18F-FDG PET bio-metabolic monitoring of neoadjuvant therapy effects in rectal cancer: Focus on nodal disease characteristics

Calvo, Felipe A.; Cabezón, L.; González, Carmen González; Soria, A.; Mata, Dolores de la; Gómez-Espí, M.; García‐Alfonso, Pilar; Álvarez, E.; Carreras, José

doi:10.1016/j.radonc.2010.09.021

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…We excluded six studies because <10 patients with rectal cancer were studied. Thus, 28 studies consisting of a total of 1,204 patients were included in this study5, 6, 13–38 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

Zhang

Tong

Sun

et al. 2012

Intl Journal of Cancer

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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.A standard treatment of locally advanced rectal cancer consists of neo-adjuvant therapy followed by surgery. The preoperative treatment is intended to control pelvic disease and to improve the chance of sphincter preservation during subsequent surgery, thereby improving overall survival and quality of life. Unfortunately, a complete response to neo-adjuvant therapy is noted in only 12-27% 1-3 of patients, while the remaining patients suffer from side effects without effective treatment. Therefore, early evaluation of therapy response is important because it may reduce morbidity and the cost of ineffective treatment as well as explore the feasibility of a response-guided early reorientation treatment in nonresponders. The first study using fluor-18-deoxyglucose-positron emission tomography (FDG-PET) to assess tumour response to

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“…We excluded six studies because <10 patients with rectal cancer were studied. Thus, 28 studies consisting of a total of 1,204 patients were included in this study5, 6, 13–38 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

Zhang

Tong

Sun

et al. 2012

Intl Journal of Cancer

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“…28,[34][35][36][37][38][39][40][41][42] The results were varying and at times contradictory. These studies differ in their design (prospective vs retrospective), PET methodology (including variations in FDG-PET injection timing, PET parameters evaluated, use of PET and/or PET/CT, and interval of time between chemoradiation completion and repeat imaging), and definition of pathological response (the Mandard tumor regression grade 43 vs Dworak grading of regression 44 vs percentage of pathological response categories).…”

Section: Discussionmentioning

confidence: 99%

Neither FDG-PET Nor CT Can Distinguish Between a Pathological Complete Response and an Incomplete Response After Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Guillem¹,

Ruby²,

Leibold³

et al. 2013

Annals of Surgery

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“…The problem lies in the fact that, although it is very specifi c, it is not sensitive enough. It could be recommended for detecting oligometastases in selected cases and for the evaluation of response and follow-up [13,14].…”

Section: Aimsmentioning

confidence: 99%

“…Some studies have published a significant reduction in SUV in responders vs. non-responders. Some authors have defi ned metabolic response as a reduction in SUV of >36% and this has been correlated to pathological response [13,14].…”

Section: How Is the Benefi T Of Neoadjuvant Treatment Evaluated?mentioning

confidence: 99%

Multidisciplinary management in rectal cancer

2010

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The treatment of rectal cancer has evolved over the last few decades from surgery alone to treatments with trimodal therapy for high-risk patients. The involvement of a multidisciplinary team of radiologists, pathologists, surgeons, radiotherapists and medical oncologists is now fundamental for decision-making and outcomes. The evolution of different diagnostic and therapeutic techniques has optimised the therapeutic rate. Future studies will determine the optimal regimen for inducing complete responses in locally advanced disease and whether the intensification of local treatments could enable the use of more conservative treatments, as for other tumour locations. The study of biomarkers will be essential in this respect.

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18F-FDG PET bio-metabolic monitoring of neoadjuvant therapy effects in rectal cancer: Focus on nodal disease characteristics

Cited by 14 publications

References 29 publications

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

Neither FDG-PET Nor CT Can Distinguish Between a Pathological Complete Response and an Incomplete Response After Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Multidisciplinary management in rectal cancer

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18F-FDG PET bio-metabolic monitoring of neoadjuvant therapy effects in rectal cancer: Focus on nodal disease characteristics

Cited by 14 publications

References 29 publications

18F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

18F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

Neither FDG-PET Nor CT Can Distinguish Between a Pathological Complete Response and an Incomplete Response After Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Multidisciplinary management in rectal cancer

Contact Info

Product

Resources

About

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis

¹⁸F‐FDG‐PET evaluation of treatment response to neo‐adjuvant therapy in patients with locally advanced rectal cancer: A meta‐analysis