scholarly journals P-P58 The role of PET-CT in the management of pancreatic cancer. A Northern Ireland experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Lauren Laverty ◽  
Stephen McCain ◽  
Lloyd McKie
Keyword(s):  
Pancreatic Cancer ◽  
Northern Ireland ◽  
Ct Scan ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Time Interval ◽  
Resectable Disease ◽  
Number Of Patients ◽  
Pet Ct ◽  
The Impact

Abstract Background Diagnosis and staging has proven to be difficult in 10-20% of patients with pancreatic cancer. The PET-PANC study found that PET-CT significantly influenced the staging and management of pancreatic cancer and therefore the NICE guidelines now advise PET-CT in all patients who have localised potentially resectable disease. This study aimed to investigate the impact of PET-CT on the management of pancreatic cancer patients in a single tertiary referral centre. Methods There were 288 patients with pancreatic cancer discussed at the Northern Ireland Regional Hepatobiliary MDM from January 2020 to March 2021. Of these patients, 176 were deemed to have inoperable disease based on initial CT, 5 had borderline resectable disease, 1 had holding chemotherapy due to COVID restrictions and 57 were excluded from surgical resection for a variety of reasons. These included the patient being unfit for surgery, the patient declining operative intervention and an alternative treatment offered as result of COVID-19 pandemic. Therefore, there were 49 patients with pancreatic adenocarcinoma which the MDT concluded should be considered for surgical resection. Results A total of 27 patients who were due to undergo a curative resection had a pre-operative PET-CT scan (55.1%). This demonstrated metastatic disease in 9 cases (33.3%). Four patients who did not have a preoperative PET-CT were found to have metastatic disease at operation (9.7%). This equated to a total metastatic incidence of 26.5% in those who had been initially deemed resectable based on CT scan alone. The time interval from MDM decision to surgery averaged 25.4 days in those who did not have a PET/CT compared to 40.43 days in those who did. This was an average delay of 15.07 days until treatment. Conclusions This study demonstrates the important role the PET-CT has in the management of patients with pancreatic cancer. A significant number of patients avoided an unnecessary operation which would have delayed the commencement of chemotherapy. However, there are limitations to PET-CT, demonstrated in the patient with an inconclusive result, who was found to have liver metastases at surgery. The introduction of PET-CT in the staging process does undoubtedly cause delays to surgical resection and a more streamlined pathway needs to be developed to limit the delay to curative treatment.

Utility of PET/CT as initial staging work up for early pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 183-183
Author(s):  
Gopi Kesaria Prithviraj ◽  
Nishi Kothari ◽  
Binglin Yue ◽  
Jongphil Kim ◽  
Gregory M. Springett ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Ct Scan ◽  
Metastatic Disease ◽  
Treatment Plan ◽  
Borderline Resectable ◽  
Pet Ct ◽  
Borderline Pancreatic Cancer ◽  
Work Up ◽  
Pet Ct Scan ◽  
Initial Staging

183 Background: In pancreatic cancer, early detection and complete surgical resection with negative margins offers the only cure for the disease. Work up to evaluate resectability includes triple phase helical scan CT of the pancreas and endoscopic ultrasound (EUS). A paucity of data exists in using PET/CT scan as staging work up in early resectable pancreatic cancer. The objective of our study was to determine if PET/CT prevents futile laparotomy by detecting occult metastatic disease in patients with resectable/borderline pancreatic cancer. Methods: We looked at our institutional PET/CT data base incorporating National Oncologic PET Registry (NOPR) with diagnosis of resectable or borderline pancreatic cancer from 2005-2012. Clinical, radiographic, and pathologic follow-up was evaluated, including age, gender, evidence of metastatic disease, and initial CA 19–9 levels. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT. The confidence interval was computed using the exact binomial distribution. The effect on the change was evaluated by the multiple logistic regression model. The final model was selected using the backward elimination method. Results: 287 patients with early stage (resectable or borderline) pancreatic cancer who received PET/CT as part of initial staging workup were identified. Upon initial work up (CT + EUS), 62% of patients were considered resectable and 38% were borderline resectable. However, PET/CT findings changed the management in 11.9% (n=34) of patients (95% CI: 0.084 – 0.162). 33 patients were upstaged to stage IV and 1 patient was upstaged to stage III. Median time from CT to PET/CT was 5 days. Metastatic lesions were confirmed with biopsy in 21 patients. The proportion in the change in treatment plan is significantly higher in patients who were borderline resectable (p=0.005; OR=2.94; 95% CI: 1.38 – 6.26). In 204 patients who were taken to surgery, 17.7% (n=36) were found to have metastatic disease intraoperatively. Conclusions: PET/CT helped improve detection of occult metastases, ultimately sparing these patients a potentially unnecessary operation. The role of PET/CT scan should be validated in prospective study.

