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Shanmugan S , Arrangoiz R , Nitzkorski JR , Yu JQ , Li TY , Cooper H , Konski A , Farma JM , Sigurdson ER
Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using (18)FDG-PET/CT
Annals of Surgical Oncology. 2012 Jul;19(7) :2178-2185
AbstractPathologic complete response (pCR) after neoadjuvant chemoradiation (CRT) has been observed in 15-30% of patients with locally advanced rectal cancer (LARC). The objective of this study was to determine whether PET/CT can predict pCR and disease-free survival in patients receiving CRT with LARC. This is a retrospective review of patients with EUS-staged T3-T4, N + rectal tumors treated with CRT, who underwent pre/post-treatment PET/CT from 2002-2009. All patients were treated with CRT and surgical resection. 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 CRT and surgery, compared with pCR. Kaplan-Meier estimation evaluated significant predictors of survival. Seventy patients (age 62 years; 42M:28F) with preoperative stage T3 (n = 61) and T4 (n = 9) underwent pre- and post-CRT PET/CT followed by surgery. The pCR rate was 26%. Median pre-CRT SUV was 10.8, whereas the median post-CRT SUV was 4 (P = 0.001). Patients with pCR had a lower median post-CRT SUV compared with those without (2.7 vs. 4.5, P = 0.01). Median SUV decrease was 63% (7.5-95.5%) and predicted pCR (P = 0.002). Patients with a pCR had a greater time interval between CRT and surgery (median, 58 vs. 50 days) than those without (P = 0.02). Patients with post-CRT SUV < 4 had a lower recurrence compared with those without (P = 0.03). Patients with SUV decrease a parts per thousand yen63% had improved overall survival at median follow-up of 40 months than those without (P = 0.006). PET/CT can predict response to CRT in patients with LARC. Posttreatment SUV, %SUV decrease, and greater time from CRT to surgery correlate with pCR. Post-CRT, SUV < 4, and SUV decrease a parts per thousand yen63% were predictive of recurrence-free and overall survival.
NotesShanmugan, Skandan Arrangoiz, Rodrigo Nitzkorski, James R. Yu, Jian Q. Li, Tianyu Cooper, Harry Konski, Andre Farma, Jeffrey M. Sigurdson, Elin R. 35 Springer New york 962ps