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Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Standardized added metabolic activity (SAM) is a PET parameter for assessing the total metabolic load of malignant processes, avoiding partial volume effects and lesion segmentation. The potential role of this parameter in the assessment of response to chemotherapy and bevacizumab was tested in patients with metastatic colorectal cancer with potentially resectable liver metastases (mCRC).

Methods

18F-FDG PET/CT was performed in 18 mCRC patients with liver metastases before treatment and after five cycles of FOLFOX/FOLFIRI and bevacizumab. Of the 18 patients, 16 subsequently underwent resection of liver metastases. Baseline and follow-up SUVmax, and SAM as well as reduction in SUVmax (∆SUVmax) and SAM (∆SAM) of all liver metastases were correlated with morphological response, and progression-free and overall survival (PFS and OS).

Results

A significant reduction in metabolic activity of the liver metastases was seen after chemotherapy with a median ∆SUVmax of 25.3 % and ∆SAM of 94.5 % (p = 0.033 and 0.003). Median baseline SUVmax and SAM values were significantly different between morphological responders and nonresponders (3.8 vs. 7.2, p = 0.021; and 34 vs. 211, p = 0.002, respectively), but neither baseline PET parameters nor morphological response was correlated with PFS or OS. Follow-up SUVmax and SAM as well as ∆SAM were found to be prognostic factors. The median PFS and OS in the patient group with a high follow-up SUVmax were 10.4 months and 32 months, compared to a median PFS of 14.7 months and a median OS which had not been reached in the group with a low follow-up SUVmax (p = 0.01 and 0.003, respectively). The patient group with a high follow-up SAM and a low ∆SAM had a median PFS and OS of 9.4 months and 32 months, whereas the other group had a median PFS of 14.7 months and a median OS which had not been reached (p = 0.002 for both PFS and OS).

Conclusion

18F-FDG PET imaging is a useful tool to assess treatment response and predict clinical outcome in patients with mCRC who undergo chemotherapy before liver metastasectomy. Follow-up SUVmax, follow-up SAM and ∆SAM were found to be significant prognostic factors for PFS and OS.

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Acknowledgments

This work was supported by an unrestricted educational grant from Roche and by the Belgian National Cancer Plan (NKP29/026).

Conflicts of interest

M.P. received an educational grant from Roche. The other authors disclose no conflicts.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Jeroen Mertens, I. Goethals & C. Van de Wiele

  2. Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium

    S. De Bruyne

  3. Department of Surgery, Ghent University Hospital, Ghent, Belgium

    N. Van Damme & W. Ceelen

  4. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    P. Smeets

  5. Department of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium

    R. Troisi

  6. Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium

    S. Laurent, K. Geboes & M. Peeters

  7. Department of Oncology, Antwerp University Hospital, Edegem, Belgium

    M. Peeters

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  1. Jeroen Mertens
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Correspondence to Jeroen Mertens.

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Mertens, J., De Bruyne, S., Van Damme, N. et al. Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases. Eur J Nucl Med Mol Imaging 40, 1214–1222 (2013). https://doi.org/10.1007/s00259-013-2421-z

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  • DOI: https://doi.org/10.1007/s00259-013-2421-z

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