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Gao PF, Lu N, Liu W. MRI VS. FDG-PET for diagnosis of response to neoadjuvant therapy in patients with locally advanced rectal cancer. Front Oncol 2023; 13:1031581. [PMID: 36741013 PMCID: PMC9890074 DOI: 10.3389/fonc.2023.1031581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Aim In this study, we aimed to compare the diagnostic values of MRI and FDG-PET for the prediction of the response to neoadjuvant chemoradiotherapy (NACT) of patients with locally advanced Rectal cancer (RC). Methods Electronic databases, including PubMed, Embase, and the Cochrane library, were systematically searched through December 2021 for studies that investigated the diagnostic value of MRI and FDG-PET in the prediction of the response of patients with locally advanced RC to NACT. The quality of the included studies was assessed using QUADAS. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and the area under the ROC (AUC) of MRI and FDG-PET were calculated using a bivariate generalized linear mixed model, random-effects model, and hierarchical regression. Results A total number of 74 studies with recruited 4,105 locally advanced RC patients were included in this analysis. The pooled sensitivity, specificity, PLR, NLR, and AUC for MRI were 0.83 (95% CI: 0.77-0.88), 0.85 (95% CI: 0.79-0.89), 5.50 (95% CI: 4.11-7.35), 0.20 (95% CI: 0.14-0.27), and 0.91 (95% CI: 0.88-0.93), respectively. The summary sensitivity, specificity, PLR, NLR and AUC for FDG-PET were 0.81 (95% CI: 0.77-0.85), 0.75 (95% CI: 0.70-0.80), 3.29 (95% CI: 2.64-4.10), 0.25 (95% CI: 0.20-0.31), and 0.85 (95% CI: 0.82-0.88), respectively. Moreover, there were no significant differences between MRI and FDG-PET in sensitivity (P = 0.565), and NLR (P = 0.268), while the specificity (P = 0.006), PLR (P = 0.006), and AUC (P = 0.003) of MRI was higher than FDG-PET. Conclusions MRI might superior than FGD-PET for the prediction of the response of patients with locally advanced RC to NACT.
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Affiliation(s)
- Peng Fei Gao
- Department of Traditional Chinese medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Na Lu
- Department of Radiology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Wen Liu
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China,*Correspondence: Wen Liu,
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2
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Boustani J, Créhange G. [Dose-escalated radiotherapy in esophageal cancer: A review of the literature]. Cancer Radiother 2022; 26:884-889. [PMID: 36008261 DOI: 10.1016/j.canrad.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 10/15/2022]
Abstract
For non-operable, localized esophageal cancer, definitive concurrent chemoradiotherapy is the standard treatment. Currently, the radiation dose recommended is 50 to 50,4Gy. However, the optimal radiation dose remains controversial. Many studies have demonstrated that locoregional failure remains a common failure pattern, most likely to occur within the original gross tumor volume. Several retrospective studies have indicated that higher radiation dose may improve local control and survival while others failed to demonstrate improved oucomes. In three randomized trials (INT0123, ARTDECO, and CONCORDE), dose escalation did not improve locoregional control nor survival, establishing 50Gy as the standard chemoradiation dose for patients who will not undergo surgery. Here, we reviewed the results of dose escalation in the literature in the neoadjuvant and definitive settings.
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Affiliation(s)
- J Boustani
- Département de radiothérapie, Centre hospitalo-universitaire de Besançon, Besançon, France.
| | - G Créhange
- Département de radiothérapie, Institut Curie, Paris, France
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3
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The Correlation between 18F-FDG PET/CT Imaging SUVmax of Preoperative Colon Cancer Primary Lesions and Clinicopathological Factors. JOURNAL OF ONCOLOGY 2021; 2021:4312296. [PMID: 34567115 PMCID: PMC8463203 DOI: 10.1155/2021/4312296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study is to explore the correlation between the 18F-FDG PET/CT imaging maximum standardized uptake value (SUVmax) of preoperative colon cancer primary lesions and clinicopathological factors. Methods 88 colon cancer patients diagnosed by histopathology were collected from January 2014 to December 2015. 18F-FDG PET/CT imaging was performed before surgery. Kaplan–Meier survival analysis was used to assess the prognosis of colon cancer patients. Results The 18F-FDG PET/CT imaging SUVmax value of preoperative colon cancer primary lesion was significantly correlated with the length of the lesion, clinical stage, histopathological type, and the degree of tumor differentiation. The SUVmax value of tumors with long-diameter, ≥ 3 cm, clinically high-stage, adenocarcinoma, and poorly differentiated lesions was significantly high. In addition, the consistency between PET/CT and surgical pathological results at stage I and IV was higher. Stage II and III PET/CT are basically consistent with the pathological results of surgery. Kaplan–Meier survival analysis showed that the 5-year event-free survival rate of the SUVmax > 18.26 group was significantly lower than that of the SUVmax ≤ 18.26 group. Conclusion 18F-FDG PET/CT imaging SUVmax of preoperative colon cancer primary lesions can not only reflect the proliferation and invasion ability but also monitor the recurrence and metastasis of colon cancer.
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4
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Kim JY, Park SG, Kim KS, Choi YH, Kim NK. The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer. Ann Surg Treat Res 2019; 97:83-92. [PMID: 31388510 PMCID: PMC6669127 DOI: 10.4174/astr.2019.97.2.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Preoperative chemoradiation therapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer, 15%–30% of patients still progress while being treated with CRT. The aim of this study was to identify as important biomarker of poor response and evaluate the mechanism associated with CRT resistance. Methods This study included 60 human colon tumour pre-irradiation specimens. Expressions of epidermal growth factor receptor (EGFR), p53, Krüppel-like factor 5 (KLF5), C-ern, Ki67 were assessed and correlated with tumor regression grades and complete remission. We added in vitro study with biomarker which has been identified as important biomarker of poor response to evaluate the mechanism associated with CRT resistance. Results Pathologic complete remission (pCR) was achieved by 9 patients (18%). EGFR and KLF5 were significantly associated with pCR (P = 0.048, P = 0.023, respectfully). And multivariate analysis showed high KLF5 intensity was worse factor for pCR (P = 0.012). In vitro study, radiation or chemotherapy therapy stabilized KLF5 protein levels in a time- and dose-depended manner in HCT116 and Caco-2 cells. KLF5 overexpression in HCT116 stable cell line showed significantly better cell viability by increasing cyclinD1 and b-catenin compared to control cells in MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, suggesting that KLF5 mediates cell survival. Conclusion KLF5 was significantly associated with the presence of KRAS mutations, and KLF5 was an independent poor response predictor of CRT in rectal cancer. Our study is pilot study and more research will be needed in the future.
