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European Journal of Nuclear Medicine and Molecular Imaging

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01.12.2012 | Original Article

Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome

verfasst von: Antonio Avallone, Luigi Aloj, Corradina Caracò, Paolo Delrio, Biagio Pecori, Fabiana Tatangelo, Nigel Scott, Rossana Casaretti, Francesca Di Gennaro, Massimo Montano, Lucrezia Silvestro, Alfredo Budillon, Secondo Lastoria

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 12/2012

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Abstract

Purpose

The aim of the present study is to prospectively evaluate the prognostic value of previously defined [¹⁸F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) criteria of early metabolic response in patients with locally advanced rectal cancer (LARC) after long-term follow-up.

Methods

Forty-two patients with poor prognosis LARC underwent three biweekly courses of chemotherapy with oxaliplatin, raltitrexed and 5-fluorouracil modulated by levofolinic acid during pelvic radiotherapy. FDG PET studies were performed before and 12 days after the beginning of the chemoradiotherapy (CRT) treatment. Total mesorectal excision (TME) was carried out 8 weeks after completion of CRT. A previously identified cutoff value of ≥52 % reduction of the baseline mean FDG standardized uptake value (SUV_mean) was applied to differentiate metabolic responders from non-responders and correlated to tumour regression grade (TRG) and survival.

Results

Twenty-two metabolic responders showed complete (TRG1) or subtotal tumour regression (TRG2) and demonstrated a statistically significantly higher 5-year relapse-free survival (RFS) compared with the 20 non-responders (86 vs 55 %, p = .014) who showed TRG3 and TRG4 pathologic responses. A multivariate analysis demonstrated that early ∆SUV_mean was the only pre-surgical parameter correlated to the likelihood of recurrence (p = .05).

Conclusion

This study is the first prospective long-term evaluation demonstrating that FDG PET is not only an early predictor of pathologic response but is also a valuable prognostic tool. Our results indicate the potential of FDG PET for optimizing multidisciplinary management of patients with LARC.

NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–50.CrossRef

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRef

Avallone A, Delrio P, Lastoria S, Comella P. Chemo-radiotherapy in locally advanced rectal cancer: what is the optimal strategy? Eur J Cancer Suppl 2008;6:70–3.CrossRef

Gunderson LL, Sargent DJ, Tepper JE, Wolmark N, O’Connell MJ, Begovic M, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol 2004;22:1785–96.PubMedCrossRef

Bujko K, Glynne-Jones R, Bujko M. Does adjuvant fluoropyrimidine-based chemotherapy provide a benefit for patients with resected rectal cancer who have already received neoadjuvant radiochemotherapy? A systematic review of randomised trials. Ann Oncol 2010;21:1743–50.PubMedCrossRef

Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23:8688–96.PubMedCrossRef

Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 2005;62:752–60.PubMedCrossRef

Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 2008;15:712–20.PubMedCrossRef

Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro Jr U, Silva e Sousa Jr AH, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004;240:711–7, discussion 717-8.PubMed

10.

Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2008;22:352–8.PubMedCrossRef

11.

MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006;333:779.CrossRef

12.

Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D, et al. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 2006;94:351–7.PubMedCrossRef

13.

Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 2005;48:722–8.PubMedCrossRef

14.

Huh JW, Park YA, Jung EJ, Lee KY, Sohn SK. Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg 2008;207:7–12.PubMedCrossRef

15.

Kubota K. From tumor biology to clinical Pet: a review of positron emission tomography (PET) in oncology. Ann Nucl Med 2001;15:471–86.PubMedCrossRef

16.

Mac Manus MP, Hicks RJ, Matthews JP, McKenzie A, Rischin D, Salminen EK, et al. Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 2003;21:1285–92.PubMedCrossRef

17.

Schelling M, Avril N, Nährig J, Kuhn W, Römer W, Sattler D, et al. Positron emission tomography using [(18)F]fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 2000;18:1689–95.PubMed

18.

