scholarly journals Development and external validation of a predictive model for pathological complete response of rectal cancer patients including sequential PET-CT imaging

2011 ◽  
Vol 98 (1) ◽  
pp. 126-133 ◽  
Author(s):  
Ruud G.P.M. van Stiphout ◽  
Guido Lammering ◽  
Jeroen Buijsen ◽  
Marco H.M. Janssen ◽  
Maria Antonietta Gambacorta ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Predictive Model ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
External Validation ◽  
Complete Response ◽  
Ct Imaging ◽  
Pet Ct

Early prediction of pathological complete response (pCR) of rectal cancer after 1 week of preoperative radiochemotherapy (RCT) using positron emission computererized tomography (PET-CT) imaging.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 572-572
Author(s):  
O. Purim ◽  
N. Goldberg ◽  
Y. Kundel ◽  
R. Brenner ◽  
N. Efremov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Metabolic Response ◽  
Complete Response ◽  
Ct Imaging ◽  
Preoperative Radiochemotherapy ◽  
Surgical Specimen ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Significant Difference

572 Background: Preoperative radiochemotherapy (RCT) is the standard treatment of locally advanced rectal cancer (LARC), obtaining pathological complete response (pCR) in 15%-30% of cases. Post-RCT reduction of 18F-fluorodeoxyglucose (FDG) uptake within the tumor compared with the baseline, i.e. the tumor's metabolic response, correlates with pCR. However, an earlier prediction of pCR could enable tailored modifications of the treatment. We hence evaluated the correlation between the metabolic response after only one week of RCT for LARC and the actual pCR at the post-RCT surgery. Methods: Patients (pts) were eligible for this prospective study if they had LARC, defined as T3-4NX or TxN+ tumors by pre-treatment PET-CT and endoscopic ultrasound. Pts received standard RCT regimen, consisting of 50.4Gy radiotherapy concurrently with a fluoropyrimidine-based chemotherapy, followed by surgery. Pts underwent baseline FDG-PET-CT imaging within 2 weeks prior to the initiation of RCT and a second one on day 8 of RCT. Maximum standardized uptake value (SUV-max) was measured in both scans and changes in FDG- uptake were recorded. Man-Whitney test was used to evaluate differences in the SUV-max between baseline and day 8 in pts obtaining pCR and those who did not. Results: Twenty pts participated in the study. Half were males and the median age was 64 years. Ten pts had T3N0 tumors and 10 had T3N+ disease. Radical surgery was done in 19 pts and local excision in one. Considering the entire group, there was a borderline-significant difference between the metabolic response of pts with pCR and those without pCR (Chi-square = 3.429, p = 0.064). Yet, the changes in FGD-uptake were able to identify pts who achieved pCR and those who did not: only pts with a decrease of more than 33% in SUV-max had pCR while none of the pts who had less than 8.9% decrease in SUV-max had pCR. Conclusions: A decrease in SUV-max between baseline-PET-CT scans and scans done after only one week of RCT for LARC may be able to predict the achievement of pCR in the post-RCT surgical specimen. Validation in a larger independent cohort is planned. No significant financial relationships to disclose.

Can PET CT predict response in locally advanced rectal cancer patients treated with induction FOLFOX?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14696-e14696
Author(s):  
Seyda Gunduz ◽  
Hasan Senol Coskun ◽  
Sema Sezgin Goksu ◽  
Deniz Arslan ◽  
Ali Murat Tatli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Induction Chemotherapy ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Pet Ct ◽  
Folfox Chemotherapy

e14696 Background: The aim of this study was to determine the pathological complete response rates in a group of locally advanced rectal cancer patients who underwent chemoradiotherapy after treatment with induction FOLFOX chemotherapy and the relationship between the complete response and Positron emission tomography - computed tomography (PET-CT). Methods: The files of 239 patients who were diagnosed with rectal cancer between January 2008 and January 2012 were evaluated retrospectively. Of these, there were 24 locally advanced rectal cancer patients who met the following criteria: they were administered chemoradiotherapy after receiving four courses induction oxaliplatin, folinic acid and 5-Florouracil (FOLFOX) and they underwent PET-CT for staging and for the evaluation of their response to FOLFOX treatment. Of these 24 patients, 20 operable patients were included in the study. Results: The pathological complete response was obtained in 7 patients (35%) who were operated on, and then given induction four courses FOLFOX chemotherapy and chemoradiotherapy. We determined that age, gender, clinical stage at diagnosis, and PET-CT before and after induction chemotherapy were not predictive of the pathological complete response to tumor fluorodeoxyglucose (FDG) uptake activity. Conclusions: The rates of pathological complete response were increased in locally advanced rectal cancer patients who underwent short-term induction chemotherapy. Although the PET-CT has retained its importance in predicting pathological complete response, there is still a need for studies with a larger number of patients and long-term follow-ups.