Role of FDG PET/CT scan in preoperative pancreatic cancer staging.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 511-511
Author(s):  
Bhargavi Ghanta ◽  
Thavam C. Thambi-Pillai ◽  
Gary Timmerman ◽  
Christopher Fischer ◽  
Annie Nelson ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Preoperative Staging ◽  
False Negative ◽  
Number Of Patients ◽  
Pet Ct ◽  
Hepatic Metastatic Disease ◽  
Fdg Pet Ct

511 Background: Guidelines do not recommend routine FDG PET/CT (PET) as preoperative staging for pancreatic cancer, although many single center series have demonstrated that PET can lead to changes in management in a sizable minority of patients. We performed a retrospective analysis of patients undergoing PET for potentially resectable pancreatic adenocarcinoma at our institution to help define the utility of PET in this setting. Methods: We reviewed patients with pancreatic adenocarcinoma diagnosed at our center from June 2010 to May 2017 and included patients with pancreatic adenocarcinoma felt to be potentially resectable following standard staging studies [computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS)] who also underwent preoperative PET. Data collected and analyzed included: demographics, pre-PET staging, CA19-9 levels, PET results and surgical outcomes. Results: Forty eight patients with pancreatic adenocarcinoma felt to be surgically resectable underwent PET. PET changed management in 4/48 (8.3%) of these patients. In all 4 of these patients, hepatic metastatic disease was detected on PET and planned surgery was canceled; metastatic disease was confirmed by biopsy in 1 of these patients. 1/48 (2.1%) of patients had a false positive PET scan, where a focus of suspected metastatic disease on PET was biopsied and found to be benign, allowing the patient to proceed to surgery. 3/48 (6.3%) of patients had a false negative PET; 2 patients had hepatic metastatic disease and one had peritoneal disease discovered during surgery. Mean time from negative PET to surgery in these 3 patients was 31 days (range 21-45). Degree of CA19-9 elevation and primary tumor FDG avidity did not correlate with detection of metastatic disease on PET. Conclusions: PET changed management in a smaller number of patients in this cohort than in many previously reported series with a nearly equal number of patients with false negative PET results proceeding to unnecessary surgery. These results are consistent with the currently uncertain role of PET in preoperative staging for pancreatic cancer and further work must be undertaken to optimize presurgical staging in this population.

scholarly journals Diagnostic Role of 18F-PSMA-1007 PET/CT in Prostate Cancer Staging: A Systematic Review

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 552
Author(s):  
Salam Awenat ◽  
Arnoldo Piccardo ◽  
Patricia Carvoeiras ◽  
Giovanni Signore ◽  
Luca Giovanella ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Metastatic Disease ◽  
Cancer Staging ◽  
Relevant Information ◽  
Cochrane Library ◽  
Number Of Patients ◽  
Pet Ct

Background: The use of prostate-specific membrane antigen (PSMA)-targeted agents for staging prostate cancer (PCa) patients using positron emission tomography/computed tomography (PET/CT) is increasing worldwide. We performed a systematic review on the role of 18F-PSMA-1007 PET/CT in PCa staging to provide evidence-based data in this setting. Methods: A comprehensive computer literature search of PubMed/MEDLINE and Cochrane Library databases for studies using 18F-PSMA-1007 PET/CT in PCa staging was performed until 31 December 2020. Eligible articles were selected and relevant information was extracted from the original articles by two authors independently. Results: Eight articles (369 patients) evaluating the role of 18F-PSMA-1007 PET/CT in PCa staging were selected. These studies were quite heterogeneous, but, overall, they demonstrated a good diagnostic accuracy of 18F-PSMA-1007 PET/CT in detecting PCa lesions at staging. Overall, higher primary PCa aggressiveness was associated with higher 18F-PSMA-1007 uptake. When compared with other radiological and scintigraphic imaging methods, 18F-PSMA-1007 PET/CT had superior sensitivity in detecting metastatic disease and the highest inter-reader agreement. 18F-PSMA-1007 PET/CT showed similar results in terms of diagnostic accuracy for PCa staging compared with PET/CT with other PSMA-targeted tracers. Dual imaging with multi-parametric magnetic resonance imaging and 18F-PSMA-1007 PET/CT may improve staging of primary PCa. Notably, 18F-PSMA-1007-PET/CT may detect metastatic disease in a significant number of patients with negative standard imaging. Conclusions: 18F-PSMA-1007 PET/CT demonstrated a good accuracy in PCa staging, with similar results compared with other PSMA-targeted radiopharmaceuticals. This method could substitute bone scintigraphy and conventional abdominal imaging for PCa staging. Prospective multicentric studies are needed to confirm these findings.

