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Role of 18F-Fluorodeoxyglucose Positron-Emission Tomography (FDG-PET) in the Management of Pancreatic Cancer

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Management of Localized Pancreatic Cancer

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Abstract

A hallmark of cancer cells is the deregulated uptake of glucose in an effort to sustain the biosynthetic demands of rapid cellular proliferation. This metabolic process was first described by German physiologist Otto Warburg in the 1920s. In the seminal study, Warburg et al. observed a significant increase in glucose consumption and lactic acid production by cancer cells as compared to normal (non-cancerous) cells, despite aerobic conditions, suggesting an anomalous energy metabolism. Subsequent investigators have corroborated this clinical observation and concluded that cancer cells have the ability to reprogram their energy metabolism such that they rely primarily on glucose catabolism for cellular energy production. In contrast, the energy pathway favored by normal tissue cells under aerobic conditions is the coupling of glycolysis with mitochondrial oxidative phosphorylation, as it yields an approximately 18-fold increase in energy production in comparison to glycolysis alone. However, cancer cells are able to compensate by upregulating glucose transporters (GLUT) on the cell membrane, namely, GLUT1, resulting in an increased uptake of glucose into cells.

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References

  1. Pavlova NN, Thompson CB. The emerging hallmarks of cancer metabolism. Cell Metab. 2016;23(1):27–47.

    Article  CAS  Google Scholar 

  2. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.

    Article  CAS  Google Scholar 

  3. Warburg O, Wind F, Negelein E. The metabolism of tumors in the body. J Gen Physiol. 1927;8(6):519–30.

    Article  CAS  Google Scholar 

  4. Halbrook CJ, Lyssiotis CA. Employing metabolism to improve the diagnosis and treatment of pancreatic cancer. Cancer Cell. 2017;31(1):5–19.

    Article  CAS  Google Scholar 

  5. Swisher SG, Erasmus J, Maish M, Correa AM, Macapinlac H, Ajani JA, Cox JD, Komaki RR, Hong D, Lee HK, Putnam JB Jr, Rice DC, Smythe WR, Thai L, Vaporciyan AA, Walsh GL, Wu TT, Roth JA. 2-Fluoro-2-deoxy-D-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer. 2004;101(8):1776–85.

    Article  Google Scholar 

  6. Kim JW, Oh JS, Roh JL, Kim JS, Choi SH, Nam SY, Kim SY. Prognostic significance of standardized uptake value and metabolic tumour volume on (1)(8)F-FDG PET/CT in oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2015;42(9):1353–61.

    Article  CAS  Google Scholar 

  7. Kim YH, Lee JA, Baek JM, Sung GY, Lee DS, Won JM. The clinical significance of standardized uptake value in breast cancer measured using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Nucl Med Commun. 2015;36(8):790–4.

    Article  Google Scholar 

  8. Pimiento JM, Davis-Yadley AH, Kim RD, Chen DT, Eikman EA, Berman CG, Malafa MP. Metabolic activity by 18F-FDG-PET/CT is prognostic for stage I and II pancreatic cancer. Clin Nucl Med. 2016;41(3):177–81.

    Article  Google Scholar 

  9. Ahn SJ, Park MS, Lee JD, Kang WJ. Correlation between 18F-fluorodeoxyglucose positron emission tomography and pathologic differentiation in pancreatic cancer. Ann Nucl Med. 2014;28(5):430–5.

    Article  Google Scholar 

  10. Chirindel A, Alluri KC, Chaudhry MA, Wahl RL, Pawlik TM, Herman JM, Subramaniam RM. Prognostic value of FDG PET/CT-derived parameters in pancreatic adenocarcinoma at initial PET/CT staging. AJR Am J Roentgenol. 2015;204(5):1093–9.

    Article  Google Scholar 

  11. Hu SL, Yang ZY, Zhou ZR, Yu XJ, Ping B, Zhang YJ. Role of SUV(max) obtained by 18F-FDG PET/CT in patients with a solitary pancreatic lesion: predicting malignant potential and proliferation. Nucl Med Commun. 2013;34(6):533–9.

    Article  Google Scholar 

  12. Okamoto K, Koyama I, Miyazawa M, Toshimitsu Y, Aikawa M, Okada K, Imabayashi E, Matsuda H. Preoperative 18[F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts early recurrence after pancreatic cancer resection. Int J Clin Oncol. 2011;16(1):39–44.

