The use of PET in assessing tumor response after neoadjuvant chemoradiation for rectal cancer

Mak, Daisy; Joon, Daryl Lim; Chao, Michael; Wada, M.; Joon, Michael Lim; See, Andrew; Feigen, M.; Jenkins, Patricia; Mercuri, Angelina; McNamara, Josephine; Poon, Aurora; Khoo, Vincent

doi:10.1016/j.radonc.2010.05.016

Cited by 29 publications

(14 citation statements)

References 28 publications

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“…The few studies that have focused specifically on patients with a pCR have been limited by their retrospective design [45][46][47] or small sample size (30-50 patients). [48][49][50] One retrospective review of 78 patients with rectal cancer treated by neoadjuvant chemoradiation found a discordance between metabolic response and pathological response: 47% of patients had a complete metabolic response on PET (no identifiable FDG activity above adjacent physiologic bowel activity), but only 5% of patients had a pCR.…”

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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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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“…Several authors have suggested applying PET integrated with CT to evaluate metastatic or recurrent disease, but its role in assessing mesorectal disease is not clearly defined [27,28]. Mak et al [28] reported that the correlation between PET and pathology in complete responders was 71%.…”

Section: Radiologic Assessment Of Tumor Responsementioning

confidence: 99%

“…Mak et al [28] reported that the correlation between PET and pathology in complete responders was 71%. In a study on PET/CT for detecting residual cancer, Perez et al [29] reported measures of 93% sensitivity, 53% specificity, 73% negative predictive value, 87% positive predictive value, and 85% accuracy; clinical assessment alone resulted in an accuracy of 91%.…”

Section: Radiologic Assessment Of Tumor Responsementioning

confidence: 99%

Complete Response after Neoadjuvant Therapy in Rectal Cancer: To Operate or Not to Operate?

Dedemadi¹,

Wexner²

2012

Dig Dis

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Background/Aims: Evidence exists to support both surgical and nonoperative observational approaches to the management of patients with distal rectal cancer who achieve a complete response following neoadjuvant chemoradiotherapy (CRT). This article summarizes findings from key studies on management strategies for complete pathologic and clinical responders after neoadjuvant CRT for rectal cancer. Methods: A comprehensive literature review was undertaken comparing complete responders to neoadjuvant CRT who underwent surgical procedures or nonoperative observation. Results: The sensitivity and specificity of clinical assessment tools following neoadjuvant CRT are generally low. Endoscopic ultrasound and MRI are widely used for rectal cancer staging; PET/CT is applied for detecting residual cancer, although limitations exist in assessing mesorectal disease. In patients with rectal cancer who receive neoadjuvant CRT, rates of complete pathologic response vary from 5 to 44%. Rates of nodal disease in patients with complete pathologic response vary from 0 to 15%. In patients with stage 0 rectal cancer, excellent long-term oncologic results have been reported for both surgical resection and nonoperative observation; therefore, some authors consider that surgical resection may result in unnecessary morbidity. Whereas neoadjuvant CRT followed by total mesorectal excision (TME) reduces local recurrence and improves 5-year survival, TME is associated with significant morbidity and suboptimal functional results. Conclusion: Informed consent in patients with distal rectal cancer who achieve a complete response to neoadjuvant CRT must address both the potential risks of recurrence following nonoperative observation and the increased risks of postoperative morbidity and compromised function following extirpative surgery.

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“…Current imaging techniques are reportedly highly accurate in the primary staging of rectal cancer; however, the CRT course extensively modi!ies cancer tissue and surrounding structures, causing overgrowth !ibrosis, wall thickness, muscle disarrangement, tumor necrosis, calci!ication, and in!lammatory in!iltration. As a result, the same imaging techniques are far less accurate when used for restaging; although PET is a promising tool for assessing tumor response after CRT; a general consensus has not been reached (7) .…”

Section: Introductionmentioning

confidence: 99%

Optimal timing of computed tomography for assessing lymph nodes after neoadjuvant chemoradiotherapy for rectal cancer

Lai

Liu

et al. 2016

IJRR

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Background: This study assessed the op mal ming of computed tomography for detec on of metasta c disease in locoregional lymph nodes in pa ents with rectal cancer who have undergone chemoradiotherapy. Materials and Methods: This observa onal retrospec ve study was performed in a single ins tu on. All pa ents with locally advanced rectal cancer treated with chemoradiotherapy, followed by a total mesorectum excision from January 1, 2003 to December 31, 2012, were included. Lymph node metastases evident on preopera ve computed tomography were compared with postopera ve pathologic lymph node status. Results: The study popula on consisted of 108 pa ents: Group A (nodal nega ve on preopera ve computed tomography, n = 52) and Group B (nodal posi ve on preopera ve computed tomography, n = 56). Analysis of the computed tomography scans in Group A revealed a high ability (98.07%) to predict nega ve lymph nodes, compared to 58.92% for predic ng posi ve lymph nodes in Group B. Conclusion: The results of this study suggest that the op mal ming of computed tomography for assessing lymph nodes a0er neoadjuvant chemoradiotherapy for rectal cancer is a0er 6 weeks; this ming might be key for predic on of complete clinical responses.

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The use of PET in assessing tumor response after neoadjuvant chemoradiation for rectal cancer

Cited by 29 publications

References 28 publications

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

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

Complete Response after Neoadjuvant Therapy in Rectal Cancer: To Operate or Not to Operate?

Optimal timing of computed tomography for assessing lymph nodes after neoadjuvant chemoradiotherapy for rectal cancer

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