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Prediction of neoadjuvant radiation chemotherapy response and survival using pretreatment [18F]FDG PET/CT scans in locally advanced rectal cancer

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Abstract

Purpose

The aim of this study was to investigate metabolic and textural parameters from pretreatment [18F]FDG PET/CT scans for the prediction of neoadjuvant radiation chemotherapy response and 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC).

Methods

We performed a retrospective review of 74 patients diagnosed with LARC who were initially examined with [18F]FDG PET/CT, and who underwent neoadjuvant radiation chemotherapy followed by complete resection. The standardized uptake value (mean, peak, and maximum), metabolic volume (MV), and total lesion glycolysis of rectal cancer lesions were calculated using the isocontour method with various thresholds. Using three-dimensional textural analysis, about 50 textural features were calculated for PET images. Response to neoadjuvant radiation chemotherapy, as assessed by histological tumour regression grading (TRG) after surgery and 3-year DFS, was evaluated using univariate/multivariate binary logistic regression and univariate/multivariate Cox regression analyses.

Results

MVs calculated using the thresholds mean standardized uptake value of the liver + two standard deviations (SDs), and mean standard uptake of the liver + three SDs were significantly associated with TRG. Textural parameters from histogram-based and co-occurrence analysis were significantly associated with TRG. However, multivariate analysis revealed that none of these parameters had any significance. On the other hand, MV calculated using various thresholds was significantly associated with 3-year DFS, and MV calculated using a higher threshold tended to be more strongly associated with 3-year DFS. In addition, textural parameters including kurtosis of the absolute gradient (GrKurtosis) were significantly associated with 3-year DFS. Multivariate analysis revealed that GrKurtosis could be a prognostic factor for 3-year DFS.

Conclusion

Metabolic and textural parameters from initial [18F]FDG PET/CT scans could be indexes to assess tumour heterogeneity for the prediction of neoadjuvant radiation chemotherapy response and recurrence in LARC.

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Compliance with ethical standards

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Funding

This research was supported by Korea Mouse Phenotyping Project (2013M3A9D5072560) of the Ministry of Science, ICT and Future Planning through the National Research Foundation.

Conflicts of interest

None.

Ethical approval

All procedures were performed in accordance with the principles of the 1975 Declaration of Helsinki (2000 revision). The study design and exemption from informed consent were approved by the Institutional Review Board of Seoul National University Bundang Hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Ji-In Bang, Seunggyun Ha, Ho-Young Lee & Sang Eun Kim

  2. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Sung-Bum Kang & Heung-Kwon Oh

  3. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Keun-Wook Lee

  4. Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Hye-Seung Lee

  5. Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Jae-Sung Kim

  6. Cancer Research Institute, Seoul National University, Seoul, Republic of Korea

    Ho-Young Lee

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  1. Ji-In Bang
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Correspondence to Ho-Young Lee.

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Bang, JI., Ha, S., Kang, SB. et al. Prediction of neoadjuvant radiation chemotherapy response and survival using pretreatment [18F]FDG PET/CT scans in locally advanced rectal cancer. Eur J Nucl Med Mol Imaging 43, 422–431 (2016). https://doi.org/10.1007/s00259-015-3180-9

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  • DOI: https://doi.org/10.1007/s00259-015-3180-9

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