Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: A means for determining longterm outcomes of rectal cancer Journal Article
| Authors: | Guillem, J. G.; Moore, H. G.; Akhurst, T.; Klimstra, D. S.; Ruo, L.; Mazumdar, M.; Minsky, B. D.; Saltz, L.; Wong, W. D.; Larson, S. |
| Article Title: | Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: A means for determining longterm outcomes of rectal cancer |
| Abstract: | Background We have previously demonstrated that fluorodeoxyglucose-positron emission tomography (FDG-PET) can assess extent of pathologic response of primary rectal cancer to preoperative chemoradiation. Our goal was to determine the prognostic significance of FDG-PET assessment of rectal cancer response to preoperative chemoradiation. Study design Fifteen patients with locally advanced primary rectal cancer (clinically bulky or tethered, or ultrasound evidence of T3-4 disease, N1 disease, or both) deemed eligible for preoperative radiation and 5-FU-based chemotherapy (5,040 cGy to the pelvis and 2 cycles of bolus 5-FU/leucovorin) were prospectively enrolled from May 1997 to September 1998. FDG-PET was performed before and 4 to 5 weeks after completion of preoperative chemoradiation. FDG-PET parameters included maximum standard uptake value (SUVmax), total lesion glycolysis (TLG), and visual response score. Patients were prospectively followed after operation, and disease status was determined. Results All patients demonstrated some degree of response to preoperative therapy based on pathologic examination. At a median followup of 42 months (range 23 to 54 months), 11 patients had no evidence of disease and 4 had died of disease. The mean percentage decrease in SUVmax (ΔSUVmax) was 69% for patients free from recurrence and 37% for patients with recurrence (p = 0.004). ΔSUVmax ≥ 62.5 and δTLG ≥ 69.5 were the best predictors of no-evidence-of-disease status and freedom from recurrence. Patients with ΔSUVmax ≥ 62.5 and δTLG ≥ 69.5 had significantly improved disease-specific and recurrence-free survival (p = 0.08, 0.02 and p = 0.03, 0.01, respectively). Conclusions Our results indicate that FDG-PET assessment of locally-advanced rectal cancer response to preoperative chemoradiation may predict longterm outcomes. © 2004 by the American College of Surgeons. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; controlled study; treatment outcome; aged; survival analysis; disease course; fluorouracil; patient selection; antineoplastic agents; preoperative care; chemotherapy, adjuvant; combined modality therapy; radiotherapy, adjuvant; follow up; antineoplastic agent; pelvis; prospective study; prospective studies; radiopharmaceuticals; bolus injection; prediction; medical assessment; ultrasound; cancer mortality; imaging system; statistical significance; folinic acid; fdg-pet; computer assisted emission tomography; fluorodeoxyglucose f18; scoring system; long term care; remission induction; recurrent disease; parameter; rectal neoplasms; rectum cancer; glycolysis; fluorodeoxyglucose; tomography, emission-computed; colectomy; suv; total lesion glycolysis; humans; prognosis; human; priority journal; article; standard uptake value; δtlg; cmt; dead of disease; dod; fluorodeoxyglucose-positron emission tomography; ned; no evidence of disease; visual response score; vrs |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 199 |
| Issue: | 1 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2004-07-01 |
| Start Page: | 1 |
| End Page: | 7 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2004.02.024 |
| PROVIDER: | scopus |
| PUBMED: | 15217621 |
| DOI/URL: | |
| Notes: | J. Am. Coll. Surg. -- Cited By (since 1996):130 -- Export Date: 16 June 2014 -- CODEN: JACSE -- Source: Scopus |