Circulating tumor cells (CTC), [18F]fluorodeoxyglucose positron emission tomography, and computed tomography (PET/CT) for treatment monitoring in patients with metastatic breast cancer (MBC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e12007-e12007
Author(s):  
D. Tamkus ◽  
S. R. Chandana ◽  
K. Berger ◽  
T. Aung
Keyword(s):  
Ct Scan ◽  
Metastatic Disease ◽  
Response To Therapy ◽  
Predictive Values ◽  
Positive Correlation ◽  
Time Points ◽  
Female Patients ◽  
18F Fluorodeoxyglucose ◽  
Pet Ct

e12007 Background: Use of [18F]-fluorodeoxyglucose PET /CT and/or CTC is being investigated to follow up response to treatment in patients with MBC. It is not clear if these tests can be a surrogate for one another. Methods: We retrospectively analyzed a database of female patients with MBC undergoing chemotherapy or hormonal therapy. Most of these patients received at least 2 lines of therapy. Standard CT scan tumor measurements were used to assess response to therapy. CTC were defined either low (0–5) or high (>5). Maximum standard uptake values (max SUV) on PET scan were defined either low (<3) or high (>3). Correlation between the max SUV and CTC counts was statistically analyzed. Sensitivity, specificity, positive and negative predictive values were calculated from 2 x 2 table. Results: A total of 9 female patients with MBC were identified (mean age of 52 years). The receptor status of these patients includes 67 % positive for ER and 33 % positive for HER-2/neu. Median follow up was 9.8 months. There were 59 time points (> or = 4 weeks apart) when either PET/CT or CTC were performed. The results of PET/CT scans were compared with CTC at 38 events. The sensitivity of CTC to detect metastatic disease shown on PET/CT was 32% and specificity of 100%. The positive and negative predictive values were 100% and 32% respectively. There was a positive correlation between the max SUV and CTC count (p = 0.001). However in three patients, despite of progression of disease per PET/CT, CTC were undetectable at three different time points. Interestingly, two out of these three patients were triple negative. Disease progression was confirmed by biopsy in two of these patients. Conclusions: Our data suggest positive correlation between PET/CT scan and CTC. However, CTC had poor sensitivity and negative predictive value to detect progressive metastatic disease. Normal CTC values have to be interpreted cautiously in patients with MBC. We are now planning to investigate the utility of these tests, prospectively, in a large cohort of MBC patients. No significant financial relationships to disclose.

scholarly journals P-P46 The use of FDG-PET/CT in the pre-operative staging of pancreatic ductal adenocarcinoma

