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18F-Fluorodeoxyglucose positron emission tomography (18F-FDG PET) for the early detection of response to neoadjuvant chemotherapy for locally advanced rectal cancer

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Abstract

Purpose

Early detection of a response to neoadjuvant chemotherapy for locally advanced rectal cancer may spare patients from additional toxic but ineffective chemotherapy. Using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), we evaluated tumor response prospectively in the early course of preoperative chemotherapy.

Methods

The subjects were 15 patients who received neoadjuvant chemotherapy (XELOX or XELOX plus bevacizumab) for locally advanced rectal cancer. Patients underwent 18F-FDG PET before chemotherapy, at the end of the first cycle of chemotherapy, and before surgical resection. Magnetic resonance imaging (MRI) was performed before chemotherapy, after the second cycle of chemotherapy, and before resection. After resection, the SUVmax and diameter were compared and graded according to the tumor regression grade (TRG).

Results

The TRG was assessed as TRG1 in one patient, TRG2 in five patients, and TRG3 in nine patients. We divided the patients into two groups: non-responders (NR) included the TRG1 and TRG2 patients, and responders (R) included the TRG3 patients. The tumor size before surgery was significantly smaller in the R group than in the NR group. The SUVmax at the end of the first cycle of chemotherapy and before surgical resection was significantly lower in the R group than in the NR group.

Conclusion

Performing 18F-FDG PET at the end of the first cycle of chemotherapy allowed us to predict the pathological response of locally advanced rectal cancer.

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References

  1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82.

    Article  CAS  PubMed  Google Scholar 

  2. Hida J, Okuno K, Tokoro T. Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer. Surg Today. 2014;44(12):2227–42.

    Article  CAS  PubMed  Google Scholar 

  3. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60.

    Article  CAS  PubMed  Google Scholar 

  4. Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007;2:CD002102.

    PubMed  Google Scholar 

  5. Uehara K, Nagino M. Neoadjuvant treatment for locally advanced rectal cancer: a systematic review. Surg Today. 2015. doi:10.1007/s00595-015-1218-z.

  6. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355(11):1114–23.

    Article  CAS  PubMed  Google Scholar 

  7. Hospers GA, Punt CJ, Tesselaar ME, Cats A, Havenga K, Leer JW, et al. Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I-II multicenter study of the Dutch Colorectal Cancer Group. Ann Surg Oncol. 2007;14(10):2773–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. van Duijvendijk P, Slors JF, Taat CW, van Tets WF, van Tienhoven G, Obertop H, et al. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol. 2002;97(9):2282–9.

    Article  PubMed  Google Scholar 

  9. Birgisson H, Pahlman L, Gunnarsson U, Glimelius B, Swedish Rectal Cancer Trial Group. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol. 2005;23(34):8697–705.

    Article  PubMed  Google Scholar 

  10. Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol. 2005;23(25):6199–206.

    Article  CAS  PubMed  Google Scholar 

  11. Hasegawa J, Nishimura J, Mizushima T, Miyake Y, Kim HM, Takemoto H, et al. Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer. Cancer Chemother Pharmacol. 2014;73(5):1079–87.

    Article  CAS  PubMed  Google Scholar 

  12. Ishii Y, Hasegawa H, Endo T, Okabayashi K, Ochiai H, Moritani K, et al. Medium-term results of neoadjuvant systemic chemotherapy using irinotecan, 5-fluorouracil, and leucovorin in patients with locally advanced rectal cancer. Eur J Surg Oncol. 2010;36(11):1061–5.

    Article  CAS  PubMed  Google Scholar 

  13. Schrag D, Weiser MR, Goodman KA, Gonen M, Hollywood E, Cercek A, et al. Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol. 2014;32(6):513–8.

    Article  CAS  PubMed  Google Scholar 

  14. Uehara K, Hiramatsu K, Maeda A, Sakamoto E, Inoue M, Kobayashi S, et al. Neoadjuvant oxaliplatin and capecitabine and bevacizumab without radiotherapy for poor-risk rectal cancer: n-SOG 03 phase II trial. Jpn J Clin Oncol. 2013;43(10):964–71.

    Article  PubMed  Google Scholar 

  15. Capirci C, Rubello D, Chierichetti F, Crepaldi G, Fanti S, Mandoliti G, et al. Long-term prognostic value of 18F-FDG PET in patients with locally advanced rectal cancer previously treated with neoadjuvant radiochemotherapy. AJR Am J Roentgenol. 2006;187(2):W202–8.

    Article  PubMed  Google Scholar 

  16. Guillem JG, Moore HG, Akhurst T, Klimstra DS, Ruo L, Mazumdar M, et al. Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer. J Am Coll Surg. 2004;199(1):1–7.

    Article  PubMed  Google Scholar 

  17. Kalff V, Duong C, Drummond EG, Matthews JP, Hicks RJ. 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. 2006;47(1):14–22.

    PubMed  Google Scholar 

  18. Leibold T, Akhurst TJ, Chessin DB, Yeung HW, Macapinlac H, Shia J, et al. Evaluation of (1)(8)F-FDG-PET for early detection of suboptimal response of rectal cancer to preoperative chemoradiotherapy: a prospective analysis. Ann Surg Oncol. 2011;18(10):2783–9.

