Abstract
Purpose
The aim of this study was to compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation.
Methods
One hundred and eighty-one consecutive patients with locally advanced rectal cancer who underwent a total mesorectal excision after preoperative chemoradiation were prospectively enrolled. All the patients underwent FDG-PET/CT and pelvic MRI before chemoradiation and 5 weeks after the completion of chemoradiation. We evaluated the measurements of the FDG uptake (SUVmax) and the percentage of SUVmax difference (Response Index = RI) between the pre- and postchemoradiation FDG-PET/CT scans. The accuracy of repeat FDG-PET/CT and pelvic MRI for predicting pathologic CR were compared.
Results
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2 %, respectively. In terms of FDG-PET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6 % as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1 %, a specificity of 64.5 %, a PPV of 25.7 %, a NPV of 93.5 %, and an accuracy of 65.7 % (area under the curve = 0.723, 95 % confidence interval 0.619–0.828, P < 0.001).
Conclusions
The accuracy of FDG-PET/CT restaging is superior to that of MRI staging for predicting pathologic CR in irradiated rectal cancer. An NPV of 93.5 % indicates that FDG-PET/CT can rule out the pathologic CR.
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References
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
Capirci C, Rubello D, Pasini F, Galeotti F, Bianchini E, Del Favero G, Panzavolta R, Crepaldi G, Rampin L, Facci E, Gava M, Banti E, Marano G (2009) The role of dual-time combined 18-fluorodeoxyglucose positron emission tomography and computed tomography in the staging and restaging workup of locally advanced rectal cancer, treated with preoperative chemoradiation therapy and radical surgery. Int J Radiat Oncol Biol Phys 74:1461–1469
Cerfolio RJ, Bryant AS, Winokur TS, Ohja B, Bartolucci AA (2004) Repeat FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. Ann Thorac Surg 78:1903–1909; discussion 1909
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
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Flejou JF (2011) WHO classification of digestive tumors: the fourth edition. Ann Pathol 31:S27–S31
Gillham CM, Lucey JA, Keogan M, Duffy GJ, Malik V, Raouf AA, O’Byrne K, Hollywood D, Muldoon C, Reynolds JV (2006) (18) FDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour response. Br J Cancer 95:1174–1179
Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, Campos FG, Kiss DR, Gama-Rodrigues J (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–717; discussion 717–718
Higashi K, Clavo AC, Wahl RL (1993) In vitro assessment of 2-fluoro-2-deoxy-d-glucose, l-methionine and thymidine as agents to monitor the early response of a human adenocarcinoma cell line to radiotherapy. J Nucl Med 34:773–779
Hillner BE, Siegel BA, Shields AF, Liu D, Gareen IF, Hanna L, Stine SH, Coleman RE (2009) The impact of positron emission tomography (PET) on expected management during cancer treatment: findings of the National Oncologic PET Registry. Cancer 115:410–418
Hoekstra CJ, Stroobants SG, Smit EF, Vansteenkiste J, van Tinteren H, Postmus PE, Golding RP, Biesma B, Schramel FJ, van Zandwijk N, Lammertsma AA, Hoekstra OS (2005) Prognostic relevance of response evaluation using [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography in patients with locally advanced non-small-cell lung cancer. J Clin Oncol 23:8362–8370
Huh JW, Kim HR (2009) Postoperative chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer: is it essential for patients with ypT0-2N0? J Surg Oncol 100:387–391
Huh JW, Park YA, Jung EJ, Lee KY, Sohn SK (2008) Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg 207:7–12
Huh JW, Kim HR, Kim YJ (2009) Proliferating cell nuclear antigen as a prognostic factor after total mesorectal excision of stage II-III rectal cancer. Ann Surg Oncol 16:1494–1500
Huh JW, Kim HR, Kim YJ (2010) Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg 199:435–441
Huh JW, Min JJ, Lee JH, Kim HR, Kim YJ (2012) The predictive role of sequential FDG-PET/CT in response of locally advanced rectal cancer to neoadjuvant chemoradiation. Am J Clin Oncol 35:340–344
Jung SH, Heo SH, Kim JW, Jeong YY, Shin SS, Soung MG, Kim HR, Kang HK (2012) Predicting response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer: diffusion-weighted 3 Tesla MR imaging. J Magn Reson Imaging 35:110–116
Kalff V, Duong C, Drummond EG, Matthews JP, Hicks RJ (2006) Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med 47:14–22
Lambrecht M, Deroose C, Roels S, Vandecaveye V, Penninckx F, Sagaert X, van Cutsem E, de Keyzer F, Haustermans K (2010) The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol 49:956–963
Mertens K, Slaets D, Lambert B, Acou M, De Vos F, Goethals I (2010) PET with (18) F-labelled choline-based tracers for tumour imaging: a review of the literature. Eur J Nucl Med Mol Imaging 37:2188–2193
Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260:771–780
Schiepers C, Haustermans K, Geboes K, Filez L, Bormans G, Penninckx F (1999) The effect of preoperative radiation therapy on glucose utilization and cell kinetics in patients with primary rectal carcinoma. Cancer 85:803–811
Seam P, Juweid ME, Cheson BD (2007) The role of FDG-PET scans in patients with lymphoma. Blood 110:3507–3516
Shanmugan S, Arrangoiz R, Nitzkorski JR, Yu JQ, Li T, Cooper H, Konski A, Farma JM, Sigurdson ER (2012) Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using (18)FDG-PET/CT. Ann Surg Oncol 19:2178–2185
van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S (2013) Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 269:101–112
Vanagunas A, Lin DE, Stryker SJ (2004) Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol 99:109–112
Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: evolving Considerations for PET response criteria in solid tumors. J Nucl Med 50(Suppl 1):122S–150S
Wieder HA, Geinitz H, Rosenberg R, Lordick F, Becker K, Stahl A, Rummeny E, Siewert JR, Schwaiger M, Stollfuss J (2007) PET imaging with [18F]3′-deoxy-3′-fluorothymidine for prediction of response to neoadjuvant treatment in patients with rectal cancer. Eur J Nucl Med Mol Imaging 34:878–883
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
Acknowledgments
This research was presented at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2–6, 2012. This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (Grant number 2012R1A1A1004888) and a Research Grant 0720570 from the National Cancer Center, South Korea.
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The authors declare they have no conflict of interests.
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Huh, J.W., Kwon, S.Y., Lee, J.H. et al. Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer. J Cancer Res Clin Oncol 141, 353–359 (2015). https://doi.org/10.1007/s00432-014-1815-z
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DOI: https://doi.org/10.1007/s00432-014-1815-z