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rebecca Jordan ◽  
Duncan Muir ◽  
Stijn van Laarhoven ◽  
Stephen Falk ◽  
Andrew Strickland ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Fdg Pet ◽  
Clinical Information ◽  
Ductal Adenocarcinoma ◽  
Conventional Imaging ◽  
Resectable Disease ◽  
Additional Information ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background  The NICE Quality Standard for Pancreatic Cancer (December 2018) recommends that ‘adults with localised pancreatic cancer on CT(should) have staging using fluorodeoxyglucose positron emission tomography/CT(FDG-PET/CT) before they have surgery, radiotherapy or systemic therapy’. Such FDG-PET/CT staging aims to provide additional information to conventional cross-sectional imaging, thus presenting the most accurate staging of disease. However, the sensitivity and specificity of FDG-PET/CT to deliver relevant additional clinical information must be balanced with potential delays to treatment, and additional cost associated with its use, in the management of a time-critical pathology. Methods Consecutive pancreatic ductal adenocarcinoma(PDAC) patients deemed resectable on conventional imaging, and therefore referred for FDG-PET/CT assessment, were included for analysis. Data were derived from a single tertiary Hepatopancreaticobiliary(HPB) centre between May 2018 and June 2021. Data were collected and analysed from a combination of prospectively-collated electronic databases and paper patient records. Results Of 89 patients analysed, 55(61.7%) patients were male. Primary pancreatic lesions were PET avid in 81 cases(91%). Median time from request to FDG-PET/CT performance was 11 days(Range 1-35). Additional clinical information from FDG-PET/CT was provided in 61(68.5%) patients. Further investigations to assess FDG-PET/CT findings were arranged in 23 patients(25.8%; including liver MRI and EUS), demonstrating that FDG-PET/CT findings were true-positive in 6(26.1%), false-positive in 15(65.2%) and equivocal in 2(8.7%). There was a median delay of 60.5 days(Range 26 to 256) from FDG-PET/CT to surgery in those undergoing additional investigation. In total, a new diagnosis of metastatic/non-resectable disease was made in 14(15.7%) patients, preventing progression to planned operative intervention. Conclusions FDG-PET/CT provided additional information to conventional imaging that led to cancellation of planned operative resection in 14(15.7%) PDAC patients-8 directly and 6 following further investigation. However, there was a median delay of 11 days to FDG-PET/CT and 60.5 days from FDG-PET/CT to surgery in those undergoing additional investigation.   Whilst FDG-PET/CT can lead to avoidance of unnecessary surgical intervention in PDAC patients with unsuspected metastatic/non-resectable disease, it can lead to delay, over-investigation, excess cost and anxiety in resectable patients. HPB units should audit their own findings to assess whether the use of FDG-PET/CT should be considered on a standard or selected basis.

Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer

2020 ◽  
Vol 9 (17) ◽  
pp. 1233-1241
Author(s):  
Omar Abdel-Rahman
Keyword(s):  
Pancreatic Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Surgical Resection ◽  
Multivariable Logistic Regression Analysis ◽  
Cancer Specific Survival ◽  
Group 3 ◽  
Regional Disease ◽  
The Impact ◽  
Group 1

Objective: To assess the impact of socioeconomic status (SES) on the patterns of care and outcomes of patients with pancreatic cancer. Materials & methods: Surveillance, Epidemiology and End Results specialized SES registry has been accessed and patients with pancreatic cancer diagnosed (2000–2015) were evaluated. The following SES variables were included: employment percentage, percent of people above the poverty line, percent of people identified as working-class, educational level, median rent, median household value and median household income. Within this SES registry, patients were classified according to their census-tract SES into three groups (where group-1 represents the lowest SES category and group-3 represents the highest SES category). Multivariable logistic regression analysis was used to assess the impact of SES on access to surgical resection and multivariable Cox regression analysis was used to assess the impact of SES on pancreatic cancer-specific survival. Kaplan–Meier survival estimates were also used to compare overall survival (OS) outcomes according to SES. Results: A total of 83,902 pancreatic cancer patients were included in the current analysis. Within multivariable logistic regression analysis among patients with a localized/regional disease, patients with lower SES were less likely to undergo surgical resection for pancreatic cancer (odds ratio: 0.719; 95% CI: 0.673–0.767; p < 0.001). Among patients with a localized/regional disease who underwent surgical resection, patients with higher SES have better OS (median OS for group-3: 20.0 vs 17.0 months for group-1; p < 0.001). Moreover, patients with lower SES have worse pancreatic cancer-specific survival compared with patients with higher SES: (hazard ratio for group-1 vs group-3: 1.212; 95% CI: 1.135–1.295; p < 0.001). Conclusion: Poor neighborhood SES is associated with more advanced disease at presentation, less probability of surgical resection and even poorer outcomes after surgical resection.

Correlation among [18-F] FDG-PET/CT, tumor marker CA 27.29, and circulating tumor cells in metastatic breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10533-10533 ◽  
Author(s):  
A. A. Saad ◽  
S. Rikhye ◽  
A. Kanate ◽  
A. Sehbai ◽  
G. Marano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ct Scan ◽  
Negative Predictive Value ◽  
Metastatic Disease ◽  
Predictive Value ◽  
Metastatic Breast ◽  
P Value ◽  
Time Points ◽  
Pet Ct ◽  
Pet Ct Scan