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Affiliation(s)
- Jeong Yeon Kim
- Department of Surgery, Colorectal Cancer Special Clinic, University Health System, Yonsei University College of Medicine, Seoul, Korea.,Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwasung, Korea
| | - Sung Gil Park
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwasung, Korea
| | - Kyung-Sub Kim
- Department of Biochemistry, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hee Choi
- Department of Pathology, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Colorectal Cancer Special Clinic, University Health System, Yonsei University College of Medicine, Seoul, Korea
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5
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Yu J, Lee SH, Jeung TS, Chang H. Expression of vascular endothelial growth factor as a predictor of complete response for preoperative chemoradiotherapy in rectal cancer. Medicine (Baltimore) 2019; 98:e16190. [PMID: 31261557 PMCID: PMC6617461 DOI: 10.1097/md.0000000000016190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Biomarkers that predict tumor response before surgical treatment are necessary to help select patients for preoperative chemoradiotherapy for rectal cancer. However, no definite predictive biomarker has been established. This study explored programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), p-signal transducer and activator of transcription 3 (p-STAT3), and death-domain associated protein as predictive biomarkers with regard to preoperative chemoradiotherapy in rectal cancer.Formalin-fixed paraffin-embedded cancer tissues from pretreatment biopsies from 31 patients who underwent preoperative chemoradiotherapy were studied. The biomarkers were evaluated by immunohistochemistry.PD-L1 positivity was found in 22.6% of 31 patients and complete response (CR) showed 33.3% and non-CR showed 18.2%. EGFR positivity was found in 71.0% of 31 patients and CR showed 88.9% and non-CR showed 73.6%. VEGF positivity was found in 83.9% of 31 patients and CR showed 88.9% and non-CR showed 81.8%. p-STAT3 positivity was found in 80.6% of 31 patients and CR showed 88.9% and non-CR showed 77.3%. On multiple logistic regression analysis, only VEGF expression was found to be a significant predictive factor for CR (P = .001). VEGF expression in pretreatment biopsies might be a predictive marker for CR after preoperative chemoradiation in rectal cancer.Although there is a restriction of small sample size, our finding suggested that this study can be foundation for a larger further study for biomarkers which can predict neoadjuvant therapy response of specimens obtained for diagnosis before surgery.
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Affiliation(s)
- Jesang Yu
- Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul
| | - Seung-Hyun Lee
- Department of Surgery, Kosin University Gospel Hospital, Busan
| | - Tae Sig Jeung
- Department of Radiation Oncology, Good Sunlin Hospital, Gyeongsangbuk-do
| | - HeeKyung Chang
- Department of Pathology, Kosin University Gospel Hospital, Busan, South Korea
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6
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Avallone A, Aloj L, Pecori B, Caracò C, De Stefano A, Tatangelo F, Silvestro L, Granata V, Bianco F, Romano C, Di Gennaro F, Budillon A, Petrillo A, Muto P, Botti G, Delrio P, Lastoria S. 18F-FDG PET/CT Is an Early Predictor of Pathologic Tumor Response and Survival After Preoperative Radiochemotherapy with Bevacizumab in High-Risk Locally Advanced Rectal Cancer. J Nucl Med 2019; 60:1560-1568. [PMID: 30877175 DOI: 10.2967/jnumed.118.222604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
There is an unmet need for predictive biomarkers of the clinical benefit of antiangiogenic drugs. The aim of the present study was to prospectively evaluate the value of 18F-FDG PET/CT performed during and after preoperative chemoradiotherapy with bevacizumab for the prediction of complete pathologic tumor regression and survival in patients with MRI-defined high-risk locally advanced rectal cancer. Methods: Sixty-one patients treated in a nonrandomized phase II study (BRANCH) with concomitant or sequential (4 d before chemoradiotherapy) administration of bevacizumab with preoperative chemoradiotherapy were included. 18F-FDG PET/CT was performed at baseline, 11 d after the beginning of chemoradiotherapy (early), and before surgery (late). Metabolic changes were compared with pathologic complete tumor regression (TRG1) versus incomplete tumor regression (TRG2-TRG5), progression-free survival, cancer-specific survival, and overall survival. Receiver-operating-characteristic curves were calculated for those 18F-FDG PET/CT parameters that significantly correlated with TRG1. Results: Early total-lesion glycolysis and its percentage change compared with baseline (ΔTLG-early) could discriminate TRG1 from TRG2-TRG5. Only receiver-operating-characteristic analysis of ΔTLG-early showed an area under the curve greater than 0.7 (0.76), with an optimal cutoff at 59.5% (80% sensitivity, 71.4% specificity), for identifying TRG1. Late metabolic assessment could not discriminate between the 2 groups. After a median follow-up of 98 mo (range, 77-132 mo), metabolic responders (ΔTLG-early ≥ 59.5%) demonstrated a significantly higher 10-y progression-free survival (89.3% vs. 63.6%, P = 0.02) and cancer-specific survival (92.9% vs. 72.6%, P = 0.04) than incomplete metabolic responders. Conclusion: Our results suggest that early metabolic response can act as a surrogate marker of the benefit of antiangiogenic therapy. The findings provide further support for the use of early 18F-FDG PET/CT evaluation to predict pathologic response and survival in the preoperative treatment of patients with locally advanced rectal cancer. ΔTLG-early showed the best accuracy in predicting tumor regression and may be particularly useful in guiding treatment-modifying decisions during preoperative chemoradiotherapy based on expected response.
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Affiliation(s)
- Antonio Avallone
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Luigi Aloj
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Biagio Pecori
- Radiotherapy, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Corradina Caracò
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Alfonso De Stefano
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Fabiana Tatangelo
- Pathology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Lucrezia Silvestro
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Vincenza Granata
- Radiology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Francesco Bianco
- Colorectal Oncological Surgery, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy; and
| | - Carmela Romano
- Experimental Clinical Abdominal Oncology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Francesca Di Gennaro
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Alfredo Budillon
- Experimental Pharmacology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Antonella Petrillo
- Radiology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Paolo Muto
- Radiotherapy, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Gerardo Botti
- Pathology, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
| | - Paolo Delrio
- Colorectal Oncological Surgery, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy; and
| | - Secondo Lastoria
- Nuclear Medicine, IRCCS Istituto Nazionale Tumori "Fondazione Giovanni Pascale," Naples, Italy
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7
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Luterstein E, Raldow A, Yang Y, Lee P. Functional Imaging Predictors of Response to Chemoradiation. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Early metabolic response in sequential FDG-PET/CT under cetuximab is a predictive marker for clinical response in first-line metastatic colorectal cancer patients: results of the phase II REMOTUX trial. Br J Cancer 2018; 119:170-175. [PMID: 29961759 PMCID: PMC6048023 DOI: 10.1038/s41416-018-0152-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background To assess the predictive value of early metabolic response (ΔSUV)
after short-term treatment with first-line cetuximab in patients (pts) with RAS-wt
metastatic colorectal cancer (mCRC). Methods In this prospective phase II study, RAS-wt mCRC pts received a
single-agent cetuximab run-in therapy of 2 weeks. ΔSUV was assessed with
FDG-PET/CT on days 0 and 14. Early clinical response (ECR) was evaluated with CT
on day 56 after treatment with FOLFIRI-cetuximab. Primary endpoint was the
predictive significance of ΔSUV for ECR. Secondary endpoints were PFS (progression
free survival), OS and the influence of ΔSUV on survival. Results Forty pts were enroled and 33 pts were evaluable for the primary
endpoint. The CT response rate was 57.6%. For responders, ΔSUV was significantly
higher (p = 0.0092). A significant association
of ΔSUV with ECR was found (p = 0.02). Median
PFS was 11.7 months and median OS was 33.5 months with a 1-year survival rate of
87.9%. ΔSUV was found to significantly impact the hazard for OS (p = 0.045). Conclusions We demonstrate that cetuximab induces metabolic responses in mCRC
pts. The study endpoint was met with the ΔSUV discriminating between responders
and non-responders. However, these data should be validated in larger patient
cohorts.