scholarly journals CEA, EpCAM, αvβ6 and uPAR Expression in Rectal Cancer Patients with a Pathological Complete Response after Neoadjuvant Therapy

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 516
Author(s):  
Daan Linders ◽  
Marion Deken ◽  
Maxime van der Valk ◽  
Willemieke Tummers ◽  
Shadhvi Bhairosingh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Response Evaluation ◽  
Tumor Bed ◽  
Upar Expression ◽  
Diagnostic Biopsy

Rectal cancer patients with a complete response after neoadjuvant therapy can be monitored with a watch-and-wait strategy. However, regrowth rates indicate that identification of patients with a pathological complete response (pCR) remains challenging. Targeted near-infrared fluorescence endoscopy is a potential tool to improve response evaluation. Promising tumor targets include carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (EpCAM), integrin αvβ6, and urokinase-type plasminogen activator receptor (uPAR). To investigate the applicability of these targets, we analyzed protein expression by immunohistochemistry and quantified these by a total immunostaining score (TIS) in tissue of rectal cancer patients with a pCR. CEA, EpCAM, αvβ6, and uPAR expression in the diagnostic biopsy was high (TIS > 6) in, respectively, 100%, 100%, 33%, and 46% of cases. CEA and EpCAM expressions were significantly higher in the diagnostic biopsy compared with the corresponding tumor bed (p < 0.01). CEA, EpCAM, αvβ6, and uPAR expressions were low (TIS < 6) in the tumor bed in, respectively, 93%, 95%, 85%, and 62.5% of cases. Immunohistochemical evaluation shows that CEA and EpCAM could be suitable targets for response evaluation after neoadjuvant treatment, since expression of these targets in the primary tumor bed is low compared with the diagnostic biopsy and adjacent pre-existent rectal mucosa in more than 90% of patients with a pCR.

Predictive value of PET/CT for pathological complete response and survival in patients with locally advanced rectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 697-697 ◽  
Author(s):  
Eric C Sorenson ◽  
Aruj J Choudhry ◽  
Jian Qin Yu ◽  
Sanjay S. Reddy ◽  
Crystal Shereen Denlinger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pet Imaging ◽  
Nonoperative Management ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Pet Ct ◽  
Percent Decrease

697 Background: A major challenge in identifying candidates for nonoperative management of locally advanced rectal cancer is predicting pathological complete response (pCR) following chemoradiation therapy (CRT). We evaluated the ability of pre- and post-CRT PET imaging to predict pCR and long-term prognosis. Methods: We retrospectively identified patients at our institution from 2002–2015 with locally advanced rectal cancer who underwent CRT, pre- and post-CRT PET imaging, and surgical resection. Logistic regression and Kaplan-Meier estimates were used to analyze the association of PET variables with tumor pCR and survival outcomes. Receiver operator characteristic curves were generated to define optimal cutoff points for predictive PET variables. Results: 140 patients matched the inclusion criteria. The pCR rate was 28%, and median follow-up time was 48 months. On multivariable analysis, pCR was associated with lower median post-CRT SUVmax(3.2 vs 5.2, p=0.009) and higher median SUV percent decrease (72 vs 58%, p=0.009). ROC curves were generated for SUV percent decrease (AUC=0.70) and post-CRT SUV (AUC=0.69) to estimate cutoff points for maximum specificity and sensitivity to predict pCR. Post-CRT SUV <4.3 and SUV percent decrease of >66% were equally predictive of pCR with a sensitivity of 65%, specificity of 72%, PPV of 44%, and NPV of 86%. Median 5-year OS and RFS were significantly improved for patients with post-CRT SUV <4.3 (OS, 86 vs 66%, p=0.01; RFS, 75 vs 52%, p=0.01) or SUV percent decrease of >66% (OS, 82 vs 66%, p=0.05; RFS, 75 vs 54%, p=0.01). Patients with stage III disease and a post-CRT SUV <4.3 were in effect downstaged, with a median 5-year OS equivalent to that of patients with stage II disease (Table 1; 86 vs 86%). Conclusions: PET/CT may be a useful modality in predicting pCR and overall survival in patients undergoing CRT for rectal cancer. Inclusion of pre-CRT PET does not appear to add prognostic value for pCR compared with post-CRT PET alone. Patients with a post-CRT SUV of >4.3 should not be considered for nonoperative management, as an estimated 86% of these patients will not have a pCR.

PO-1094: Pathological complete response and outcomes in rectal cancer patients with treatment intensification

2020 ◽  
Vol 152 ◽  
pp. S579
Author(s):  
C. Rosa ◽  
M. Di Tommaso ◽  
L. Caravatta ◽  
M. Taraborrelli ◽  
D. Fasciolo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
Complete Response ◽  
Treatment Intensification
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