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.

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

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.

scholarly journals A Nomogram for Predicting Pathological Complete Response to Neoadjuvant Chemoradiotherapy Using Semiquantitative Parameters Derived From Sequential PET/CT in Locally Advanced Rectal Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Dae Hee Pyo ◽  
Joon Young Choi ◽  
Woo Yong Lee ◽  
Seong Hyeon Yun ◽  
Hee Cheol Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Multivariable Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Training Group ◽  
Complete Response ◽  
Validation Group ◽  
Pet Ct ◽  
Before And After ◽  
Sensitivity Specificity

We evaluated the predictive value of semiquantitative volumetric parameters derived from sequential PET/CT and developed a nomogram to predict pathological complete response (pCR) in patients with rectal cancer treated by neoadjuvant chemoradiotherapy (nCRT). From April 2008 to December 2013, among the patients who underwent nCRT, those who were taken sequential PET/CT before and after nCRT were included. MRI-based staging and semiquantitative parameters of PET/CT including standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated before and after nCRT. Multivariable analysis was performed to select significant predictors to construct a nomogram. Sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve (AUC) of the model were evaluated to determine its performance. Among 137 eligible patients, 17 (12.4%) had pCR. All post-PET/CT parameters showed significant differences between pCR and non-pCR groups. Patients were randomly assigned to a training group (91 patients) and a validation group (46 patients). In multivariable analysis with the training group, post-CEA, post-MRI T staging, post-SUVmax, and post-MTV were significantly associated with pCR. There was no significant pre-nCRT variable for predicting pCR. Using significant predictors, a nomogram was developed. Sensitivity, specificity, accuracy, and AUC of the nomogram were 0.882, 0.808, 0.848, and 0.884 with the training group and 0.857, 0.781, 0.783, and 0.828 with the validation group, respectively. This model showed the better performance than other predictive models that did not contain PET/CT parameters. A nomogram containing semiquantitative post-PET/CT could effectively select candidates for organ-sparing strategies.

Efficacy of FDG-PET/CT Imaging To Guide Biopsies in the Detection of Richter’s Syndrome.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1390-1390
Author(s):  
Steven Le Gouill ◽  
Caroline Bodet-Milin ◽  
Françoise Kraeber-Bodere ◽  
Anne Moreau ◽  
Laurent Campion ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Ct Imaging ◽  
Aggressive Lymphoma ◽  
Histopathological Analysis ◽  
Low Grade ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct ◽  
Richter’S Syndrome

Abstract Introduction: Most lymphomas show a good FDG uptake, with significant difference in intensity according to different histopathological subtypes. Richter’s syndrome </DEL> (RS) is defined as the development of aggressive lymphoma in patients with low grade histopathological subtypes. Diagnosis requires histological findings. The aim of our study was to investigate prospectively FDG-PET/CT to guide biopsy in the diagnosis of aggressive transformation of low grade lymphomas. Material and methods: Thirty-eight patients, presenting clinical and/or biological signs of aggressive transformation were included. The 38 underwent FDG-PET/CT. FDG-PET/CT scans were analysed visually and semi-quantitatively with maximal standardised uptake value (SUVmax) normalised for body mass. Guided-biopsy was performed 4 weeks after FDG-PET/CT, in the abnormal focus showing the highest SUVmax and histopathological analysis was performed. Results: Histopathological analysis concluded to aggressive transformations in 17 cases (15 NHL and 2 Hodgkin diseases included one composite lymphoma) and low grade lymphomas in 21 cases. Size of lesions on CT was not predictive of RS (p=0.094). FDG-PET/CT images showed abnormal FDG uptake in the 38 included patients. SUVmax ranged from 11.7 to 41.2 in patients with Richter’s syndrome and from 1.7 to 17.0 in patients with no sign of transformation(p<0.0001). Gradient of SUVmax was significantly higher in patients with Richter’s syndrome (p<0.0001). A SUVmax threshold of 14.0 gave the better balance with sensitivity, specificity, predictive positive and negative values around 95.0%. This threshold of 14.0 correctly classified as transformed or not transformed 36/38 patients (94.7%). Conclusion: FDG-PET/CT imaging is a very relevant tools to detect aggressive transformation of low grade lymphomas and to guide biopsy.

Predicting complete response to neoadjuvant CRT for distal rectal cancer using sequential PET/CT imaging

2014 ◽  
Vol 18 (8) ◽  
pp. 699-708 ◽  
Author(s):  
R. O. Perez ◽  
A. Habr-Gama ◽  
G. P. São Julião ◽  
P. B. Lynn ◽  
C. Sabbagh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Complete Response ◽  
Ct Imaging ◽  
Distal Rectal Cancer ◽  
Pet Ct

scholarly journals Total neoadjuvant chemoradiotherapy (consolidation chemotherapy during the interval after chemoradiotherapy) for distal rectal cancer increases the rates of complete response

2020 ◽  
Author(s):  
Zhiwei Zhai ◽  
Kunning Zhang ◽  
Chen Wang ◽  
Jiagang Han ◽  
Tian Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Consolidation Chemotherapy ◽  
Significant Difference

