18F-Fluorodeoxyglucose Positron Emission Tomography Predicts Treatment Efficacy and Clinical Outcome for Patients With Pancreatic Carcinoma

Wang, Li; Dong, Ping; Shen, Guohua; Hou, Shengzhong; Zhang, Yi; Liu, Xuedong; Tian, Bole

doi:10.1097/mpa.0000000000001375

Cited by 14 publications

(9 citation statements)

References 46 publications

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“…Meta-analyses of retrospective studies have suggested that high baseline SUV max is associated with better response to neoadjuvant chemoradiotherapy, and SUV reduction of 40%-60% corresponded to pathologic response. [83][84][85] Although prospective studies have been limited, the use of FDG/PET as a marker of response and predictor of survival warrants future validation. 86 Radiomic analysis using standard CT may also provide information regarding therapeutic response in a noninvasive manner.…”

Section: Radiomicsmentioning

confidence: 99%

“…Positron emission tomography (PET) with 18 F‐fuorodeoxyglucose (FDG) measures the metabolic rate of tumors and may be used to quantify response to neoadjuvant therapy, based on the change in standard uptake value (SUV) over the course of treatment. Meta‐analyses of retrospective studies have suggested that high baseline SUV max is associated with better response to neoadjuvant chemoradiotherapy, and SUV reduction of 40%–60% corresponded to pathologic response 83–85 . Although prospective studies have been limited, the use of FDG/PET as a marker of response and predictor of survival warrants future validation 86 …”

Section: Moving Forwardmentioning

confidence: 99%

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Preoperative therapy for pancreatic adenocarcinoma—precision beyond anatomy

Seo

Katz

2022

Cancer

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Despite recent advances in the systemic treatment of gastrointestinal tumors, pancreatic adenocarcinoma (PDAC) remains a challenging disease, with 5‐year survival just over 10%. Pancreatectomy in patients meeting defined anatomic criteria can result in cure; however, perioperative morbidity and mortality, as well as high rates of both local and distant recurrence even after “potentially curative” resection, have limited survival. Although perioperative chemotherapy has been shown to improve patients' longevity and chance for cure, debate continues about whether the preoperative or adjuvant approach is most effective in treatment of localized PDAC. Large, randomized multicenter trials in patients with resectable and borderline resectable PDAC have evaluated an evolving therapeutic landscape with mixed results. Importantly, these landmark studies share the fundamentally flawed assumption that tumor anatomical characteristics are an indicator of behavior and natural history. Concurrent biologic and translational research has revealed that rather than a single disease, PDAC represents a phenotypically variable group of malignancies arising in physiologically diverse patients. Ongoing novel trials have begun to capture this heterogeneity both in patient selection as well as the measurement of response by using genomic, transcriptional and radiomic markers. By moving away from classic anatomic descriptors to a more nuanced landscape of biomarkers predictive of tumor behavior and response, we can further refine the questions asked in preoperative trials and translate the answers to clinically meaningful precision therapy in localized PDAC.

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Section: Radiomicsmentioning

confidence: 99%

Section: Moving Forwardmentioning

confidence: 99%

Preoperative therapy for pancreatic adenocarcinoma—precision beyond anatomy

Seo

Katz

2022

Cancer

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“…Hybrid PET/CT scanners have already been employed to measure response to neoadjuvant therapy in a number of solid tumors [ 5 ]. Some experiences are now available for PDAC too [ 6 ]. The aim of the present systematic review is to investigate the role of FDG PET/CT or PET/MRI in assessing response to preoperative chemotherapy or chemoradiotherapy (CRT) in patients with borderline and resectable PDAC.…”

Section: Introductionmentioning

confidence: 99%

The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review

et al. 2021

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The aim of the present systematic review is to examine the role of fluorodeoxyglucose (FDG) positron emission tomography (PET) associated with computed tomography (CT) or magnetic resonance imaging (MRI) in assessing response to preoperative chemotherapy or chemoradiotherapy (CRT) for patients with borderline and resectable pancreatic ductal adenocarcinoma (PDAC). Three researchers ran a database query in PubMed, Web of Science and EMBASE. The total number of patients considered was 488. The most often used parameters of response to therapy were the reductions in the maximum standardized uptake value (SUVmax) or the peak standardized uptake lean mass (SULpeak). Patients whose SUVs were higher at the baseline (before CRT) were associated with a better response to therapy and a better overall survival. SUVs remaining high after neoadjuvant therapy correlated with a poor prognosis. Available data indicate that FDG PET/CT or PET/MRI can be useful for predicting and assessing response to CRT in patients with resectable or borderline PDAC.

