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Evaluation of Effect of Neoadjuvant Therapy Using Positron Emission Tomography

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Innovation of Diagnosis and Treatment for Pancreatic Cancer

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Abstract

Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United States, and the majority of patients presents borderline resectable or locally advanced pancreatic cancers. Therefore, neoadjuvant therapy with induction chemotherapy or concurrent chemoradiotherapy (CRT) could provide a chance converting tumors to resectable status. Recently, there has been a growing evidence showing importance of metabolic imaging in predicting clinical outcome after the introduction of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). However, the significance of changes of PET in patients with locally advanced pancreatic cancer after neoadjuvant therapy hasn’t been well defined. In this chapter, we reviewed the role of PET in patients with pancreatic cancer in terms of differential diagnosis, staging malignant lesions, detection of recurrence, and assessment of tumor response to neoadjuvant therapy. The maximum standardized uptake value (SUVmax) was widely used for these clinical outcomes. The cutoff values of SUVmax for predicting survival were variable (3.4–7.0), and high-SUVmax values was associated with poor survival. The initial metabolic response was shown to be proportional to size change during subsequent follow-up, and median SUVmax significantly decreased after 6 weeks of CRT (pre-CRT median SUVmax = 8, range 0–15.6; post-CRT median SUVmax = 3.6, range 0–7.9; p = 0.009). The baseline SUVmax (3.5) and decline in SUVmax (60%) shown as significant factors in predicting survival after neoadjuvant therapy. Volumetric parameters such as gross tumor volume, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were also studied. Although a wide spectrum in MTV and TLG thresholds still exist.

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Authors and Affiliations

  1. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea

    Ik Jae Lee M.D., Ph.D.

  2. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Jinsil Seong M.D., Ph.D.

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  1. Ik Jae Lee M.D., Ph.D.
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Correspondence to Jinsil Seong M.D., Ph.D. .

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  1. Second Department of Surgery, Wakyama Medical University, Wakayama, Japan

    Hiroki Yamaue

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Lee, I.J., Seong, J. (2017). Evaluation of Effect of Neoadjuvant Therapy Using Positron Emission Tomography. In: Yamaue, H. (eds) Innovation of Diagnosis and Treatment for Pancreatic Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-2486-3_4

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  • DOI: https://doi.org/10.1007/978-981-10-2486-3_4

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