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Luo Y, Mao Q, Wang X, Yu J, Li M. Radiotherapy for esophageal carcinoma: dose, response and survival. Cancer Manag Res 2017; 10:13-21. [PMID: 29343986 PMCID: PMC5749557 DOI: 10.2147/cmar.s144687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Esophageal cancer (EC) is an extremely aggressive, lethal malignancy that is increasing in incidence worldwide. At present, definitive chemoradiotherapy is accepted as the standard treatment for locally advanced EC. The EC guidelines recommend a radiation dose of 50.4 Gy for definitive treatment, yet the outcomes for patients who have received standard-dose radiotherapy remain unsatisfactory. However, some studies indicate that a higher radiation dose could improve local tumor control, and may also confer survival benefits. Some studies, however, suggest that high-dose radiotherapy does not bring survival benefit. The available data show that most failures occurred in the gross target volume (especially in the primary tumor) after definitive chemoradiation. Based on those studies, we hypothesize that at least for some patients, more intense local therapy may lead to better local control and survival. The aim of this review is to evaluate the radiation dose, fractionation strategies, and predictive factors of response to therapy in functional imaging for definitive chemoradiotherapy in esophageal carcinoma, with an emphasis on seeking the predictive model of response to CRT and trying to individualize the radiation dose for EC patients.
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Affiliation(s)
- Yijun Luo
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Qingfeng Mao
- School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences.,Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaoli Wang
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Jinming Yu
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Minghuan Li
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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10
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Kawai K, Nozawa H, Hata K, Tanaka T, Nishikawa T, Oba K, Watanabe T. Optimal Interval for 18F-FDG-PET After Chemoradiotherapy for Rectal Cancer. Clin Colorectal Cancer 2017; 17:e163-e170. [PMID: 29208445 DOI: 10.1016/j.clcc.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/27/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Although 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) has been increasingly used to evaluate the response to preoperative chemoradiotherapy (CRT) in patients with rectal cancer, the optimal intervals between completion of CRT, PET, and surgery have not been fully investigated. PATIENTS AND METHODS A total of 148 consecutive patients with rectal adenocarcinoma who received CRT followed by FDG-PET and radical surgery were retrospectively analyzed. The association between the FDG-PET maximum standardized uptake value (SUVmax) and pathological response was assessed using a logistic regression model, with a primary focus on the intervals between CRT and PET as well as between PET and surgery. RESULTS The baseline SUVmax showed no association with pathological response (P = .201; area under the curve [AUC] = 0.528), whereas the SUVmax after CRT completion showed a strong association (P < .001; AUC = 0.707). Logistic regression analysis revealed that the ability of the SUVmax to accurately predict pathological good responders was significantly associated with a long CRT-PET interval (≥ 7 weeks; P = .027), but was not affected by the length of PET-surgery interval. In patients with a short CRT-PET interval (< 7 weeks), the ability of the SUVmax to predict good responders was poor (P = .201; AUC = 0.669); however, in patients with long intervals (≥ 7 weeks), the predictive ability markedly improved (P < .001; AUC = 0.879). CONCLUSION A minimum wait time of 7 weeks is recommended before performing FDG-PET after neoadjuvant CRT for rectal cancer to obtain maximal predictive accuracy for pathological response.
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Affiliation(s)
- Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Oba
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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11
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Santos MD, Silva C, Rocha A, Nogueira C, Castro-Poças F, Araujo A, Matos E, Pereira C, Medeiros R, Lopes C. Predictive clinical model of tumor response after chemoradiation in rectal cancer. Oncotarget 2017; 8:58133-58151. [PMID: 28938543 PMCID: PMC5601639 DOI: 10.18632/oncotarget.19651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/18/2017] [Indexed: 12/25/2022] Open
Abstract
Survival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design. CONCLUSION It seems possible to use pretreatment expression of blood and tissue biomarkers, and build a model of tumor response prediction to neoadjuvant chemoradiation in rectal cancer.
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Affiliation(s)
- Marisa D Santos
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Cristina Silva
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Anabela Rocha
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Carlos Nogueira
- Department of Surgery, Digestive Surgery Service, Hospital Center of Porto, Porto, Portugal.,Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Fernando Castro-Poças
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Gastroenterology Service, Hospital Center of Porto, Porto, Portugal
| | - António Araujo
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Service of Medical Oncology, Hospital Center of Porto, Porto, Portugal
| | - Eduarda Matos
- Department of Health Community, Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
| | - Carina Pereira
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Molecular Oncology and Viral Pathology Group, IPO Research Center, Portuguese Oncologic Institute, Porto, Portugal.,Research Department, Portuguese League Against Cancer, Porto, Portugal
| | - Rui Medeiros
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Molecular Oncology and Viral Pathology Group, IPO Research Center, Portuguese Oncologic Institute, Porto, Portugal.,Research Department, Portuguese League Against Cancer, Porto, Portugal.,CEBIMED, Faculty of Health Sciences of Fernando Pessoa, University of Porto, Porto, Portugal
| | - Carlos Lopes
- Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal.,Department of Pathology, Pathological Anatomy Service, Hospital Center of Porto, Porto, Portugal.,Department of Pathology and Molecular Immunology, Abel Salazar Biomedical Science Institute, University of Porto, Porto, Portugal
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12
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Biomarkers that Predict Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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FDG PET/CT Can Assess the Response of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiotherapy: Evidence From Meta-analysis and Systematic Review. Clin Nucl Med 2016; 41:371-5. [PMID: 26914561 DOI: 10.1097/rlu.0000000000001166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Neoadjuvant chemoradiotherapy (CRT) is indicated in locally advanced rectal adenocarcinoma where there is a high risk of local recurrence based on preoperative imaging. Optimal radiological assessment of CRT response is unknown, and metabolic assessment of the tumor has been suggested to gauge response before surgical resection. PATIENTS AND METHODS A systematic search of the MEDLINE database was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to identify papers comparing pre- and post-CRT PET/CT in patients with locally advanced rectal adenocarcinoma with histopathological assessment of tumor regression. Papers were assessed with the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Meta-analysis was performed for response index (RI) and SUVmax post-CRT. RESULTS Ten of 69 studies met inclusion criteria containing a total of 538 patients. Methodological quality was high with low heterogeneity. In all studies, post-CRT PET/CT showed a reduction in SUVmax and the RI irrespective of histological findings. Tumors confirmed to have regressed after CRT had a mean difference of 12.21% higher RI (95% confidence interval, 6.51-17.91; P < 0.00001) compared with nonresponders. Mean difference between pre- and post-CRT SUVmax groups was -2.48 (95% confidence interval, -3.06 to -1.89; P < 0.00001) with histopathological responders having a lower post-CRT SUVmax. CONCLUSIONS The available evidence suggests that PET/CT may be a useful addition to the current imaging modalities in the assessment of treatment response.
