Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography Journal Article
| Authors: | Guillem, J. G.; Puig-la Calle, J. Jr; Akhurst, T.; Tickoo, S.; Ruo, L.; Minsky, B. D.; Gollub, M. J.; Klimstra, D. S.; Mazumdar, M.; Paty, P. B.; Macapinlac, H.; Yeung, H.; Saltz, L.; Finn, R. D.; Erdi, Y.; Humm, J.; Cohen, A. M.; Larson, S. |
| Article Title: | Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography |
| Abstract: | PURPOSE: The purpose of this prospective study was to determine the ability of fluorine-18 fluorodeoxyglucose positron emission tomography to assess extent of pathologically confirmed rectal cancer response to preoperative radiation and 5-fluorouracil-based chemotherapy. METHODS: Patients with primary rectal cancer deemed eligible for preoperative radiation and 5-fluorouracil-based chemotherapy because of a clinically bulky or tethered tumor or endorectal ultrasound evidence of T3 and/or N1 were prospectively enrolled. Positron emission tomography and CT scans were obtained before preoperative radiation and 5-fluorouracil-based chemotherapy (5,040 cGy to the pelvis and 2 cycles of bolus 5-fluorouracil with leucovorin) and repeated four to five weeks after completion of radiation and 5-fluorouracil-based chemotherapy. In addition to routine pathologic staging, detailed assessment of rectal cancer response to preoperative radiation and 5-fluorouracil-based chemotherapy was performed independently by two pathologists. Positron emission tomography parameters studied included conventional measures such as standardized uptake value (average and maximum), positron emission tomography-derived tumor volume (size), and two novel parameters: visual response score and change in total lesion glycolysis. RESULTS: Of 21 patients enrolled, prospective data (pretreatment and posttreatment positron emission tomography, and complete pathologic assessment) were available on 15 patients. All 15 demonstrated pathologic response to preoperative radiation and 5-fluorouracil-based chemotherapy. This was confirmed in 100 percent of the cases by positron emission tomography compared with 78 percent (7/9) by CT. In addition, one positron emission tomography parameter (visual response score) accurately estimated the extent of pathologic response in 60 percent (9/15) of cases compared with 22 percent (2/9) of cases with CT. CONCLUSIONS: This pilot study demonstrates that fluorine-18 fluorodeoxyglucose positron emission tomography imaging adds incremental information to the preoperative assessment of patients with rectal cancer. However, further studies in a larger series of patients are needed to verify these findings and to determine the value of fluorine-18 fluorodeoxyglucose positron emission tomography in a preoperative strategy aimed at identifying patients suitable for sphincter-preserving rectal cancer surgery. |
| Keywords: | clinical article; cancer surgery; fluorouracil; cancer combination chemotherapy; patient selection; cancer radiotherapy; preoperative care; neoadjuvant therapy; chemotherapy; antineoplastic agent; neoplasm staging; prospective study; prospective studies; radiopharmaceuticals; computer assisted tomography; antimetabolites, antineoplastic; radiotherapy dosage; adenocarcinoma, mucinous; tomography, x-ray computed; furosemide; pilot projects; folinic acid; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; remission induction; preoperative treatment; rectal neoplasms; rectum cancer; glycolysis; rectum surgery; positron emission tomography (pet); rectal cancer; tomography, emission-computed; positive end expiratory pressure; humans; human; article; preoperative radiation |
| Journal Title: | Diseases of the Colon and Rectum |
| Volume: | 43 |
| Issue: | 1 |
| ISSN: | 0012-3706 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2000-01-01 |
| Start Page: | 18 |
| End Page: | 24 |
| Language: | English |
| PUBMED: | 10813118 |
| PROVIDER: | scopus |
| DOI: | 10.1007/BF02237238 |
| DOI/URL: | |
| Notes: | Export Date: 18 November 2015 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work