Abstract Objective To compare the safety and efficacy between neoadjuvant concurrent chemoradiotherapy (CRT) and total neoadjuvant chemoradiotherapy (TNT) in patients with locally advanced rectal cancer. Methods Patients with cT3/T4 or TxN+M0 rectal cancer were randomized to receive CRT/TNT. In CRT group, we planned pelvic radiotherapy (50.0Gy in 25 fractions) with two cycles of concurrent CAPOX followed by total mesorectal excision (TME). In TNT group, 3 cycles of CAPOX were administered 2 weeks after the completion of CRT before TME. The primary endpoints of my study were pathological complete response (pCR) rates in the two cohorts. Results A total of 197 patients were included in our study. Eighty-one patients received CRT while one hundred and sixteen patients received TNT (consolidation chemotherapy). Nine patients did not undergo surgery because of the distant metastases (1 patient (1.2%) in CRT group, 2 patients (1.7%) in TNT group) or clinical complete response (cCR) (2 patients in CRT group, 4 patients in TNT group). The rate of pathological complete response in TNT was significantly higher than the rate in CRT (32.7% vs12.8%, P =0.002). No grade 4 or serious adverse events were observed. There was no statistically significant difference in the grade 3 acute toxicities of neoadjuvant treatment and surgical complications between the two groups (all P >0.05). Conclusions Our data suggests that total neoadjuvant chemoradiotherapy (consolidation chemotherapy) is effective and safe for patients with locally advanced rectal cancer and is associated with high rates of pathological complete response. The long-term follow-up and survival outcomes for patients are necessary to be evaluated in future prospective randomized trial.

scholarly journals FDG-PET/CT imaging for evaluating durable responses to immune check point inhibitors in patients with advanced cutaneous squamous cell carcinoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Luke S. McLean ◽  
Karda Cavanagh ◽  
Rodney J. Hicks ◽  
Jason Callahan ◽  
Jing Xie ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Complete Response ◽  
Ct Imaging ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background The role of FDG-PET/CT imaging in assessing response to immunotherapy in advanced cutaneous squamous cell carcinoma (CSCC) is unknown. This study compared complete metabolic response (CMR) rates by FDG-PET and RECIST1.1 via CT or MRI in patients on cemiplimab for > 10 months. Methods This was a single-centre retrospective study of 15 patients treated with cemiplimab for advanced CSCC who had CT/MRI and FDG-PET/CT at > 10 months to assess metabolic treatment response. The median age was 73 years (range 55–84) and 93% were male. RECIST1.1 and PERCIST1.0 tumor responses were evaluated by blinded readers. Results Seventy-three percent (11/15) (95%CI 44.9, 92.2%) achieved a CMR on PET. Of these 11, on RECIST1.1 there was one complete response, 9 partial responses and one stable disease. Conclusions In patients on cemiplimab for > 10 months, there was discordance between CR rates on FDG-PET versus RECIST1.1. FDG-PET/CT may have utility for clarifying depth of response in patients treated with immunotherapy for CSCC.

Molecular subtyping of breast cancer using dedicated breast PET-CT.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22090-e22090
Author(s):  
Katja Pinker-Domenig ◽  
Heinrich Magometschnigg ◽  
Marius Mayerhoefer ◽  
Peter Christian Dubsky ◽  
Rupert Bartsch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Triple Negative ◽  
Breast Tumors ◽  
Surgical Specimen ◽  
Statistical Significant Difference ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Significant Difference ◽  
Er Positive

e22090 Background: Recently dedicated breast 18FDG breast PET-CT has emerged as an additional imaging tool for assessment and staging of primary breast cancer. Expression of specific molecular markers such as estrogen receptor (ER), progesterone receptor (PR), and HER2 status, has direct prognostic and therapeutic implications in patient management. This study aimed to determine whether correlations exist between 18FDG up-take of the primary breast cancer lesions and these predictive and prognostic factors. Methods: Before undergoing surgery 114 patients with primary breast cancer underwent 18FDG breast PET-CT. The maximum standardized uptake value (SUVmax) of the primary breast cancer was measured in each patient and standard immunohistochemistry was performed on a surgical specimen to characterize the receptor state of tumor cells. Appropriate statistical tests were used to test for any association that may exist among ER, PR, and HER2. Results: A significant association was found between a triple negative status and the SUVmax (p < 0.001) of breast tumors. ER-negative tumors (mean SUVmax, 10.4) demonstrated a significantly higher SUVmax than did ER-positive tumors (median SUV, 5.1) (p= 0.045). No statistical significant difference was found for SUVmax of PR-negative vs. PR-positive lesions with a mean SUVmax of 8.6 and 4.9 (p=0.15) respectively. No statistical significant difference was found for SUVmax of HER2-negative vs. HER2-positive lesions with mean SUVmax of 6.4 and 5.3 respectively (p=0.55). If either ER or PR was positive, then the other tended to be positive as well (chi2 = 84%, P < 0.01). No such significant relationship was detected between PR or ER and HER2 (P > 0.05). Conclusions: ER-negative breast cancer tumors display higher 18FDG uptake than ER-positive tumors. Triple-negative breast tumors are associated with increased 18FDG uptake commensurate with their aggressive biology. The data suggest that SUVmax measurements of 18FDG breast PET-CT can provide valuable information about the state of ER, PR, and HER2 and the associated glucose metabolism of the primary breast cancer lesions. Such an association may be of importance to treatment planning and outcome in these patients.

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