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Koo PJ, Kim SJ, Chang S, Kwak JJ. Interim Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict Pathologic Response to Preoperative Chemoradiotherapy and Prognosis in Patients With Locally Advanced Rectal Cancer. Clin Colorectal Cancer 2016; 15:e213-e219. [DOI: 10.1016/j.clcc.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/03/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023]
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Lee DH, Lee JM. Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magn Reson Imaging 2016; 45:21-35. [DOI: 10.1002/jmri.25337] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
| | - Jeong Min Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
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Sotoudeh H, Sharma A, Fowler KJ, McConathy J, Dehdashti F. Clinical application of PET/MRI in oncology. J Magn Reson Imaging 2016; 44:265-76. [DOI: 10.1002/jmri.25161] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 12/31/2015] [Indexed: 12/19/2022] Open
Affiliation(s)
- Houman Sotoudeh
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
| | - Akash Sharma
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
| | - Kathryn J. Fowler
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
| | - Jonathan McConathy
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
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Predictive value of repeated F-18 FDG PET/CT parameters changes during preoperative chemoradiotherapy to predict pathologic response and overall survival in locally advanced esophageal adenocarcinoma patients. Cancer Chemother Pharmacol 2016; 77:723-31. [PMID: 26891957 DOI: 10.1007/s00280-016-2988-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/06/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The goal of the current study was to investigate the predictive and prognostic values of repeated F-18 FDG PET/CT parameter changes for prediction of complete pathologic response (pCR) in patients with adenocarcinoma of locally advanced esophageal cancer (LAEC) who received preoperative concurrent chemoradiotherapy (PCRT). METHODS A total 53 patients with LAEC patients were included in the current study. All patients were evaluated by F-18 FDG PET/CT before and during chemoradiotherapy. The percent changes (∆, %) in F-18 FDG PET/CT parameters were used to predict pCR and to calculate overall survival (OS). The predictive value for pCR of F-18 FDG PET/CT cutoff values was determined by ROC analysis. The prognostic significance was assessed using Kaplan-Meier analysis. RESULTS pCR occurred in 15 patients (28.3 %). When ΔSUVmax > 23.5 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 % and 52.6, respectively. The AUC was 0.750 (95 % CI; 0.612-0.859), and standard error (SE) was 0.0633 (p = 0.0002). ΔMTV resulted in 80 % sensitivity, 76.3 % specificity, and 0.731 AUC (95 % CI; 0.591-0.843, SE = 0.077, p = 0.0027) for cutoff values >25.5 %. When ΔTLG > 44.8 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 and 65.8 %, respectively. The AUC was 0.893 (95 % CI; 0.777-0.961), and SE was 0.0431 (p < 0.0001). Kaplan-Meier analysis showed that high ΔSUVmax, ΔMTV, and ΔTLG were associated with improved OS. CONCLUSION In conclusion, the current study shows the capability of the changes (Δ) in repeated F-18 FDG PET/CT parameters to predict the achievement of pCR during PCRT in LAEC patients. Among the parameters, the ΔSUVmax, ΔMTV, and ΔTLG were predictors for pCR and well associated with OS.
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Value of 18F-FDG PET for Predicting Response to Neoadjuvant Therapy in Rectal Cancer: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2015; 204:1261-8. [DOI: 10.2214/ajr.14.13210] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Altini C, Niccoli Asabella A, De Luca R, Fanelli M, Caliandro C, Quartuccio N, Rubini D, Cistaro A, Montemurro S, Rubini G. Comparison of (18)F-FDG PET/CT methods of analysis for predicting response to neoadjuvant chemoradiation therapy in patients with locally advanced low rectal cancer. ABDOMINAL IMAGING 2015; 40:1190-202. [PMID: 25348731 DOI: 10.1007/s00261-014-0277-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to prospectively investigate the predictive value of (18)F-FDG PET/CT semiquantitative parameters for locally advanced low rectal cancer (LARC) treated by neoadjuvant chemoradiation therapy (nCRT). METHODS 68 patients with LARC had (18)F-FDG PET/CT scans twice (baseline and 5-6 weeks post-nCRT). All patients underwent surgery with preservation of the sphincter 8 weeks later. (18)F-FDG PET/CT analysis was performed by visual response assessment (VRA) and semiquantitative parameters: SUVmax(baseline), SUVmean(baseline), MTV(baseline), TLG(baseline), SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), TLG(post-nCRT); ΔSUVmax and mean and Response indexes (RImax% and RImean%). Assessment of nCRT tumor response was performed according to the Mandard's Tumor Regression Grade (TRG) and (y)pTNM staging on the surgical specimens. Concordances of VRA with TRG, and with (y)pTNM criteria were evaluated by Cohen's K. Results were compared by t student test for unpaired groups. ROC curve analysis was performed. RESULTS VRA analysis of post-nCRT (18)F-FDG PET/CT scan for the (y)pTNM outcome showed sensitivity, specificity, accuracy, PPV, and NPV of 87.5%, 66.7%, 83.8%, 92.5%, and 53.3%, respectively. Concordances of VRA with TRG and with (y)pTNM were moderate. For the outcome variable TRG, the statistical difference between responders and non-responders was significant for SUVmax(post-nCRT) and RImean%; for the outcome variable (y)pTNM, there was a significant difference for MTV(baseline), SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), RImax%, and RImean%. ROC analysis showed better AUCs: for the outcome variable TRG for SUVmax(post-nCRT), SUVmean(post-nCRT), and RImean%; for the outcome variable (y)pTNM for MTVbaseline, SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), RImax%, and RImean%. No significant differences among parameters were found. CONCLUSIONS Qualitative and semiquantitative evaluations for (18)F-FDG PET/CT are the optimal approach; a valid parameter for response prediction has still to be established.