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“…In addition to conventional CT-imaging, molecular-based FDG-PET/CT-imaging has been evaluated for monitoring of (neo)adjuvant treatment response in various malignancies, including PDAC [ 36 , 37 , 38 ]. Despite some favorable results, the main disadvantage of FDG-based PET/CT-imaging of pancreatic tissue is the increased uptake seen in TAP, complicating adequate differentiation between the remaining tumor and adjacent benign tissue [ 39 ]. Molecular-targeted tumor imaging has the potential to overcome these challenges by selectively targeting tumor biomarkers overexpressed on or in close proximity to PDAC cells, resulting in high tumor-specific signals with minimal background accumulation in surrounding normal tissue.…”

Section: Introductionmentioning

confidence: 99%

Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

Dam

Vuijk

Stibbe

et al. 2021

Cancers

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Background: Despite recent advances in the multimodal treatment of pancreatic ductal adenocarcinoma (PDAC), overall survival remains poor with a 5-year cumulative survival of approximately 10%. Neoadjuvant (chemo- and/or radio-) therapy is increasingly incorporated in treatment strategies for patients with (borderline) resectable and locally advanced disease. Neoadjuvant therapy aims to improve radical resection rates by reducing tumor mass and (partial) encasement of important vascular structures, as well as eradicating occult micrometastases. Results from recent multicenter clinical trials evaluating this approach demonstrate prolonged survival and increased complete surgical resection rates (R0). Currently, tumor response to neoadjuvant therapy is monitored using computed tomography (CT) following the RECIST 1.1 criteria. Accurate assessment of neoadjuvant treatment response and tumor resectability is considered a major challenge, as current conventional imaging modalities provide limited accuracy and specificity for discrimination between necrosis, fibrosis, and remaining vital tumor tissue. As a consequence, resections with tumor-positive margins and subsequent early locoregional tumor recurrences are observed in a substantial number of patients following surgical resection with curative intent. Of these patients, up to 80% are diagnosed with recurrent disease after a median disease-free interval of merely 8 months. These numbers underline the urgent need to improve imaging modalities for more accurate assessment of therapy response and subsequent re-staging of disease, thereby aiming to optimize individual patient’s treatment strategy. In cases of curative intent resection, additional intra-operative real-time guidance could aid surgeons during complex procedures and potentially reduce the rate of incomplete resections and early (locoregional) tumor recurrences. In recent years intraoperative imaging in cancer has made a shift towards tumor-specific molecular targeting. Several important molecular targets have been identified that show overexpression in PDAC, for example: CA19.9, CEA, EGFR, VEGFR/VEGF-A, uPA/uPAR, and various integrins. Tumor-targeted PET/CT combined with intraoperative fluorescence imaging, could provide valuable information for tumor detection and staging, therapy response evaluation with re-staging of disease and intraoperative guidance during surgical resection of PDAC. Methods: A literature search in the PubMed database and (inter)national trial registers was conducted, focusing on studies published over the last 15 years. Data and information of eligible articles regarding PET/CT as well as fluorescence imaging in PDAC were reviewed. Areas covered: This review covers the current strategies, obstacles, challenges, and developments in targeted tumor imaging, focusing on the feasibility and value of PET/CT and fluorescence imaging for integration in the work-up and treatment of PDAC. An overview is given of identified targets and their characteristics, as well as the available literature of conducted and ongoing clinical and preclinical trials evaluating PDAC-targeted nuclear and fluorescent tracers.

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18F-Fluorodeoxyglucose Positron Emission Tomography Predicts Treatment Efficacy and Clinical Outcome for Patients With Pancreatic Carcinoma

Cited by 14 publications

References 46 publications

Preoperative therapy for pancreatic adenocarcinoma—precision beyond anatomy

Preoperative therapy for pancreatic adenocarcinoma—precision beyond anatomy

The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review

Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

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