    Article  PubMed  Google Scholar 

  19. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  20. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23(34):8688–96.

    Article  PubMed  Google Scholar 

  21. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  22. Cassidy J, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26(12):2006–12.

    Article  CAS  PubMed  Google Scholar 

  23. Cassidy J, Tabernero J, Twelves C, Brunet R, Butts C, Conroy T, et al. XELOX (capecitabine plus oxaliplatin): active first-line therapy for patients with metastatic colorectal cancer. J Clin Oncol. 2004;22(11):2084–91.

    Article  CAS  PubMed  Google Scholar 

  24. Yoshida Y, Hoshino S, Aisu N, Naito M, Tanimura S, Mogi A, et al. Administration of chemotherapy via the median cubital vein without implantable central venous access ports: port-free chemotherapy for metastatic colorectal cancer patients. Int J Clin Oncol. 2015;20(2):332–7.

    Article  CAS  PubMed  Google Scholar 

  25. Yoshida Y, Hoshino S, Aisu N, Mogi A, Yamada T, Kojima D, et al. Can grade 2 neutropenia predict the risk of grade 3 neutropenia in metastatic colorectal cancer patients treated with chemotherapy? Support Care Cancer. 2015;23(6):1623–7.

    Article  PubMed  Google Scholar 

  26. Gosens MJ, Dresen RC, Rutten HJ, Nieuwenhuijzen GA, van der Laak JA, Martijn H, et al. Preoperative radiochemotherapy is successful also in patients with locally advanced rectal cancer who have intrinsically high apoptotic tumours. Ann Oncol. 2008;19(12):2026–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lange MM, den Dulk M, Bossema ER, Maas CP, Peeters KC, Rutten HJ, et al. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg. 2007;94(10):1278–84.

    Article  CAS  PubMed  Google Scholar 

  28. Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23(9):1847–58.

    Article  PubMed  Google Scholar 

  29. Pollack J, Holm T, Cedermark B, Holmstrom B, Mellgren A. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum. 2006;49(3):345–52.

    Article  PubMed  Google Scholar 

  30. Avril NE, Weber WA. Monitoring response to treatment in patients utilizing PET. Radiol Clin North Am. 2005;43(1):189–204.

    Article  PubMed  Google Scholar 

  31. Barbaro B, Fiorucci C, Tebala C, Valentini V, Gambacorta MA, Vecchio FM, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250(3):730–9.

    Article  PubMed  Google Scholar 

  32. Curvo-Semedo L, Lambregts DM, Maas M, Thywissen T, Mehsen RT, Lammering G, et al. Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy–conventional MR volumetry versus diffusion-weighted MR imaging. Radiology. 2011;260(3):734–43.

    Article  PubMed  Google Scholar 

  33. Yeo SG, Kim DY, Kim TH, Chang HJ, Oh JH, Park W, et al. Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg. 2010;252(6):998–1004.

    Article  PubMed  Google Scholar 

  34. Musio D, De Felice F, Magnante AL, Ciolina M, De Cecco CN, Rengo M, et al. Diffusion-weighted magnetic resonance application in response prediction before, during, and after neoadjuvant radiochemotherapy in primary rectal cancer carcinoma. Biomed Res Int. 2013;2013:740195.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nougaret S, Fujii S, Addley HC, Bibeau F, Pandey H, Mikhael H, et al. Neoadjuvant chemotherapy evaluation by MRI volumetry in rectal cancer followed by chemoradiation and total mesorectal excision: Initial experience. J Magn Reson Imaging. 2013;38(3):726–32.

    Article  PubMed  Google Scholar 

  36. Aiba T, Uehara K, Nihashi T, Tsuzuki T, Yatsuya H, Yoshioka Y, et al. MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer. Ann Surg Oncol. 2014;21(6):1801–8.

    Article  PubMed  Google Scholar 

  37. Guerra L, Niespolo R, Di Pisa G, Ippolito D, De Ponti E, Terrevazzi S, et al. Change in glucose metabolism measured by 18F-FDG PET/CT as a predictor of histopathologic response to neoadjuvant treatment in rectal cancer. Abdom Imaging. 2011;36(1):38–45.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the Osaka Medical Research Foundation for Incurable Disease.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan

    Junichi Nishimura, Mamoru Uemura, Naotsugu Haraguchi, Taishi Hata, Hirofumi Yamamoto, Ichiro Takemasa, Tsunekazu Mizushima, Yuichiro Doki & Masaki Mori

  2. Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan

    Junichi Nishimura, Junichi Hasegawa & Riichiro Nezu

  3. Department of Diagnostic Radiology, Hanwa Intelligent Medical Center, Sakai, Osaka, Japan

    Yoji Ogawa

  4. Department of Pathology, Osaka Rosai Hospital, Sakai, Osaka, Japan

    Hideaki Miwa

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  1. Junichi Nishimura
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Correspondence to Junichi Hasegawa.

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Nishimura, J., Hasegawa, J., Ogawa, Y. et al. 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG PET) for the early detection of response to neoadjuvant chemotherapy for locally advanced rectal cancer. Surg Today 46, 1152–1158 (2016). https://doi.org/10.1007/s00595-015-1297-x

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  • DOI: https://doi.org/10.1007/s00595-015-1297-x

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