FDG-PET assessment of rectal cancer response to neoadjuvant chemoradiotherapy is not associated with long-term prognosis: A prospective evaluation Journal Article

Authors: Ruby, J. A.; Leibold, T.; Akhurst, T. J.; Shia, J.; Saltz, L. B.; Mazumdar, M.; Riedel, E. R.; Larson, S. M.; Guillem, J. G.
Article Title: FDG-PET assessment of rectal cancer response to neoadjuvant chemoradiotherapy is not associated with long-term prognosis: A prospective evaluation
Abstract: BACKGROUND: At present there is no defined role for routine FDG-PET in the preoperative evaluation of nonmetastatic rectal cancer. OBJECTIVE: The primary objective of this study was to evaluate the ability of FDG-PET to predict long-term prognosis based on the response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. DESIGN: This was a prospective study. SETTINGS: This study was performed at an academic, tertiary care, comprehensive cancer center. PATIENTS: One hundred twenty-seven patients with locally advanced rectal cancer were enrolled between September 1999 and December 2005. INTERVENTIONS: All patients underwent FDG-PET scans before and after neoadjuvant chemoradiotherapy. MAIN OUTCOME MEASURES: FDG-PET parameters were evaluated by at least 2 study board-certified nuclear medicine physicians, and included mean standard uptake value, maximum standard uptake value, total lesion glycolysis, and visual response score. The main outcome measures were time to recurrence and disease-specific survival. RESULTS: Of 127 patients, 82 (65%) were men, the median age was 60 years (range, 27-82), 110 patients had stage II/III disease, and 17 patients had stage IV disease. Median follow-up among survivors was 77 months (range, 1-115 months). Nine patients had unresectable metastatic disease and were excluded from the time-torecurrence analysis. At 5 years, 74% (95% CI = 66%-81%) of patients had not had recurrences (locally and/ or distantly). The 5-year disease-specific survival was 89% (95% CI = 81%-93%). On univariate analysis, visual response score and time to recurrence came closest to having an association (HR = 0.83, 95% CI = 0.68 -1.01, p = 0.06). On multivariate analysis, the visual response score was not significant (p = 0.85). No FDG-PET parameter was associated with diseasespecific survival. CONCLUSIONS: Assessment of rectal cancer response to neoadjuvant chemoradiotherapy by FDG-PET provides no prognostic information. Therefore, serial FDG-PET before and after neoadjuvant chemoradiotherapy should not be performed for this purpose. © The ASCRS 2012.
Keywords: neoadjuvant therapy; positron emission tomography; chemoradiotherapy; rectal cancer; assessment of response
Journal Title: Diseases of the Colon and Rectum
Volume: 55
Issue: 4
ISSN: 0012-3706
Publisher: Lippincott Williams & Wilkins  
Date Published: 2012-04-01
Start Page: 378
End Page: 386
Language: English
DOI: 10.1097/DCR.0b013e318244a666
PROVIDER: scopus
PUBMED: 22426260
Notes: --- - "Export Date: 1 May 2012" - "CODEN: DICRA" - "Source: Scopus"
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MSK Authors
  1. Leonard B Saltz
    592 Saltz
  2. Madhu Mazumdar
    123 Mazumdar
  3. Jose Guillem
    371 Guillem
  4. Tobias Leibold
    11 Leibold
  5. Jinru Shia
    459 Shia
  6. Jeannine Alberts Ruby
    8 Ruby
  7. Timothy J Akhurst
    134 Akhurst
  8. Steven M Larson
    774 Larson