Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer - 24/08/11
, ⁎ : FACS, Harvey G Moore, MD , Timothy Akhurst, MD †, David S Klimstra, MD ‡, Leyo Ruo, MD , Madhu Mazumdar, PhD §, Bruce D Minsky, MD 
, Leonard Saltz, MD ¶, W Douglas Wong, MD : FACS, Steven Larson, MD † Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Abstract |
Background |
We have previously demonstrated that fluorodeoxyglucose-positron emission tomography (FDG-PET) can assess extent of pathologic response of primary rectal cancer to preoperative chemoradiation. Our goal was to determine the prognostic significance of FDG-PET assessment of rectal cancer response to preoperative chemoradiation.
Study design |
Fifteen patients with locally advanced primary rectal cancer (clinically bulky or tethered, or ultrasound evidence of T3–4 disease, N1 disease, or both) deemed eligible for preoperative radiation and 5-FU-based chemotherapy (5,040 cGy to the pelvis and 2 cycles of bolus 5-FU/leucovorin) were prospectively enrolled from May 1997 to September 1998. FDG-PET was performed before and 4 to 5 weeks after completion of preoperative chemoradiation. FDG-PET parameters included maximum standard uptake value (SUVmax), total lesion glycolysis (TLG), and visual response score. Patients were prospectively followed after operation, and disease status was determined.
Results |
All patients demonstrated some degree of response to preoperative therapy based on pathologic examination. At a median followup of 42 months (range 23 to 54 months), 11 patients had no evidence of disease and 4 had died of disease. The mean percentage decrease in SUVmax (ΔSUVmax) was 69% for patients free from recurrence and 37% for patients with recurrence (p = 0.004). ΔSUVmax ≥ 62.5 and δTLG ≥ 69.5 were the best predictors of no-evidence-of-disease status and freedom from recurrence. Patients with ΔSUVmax ≥ 62.5 and δTLG ≥ 69.5 had significantly improved disease-specific and recurrence-free survival (p = 0.08, 0.02 and p = 0.03, 0.01, respectively).
Conclusions |
Our results indicate that FDG-PET assessment of locally-advanced rectal cancer response to preoperative chemoradiation may predict longterm outcomes.
Le texte complet de cet article est disponible en PDF.Abbreviations : CMT, DOD, FDG-PET, NED, SUV, VRS, δTLG
Plan
 | This work was supported, in part, by the Gerschel Foundation and the National Cancer Institute, RO1 CA 82534-01, awarded to Jose G Guillem, MD, MPH, FACS. |
Vol 199 - N° 1
P. 1-7 - juillet 2004 Retour au numéro
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