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Affiliation(s)
- Corinna Altini
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
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The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy. Eur J Nucl Med Mol Imaging 2015; 42:657-66. [PMID: 25687534 DOI: 10.1007/s00259-014-2820-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate whether metabolic changes in the primary tumour during and after preoperative radiochemotherapy (RCT) can predict the histopathological response in patients with locally advanced rectal cancer as well as disease-free survival (DFS) and overall survival (OS). METHODS Consecutive patients with cT2-4 N0-2 rectal adenocarcinoma were included. (18)F-FDG PET/CT was performed at baseline, at the end of the second week of RCT (early PET/CT) and before surgery (late PET/CT). The PET/CT results were compared with histopathological data (ypT0 N0 vs. ypT1-4 N0-2 as well as TRG1 vs.TRG2-5) and survival. RESULTS The study included 126 patients. Among 124 patients in whom TNM classification was available, 28 (22.6 %) were ypT0 N0, and among all 126 patients, 31 (24.6 %) were TRG1. The areas under the curve of the early response index (RI) for identifying non-complete pathological response (non-cPR) were 0.74 (95 % CI 0.61 - 0.87) for ypT1-4 N0-2 patients and 0.75 (95 % CI 0.62 - 0.88) for TRG2-5 patients. The optimal cut-off for differentiating patients with non-cPR and cPR was found to be a reduction of 61.2 % (83.1 % sensitivity and 65 % specificity in ypT1-4 N0-2 patients; 85.4 % sensitivity and 65.2 % specificity in TRG2-5 patients). The optimal cut-off for late RI could not be found. The qualitative analysis of images obtained after RCT demonstrated 81.5 % sensitivity and 61.3 % specificity in predicting TRG2-5. After a median follow-up of 68 months, the low number of patients with local/distant recurrence or who had died did not allow the value of PET/CT for predicting DFS and OS to be calculated. CONCLUSION The early assessment of response to RCT by (18)F-FDG PET/CT can predict non-cPR allowing practical modification of preoperative treatment. Conversely, late RI is not sufficiently accurate for guiding the decision as to whether local excision or even observation is appropriate in an individual patient. Qualitative analysis of late PET/CT images is also not sensitive enough alone to rule out the presence of residual disease.
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Li YL, Wu LM, Chen XX, Delproposto Z, Hu JN, Xu JR. Is diffusion-weighted MRI superior to FDG-PET or FDG-PET/CT in evaluating and predicting pathological response to preoperative neoadjuvant therapy in patients with rectal cancer? J Dig Dis 2014; 15:525-37. [PMID: 25060294 DOI: 10.1111/1751-2980.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This meta-analysis aimed to compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) or FDG-PET/computed tomography (CT) in evaluating and predicting pathological response to preoperative neoadjuvant chemoradiotherapy (NCRT) in patients with rectal cancer. METHODS A comprehensive literature research was conducted to identify the relevant studies for this meta-analysis. Combined sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. RESULTS A total of 33 studies including 1564 patients met the inclusion criteria. The pooled sensitivity (81% [95% CI 74-86%] vs 85% [95% CI 75-91%]) and NPV (80% [95% CI 68-89%] vs 91% [95% CI 80-95%]) for FDG-PET or FDG-PET/CT were significantly lower than those for DW-MRI (P < 0.05). No differences were observed in pooled specificity and PPV between DW-MRI and FDG-PET or FDG-PET/CT. Further subgroup analyses showed that DW-MRI had higher sensitivity on adenocarcinomas alone than on those including mucinous-type adenocarcinomas (92% [95% CI 83-99%] vs 76% [95% CI 63-90%], P = 0.00). CONCLUSIONS DW-MRI is superior to FDG-PET or FDG-PET/CT in predicting and evaluating pathological responses to preoperative NCRT in patients with rectal cancer. However, its relatively low specificity and PPV limit its application in clinic, making it currently inappropriate to monitor such patients, especially those with mucinous-type rectal adenocarcinomas.
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Affiliation(s)
- Yu Lai Li
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yuan F, Zhang C, Cui Z, Li X, Li X, Lin W, Yang X. Cervical squamous cell carcinoma with isolated tibial metastasis: A case report and review of the literature. Oncol Lett 2014; 8:2535-2538. [PMID: 25364422 PMCID: PMC4214447 DOI: 10.3892/ol.2014.2540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/23/2014] [Indexed: 11/06/2022] Open
Abstract
Bone metastasis resulting from carcinoma of the cervix is rare, particularly in the isolated distal appendicular bone. A 43-year-old female was diagnosed with a right tibial tumor with progressive right knee pain for three months, which was diagnosed as poorly differentiated metastatic squamous cell carcinoma, and further confirmed by biopsy of the proximal tibia. The patient was diagnosed with cervical squamous cell carcinoma with tibial metastasis following further examination, despite a lack of gynecological symptoms. In contrast to the poor outcome commonly observed in patients with bone metastasis, the patient survived and remained disease-free 41 months after surgical excision of the metastatic tumor and radical hysterectomy followed by chemoradiotherapy. The present case is one of the few documented cases of metastasis to the tibia arising from carcinoma of the uterine cervix and may be the first regarding isolated metastasis at this site.
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Affiliation(s)
- Fang Yuan
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China ; Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Chunmei Zhang
- Reproductive Medicine Center, Peking University Third Hospital, Beijing 100000, P.R. China
| | - Zhumei Cui
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xiang Li
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xia Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Wei Lin
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer. J Cancer Res Clin Oncol 2014; 141:353-9. [DOI: 10.1007/s00432-014-1815-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/26/2014] [Indexed: 01/11/2023]
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Vignali A, Nardi PD. Multidisciplinary treatment of rectal cancer in 2014: Where are we going? World J Gastroenterol 2014; 20:11249-11261. [PMID: 25170209 PMCID: PMC4145763 DOI: 10.3748/wjg.v20.i32.11249] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended. The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.
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Prospective analysis of 18F-FDG PET/CT predictive value in patients with low rectal cancer treated with neoadjuvant chemoradiotherapy and conservative surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:952843. [PMID: 24877151 PMCID: PMC4024401 DOI: 10.1155/2014/952843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 04/09/2014] [Accepted: 04/13/2014] [Indexed: 12/15/2022]
Abstract
This study prospectively assessed 18F-FDG PET/CT in predicting the response of locally advanced low rectal cancer (LRC) to neoadjuvant chemoradiation (nCRT). Methods. 56 patients treated with chemoradiation underwent two 18F-FDG PET/CT scans (baseline and 5-6 weeks post-nCRT). 18F-FDG uptake (SUVmax and SUVmean) and differences between baseline (SUV1) and post-nCRT (SUV2) scans (ΔSUV and RI%) were evaluated. Results were related to the Mandard's TRG and (y)pTNM. Results. 18F-FDG PET/CT sensitivity, specificity, accuracy, PPV and NPV resulted in 88.6%, 66.7%, 83.92%, 90.7%, and 61.5%. SUV2 resulted in better than SUV1 to predict nCRT response by TRG, with no significant statistical difference between the SUVmax2 and SUVmean2 AUC (0.737 versus 0.736; P = 0.928). The same applies to the (y)pTNM (0.798 versus 0.782; P = 0.192). In relation to the TRG, RI values had a higher AUC than ΔSUV, with no significant difference between RImax and RImean (0.672 versus 0.695; P = 0.292). The same applied to the (y)pTNM (0.742 versus 0.741; P = 0.940). In both cases ΔSUV does not appear to be a good predictive tool. Logistic regression confirmed the better predictive role of SUVmax2 for the (y)pTNM (odds ratio = 1.58) and SUVmean2 for the TRG (odds ratio = 1.87). Conclusions. 18F-FDG PET/CT can evaluate response to nCRT in LRC, even if more studies are required to define the most significant parameter for predicting pathologic tumor changes.
