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The predictive value of metabolic response to preoperative radiochemotherapy in locally advanced rectal cancer measured by PET/CT

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

To evaluate the value of positron emission tomography using fluorodeoxyglucose and computer tomography scan (FDG-PET/CT) for prediction of histopathological response of preoperative radiochemotherapy (RCTX) in patients with rectal carcinoma.

Methods

Thirty patients with uT3 rectal carcinoma were examined by FDG-PET/CT at baseline, 14 days after initiation, and after completion of preoperative RCTX. The FDG decreases seen with PET scanning from baseline to day 14 (early metabolic response) and after completion of therapy (late metabolic response) were compared with histopathological tumor response. One patient denied surgery after RCTX.

Results

The mean (±SD) reduction of tumor FDG uptake in histopathologically responding compared to non-responding tumors was −44.3% (±20.1%) versus −29.6% (±13.1%) (p = 0.085) at day 14 and −66.0% (±20.3%) versus −48.3% (±23.4%) (p = 0.040) after completion of RCTX. Best differentiation of histopathological tumor response was achieved by a cut-off value of 35% reduction of initial FDG uptake at day 14 and 57.5% after completion of therapy. Applying the cut-off values as a criterion for metabolic response, histopathological response was predicted with a sensitivity of 74% (14/19) at day 14 and 79% (15/19) after completion of therapy. The positive predictive value for early metabolic response was 82% (14/17) and for late metabolic response was 83% (15/18). Histopathological evidence of accumulated peritumoral inflammation cells was associated with a minor FDG decrease in five histopathologically responding patients, and influenced the results with negative predictive values of 58% (7/12) and 64% (7/11) at the early and late time points, respectively.

Conclusions

Metabolic response to a preoperative RCTX using FDG-PET/CT in rectal cancer patients can be correlated with histopathological response, but FDG uptake of peritumoral inflammation cells limited the results and led to false negative results.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Robert Rosenberg, Ralf Gertler, Beat Künzli, Florian Lordick, Matthias Maak & Jörg-Rüdiger Siewert

  2. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Ken Herrmann, Markus Essler, Markus Schwaiger & Bernd Krause

  3. Institut für Pathologie und Pathologische Anatomie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Karen Becker

  4. Institut für medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Tibor Schuster

  5. Klinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Hans Geinitz

Authors
  1. Robert Rosenberg
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  2. Ken Herrmann
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  3. Ralf Gertler
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  7. Karen Becker
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  9. Hans Geinitz
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  13. Bernd Krause
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Correspondence to Robert Rosenberg.

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Rosenberg, R., Herrmann, K., Gertler, R. et al. The predictive value of metabolic response to preoperative radiochemotherapy in locally advanced rectal cancer measured by PET/CT. Int J Colorectal Dis 24, 191–200 (2009). https://doi.org/10.1007/s00384-008-0616-8

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  • DOI: https://doi.org/10.1007/s00384-008-0616-8

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