Abstract
Purpose
To prospectively evaluate the usefulness of 18F-FDG PET/CT) imaging for predicting histopathological response and long-term clinical outcomes in locally advanced rectal cancer (LARC).
Methods
This prospective study included 38 patients with a confirmed diagnosis of LARC (cT3-4 or cN+) who underwent 18F-FDG PET/CT before and after neoadjuvant therapy (NAT). Total mesorectal excision was scheduled 6 weeks after NAT and was followed by an expert histopathological analysis of the surgical specimen. Baseline variables and previously identified maximum FDG standardized uptake value (SUVmax) cut-off values before NAT (SUVmaxPRE ≥6) and after NAT (SUVmaxPOST ≥2), and the absolute and percentage reductions from baseline SUVmax (∆SUVmax <4 and ∆SUVmax% <65 %, respectively) were applied to differentiate patients showing a metabolic tumour response from nonresponders. These features were correlated with tumour regression grade (TRG), disease-free survival (DFS) and overall survival (OS).
Results
Significantly higher 5-year DFS and OS were seen in 19 responders (TRG 3 or 4) than in 19 nonresponders (TRG 0–2; 94.4 vs. 48.8 %, p = 0.001; 94.7 vs. 63.2 %, p = 0.02, respectively). In multivariate analysis the only PET/CT SUVmax-based parameter significantly correlated with the likelihood of recurrence and survival was ∆SUV% <65 % (HR = 5.95, p = 0.02, for DFS; HR = 5.26, p = 0.04, for OS)
Conclusion
This prospective study proved that 18F-FDG PET/CT is a valuable imaging tool for assessing rectal cancer TRG and long-term prognosis, and could potentially serve as an intermediate endpoint in treatment optimization research and rectal cancer patient care.
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This article is discussed in the editorial commentary available at doi:10.1007/s00259-013-2367-1.
Felipe A. Calvo and Claudio V. Sole contributed equally to this work.
Financed in part by a Research Grant from Mutua Madrileña Biomedical, Foundation Institute Health Research Marañon, study code CMF, FMM 06-02.
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Calvo, F.A., Sole, C.V., de la Mata, D. et al. 18F-FDG PET/CT-based treatment response evaluation in locally advanced rectal cancer: a prospective validation of long-term outcomes. Eur J Nucl Med Mol Imaging 40, 657–667 (2013). https://doi.org/10.1007/s00259-013-2341-y
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DOI: https://doi.org/10.1007/s00259-013-2341-y