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Intraoperative staging by surgeons in patients with rectal cancer after preoperative chemoradiation: diagnostic accuracy and prognostic value. J Cancer Res Clin Oncol 2014; 140:1221-7. [DOI: 10.1007/s00432-014-1657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/19/2014] [Indexed: 01/02/2023]
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Pretreatment expression of 13 molecular markers as a predictor of tumor responses after neoadjuvant chemoradiation in rectal cancer. Ann Surg 2014; 259:508-15. [PMID: 23787217 DOI: 10.1097/sla.0b013e31829b3916] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the predictive value of a number of tissue biomarkers, including proliferating cell nuclear antigen, survivin, thymidine phosphorylase, thymidylate synthase, bax, p53, nuclear factor-kappa B, vascular endothelial growth factor, matrix metalloproteinase-2, matrix metalloproteinase-9, CD133, CD44, and cyclooxygenase-2 with regard to preoperative chemoradiation in rectal cancer. BACKGROUND The ability to predict tumor response before treatment may significantly impact the selection of patients for preoperative chemoradiation therapy for rectal cancer. However, no definite predictive marker is known. METHODS Pretreatment biopsies from 123 patients who underwent preoperative chemoradiation were included. The mRNA levels of 13 biomarkers were analyzed by reverse transcriptase-polymerase chain reaction, with normalization relative to glyceraldehydes 3-phosphate dehydrogenase. Response to treatment was assessed by a 4-point tumor regression grade scale based on the ratio of fibrosis to residual cancer. RESULTS Among the 13 markers, no significant correlations in terms of T downstaging, N downstaging, and tumor-node-metastasis downstaging were observed. On multiple logistic regression analysis, only CD44 expression was found to be significant independent predictive factors for tumor regression grade response [odds ratio, 4.694 (1.155, 17.741), P = 0.030]. CD44 mRNA expression was significantly associated with expressions of the remaining 12 markers (all P < 0.05). Among the 118 patients receiving radical resection, proliferating cell nuclear antigen was the only independent factor to predict pathologic node negative status [odds ratio, 4.328 (1.078, 12.536), P = 0.037]. CONCLUSIONS Elevated CD44 mRNA levels in pretreatment biopsies might be predictive of poor tumor regression after preoperative chemoradiation in rectal cancer. Moreover, the proliferating cell nuclear antigen mRNA level might be predictive of nodal regression.
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Li C, Lan X, Yuan H, Feng H, Xia X, Zhang Y. 18F-FDG PET predicts pathological response to preoperative chemoradiotherapy in patients with primary rectal cancer: a meta-analysis. Ann Nucl Med 2014; 28:436-46. [PMID: 24623152 DOI: 10.1007/s12149-014-0837-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 02/27/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to assess the performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in predicting pathological response to preoperative chemoradiotherapy (CRT) in patients with primary rectal cancer. METHODS Potentially relevant articles were searched in the databases of PubMed and Embase from January 1990 to September 2013. The Quality Assessment for Diagnostic Accuracy Studies criteria was employed to assess the quality of all of the included studies. The pooled sensitivity and specificity were calculated, and the area under the curve of the summary receiver operating characteristic curve was obtained. Subgroup analysis was conducted to explore the sources of heterogeneity. RESULTS Thirty-one eligible studies involving 1527 patients were ultimately included in the meta-analysis. Four main quantitative or qualitative parameters [response index (RI), post-treatment maximum standardized uptake value (SUVmax-post), visual response (VR) and the percentage change in total lesion glycolysis (TLG) before and after CRT (deltaTLG%)] related to PET or positron emission tomography/computed tomography (PET/CT) were assessed for the prediction of histopathological response. The pooled sensitivities of these four parameters were comparable and were 74, 74, 75 and 78%, respectively (P>0.05). The pooled specificity of deltaTLG% was higher than that of the other three parameters (RI, SUVmax-post and VR) and was 81, 66, 64 and 67%, respectively (P<0.05). The results from subgroup analysis showed that the RI and SUVmax-post had higher specificity in predicting tumor regression grade (TRG) than complete pathological response (pCR) [RI, 71 vs. 59% (P=0.0275); SUVmax-post, 72 vs. 61% (P=0.0178)].The diagnostic sensitivity and specificity of the RI and SUVmax-post when the post-treatment PET or PET/CT scan was performed at two different time points (during CRT and after the completion of CRT) were 82 vs. 72% (P=0.0630) and 78 vs. 63% (P=0.0059), respectively. CONCLUSIONS 18F-FDG PET could be a potentially powerful non-invasive tool for predicting pathological response; the related parameters RI and SUVmax-post may be more suitable for the prediction of TRG than pCR. The current data also suggested that the optimum post-treatment 18F-FDG PET scan could be carried out during CRT.
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Affiliation(s)
- Chongjiao Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, No. 1277, Jiefang Ave., Wuhan, Hubei, People's Republic of China
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Dehdashti F, Grigsby PW, Myerson RJ, Nalbantoglu I, Ma C, Siegel BA. Positron emission tomography with [(18)F]-3'-deoxy-3'fluorothymidine (FLT) as a predictor of outcome in patients with locally advanced resectable rectal cancer: a pilot study. Mol Imaging Biol 2013; 15:106-13. [PMID: 22684813 DOI: 10.1007/s11307-012-0566-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This pilot study was performed to evaluate whether tumor uptake of (18)F-labeled 3'-deoxy-3'fluorothymidine (FLT), a proliferative radiotracer, at baseline and early during therapy, is predictive of outcome in locally advanced rectal cancer. PROCEDURES Fourteen patients underwent positron emission tomography (PET) with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) and FLT before therapy and PET with FLT approximately 2 weeks after initiating neoadjuvant chemoradiotherapy. FLT and FDG uptake were evaluated qualitatively and by maximum standardized uptake value (SUV(max)). Tumor FLT and FDG uptake were correlated with disease-free survival (DFS). RESULTS Thirteen patients underwent surgery after therapy, one died before surgery with progressive disease. FDG-PET/computed tomography detected regional lymph node metastases in five and FLT-PET was positive in one. High pretherapy FDG uptake (SUV(max) ≥ 14.3), low during-therapy FLT uptake (SUV(max) < 2.2), and high percentage change in FLT uptake (≥60 %) were predictive of improved DFS (p < 0.05 for all three values). CONCLUSION Pretherapy FDG uptake, during-therapy FLT uptake, and percentage change in FLT uptake were equally predictive of DFS.