Weber WA, Ott K, Becker K, Dittler HJ, Helmberger H, Avril NE, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001;19:3058–65.PubMed

19.

Calvo FA, Domper M, Matute R, Martínez-Lázaro R, Arranz JA, Desco M, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004;58:528–35.PubMedCrossRef

20.

Cascini GL, Avallone A, Delrio P, Guida C, Tatangelo F, Marone P, et al. 18F-FDG PET is an early predictor of pathologic tumor response to preoperative radiochemotherapy in locally advanced rectal cancer. J Nucl Med 2006;47:1241–8.PubMed

21.

Ott K, Weber WA, Lordick F, Becker K, Busch R, Herrmann K, et al. Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction. J Clin Oncol 2006;24:4692–8.PubMedCrossRef

22.

Avallone A, Delrio P, Guida C, Tatangelo F, Petrillo A, Marone P, et al. Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I-II study. Br J Cancer 2006;94:1809–15.PubMedCrossRef

23.

Avallone A, Delrio P, Pecori B, Tatangelo F, Petrillo A, Scott N, et al. Oxaliplatin plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy for locally advanced rectal carcinoma: long-term outcome. Int J Radiat Oncol Biol Phys 2011;79:670–6.PubMedCrossRef

24.

Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73:2680–6.PubMedCrossRef

25.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.CrossRef

26.

Cox DR. Regression models and life-tables. J R Stat Soc Series B Stat Methodol 1972;34:187–220.

27.

Read TE, Andujar JE, Caushaj PF, Johnston DR, Dietz DW, Myerson RJ, et al. Neoadjuvant therapy for rectal cancer: histologic response of the primary tumor predicts nodal status. Dis Colon Rectum 2004;47:825–31.PubMedCrossRef

28.

Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72:99–107.PubMedCrossRef

29.

Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010;11:835–44.PubMedCrossRef

30.

Fietkau R, Barten M, Klautke G, Klar E, Ludwig K, Thomas H, et al. Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 2006;49:1284–92.PubMedCrossRef

31.

Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114–23.PubMedCrossRef

32.

Bujko K, Michalski W, Kepka L, Nowacki MP, Nasierowska-Guttmejer A, Tokar P, et al. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: an analysis of outcomes in a randomized trial. Int J Radiat Oncol Biol Phys 2007;67:369–77.PubMedCrossRef

33.

Gosens MJ, Klaassen RA, Tan-Go I, Rutten HJ, Martijn H, van den Brule AJ, et al. Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clin Cancer Res 2007;13:6617–23.PubMedCrossRef

34.

Garcia-Aguilar J, Smith DD, Avila K, Bergsland EK, Chu P, Krieg RM, et al. Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg 2011;254:97–102.PubMedCrossRef

35.

de Geus-Oei LF, Vriens D, van Laarhoven HW, van der Graaf WT, Oyen WJ. Monitoring and predicting response to therapy with 18F-FDG PET in colorectal cancer: a systematic review. J Nucl Med 2009;50 Suppl 1:43S–54S.PubMedCrossRef

36.

Everaert H, Hoorens A, Vanhove C, Sermeus A, Ceulemans G, Engels B, et al. Prediction of response to neoadjuvant radiotherapy in patients with locally advanced rectal cancer by means of sequential 18FDG-PET. Int J Radiat Oncol Biol Phys 2011;80:91–6.PubMedCrossRef

37.

Janssen MH, Ollers MC, Riedl RG, van den Bogaard J, Buijsen J, van Stiphout RG, et al. Accurate prediction of pathological rectal tumor response after two weeks of preoperative radiochemotherapy using (18)F-fluorodeoxyglucose-positron emission tomography-computed tomography imaging. Int J Radiat Oncol Biol Phys 2010;77:392–9.PubMedCrossRef

38.

Rosenberg R, Herrmann K, Gertler R, Künzli B, Essler M, Lordick F, et al. The predictive value of metabolic response to preoperative radiochemotherapy in locally advanced rectal cancer measured by PET/CT. Int J Colorectal Dis 2009;24:191–200.PubMedCrossRef

39.