    Article  Google Scholar 

  13. Schellenberg D, Quon A, Minn AY, Graves EE, Kunz P, Ford JM, Fisher GA, Goodman KA, Koong AC, Chang DT. 18Fluorodeoxyglucose PET is prognostic of progression-free and overall survival in locally advanced pancreas cancer treated with stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 2010;77(5):1420–5.

    Article  Google Scholar 

  14. Yamamoto T, Sugiura T, Mizuno T, Okamura Y, Aramaki T, Endo M, Uesaka K. Preoperative FDG-PET predicts early recurrence and a poor prognosis after resection of pancreatic adenocarcinoma. Ann Surg Oncol. 2015;22(2):677–84.

    Article  Google Scholar 

  15. Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, Eikman EA, Malafa M. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol. 2008;15(9):2465–71.

    Article  Google Scholar 

  16. Topkan E, Parlak C, Yapar AF. FDG-PET/CT-based restaging may alter initial management decisions and clinical outcomes in patients with locally advanced pancreatic carcinoma planned to undergo chemoradiotherapy. Cancer Imaging. 2013;13(3):423–8.

    Article  Google Scholar 

  17. Network NCC. Pancreatic Adenocarcinoma 2017. Available from: http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.

  18. Ghaneh P, Hanson R, Titman A, Lancaster G, Plumpton C, Lloyd-Williams H, Yeo ST, Edwards RT, Johnson C, Abu Hilal M, Higginson AP, Armstrong T, Smith A, Scarsbrook A, McKay C, Carter R, Sutcliffe RP, Bramhall S, Kocher HM, Cunningham D, Pereira SP, Davidson B, Chang D, Khan S, Zealley I, Sarker D, Al Sarireh B, Charnley R, Lobo D, Nicolson M, Halloran C, Raraty M, Sutton R, Vinjamuri S, Evans J, Campbell F, Deeks J, Sanghera B, Wong WL, Neoptolemos JP. PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. Health Technol Assess. 2018;22(7):1–114.

    Article  Google Scholar 

  19. Bipat S, Phoa SS, van Delden OM, Bossuyt PM, Gouma DJ, Lameris JS, Stoker J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J Comput Assist Tomogr. 2005;29(4):438–45.

    Article  Google Scholar 

  20. Rijkers AP, Valkema R, Duivenvoorden HJ, van Eijck CH. Usefulness of F-18-fluorodeoxyglucose positron emission tomography to confirm suspected pancreatic cancer: a meta-analysis. Eur J Surg Oncol. 2014;40(7):794–804.

    Article  CAS  Google Scholar 

  21. Lin E, Alavi A. Pancreatic Cancer. PET and PET/CT: A Clinical Guide. 2nd ed. New York: Thieme; 2005. p. 190–5.

    Google Scholar 

  22. Wang SL, Cao S, Sun YN, Wu R, Chi F, Tang MY, Jin XY, Chen XD. Standardized uptake value on positron emission tomography/computed tomography predicts prognosis in patients with locally advanced pancreatic cancer. Abdom Imaging. 2015;40(8):3117–21.

    Article  Google Scholar 

  23. Xu HX, Chen T, Wang WQ, Wu CT, Liu C, Long J, Xu J, Zhang YJ, Chen RH, Liu L, Yu XJ. Metabolic tumour burden assessed by (1)(8)F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection. Eur J Nucl Med Mol Imaging. 2014;41(6):1093–102.

    Article  CAS  Google Scholar 

  24. Aldakkak M, Christians KK, Krepline AN, George B, Ritch PS, Erickson BA, Johnston FM, Evans DB, Tsai S. Pre-treatment carbohydrate antigen 19-9 does not predict the response to neoadjuvant therapy in patients with localized pancreatic cancer. HPB (Oxford). 2015;17(10):942–52.

    Article  Google Scholar 

  25. Katz MH, Varadhachary GR, Fleming JB, Wolff RA, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Sun CC, Wang H, Crane CH, Lee JH, Tamm EP, Abbruzzese JL, Evans DB. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol. 2010;17(7):1794–801.

    Article  Google Scholar 

  26. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zulke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310(14):1473–81.

    Article  CAS  Google Scholar 

  27. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Buchler MW, European Study Group for Pancreatic C. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389(10073):1011–24.

    Article  CAS  Google Scholar 

  28. Groot VP, Rezaee N, Wu W, Cameron JL, Fishman EK, Hruban RH, Weiss MJ, Zheng L, Wolfgang CL, He J. Patterns, timing, and predictors of recurrence following pancreatectomy for Pancreatic ductal adenocarcinoma. Ann Surg. 2018;267(5):936.