10533 Background: Both tumor marker CA 27.29 and combined [18-F]-fluorodeoxyglucose-positron emission tomography/computed tomography scan (PET/CT) are used to follow up response to treatment and disease progression in patients with metastatic breast cancer (MBC). Recently, circulating tumor cell testing (CTC) has been used in this context. It is not known if one of the three tests can be a surrogate for the other 2 tests. Methods: We analyzed the database of 35 patients with MBC. There were 173 time points (at least 6 weeks apart), when at least 2 of these tests were done. CA 27.29 test (chemiluminescent immunoassay by Bayer Advia Centaur) was either high or normal (< 38.6 U/ml). Circulating tumor cells cell test (Cell Search by Quest Diagnostics, Nichols Institute, Chantilly, VA) was either high or normal (0 cells detected). Results: PET/CT scan results were compared to CA 27.29 at 163 time points. There was statistically significant correlation between both groups (P value: 0.02), however, sensitivity of CA 27.29 to detect metastatic disease seen in PET/CT scan was 59%. The positive predictive value (PPV) of CA 27.29 was 90%, while the negative predictive value (NPV) was only 24%. PET/CT scan results were compared to CTC at 100 events, where there was statistically significant correlation between both groups (P value: 0.0002), however, sensitivity of CTC to detect metastatic disease shown in PET/CT scan was 55%. The positive predictive value of CTC was 98% while the negative predictive value was only 33%. CTC test was more specific (94% Vs 67%) than CA 27.29 to rule out metastatic disease that is seen in PET/CT scan. CA 27.29 results were also compared to CTC at 93 events, where there was statistically significant correlation between both groups (P value: 0.0002). However, only 64 % of those with high CA 27.29 had abnormal CTC. Conclusion: Our data shows correlation among PET/CT scan, CA 27.29, and CTC. However, both CA 27.29 and CTC had poor sensitivity and negative predictive value to detect metastatic disease seen in PET/CT scan. Normal CA 27.29 test or CTC has to be interpreted cautiously in patients with MBC. No significant financial relationships to disclose.

A population-based study of the effect of FDG PET/CT in the management of liver-limited colorectal adenocarcinoma (CRC) metastases.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3610-3610
Author(s):  
Maria Yi Ho ◽  
Tarnjit Parhar ◽  
Don Wilson ◽  
Winson Y. Cheung ◽  
Howard John Lim
Keyword(s):  
British Columbia ◽  
Ct Scan ◽  
Metastatic Disease ◽  
De Novo ◽  
Ct Scanning ◽  
Primary Objective ◽  
Ct Scans ◽  
Extrahepatic Disease ◽  
Liver Lesions ◽  
Pet Ct

3610 Background: PET/CT scans are publically funded in British Columbia for staging in liver limited metastatic CRC. However, past studies have been equivocal about the utility of PET/CT as some report as high as a 20-30% change in management while others report <10% change in management. Our primary objective was to assess the effect of the addition of PET/CT to CT scanning for the management of liver limited colorectal cancer. Methods: Patients who underwent PET/CT scan for de novo liver limited metastatic disease from 2005-2011 in the province of British Columbia were identified using the PET/CT database. Patients recently completed or currently on chemotherapy were excluded. We determined the concordance rates between CT and PET/CT scans with respect to the extra-hepatic disease, the number of lesions in the liver and the location of liver lesions. Results: 349 patients were identified. The most common indications for PET/CT scans after an initial CT scan were: detection of extrahepatic disease (77%), confirmation of the malignant nature of the liver lesions (8%) and the extent of extrahepatic disease (15%). PET/CT and CT were discordant in 39% of cases for the extent of metastatic disease. PET/CT revealed extrahepatic disease in 27% of the cases for which CT only detected liver limited disease. In contrast, 13% of patients were downstaged when CT liver lesions were demonstrated not to be FDG avid. Concordance of PET/CT and CT scans on the number and location of liver lesions was 52% and 85%, respectively. PET/CT revealed additional number of liver lesions and multilobar disease in 26% and 12% of cases, respectively. Furthermore, the median time between PET/CT and CT were 64.3 days and 64.1 days for concordant and discordant cases (p=0.88). Conclusions: PET/CT scans provided additional information compared to CT scans which could have implications for surgical management. Our study supports the utility and public funding of PET/CT in addition to CT in patients with potentially surgically curable metastatic CRC involving the liver.

