Dataset Information

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer.

ABSTRACT:

Objective

The comparison of 2-deoxy-2-[18F]fluoro-D-glucose (F-18 FDG) and 3'-deoxy-3'-[18F]fluorothymidine (F-18 FLT) imaging in patients with rectal cancer before and after neoadjuvant radiochemotherapy (RCT) in relation to histopathology and immunohistochemistry obtained from surgery.

Methods

20 consecutive patients (15 m, 5 f), mean age of 65 ± 10 years were included into this prospective study with a mean follow-up of 4.1 ± 0.8 years.

Results

Among histopathological responders (n = 8 out of 20), posttreatment F-18 FLT and F-18 FDG scans were negative in 75 % (n = 6) and 38 % (n = 3), respectively. The mean response index (RI) was 61.0 % ± 14.0 % for F-18 FLT and 58.7 % ± 14.6 % for F-18 FDG imaging. Peritumoral lymphocytic infiltration (CD3 positive cells) was significantly related to posttreatment SUVmax in F-18 FDG but not F-18 FLT studies.

Conclusion

A significant decrease of SUVmax in F-18 FDG and F-18 FLT studies could be seen after RCT. Negative posttreatment F-18 FLT studies identified more histopathological responders.

SUBMITTER: Rendl G

PROVIDER: S-EPMC4661213 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Publications

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer.

Rendl Gundula G Rettenbacher Lukas L Holzmannhofer Johannes J Datz Lidwina L Hauser-Kronberger Cornelia C Fastner Gerd G Öfner Dietmar D Sedlmayer Felix F Pirich Christian C

Annals of nuclear medicine 20141211 3

<h4>Objective</h4>The comparison of 2-deoxy-2-[18F]fluoro-D-glucose (F-18 FDG) and 3'-deoxy-3'-[18F]fluorothymidine (F-18 FLT) imaging in patients with rectal cancer before and after neoadjuvant radiochemotherapy (RCT) in relation to histopathology and immunohistochemistry obtained from surgery.<h4>Methods</h4>20 consecutive patients (15 m, 5 f), mean age of 65 ± 10 years were included into this prospective study with a mean follow-up of 4.1 ± 0.8 years.<h4>Results</h4>Among histopathological re ...[more]

PMID: 25503812

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Project description:There is an unmet need for predictive biomarkers of the clinical benefit of antiangiogenic drugs. The aim of the present study was to prospectively evaluate the value of 18F-FDG PET/CT performed during and after preoperative chemoradiotherapy with bevacizumab for the prediction of complete pathologic tumor regression and survival in patients with MRI-defined high-risk locally advanced rectal cancer. Methods: Sixty-one patients treated in a nonrandomized phase II study (BRANCH) with concomitant or sequential (4 d before chemoradiotherapy) administration of bevacizumab with preoperative chemoradiotherapy were included. 18F-FDG PET/CT was performed at baseline, 11 d after the beginning of chemoradiotherapy (early), and before surgery (late). Metabolic changes were compared with pathologic complete tumor regression (TRG1) versus incomplete tumor regression (TRG2-TRG5), progression-free survival, cancer-specific survival, and overall survival. Receiver-operating-characteristic curves were calculated for those 18F-FDG PET/CT parameters that significantly correlated with TRG1. Results: Early total-lesion glycolysis and its percentage change compared with baseline (ΔTLG-early) could discriminate TRG1 from TRG2-TRG5. Only receiver-operating-characteristic analysis of ΔTLG-early showed an area under the curve greater than 0.7 (0.76), with an optimal cutoff at 59.5% (80% sensitivity, 71.4% specificity), for identifying TRG1. Late metabolic assessment could not discriminate between the 2 groups. After a median follow-up of 98 mo (range, 77-132 mo), metabolic responders (ΔTLG-early ≥ 59.5%) demonstrated a significantly higher 10-y progression-free survival (89.3% vs. 63.6%, P = 0.02) and cancer-specific survival (92.9% vs. 72.6%, P = 0.04) than incomplete metabolic responders. Conclusion: Our results suggest that early metabolic response can act as a surrogate marker of the benefit of antiangiogenic therapy. The findings provide further support for the use of early 18F-FDG PET/CT evaluation to predict pathologic response and survival in the preoperative treatment of patients with locally advanced rectal cancer. ΔTLG-early showed the best accuracy in predicting tumor regression and may be particularly useful in guiding treatment-modifying decisions during preoperative chemoradiotherapy based on expected response.

Project description:ObjectiveIn this pilot study, we investigated the feasibility of response prediction using digital [ 18 F]FDG PET/computed tomography (CT) and multiparametric MRI before, during, and after neoadjuvant chemoradiation therapy in locally advanced rectal cancer (LARC) patients and aimed to select the most promising imaging modalities and timepoints for further investigation in a larger trial.MethodsRectal cancer patients scheduled to undergo neoadjuvant chemoradiation therapy were prospectively included in this trial, and underwent multiparametric MRI and [ 18 F]FDG PET/CT before, 2 weeks into, and 6-8 weeks after chemoradiation therapy. Two groups were created based on pathological tumor regression grade, that is, good responders (TRG1-2) and poor responders (TRG3-5). Using binary logistic regression analysis with a cutoff value of P ≤ 0.2, promising predictive features for response were selected.ResultsNineteen patients were included. Of these, 5 were good responders, and 14 were poor responders. Patient characteristics of these groups were similar at baseline. Fifty-seven features were extracted, of which 13 were found to be promising predictors of response. Baseline [T2: volume, diffusion-weighted imaging (DWI): apparent diffusion coefficient (ADC) mean, DWI: difference entropy], early response (T2: volume change, DWI: ADC mean change) and end-of-treatment presurgical evaluation MRI (T2: gray level nonuniformity, DWI: inverse difference normalized, DWI: gray level nonuniformity normalized), as well as baseline (metabolic tumor volume, total lesion glycolysis) and early response PET/CT (Δ maximum standardized uptake value, Δ peak standardized uptake value corrected for lean body mass), were promising features.ConclusionBoth multiparametric MRI and [ 18 F]FDG PET/CT contain promising imaging features to predict response to neoadjuvant chemoradiotherapy in LARC patients. A future larger trial should investigate baseline, early response, and end-of-treatment presurgical evaluation MRI and baseline and early response PET/CT.

Dataset Information

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer.

Objective

Methods

Results

Conclusion

Publications

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer.

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