Role of 18F-PET-CT to Predict Pathological Response After Neoadjuvant Treatment of Rectal Cancer

Abstract Objectives: Neoadjuvant radiochemotherapy (nCRT) is universally considered to be a valid treatment to achieve downstaging, improve local disease control and obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in tumor 18F -FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of pathologic response (pR) achieved in patients with LARC.Data description: We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients received nCRT and surgical treatment was carried after 8/12th. All patients underwent a baseline 18F -FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-C T SUV2) within six weeks of the completion of nCRT. Furthermore, we evaluated the prognostic value of 18F -FDG PET-CT in terms of disease free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumor regression grade): 107 (80%) as Responders group (TRG0-TRG1) and 26 (25%) as the No-Responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups responders vs no responders (p<0.012).The results of this analysis have shown that 18F-FDG PET-CT may be an indicator in order to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumor may offer primary information in order to early identify those patients more likely to obtain a pCR to nCRT and predict those unlikely to regress significantly.

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Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer

Discover Oncology ◽

10.1007/s12672-021-00405-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Riccardo Caruso ◽

Emilio Vicente ◽

Yolanda Quijano ◽

Hipolito Duran ◽

Isabel Fabra ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Standardized Uptake Value ◽

Tumour Regression Grade ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. Data description We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.

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The value of liver-based standardized uptake value and other quantitative 18F-FDG PET-CT parameters in neoadjuvant therapy response in patients with locally advanced rectal cancer

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000000342 ◽

2015 ◽

Vol 36 (9) ◽

pp. 898-907 ◽

Cited By ~ 3

Author(s):

Murat Koç ◽

Gamze Ç. Kaya ◽

Yusuf Demir ◽

Erdem Sürücü ◽

Sülen Sarioğlu ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Standardized Uptake Value ◽

Therapy Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Prospective Analysis of18F-FDG PET/CT Predictive Value in Patients with Low Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Conservative Surgery

BioMed Research International ◽

10.1155/2014/952843 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Artor Niccoli-Asabella ◽

Corinna Altini ◽

Raffaele De Luca ◽

Margherita Fanelli ◽

Domenico Rubini ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Odds Ratio ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Low Rectal Cancer ◽

Predictive Tool ◽

Pet Ct ◽

Significant Difference ◽

Fdg Pet Ct

This study prospectively assessed18F-FDG PET/CT in predicting the response of locally advanced low rectal cancer (LRC) to neoadjuvant chemoradiation (nCRT).Methods. 56 patients treated with chemoradiation underwent two18F-FDG PET/CT scans (baseline and 5-6 weeks post-nCRT).18F-FDG uptake (SUVmax and SUVmean) and differences between baseline (SUV1) and post-nCRT (SUV2) scans (ΔSUV and RI%) were evaluated. Results were related to the Mandard’s TRG and (y)pTNM.Results.18F-FDG PET/CT sensitivity, specificity, accuracy, PPV and NPV resulted in 88.6%, 66.7%, 83.92%, 90.7%, and 61.5%. SUV2 resulted in better than SUV1 to predict nCRT response by TRG, with no significant statistical difference between the SUVmax2 and SUVmean2 AUC (0.737 versus 0.736;P=0.928). The same applies to the (y)pTNM (0.798 versus 0.782;P=0.192). In relation to the TRG, RI values had a higher AUC than ΔSUV, with no significant difference between RImax and RImean (0.672 versus 0.695;P=0.292). The same applied to the (y)pTNM (0.742 versus 0.741;P=0.940). In both cases ΔSUV does not appear to be a good predictive tool. Logistic regression confirmed the better predictive role of SUVmax2 for the (y)pTNM (odds ratio = 1.58) and SUVmean2 for the TRG (odds ratio = 1.87).Conclusions.18F-FDG PET/CT can evaluate response to nCRT in LRC, even if more studies are required to define the most significant parameter for predicting pathologic tumor changes.

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Predicting pathologic response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using FDG PET/CT.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.505 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 505-505

Author(s):

