The diagnostic performance of CT versus FDG PET-CT for the detection of recurrent pancreatic cancer: a systematic review and meta-analysis

Daamen, Lois A; Groot, Vincent P.; Goense, Lucas; Wessels, Frank J.; Rinkes, Inne H. Borel; Intven, Martijn; Santvoort, Hjalmar C. van; Molenaar, I.

doi:10.1016/j.ejrad.2018.07.010

Cited by 56 publications

(36 citation statements)

References 35 publications

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“…Postpancreatectomy surveillance for the detection of recurrent PDAC currently includes serial assessment using CT imaging and CA 19-9 testing (30). However, recent meta-analyses have shown that CT and CA 19-9 only have moderate diagnostic accuracy for the diagnosis of recurrent PDAC (14,41). This study found that postoperative follow-up with KRAS ctDNA predicts recurrence with high sensitivity (90%) and specificity (88%) and predicts recurrence with a median lead time of almost 3 months over imaging.…”

Section: Discussionmentioning

confidence: 99%

Circulating Tumor DNA as a Clinical Test in Resected Pancreatic Cancer

Groot

Mosier

Javed

et al. 2019

Clinical Cancer Research

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135

102

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Purpose: In research settings, circulating tumor DNA (ctDNA) shows promise as a tumor-specific biomarker for pancreatic ductal adenocarcinoma (PDAC). This study aims to perform analytical and clinical validation of a KRAS ctDNA assay in a Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathology-certified clinical laboratory. Experimental Design: Digital-droplet PCR was used to detect the major PDAC-associated somatic KRAS mutations (G12D, G12V, G12R, and Q61H) in liquid biopsies. For clinical validation, 290 preoperative and longitudinal postoperative plasma samples were collected from 59 patients with PDAC. The utility of ctDNA status to predict PDAC recurrence during follow-up was assessed. Results: ctDNA was detected preoperatively in 29 (49%) patients and was an independent predictor of decreased recurrence-free survival (RFS) and overall survival (OS). Patients who had neoadjuvant chemotherapy were less likely to have preoperative ctDNA than were chemo-na€ ve patients (21% vs. 69%; P < 0.001). ctDNA levels dropped significantly after tumor resection. Persistence of ctDNA in the immediate postoperative period was associated with a high rate of recurrence and poor median RFS (5 months). ctDNA detected during follow-up predicted clinical recurrence [sensitivity 90% (95% confidence interval (CI), 74%-98%), specificity 88% (95% CI, 62%-98%)] with a median lead time of 84 days (interquartile range, 25-146). Detection of ctDNA during postpancreatectomy follow-up was associated with a median OS of 17 months, while median OS was not yet reached at 30 months for patients without ctDNA (P ¼ 0.011). Conclusions: Measurement of KRAS ctDNA in a CLIA laboratory setting can be used to predict recurrence and survival in patients with PDAC.

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Section: Discussionmentioning

confidence: 99%

Circulating Tumor DNA as a Clinical Test in Resected Pancreatic Cancer

Groot

Mosier

Javed

et al. 2019

Clinical Cancer Research

Self Cite

135

102

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“…Concerning long-time follow-up, intensified radiological surveillance for early detection of recurrence, for example with enhanced imaging techniques such as PET-CT additionally to standard CE-CT, has shown increased sensitivity and specificity in a recent meta-analysis of seven retrospective studies 64. Although this might be of future importance especially in EOPC patients, prospective validation is pending and enhanced protocols to reduce significant radiation doses of PET-CT need to be considered 65…”

Section: Introductionmentioning

confidence: 99%

<p>Pancreatic cancer in young adults: changes, challenges, and solutions</p>

Primavesi¹,

Stättner²,

Schlick³

et al. 2019

OTT

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Despite improvements in multidisciplinary treatments, survival of pancreatic cancer (PC) patients remains dismal. Studies dealing with early onset pancreatic cancer (EOPC) patients are scarce. In this review, we discuss differences between EOPC and late-onset pancreatic cancer based on findings in original papers and reviews with a focus on morphology, genetics, clinical outcomes and therapy. In conclusion, families with a positive history of PC and patients with BRCA 1 or 2 mutations should be monitored. Patients with EOPC usually present with better overall fitness compared to the average PC population, however often with even more aggressive cancer behaviour. Therefore, potent state-of-the-art multi-modal systemic therapies should be applied whenever possible. Large-scale registries and randomized clinical trials dealing with EOPC in regard to distinct biology and outcome are warranted.

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“…Modern radiation techniques require accurate and reliable GTV definition. However, there is a lack of Sensitivity and Specificity of CT imaging of locally recurrent pancreatic cancer [11]. As target volumes for radiation of recurrent pancreatic cancer are primarily based on CT, this results in uncertainty among radiation oncologists with high variability in target volumes.…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been improvements concerning imaging quality in the past decade, tumor tissue can often hardly be differentiated from postoperative fibrosis or other postoperative anatomical changes in locally recurrent pancreatic cancer. In a meta-analysis of seven retrospective studies, CT imaging's pooled estimated Sensitivity and Specificity were 0.70 and 0.80 and the ones of positron emission tomography with 18F-Fluorodeoxyglucose (FDG-PET)/CT were approximately 0.9 each [11]. Nevertheless, FDG avidity in pancreatic tumors is only marginally higher than that of healthy pancreas parenchyma itself.…”

Section: Introductionmentioning

confidence: 99%

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

Liermann

Syed

Ben‐Josef

et al. 2021

Cancers

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(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer.

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The diagnostic performance of CT versus FDG PET-CT for the detection of recurrent pancreatic cancer: a systematic review and meta-analysis

Cited by 56 publications

References 35 publications

Circulating Tumor DNA as a Clinical Test in Resected Pancreatic Cancer

Circulating Tumor DNA as a Clinical Test in Resected Pancreatic Cancer

<p>Pancreatic cancer in young adults: changes, challenges, and solutions</p>

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

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