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Affiliation(s)
- Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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Nardi PD, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? World J Gastroenterol 2013; 19:5964-5972. [PMID: 24106396 PMCID: PMC3785617 DOI: 10.3748/wjg.v19.i36.5964] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/21/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced rectal cancer, neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30% of cases. After proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term survival. Several authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively, however to identify patients with true complete pathological response before surgical resection remains a challenge. Current imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer, however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis, deep stroma alteration, wall thickness, muscle disarrangement, tumor necrosis, calcification, and inflammatory infiltration. As a result, the same imaging techniques, when used for restaging, are far less accurate. Local tumor extent may be overestimated or underestimated. The diagnostic accuracy of clinical examination, rectal ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography using 18F-fluoro-2’-deoxy-D-glucose ranges between 25% and 75% being less than 60% in most studies, both for rectal wall invasion and for lymph nodes involvement. In particular the ability to predict complete pathological response, in order to tailor the surgical approach, remains low. Due to the radio-induced tissue modifications, combined with imaging technical aspects, low rate accuracy is achieved, making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.
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Kim JW, Kim HC, Park JW, Park SC, Sohn DK, Choi HS, Kim DY, Chang HJ, Baek JY, Kim SY, Kim SK, Oh JH. Predictive value of (18)FDG PET-CT for tumour response in patients with locally advanced rectal cancer treated by preoperative chemoradiotherapy. Int J Colorectal Dis 2013; 28:1217-24. [PMID: 23404344 DOI: 10.1007/s00384-013-1657-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Although (18)fluorine-2-deoxy-D-glucose positron emission tomography-computed tomography ((18)FDG PET-CT) is considered a reliable modality for determining tumour response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC), the role of (18)FDG PET-CT for predicting pathologic complete response (pCR) remains unclear. The aim of this study was to evaluate whether (18)FDG PET-CT can predict tumour response after CRT in patients with LARC, in terms of downstaging and pCR. METHODS Between March 2009 and February 2012, 151 patients with LARC treated with neoadjuvant CRT followed by radical surgery were reviewed retrospectively. Pre-CRT SUVmax (maximum standardized uptake value), post-CRT SUVmax, ΔSUVmax (difference between pre- and post-CRT SUVmax), and RI-SUV (response index) were measured before and after CRT. Univariate and multivariate analyses were used to analyse the association of PET-CT-related parameters and clinical variables, to assess downstaging and pCR. RESULTS Downstaging occurred in 48 patients (31.7 %) and pCR in 19 patients (12.5 %). Univariate and multivariate analysis revealed post-CRT SUVmax as a significant factor for prediction of downstaging, with sensitivity of 60.4 %, specificity of 65.0 %, and accuracy of 55.9 %, for a cutoff value of 3.70. Regarding pCR, post-CRT SUVmax was again found as a significant parameter by univariate and multivariate analysis, with sensitivity of 73.7 %, specificity of 63.7 %, and accuracy of 64.9 %, for a cutoff value of 3.55. CONCLUSIONS The results indicate that post-CRT SUVmax independently predicts downstaging and pCR. However, the predictive values of post-CRT SUVmax for tumour response after neoadjuvant CRT are too low in sensitivity and specificity to change the treatment plan for LARC.
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Affiliation(s)
- Jong Wan Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu-1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea
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Sun W, Xu J, Hu W, Zhang Z, Shen W. The role of sequential 18(F) -FDG PET/CT in predicting tumour response after preoperative chemoradiation for rectal cancer. Colorectal Dis 2013; 15:e231-8. [PMID: 23384167 DOI: 10.1111/codi.12165] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/19/2012] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate the potential of sequential positron emission tomography (PET)/CT standardized uptake value (SUV)/metabolic area variation in predicting the pathological response to preoperative chemoradiotherapy (CRT) for rectal cancer. METHOD Fifty-three patients diagnosed with clinical T3-4 and/or N+ rectal cancer were enrolled. All patients received CRT followed by radical surgery after 6-8 weeks. A PET/CT scan was performed before (PET/CT1) initiation of treatment and a second scan (PET/CT2) was performed within 1 week after the completion of CRT. Thirty-five of 53 patients also underwent a third (PET/CT3) scan within 1 week before surgery. Maximal SUV within the tumour (SUVmax), average SUV within the tumour (SUVmean), metabolic tumour volume (MV), total lesion glycolysis (TLG) and response indices (∆%, i.e. the percentage difference between two different PET/CT scans for SUVmax, SUVmean, MV and TLG) were calculated. The different metabolic parameters were analysed and correlated with the tumour regression grade (TRG) score. RESULTS When patients were regrouped as responders (TRG 3-4) and nonresponders (TRG 0-2), significant differences were observed in the percentage differences between PET/CT1 and PET/CT3 for MV (∆%MV(1-3); 91.08% vs 75.43%) and for TLG (∆%TLG(1-3); 94.00% vs 82.02%). As demonstrated by receiver-operating characteristics analysis, ∆%MV(1-3) and ∆%TLG(1-3) both had a strong capability to discriminate between responders and nonresponders. Patients classified as having a pathological complete response (pCR) and a non-pCR showed significant differences in the percentage difference between PET/CT1 and PET/CT3 in SUVmax (∆% SUVmax(1-3); 69.17% vs 57.77%), SUVmean (∆% SUVmean(1-3); 44.20% vs 30.19%), ∆%MV(1-3) (90.93% vs 80.30%) and ∆%TLG(1-3) (94.22% vs 85.63%). ∆%TLG (1-3) was a more powerful discriminator than the others. CONCLUSION Differences in the SUV/metabolic area with 18F-fluorodeoxyglucose (18(F) -FDG) PET/CT have the potential to predict a response to preoperative CRT for rectal cancer.
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Affiliation(s)
- W Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Li J, Xiao Y. Application of FDG-PET/CT in Radiation Oncology. Front Oncol 2013; 3:80. [PMID: 23596565 PMCID: PMC3622875 DOI: 10.3389/fonc.2013.00080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/28/2013] [Indexed: 01/19/2023] Open
Abstract
Positron emission tomography (PET)/computed tomography (CT), which combines the advantages of high sensitivity and specificity of PET and high resolution of CT, is a unique tool for cancer management. PET/CT has been widely used in cancer diagnosis and treatment. The article reviews the recent applications of PET/CT in radiation oncology, with a focus on 18F-fluorodeoxyglucose (FDG)-PET/CT, addressing the applications in treatment planning and treatment response assessment of radiation therapy.