The impact of FDG-PET/CT on the management of gynecologic cancers: A retrospective study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16500-e16500
Author(s):  
Ramiz Ahmad Abu-Hijlih ◽  
Akram Al-Ibraheem ◽  
Yazan Asad Abuodeh ◽  
Imada A. Jaradat
Keyword(s):  
Ct Scan ◽  
Treatment Response ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Gynecological Cancer ◽  
Pet Scan ◽  
Cancer Center ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
The Impact

e16500 Background: Fluoro-Deoxyglucose (FDG-PET) coupled with Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) provides valuable information in primary staging and evaluation of therapeutic response in gynecological cancer patients. The aim of this study is to investigate the additional value of PET/CT to MRI and CT scan, in patients recently diagnosed with a gynecological tumor or for evaluation of treatment response. Methods: Between January 2010 and June 2012, forty patients with gynecologic tumors (23 cervical, 8 endometrial and 9 ovarian) were evaluated at King Hussein Cancer Center. These patients were divided into two groups: (1) PET scan at presentation for initial staging workup (15 patients) and (2)PET scan at follow up for treatment response evaluation (25 patients). Results: The FDG-PET/CT scan yielded the following additional information: upstaging in 7.5% (3 in 40 patients) and down staging in 32.5% (13 in 40 patients). As a result, treatment strategy was changed from curative to palliative in one patient, and additional curative therapy was implemented following exclusion of distant metastasis in eight patients. Moreover, the discrepancy in nodal status found with FDG-PET/CT compared with anatomical imaging was detected in 8 patients (20%), which led to modifications in radiotherapy field and customizing the radiation dose with minimizing treatment-related toxicity. Conclusions: This study has demonstrated the effectiveness of FDG-PET/CT in the management of gynecological cancer patients. It is a highly valuable utility that raised the accuracy of patients’ stratification to curative or palliative treatments. Furthermore it helped radiotherapy to be more precisely targeted towards the malignant process. However, further prospective studies are still required to identify the group of patients who would benefit the most from this procedure.

Pretreatment metabolic tumor volume (MTV) as a predictor of survival in borderline resectable pancreatic cancers treated with neoadjuvant therapy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 310-310
Author(s):  
Alex Cruz ◽  
Dung-Tsa Chen ◽  
William J. Fulp ◽  
Michael Chuong ◽  
Sarah Hoffe ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Surgical Resection ◽  
Tumor Volume ◽  
Metabolic Tumor Volume ◽  
Post Treatment ◽  
Ct Scans ◽  
Borderline Resectable ◽  
Pet Ct ◽  
Pre Treatment

310 Background: A higher initial metabolic tumor burden is associated with lower median survival in locally advanced pancreatic cancer (LAPC), yet the prognostic utility of PET/CT is not defined in the setting of borderline resectable pancreatic cancer (BRPC). Methods: We performed a retrospectivereview of our institutional experience treating BRPC. Initial staging included endoscopic ultrasound as well as pancreatic protocol CT and PET/CT scans. All patients underwent neoadjuvant gemcitabine-based chemotherapy and radiation therapy (RT). RT was delivered using standard fractionation intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). Restaging CT and PET/CT scans were obtained approximately 4 weeks following RT completion. We measured the significance of the pre-treatment and post-treatment SUV maximum and metabolic tumor volume (MTV) 2.5 to 5.0, which was defined as the MTV above a threshold SUV of 2.5, 3.0, 4.0 and 5.0. Cox regression models were used to evaluate the significance between these parameters and disease free survival (DFS) and overall survival (OS). Results: We evaluated a total of 72 BRPC patients. Median follow up was 12.7 months. 56 patients (77%) received induction chemotherapy with gemcitabine, docetaxel and capecitabine (GTX). 43 (59.7 %) underwent surgical resection. Significant predictors for OS in the whole cohort included pre-treatment SUV maximum (p=0.0042), post-treatment SUV maximum (p=0.0183), pre-treatment MTV 2.5 (p=0.0016) and pre-treatment MTV 4.0 (p=0.0111). In addition, the difference between the MTV 4.0 pre-treatment and post-treatment was significant (p=0.0285). In patients who underwent surgical resection, there was a significant correlation between OS with pre-treatment SUV max (p=0.0229) and post-treatment SUV maximum (p=0.0325) but not pre-treatment MTV 2.5 (p=0.0654) nor MTV 4.0 (p=0.0928) nor the differences between each variable pre (0.1482) or post-treatment (0.0959). Conclusions: This is the first study to suggest that pre and post treatment PET activity is prognostic for BRPC.

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