMed  Google Scholar 

  17. Habr-Gama A, Perez RO (2009) Non-operative management of rectal cancer after neoadjuvant chemoradiation. Br J Surg 96:125–127

    Article  PubMed  CAS  Google Scholar 

  18. Neuman HB, Elkin EB, Guillem JG, Paty PB, Weiser MR, Wong WD, Temple LK (2009) Treatment for patients with rectal cancer and a clinical complete response to neoadjuvant therapy: a decision analysis. Dis Colon Rectum 52:863–871

    Article  PubMed  Google Scholar 

  19. de Geus-Oei LF, Vriens D, van Laarhoven HW, van der Graaf WT, Oyen WJ (2009) Monitoring and predicting response to therapy with 18F-FDG PET in colorectal cancer: a systematic review. J Nucl Med 50(Suppl 1):43S–54S

    Article  PubMed  Google Scholar 

  20. Martoni AA, Di Fabio F, Pinto C, Castellucci P, Pini S, Ceccarelli C, Cuicchi D, Iacopino B, Di Tullio P, Giaquinta S, Tardio L, Lombardi R, Fanti S, Cola B (2011) Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer. Ann Oncol 22:650–656

    Article  PubMed  CAS  Google Scholar 

  21. Larson SM, Erdi Y, Akhurst T, Mazumdar M, Macapinlac HA, Finn RD, Casilla C, Fazzari M, Srivastava N, Yeung HW, Humm JL, Guillem J, Downey R, Karpeh M, Cohen AE, Ginsberg R (1999) Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using pet-fdg imaging. The visual response score and the change in total lesion glycolysis. Clin Positron Imaging 2:159–171

    Article  PubMed  Google Scholar 

  22. Gulec SA, Suthar RR, Barot TC, Pennington K (2011) The prognostic value of functional tumor volume and total lesion glycolysis in patients with colorectal cancer liver metastases undergoing 90Y selective internal radiation therapy plus chemotherapy. Eur J Nucl Med Mol Imaging 38:1289–1295

    Article  PubMed  CAS  Google Scholar 

  23. Lee HY, Hyun SH, Lee KS, Kim BT, Kim J, Shim YM, Ahn MJ, Kim TS, Yi CA, Chung MJ (2010) Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications. Ann Surg Oncol 17:2787–2794

    Article  PubMed  Google Scholar 

  24. Liao S, Penney BC, Wroblewski K, Zhang H, Simon CA, Kampalath R, Shih MC, Shimada N, Chen S, Salgia R, Appelbaum DE, Suzuki K, Chen CT, Pu Y (2011) Prognostic value of metabolic tumor burden on (18)F-FDG PET in nonsurgical patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging

  25. Chan WK, Mak HK, Huang B, Yeung DW, Kwong DL, Khong PL (2010) Nasopharyngeal carcinoma: relationship between 18F-FDG PET-CT maximum standardized uptake value, Metabolic tumour volume and total lesion glycolysis and TNM classification. Nucl Med Commun 31:206–210

    Article  PubMed  Google Scholar 

  26. Chan SC, Chang JT, Lin CY, Ng SH, Wang HM, Liao CT, Chang CJ, Lin SY, Yen TC (2011) Clinical utility of 18F-FDG PET parameters in patients with advanced nasopharyngeal carcinoma: predictive role for different survival endpoints and impact on prognostic stratification. Nucl Med Commun 32:989–996

    Article  PubMed  Google Scholar 

  27. Leibold T, Akhurst TJ, Chessin DB, Yeung HW, Macapinlac H, Shia J, Minsky BD, Saltz LB, Riedel E, Mazumdar M, Paty PB, Weiser MR, Wong WD, Larson SM, Guillem JG (2011) 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

    Article  PubMed  Google Scholar 

  28. Yeung JM, Kalff V, Hicks RJ, Drummond E, Link E, Taouk Y, Michael M, Ngan S, Lynch AC, Heriot AG (2011) Metabolic response of rectal cancer assessed by 18-FDG PET following chemoradiotherapy is prognostic for patient outcome. Dis Colon Rectum 54:518–525

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by a grant from the Korea Health Technology R and D Project, Ministry of Health and Welfare, Republic of Korea (A111345).

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Authors and Affiliations

  1. Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 807 Hogukno Buk-gu, Daegu, 702-210, South Korea

    Soo Jung Lee, Jong Gwang Kim, Yee Soo Chae, Byung Woog Kang & Yoo Jin Lee

  2. Department of Nuclear Medicine, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea

    Sang-Woo Lee

  3. Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea

    Jun Seok Park & Gyu Seog Choi

  4. Department of Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 807 Hogukno Buk-gu, Daegu, 702-210, South Korea

    Gyu Seog Choi

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  1. Soo Jung Lee
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  2. Jong Gwang Kim
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  3. Sang-Woo Lee
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Corresponding authors

Correspondence to Jong Gwang Kim or Gyu Seog Choi.

Additional information

Gyu Seog Choi and Jong Gwang Kim contributed equally to this work.

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Lee, S.J., Kim, J.G., Lee, SW. et al. Clinical implications of initial FDG-PET/CT in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Cancer Chemother Pharmacol 71, 1201–1207 (2013). https://doi.org/10.1007/s00280-013-2114-0

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  • DOI: https://doi.org/10.1007/s00280-013-2114-0

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