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Affiliation(s)
- Jun Li
- Department of Radiation Oncology, Thomas Jefferson University Philadelphia, PA, USA
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Maffione AM, Ferretti A, Grassetto G, Bellan E, Capirci C, Chondrogiannis S, Gava M, Marzola MC, Rampin L, Bondesan C, Colletti PM, Rubello D. Fifteen different 18F-FDG PET/CT qualitative and quantitative parameters investigated as pathological response predictors of locally advanced rectal cancer treated by neoadjuvant chemoradiation therapy. Eur J Nucl Med Mol Imaging 2013; 40:853-64. [PMID: 23417501 DOI: 10.1007/s00259-013-2357-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/24/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to correlate qualitative visual response and various PET quantification factors with the tumour regression grade (TRG) classification of pathological response to neoadjuvant chemoradiotherapy (CRT) proposed by Mandard. METHODS Included in this retrospective study were 69 consecutive patients with locally advanced rectal cancer (LARC). FDG PET/CT scans were performed at staging and after CRT (mean 6.7 weeks). Tumour SUVmax and its related arithmetic and percentage decrease (response index, RI) were calculated. Qualitative analysis was performed by visual response assessment (VRA), PERCIST 1.0 and response cut-off classification based on a new definition of residual disease. Metabolic tumour volume (MTV) was calculated using a 40 % SUVmax threshold, and the total lesion glycolysis (TLG) both before and after CRT and their arithmetic and percentage change were also calculated. We split the patients into responders (TRG 1 or 2) and nonresponders (TRG 3-5). RESULTS SUVmax MTV and TLG after CRT, RI, ΔMTV% and ΔTLG% parameters were significantly correlated with pathological treatment response (p < 0.01) with a ROC curve cut-off values of 5.1, 2.1 cm(3), 23.4 cm(3), 61.8 %, 81.4 % and 94.2 %, respectively. SUVmax after CRT had the highest ROC AUC (0.846), with a sensitivity of 86 % and a specificity of 80 %. VRA and response cut-off classification were also significantly predictive of TRG response (VRA with the best accuracy: sensitivity 86 % and specificity 55 %). In contrast, assessment using PERCIST was not significantly correlated with TRG. CONCLUSION FDG PET/CT can accurately stratify patients with LARC preoperatively, independently of the method chosen to interpret the images. Among many PET parameters, some of which are not immediately obtainable, the most commonly used in clinical practice (SUVmax after CRT and VRA) showed the best accuracy in predicting TRG.
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Zhang C, Tong J, Sun X, Liu J, Wang Y, Huang G. 18F-FDG-PET evaluation of treatment response to neo-adjuvant therapy in patients with locally advanced rectal cancer: a meta-analysis. Int J Cancer 2012; 131:2604-11. [PMID: 22447461 DOI: 10.1002/ijc.27557] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/16/2012] [Accepted: 03/19/2012] [Indexed: 12/16/2022]
Abstract
The purpose of this meta-analysis was to evaluate the utility of positron emission tomography (PET) using fluor-18-deoxyglucose (FDG) to predict the response of rectal cancer to neo-adjuvant therapy. All previously published studies on the role of FDG-PET in predicting the response of rectal cancer to neo-adjuvant therapy were collected. Pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using statistical software. A total of 28 studies, comprising 1,204 patients with rectal cancer, were included in the meta-analysis. Pooled sensitivity, specificity, PPV and NPV for FDG-PET predicting the response to therapy was 78% [95% confidence interval (CI): 75-82%], 66% (95% CI: 62-69%), 70% (95% CI; 66-73%) and 75% (95% CI: 71-0.79%), respectively. The included studies were of a relatively high methodological quality according to the QUADAS (quality assessment of studies of diagnostic accuracy included in systematic reviews) criteria. Based on the subgroup analyses, there was no significant difference between the response index, the standardized uptake value and the visual response score in predicting the therapy response. However, the accuracy of the group that underwent PET scanning during therapy showed significantly higher values (sensitivity 86% and specificity 80%) than the group that was scanned after completion of the therapy. Therefore, FDG-PET is valuable for predicting the response of rectal carcinoma to neo-adjuvant therapy, and early evaluation of response during the therapy may be more promising. However, additional studies using prospective clinical trials will be required to assess the clinical benefit of this strategy.
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Affiliation(s)
- Chenpeng Zhang
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Sherriff JM, Ogunremi B, Colley S, Sanghera P, Hartley A. The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemoradiotherapy. Br J Radiol 2012; 85:e1120-6. [PMID: 22744325 DOI: 10.1259/bjr/20976707] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Positron emission tomography with CT (PET/CT) scanning is increasingly being used in head and neck cancer to assess response after radical concomitant chemoradiotherapy. The purpose of this study was to assess the use of PET/CT following chemoradiotherapy at our institution. METHODS All patients receiving radical chemoradiotherapy for head and neck cancer over a 9-year period were retrospectively identified. Outcome data including local control and overall survival were collected for all patients. The negative predictive value of PET/CT for local recurrence was calculated. Of those with a reported positive PET/CT scan the maximum standardised uptake values were compared with the incidence of local recurrence. RESULTS 92 patients were identified having a post-treatment PET/CT from a total of 301 patients receiving radical concomitant chemoradiotherapy. Median time from completion of chemoradiotherapy to PET/CT scan was 3 (range 2-8) months. Median follow-up in surviving patients was 19 and 25 months in the PET/CT and non-PET/CT groups, respectively. The negative predictive value for local recurrence was 91.8%. The median maximum standardised uptake values were 10.2 (range 3.1-33) and 6.89 (range 3.1-30) in those with local recurrence and with no local recurrence, respectively. CONCLUSIONS Post-chemoradiotherapy PET/CT may aid subsequent management decisions. Patients with a negative PET/CT scan after radical chemoradiotherapy have a 91.8% chance of remaining free of local recurrence 19 months post-treatment. A higher maximum standardised uptake value on the post-chemoradiotherapy PET/CT may predict subsequent local recurrence and warrants further investigation. Advances in knowledge Post-chemoradiotherapy PET/CT imaging aids subsequent management decisions.
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Affiliation(s)
- J M Sherriff
- Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
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Abstract
The ongoing diversification of treatment strategies for rectal cancer justifies the demand for highly specialized radiological imaging. Currently, numerous studies have underlined the ability of magnetic resonance imaging (MRI) to determine those parameters that are critical for therapeutic decision-making and prognosis in rectal cancer. Computed tomography (CT) does not meet the criteria of a first line diagnostic procedure with regard to local staging but will remain the workhorse in the search for distant metastases. The increasing acceptance of extended MRI-based concepts will, however, improve cost-effectiveness and simplify patient management. Response evaluation and detection of recurrent disease are the major indications for positron emission tomography (PET)/CT, which is currently not routinely recommended.
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