S. Shanmugan ◽

R. Arrangoiz ◽

J. R. Nitzkorski ◽

J. Q. Yu ◽

T. Li ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Neoadjuvant Chemoradiation ◽

Pet Ct ◽

Fdg Pet Ct

505 Background: Pathologic complete response (pCR) after neoadjuvant chemoradiation has been observed in 15% to 30% of patients with locally advanced rectal cancer. The utility of FDG PET/CT scans in the management of patients with stage II or III rectal cancer is not well defined. The objective of this study is to determine if FDG PET/CT can be used to predict pCR and disease-free survival in patients receiving neoadjuvant chemoradiation with locally advanced rectal cancer. Methods: A retrospective chart review was conducted in patients with endorectal ultrasound-staged T3 to T4 rectal tumors who underwent preoperative and postoperative FGD PET/CT imaging. All patients were treated with neoadjuvant chemoradiotherapy (CRT). Maximum standardized uptake value (SUV) of each tumor was recorded. Logistic regression was used to analyze the association of pre-CRT SUV, post-CRT SUV, % SUV change, and time between therapy and surgery in comparison to pathological complete response. Kaplan-Meier estimation was used to look for significant predictors of survival. Results: Seventy patients (mean age 62; 42M:28F) with preoperative stage T3Nx (n = 60) and T4Nx (n = 10) underwent pre-CRT and post-CRT FDG PET/CT scans between November 2002 and March 2009. All patients underwent definitive surgery after therapy with standard pathologic evaluation.The pCR rate was 26%. Median pre-CRT SUV was 10.5 while the median post-CRT SUV was 4.05. Patients with pCR had a lower mean post-CRT SUV compared to those without pCR (2.7 vs. 4.5, p = 0.02). Median SUV decrease was 61% (range 6% to 95%) and was significant in predicting pCR (p = 0.004). Patients with a pCR had a greater time interval between neoadjuvant therapy and surgery (median 57 days vs. 50 days) than those without (p = 0.05). Furthermore, patients with post-CRT SUV < 4 had a lower local recurrence rate compared to those with post-CRT SUV > 4 (p = 0.03). Patients with SUV decrease > 61% had improved overall survival at mean follow-up of 39 months than those without (p = 0.01). Conclusions: PET/CT can predict response to neoadjuvant chemoradiation in patients with locally advanced rectal cancer. Pre-CRT SUV was the only predictor of disease-free survival. No significant financial relationships to disclose.

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Change in glucose metabolism measured by 18F-FDG PET/CT as a predictor of histopathologic response to neoadjuvant treatment in rectal cancer

Abdominal Imaging ◽

10.1007/s00261-009-9594-8 ◽

2009 ◽

Vol 36 (1) ◽

pp. 38-45 ◽

Cited By ~ 27

Author(s):

Luca Guerra ◽

Rita Niespolo ◽

Giuseppe Di Pisa ◽

Davide Ippolito ◽

Elena De Ponti ◽

...

Keyword(s):

Rectal Cancer ◽

Glucose Metabolism ◽

Fdg Pet ◽

Neoadjuvant Treatment ◽

Histopathologic Response ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Impact of 18F-FDG-PET/CT on Staging and Irradiation of Patients with Locally Advanced Rectal Cancer

Strahlentherapie und Onkologie ◽

10.1007/s00066-009-1962-3 ◽

2009 ◽

Vol 185 (4) ◽

pp. 260-265 ◽

Cited By ~ 21

Author(s):

Brigita Paskeviciute ◽

Tobias Bölling ◽

Markus Brinkmann ◽

Ganna Rudykina ◽

Iris Ernst ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Response of locally advanced rectal cancer (LARC) to radiochemotherapy: DW-MRI and multiparametric PET/CT in correlation with histopathology

Nuklearmedizin ◽

10.1055/a-0809-4670 ◽

2019 ◽

Vol 58 (01) ◽

pp. 28-38 ◽

Cited By ~ 5

Author(s):

Milena Cerny ◽

Vincent Dunet ◽

Caterina Rebecchini ◽

Dieter Hahnloser ◽

John Prior ◽

...

Keyword(s):

Rectal Cancer ◽

Tumor Cells ◽

Fdg Pet ◽

Locally Advanced ◽

Residual Tumor ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Aim To prospectively evaluate histological significance and predictive value of changes in apparent diffusion coefficient (ADC) and 18F-FDG PET/CT parameters in locally advanced rectal cancer (LARC) after neoadjuvant radiochemotherapy (RCT). Methods Twenty-one patients with untreated LARC underwent pre-RCT and post-RCT 18F-FDG PET/CT and diffusion-weighted magnetic resonance imaging (DW-MRI), followed by surgery. For both datasets, two readers measured the tumor SUVmax, SUVmean, MTV, TLG, ADCmin, ADCmean, and respective differences (∆SUVmax, ∆SUVmean, ∆MTV, ∆TLG, ∆ADCmin, ∆ADCmean) for the whole tumor. Tumor regression grade according to Mandard (TRGm), percentage of residual tumor cells and fibrosis were estimated by two pathologists in consensus. Relationship between parameters was assessed on stepwise multivariate regression analysis and ROC curve analysis to evaluate their performance and predict the treatment response. Results Eighteen LARCs were analyzed. SUVmax and SUVmean decreased from 21.3 ± 8.9 to 9.3 ± 5.5 g/mL, (p = 0.0002) and 12.3 ± 5.1 to 5.4 ± 3.1 g/mL, (p = 0.0002), respectively, after RCT, whereas ADCmin and ADCmean increased from 396 ± 269 to 573 ± 313×10–6 mm2/s (p = 0.014) and 1159 ± 212 to 1355 ± 194×10–6 mm2/s (p = 0.0008), respectively. TRGm and percentage of residual tumor cells independently correlated with post-RCT SUVmean (β = 0.73 and β = 0.76, p < 0.001) and post-RCT SUVmax (β = 0.72 and β = 0.78, p < 0.001), whereas percentage of fibrosis independently correlated with ∆ADCmean (β = 0.38, p = 0.008). Post-RCT, SUVmax and SUVmean performed well in predicting TRGm < 3 and residual tumor cells ≤ 20 %. ΔADCmean predicted fibrosis > 70 % well. Conclusion Post-RCT SUVmean, SUVmax and ∆ADCmean are complementary parameters for respectively evaluating residual tumor burden and amount of fibrosis in LARC. However, only SUV independently correlated with TRGm.

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