    Article  Google Scholar 

  29. Pergolini I, Crippa S, Salgarello M, Belfiori G, Partelli S, Ruffo G, Pucci A, Zamboni G, Falconi M. SUVmax after (18)fluoro-deoxyglucose positron emission tomography/computed tomography: a tool to define treatment strategies in pancreatic cancer. Dig Liver Dis. 2018;50(1):84–90.

    Article  Google Scholar 

  30. Imdahl A, Nitzsche E, Krautmann F, Hogerle S, Boos S, Einert A, Sontheimer J, Farthmann EH. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg. 1999;86(2):194–9.

    Article  CAS  Google Scholar 

  31. Delbeke D, Rose DM, Chapman WC, Pinson CW, Wright JK, Beauchamp RD, Shyr Y, Leach SD. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med. 1999;40(11):1784–91.

    CAS  PubMed  Google Scholar 

  32. Kato K, Nihashi T, Ikeda M, Abe S, Iwano S, Itoh S, Shimamoto K, Naganawa S. Limited efficacy of (18)F-FDG PET/CT for differentiation between metastasis-free pancreatic cancer and mass-forming pancreatitis. Clin Nucl Med. 2013;38(6):417–21.

    Article  Google Scholar 

  33. Diederichs CG, Staib L, Glatting G, Beger HG, Reske SN. FDG PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 1998;39(6):1030–3.

    CAS  PubMed  Google Scholar 

  34. Matthews R, Choi M. Clinical utility of positron emission tomography magnetic resonance imaging (PET-MRI) in gastrointestinal cancers. Diagnostics (Basel). 2016;6(3).

    Article  Google Scholar 

  35. Yeh R, Dercle L, Garg I, Wang ZJ, Hough DM, Goenka AH. The role of 18F-FDG PET/CT and PET/MRI in pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 2017.

    Google Scholar 

  36. Tatsumi M, Isohashi K, Onishi H, Hori M, Kim T, Higuchi I, Inoue A, Shimosegawa E, Takeda Y, Hatazawa J. 18F-FDG PET/MRI fusion in characterizing pancreatic tumors: comparison to PET/CT. Int J Clin Oncol. 2011;16(4):408–15.

    Article  Google Scholar 

  37. Nagamachi S, Nishii R, Wakamatsu H, Mizutani Y, Kiyohara S, Fujita S, Futami S, Sakae T, Furukoji E, Tamura S, Arita H, Chijiiwa K, Kawai K. The usefulness of (18)F-FDG PET/MRI fusion image in diagnosing pancreatic tumor: comparison with (18)F-FDG PET/CT. Ann Nucl Med. 2013;27(6):554–63.

    Article  Google Scholar 

  38. Lee JW, Kang CM, Choi HJ, Lee WJ, Song SY, Lee JH, Lee JD. Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative (1)(8)F-FDG PET/CT in patients with pancreatic cancer. J Nucl Med. 2014;55(6):898–904.

    Article  Google Scholar 

  39. Hwang JP, Lim I, Chang KJ, Kim BI, Choi CW, Lim SM. Prognostic value of SUVmax measured by Fluorine-18 Fluorodeoxyglucose positron emission tomography with computed tomography in patients with pancreatic cancer. Nucl Med Mol Imaging. 2012;46(3):207–14.

    Article  CAS  Google Scholar 

  40. Sperti C, Pasquali C, Chierichetti F, Ferronato A, Decet G, Pedrazzoli S. 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma. J Gastrointest Surg. 2003;7(8):953–9; discussion 959-960.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Chad A. Barnes

  2. Department of Radiology, The Medical College of Wisconsin, Milwaukee, WI, USA

    Michael Holt

  3. Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Susan Tsai

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  1. Chad A. Barnes
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  2. Michael Holt
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  3. Susan Tsai
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Corresponding author

Correspondence to Susan Tsai .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Susan Tsai

  2. Division of Medical Oncology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA

    Paul S. Ritch

  3. Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA

    Beth A. Erickson

  4. Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Douglas B. Evans

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Barnes, C.A., Holt, M., Tsai, S. (2019). Role of 18F-Fluorodeoxyglucose Positron-Emission Tomography (FDG-PET) in the Management of Pancreatic Cancer. In: Tsai, S., Ritch, P., Erickson, B., Evans, D. (eds) Management of Localized Pancreatic Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-98944-0_15

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  • DOI: https://doi.org/10.1007/978-3-319-98944-0_15

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