Leibold T, Akhurst TJ, Chessin DB, Yeung HW, Macapinlac H, Shia J, et al. Evaluation of (18)F-FDG-PET for early detection of suboptimal response of rectal cancer to preoperative chemoradiotherapy: a prospective analysis. Ann Surg Oncol 2011;18:2783–9.PubMedCrossRef

40.

Capirci C, Rubello D, Chierichetti F, Crepaldi G, Fanti S, Mandoliti G, et al. Long-term prognostic value of 18F-FDG PET in patients with locally advanced rectal cancer previously treated with neoadjuvant radiochemotherapy. AJR Am J Roentgenol 2006;187:W202–8.PubMedCrossRef

41.

Martoni AA, Di Fabio F, Pinto C, Castellucci P, Pini S, Ceccarelli C, et al. Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer. Ann Oncol 2011;22:650–6.PubMedCrossRef

42.

Yeung JM, Kalff V, Hicks RJ, Drummond E, Link E, Taouk Y, et al. Metabolic response of rectal cancer assessed by 18-FDG PET following chemoradiotherapy is prognostic for patient outcome. Dis Colon Rectum 2011;54:518–25.PubMedCrossRef

43.

Ruby JA, Leibold T, Akhurst TJ, Shia J, Saltz LB, Mazumdar M, et al. FDG-PET assessment of rectal cancer response to neoadjuvant chemoradiotherapy is not associated with long-term prognosis: a prospective evaluation. Dis Colon Rectum 2012;55:378–86.PubMedCrossRef

44.

Ott K, Herrmann K, Lordick F, Wieder H, Weber WA, Becker K, et al. Early metabolic response evaluation by fluorine-18 fluorodeoxyglucose positron emission tomography allows in vivo testing of chemosensitivity in gastric cancer: long-term results of a prospective study. Clin Cancer Res 2008;14:2012–8.PubMedCrossRef

45.

Aloj L, Caracò C, Di Gennaro F, Squame E, Imbimbo S, Pecori B, et al. Predictive role of FDG PET-CT in monitoring locally advanced rectal cancer (LARC) during preoperative radiochemotherapy with an experimental bevacizumab schedule. Proceedings of the Annual Meeting of the Society of Nuclear Medicine, Miami Beach, 9–13 June 2012, abstract 569.

46.

Janssen MH, Ollers MC, van Stiphout RG, Buijsen J, van den Bogaard J, de Ruysscher D, et al. Evaluation of early metabolic responses in rectal cancer during combined radiochemotherapy or radiotherapy alone: sequential FDG-PET-CT findings. Radiother Oncol 2010;94:151–5.PubMedCrossRef

47.

Ghadimi BM, Grade M, Difilippantonio MJ, Varma S, Simon R, Montagna C, et al. Effectiveness of gene expression profiling for response prediction of rectal adenocarcinomas to preoperative chemoradiotherapy. J Clin Oncol 2005;23:1826–38.PubMedCrossRef

48.

Watanabe T, Komuro Y, Kiyomatsu T, Kanazawa T, Kazama Y, Tanaka J, et al. Prediction of sensitivity of rectal cancer cells in response to preoperative radiotherapy by DNA microarray analysis of gene expression profiles. Cancer Res 2006;66:3370–4.PubMedCrossRef

49.

Bui T, Thompson CB. Cancer’s sweet tooth. Cancer Cell 2006;9:419–20.PubMedCrossRef

50.

Kim JW, Dang CV. Cancer’s molecular sweet tooth and the Warburg effect. Cancer Res 2006;66:8927–30.PubMedCrossRef

Titel: Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome
verfasst von: Antonio Avallone
Luigi Aloj
Corradina Caracò
Paolo Delrio
Biagio Pecori
Fabiana Tatangelo
Nigel Scott
Rossana Casaretti
Francesca Di Gennaro
Massimo Montano
Lucrezia Silvestro
Alfredo Budillon
Secondo Lastoria
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 12/2012
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-012-2229-2

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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