Evaluation of 18F-FDG-PET for early detection of suboptimal response of rectal cancer to preoperative chemoradiotherapy: A prospective analysis Journal Article

Authors: Leibold, T.; Akhurst, T. J.; Chessin, D. B.; Yeung, H. W.; Macapinlac, H.; Shia, J.; Minsky, B. D.; Saltz, L. B.; Riedel, E.; Mazumdar, M.; Paty, P. B.; Weiser, M. R.; Wong, W. D.; Larson, S. M.; Guillem, J. G.
Article Title: Evaluation of 18F-FDG-PET for early detection of suboptimal response of rectal cancer to preoperative chemoradiotherapy: A prospective analysis
Abstract: Background: Early identification of inadequate response to preoperative chemoradiotherapy (CRT) may spare rectal cancer patients the toxicity of ineffective treatment. We prospectively evaluated tumor response with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) early in the course of preoperative CRT. Methods: A total of 27 prospectively accrued patients with locally advanced rectal cancer (T3-4/N1) received preoperative CRT (5040 cGy + 5FU-based chemotherapy). Patients underwent PET scanning before and 8-14 days after commencement of CRT. Scans were interpreted using 3 standard parameters: SUVmax, SUV avg, and total lesion glycolysis (TLG) as well as an investigational parameter: visual response score (VRS). Percent pathologic response was quantified as a continuous variable. All PET parameters were correlated with pathology. Pathologic complete/near-complete response was defined as ≥95% tumor destruction, suboptimal response as <95%. Statistical analysis was performed using the Wilcoxon rank sum test and receiver operating characteristic (ROC) curve analysis. Results: Of the 27 patients, 11 (41%) had pathologic complete/near-complete response; 16 (59%) had suboptimal response. SUV max, SUVavg, and TLG did not discriminate between responders and nonresponders. Visual response score (VRS) was statistically significantly higher for complete/near-complete responders than for suboptimal responders (65 vs. 33%, P = 0.02). Suboptimal responders were identified with 94% sensitivity and 78% accuracy using a VRS cut-off of 50%. Conclusions: In this pilot study, FDG-PET at 8-14 days after the beginning of preoperative CRT was unsuccessful at predicting pathological response with enough accuracy to justify an early change in therapy. © 2011 Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 18
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2011-10-01
Start Page: 2783
End Page: 2789
Language: English
DOI: 10.1245/s10434-011-1634-2
PROVIDER: scopus
PUBMED: 21476107
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 3 October 2011" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. David Brian Chessin
    23 Chessin
  2. Leonard B Saltz
    592 Saltz
  3. Philip B Paty
    372 Paty
  4. Bruce Minsky
    262 Minsky
  5. Madhu Mazumdar
    123 Mazumdar
  6. Henry W D Yeung
    127 Yeung
  7. Jose Guillem
    371 Guillem
  8. Tobias Leibold
    11 Leibold
  9. Jinru Shia
    459 Shia
  10. Martin R Weiser
    344 Weiser
  11. Timothy J Akhurst
    134 Akhurst
  12. Steven M Larson
    774 Larson
  13. Douglas W Wong
    173 Wong