18F-FDG PET/CT-based treatment response evaluation in locally advanced rectal cancer: a prospective validation of long-term outcomes

Calvo, Felipe A.; Sole, Claudio V.; Mata, Dolores de la; Cabezón, L.; Gómez-Espí, M.; Álvarez, E.; Madariaga, P.; Carreras, José

doi:10.1007/s00259-013-2341-y

Cited by 31 publications

(21 citation statements)

References 29 publications

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“…The current standard method for discriminating responders from nonresponders to preoperative RCT is histopathological analysis, but this method is applicable only in a postoperative setting and consequently cannot be used for tailoring therapy. Therefore, there is growing interest in noninvasive methods suitable for the prediction of pathological response and also clinical outcome, such as PET/CT using 18 F-FDG [17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy

Leccisotti

Gambacorta

Waure

et al. 2015

Eur J Nucl Med Mol Imaging

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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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Section: Introductionmentioning

confidence: 99%

The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy

Leccisotti

Gambacorta

Waure

et al. 2015

Eur J Nucl Med Mol Imaging

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“…But does it also have a role in early prognosis? In this issue of the European Journal of Nuclear Medicine and Molecular Imaging, [24] et al confirm a role for 18 F-FDG PET/CT imaging in predicting histopathologic response and clinical long-term outcomes in locally advanced rectal cancer. Moreover, they demonstrate that a standardized uptake value (SUV)-based evaluation of tumour metabolism at 5 weeks after the end of radiotherapy (performed as a part of a neoadjuvant regimen) is able not only to predict the regression of tumours in pathology specimens, but also to prospectively identify a strong correlation with patients' longterm outcome, between responders and non-responders, in terms of PFS and OS.…”

Section: Neoadjuvant and Adjuvant Crt In Resectable Rectal Cancermentioning

confidence: 98%

“…Generally speaking, SUV (maximum SUV, mean SUV, total glycolytic activity and so on) is a semi-quantitative measure of tissue glucose utilization in cancer. For this reason, SUV and SUV modifications have been extensively used in different types of cancer for diagnosis, staging, prognosis and evaluation of local or distant relapse [24,25], although the superiority of SUV versus visual analysis has not always been demonstrated [26]. Even though higher-grade and less differentiated tumours are generally associated with higher levels of FDG accumulation, in diagnostic settings there can be a significant overlap in SUV values between cancer and other non-malignant diseases [27]; moreover, the existence of tumours characterized by low degrees of FDG uptake is well known [28].…”

Section: Is the Time Ripe For Suv-based Diagnostic Algorithms?mentioning

confidence: 99%

The emerging role of FDG PET/CT in rectal cancer management: is it time to use the technique for early prognostication?

Tagliabue

2013

Eur J Nucl Med Mol Imaging

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# Springer-Verlag Berlin Heidelberg 2013 Colorectal cancer is the second leading cause of death and the fourth most commonly diagnosed cancer in the USA [1]. One form, rectal cancer, defined as cancer growing within 12 cm of the anal verge [2], is challenging because of its unique anatomical characteristics, critical position and therapeutic options (aimed at preserving pelvic floor integrity, sphincter continence and genitourinary functions). General considerations and staging proceduresWhen a patient is diagnosed with rectal cancer, staging procedures, performed to evaluate global and specific therapeutic risk, include: complete bowel endoscopy (to identify possible synchronous tumours), rigid proctoscopy (to establish the exact level of the lesion), carcinoembryonic antigen (CEA) test and a full clinical examination (to determine performance status). Moreover, for a complete evaluation of the disease, including possible distant metastases, a contrast-enhanced (ce) CT of the thorax, abdomen and pelvis, with administration of oral and IV contrast media, must also be performed. In some circumstances, rectal wall invasion and the presence of pathologic lymph nodes can be assessed by endoscopic ultrasound (EUS) and ceMRI of the pelvis [3]. In a meta-analysis of 90 studies, performed to compare the clinical performance of EUS, MRI and CT in rectal cancer staging, Bipat et al. found EUS and MRI to show similar sensitivity in the diagnosis of muscularis propria invasion (94 %), while EUS was more accurate in the evaluation of local tumour invasion (86 vs 69 %); ceCT, on the other hand, is not considered a gold standard investigation for evaluating tumour wall penetration. Local lymph node involvement, which constitutes a major challenge in rectal cancer staging, can be effectively evaluated by using all three methods, even though only ceCT and MRI provide information on distant node status and metastasis [4]. An advantage of MRI is that it allows better evaluation of the mesorectum, while a relative disadvantage of EUS is its relatively high dependence on operator skill. Pathologic considerationsHistopathologic analysis of resected lesions is also an important part of staging, both initial staging and restaging after neoadjuvant therapy. The final report should contain the following information: a gross description of the tumour burden,

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“…In multivariate analysis, the only PET/CT SUV max -based parameter significantly correlated with the likelihood of recurrence and survival was SUV% < 65% (P = 0.02, for DFS; P = 0.04, for OS). 40 Guillem et al 41 prospectively studied 15 patients with locally advanced primary rectal cancer who had FDG-PET performed before and 4 to 5 weeks after completion of preoperative CRT. A cutoff of a 62.5% decrease/difference between baseline and 6-week PET SUV max values was a significant predictor of DFS.…”

Section: Positron Emission Tomography (Pet/ct)mentioning

confidence: 99%

Can Surgery be Avoided After Preoperative Chemoradiation for Rectal Cancer in the Era of Organ Preservation? Current Review of Literature

Chawla

Katz

Rauh

et al. 2015

American Journal of Clinical Oncology

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Approximately 10% to 25% of patients have a pathologic complete response after neoadjuvant chemoradiation. There is a compelling argument for attempting to avoid surgery in carefully selected groups of patients. Although nerve-preserving surgical techniques are now standard, the rates of urinary and sexual dysfunction are significant. Also, although sphincter function and quality of life among patients undergoing an ultra-low anterior resection is acceptable, results are poorer than expected and may be disabling. Trials of omission of surgery for selected patients with complete response after preoperative chemoradiation, otherwise known as "Watch and Wait," have shown favorable long-term results. We review the current literature on accepted standards of care and identify areas of controversy and important ongoing clinical studies aiming to resolve these issues.

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18F-FDG PET/CT-based treatment response evaluation in locally advanced rectal cancer: a prospective validation of long-term outcomes

Cited by 31 publications

References 29 publications

The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy

The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy

The emerging role of FDG PET/CT in rectal cancer management: is it time to use the technique for early prognostication?

Can Surgery be Avoided After Preoperative Chemoradiation for Rectal Cancer in the Era of Organ Preservation? Current Review of Literature

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