Volumetric Parameters Changes of Sequential 18F-FDG PET/CT for Early Prediction of Recurrence and Death in Patients With Locally Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy

Kim, Seong-Jang; Chang, Sun Ju

doi:10.1097/rlu.0000000000000917

Cited by 19 publications

(6 citation statements)

References 37 publications

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“…This is consistent with previous studies correlating PET volumetry and survival. [15][16][17] Volumetry may prognosticate better than SUVmax alone, as it takes into consideration the heterogenous nature of a tumour, and more accurately reflects tumour burden. 18,19 Despite the evidence for volumetry, the cut-off values within studies vary.…”

Section: Discussionmentioning

confidence: 99%

“…Kim utilized a percentage reduction in TLG of 47.73 compared with Guillem's 69.5%, differing from our cut-off of 94%. 16,17 Factors affecting these results may include the timing of the PET scans, the treatment protocols and the differences in PET acquisition and analysis. These variabilities may also explain the different cut-off values for SUVmax, where we found limited utility in prognosticating LARC.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic utility of serial 18F-FDG-PET/CT in patients with locally advanced rectal cancer who underwent tri-modality treatment

Fernando

Lin

Pham

et al. 2019

The British Journal of Radiology

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Objective: This study explored the value of serial 18-fludeoxyglucose-positron emission tomography (18F-FDG-PET/CT) in predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (NCRT) and surgery. Methods: We prospectively studied 46 patients with LARC who underwent NCRT and surgery. 18F-FDG-PET/CT scans were performed at three time-points before surgery (pre-NCRT-PET1, during NCRT-PET2 and following completion of NCRT-PET3). The following semi-quantitative PET parameters were analysed at each time point: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG). Absolute and percentage changes in these parameters were analysed between time points. Statistical analysis consisted of median tests, Cox regression and Kaplan–Meier analysis for DFS. Results: The median follow-up time was 24 months. A reduction in PET parameters showed statistically significant differences for patients with recurrence compared to those without; percentage changes in MTV between PET1 and PET3 (cut-off: 87%, p = 0.023), percentage changes in TLG between PET1 and PET3 (cut-off: 94%, p = 0.02) and absolute change in MTV PET1 and PET2 (cut-off: 10.25, p = 0.001). An absolute reduction in MTV between PET1 and PET3 (p=0.013), a percentage reduction in TLG between PET1 and PET2 (p=0.021), SUVmax and SUVmean at PET2 (p = 0.01, p = 0.027 respectively)were also prognostic indicators of recurrence. MTV percentage change between PET1 and PET2 and SUVmean percentage change between PET1 and PET3 were also trending towards significance (p = 0.052, p = 0.053 respectively). Conclusion: Serial 18F-FDG-PET/CT is a potentially reliable non-invasive method to predict recurrence in patients with LARC. Volumetric parameters were the best predictors. This could allow risk-stratification in patients who may benefit from conservative management. Advances in knowledge: This paper will add to the literature in risk-stratifying patients with LARC based on prognosis, using 18F-FDG-PET/CT. This may improve patient outcomes by selecting suitable candidates for conservative management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic utility of serial 18F-FDG-PET/CT in patients with locally advanced rectal cancer who underwent tri-modality treatment

Fernando

Lin

Pham

et al. 2019

The British Journal of Radiology

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“…Recently, metabolic tumor volume (MTV), as a volumetric parameter of PET/CT, has been suggested to be a predictive marker of survival outcomes in CRC 14,15 . Previous studies show that MTV could be a promising predictor for LN metastasis 16–18 ; however, no studies have attempted to develop a prediction model for LN metastases status in rectal cancer using both MTV of the primary tumor (T_MTV) and [ 18 F]FDG-avid LN findings.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of [18F]FDG PET/CT for Lymph Node Metastasis in Rectal Cancer

Kim

Song

Kim

et al. 2019

Sci Rep

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[18F]Fluorodeoxyglucose ([18F]FDG) Positron emission tomography/computed tomography (PET/CT) is commonly used for rectal cancer staging, but improved diagnostic methods for nodal metastases are needed. We aimed to evaluate whether the combination model of the metabolic tumor volume of primary tumor (T_MTV) and maximum standardized uptake value of lymph node (N_SUVmax) on pretreatment [18F]FDG PET/CT could improve nodal metastases prediction in rectal cancer. We enrolled a total of 166 rectal cancer patients who underwent pretreatment [18F]FDG PET/CT and surgical resection without neoadjuvant treatment between January 2009 and August 2016. Visual and semiquantitative PET/CT parameters were obtained. Associations between clinicopathological, PET/CT-derived variables and nodal metastases were evaluated by logistic regression analysis. Nodal metastases were confirmed histologically in 68 of the 166 patients (41%). Uni- and multivariate analyses demonstrated T_MTV and N_SUVmax were independent predictive factors for nodal metastases. The c-statistics of the combination model was 0.806 (Standard Error, 0.034; 95% Confidence Interval, 0.737–0.863), which showed significant improvement compared to T_MTV (0.698, P = 0.0002) or N_SUVmax (0.720, P = 0.0008) alone. T_MTV and N_SUVmax are independently correlated with nodal metastases. Furthermore, the combination model showed improved performance for risk prediction; thus, [18F]FDG PET/CT might have a role in rectal cancer staging and treatment planning.

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“…In a series of 138 colorectal participants undergoing surgical resection, tumours with higher MTV tended to metastasize, and the predictive value of MTV was better than SUV max [33]. Their roles as prognosticators were also demonstrated in another report consisting of 64 rectal cancer participants treated with concurrent chemoradiotherapy, MTV of the baseline PET as well as changes of TLG were prominent prognosticator in multivariate Cox regression analysis [34].…”

Section: Discussionmentioning

confidence: 82%

FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis

Chen

Miles

Taylor

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose This study assesses the potential for vascular-metabolic imaging with FluoroDeoxyGlucose (FDG)–Positron Emission Tomography/Computed Tomography (PET/CT) perfusion to provide markers of prognosis specific to the site and stage of colorectal cancer. Methods This prospective observational study comprised of participants with suspected colorectal cancer categorized as either (a) non-metastatic colon cancer (M0colon), (b) non-metastatic rectal cancer (M0rectum), or (c) metastatic colorectal cancer (M+). Combined FDG-PET/CT perfusion imaging was successfully performed in 286 participants (184 males, 102 females, age: 69.60 ± 10 years) deriving vascular and metabolic imaging parameters. Vascular and metabolic imaging parameters alone and in combination were investigated with respect to overall survival. Results A vascular-metabolic signature that was significantly associated with poorer survival was identified for each patient group: M0colon – high Total Lesion Glycolysis (TLG) with increased Permeability Surface Area Product/Blood Flow (PS/BF), Hazard Ratio (HR) 3.472 (95% CI: 1.441–8.333), p = 0.006; M0rectum – high Metabolic Tumour Volume (MTV) with increased PS/BF, HR 4.567 (95% CI: 1.901–10.970), p = 0.001; M+ participants, high MTV with longer Time To Peak (TTP) enhancement, HR 2.421 (95% CI: 1.162–5.045), p = 0.018. In participants with stage 2 colon cancer as well as those with stage 3 rectal cancer, the vascular-metabolic signature could stratify the prognosis of these participants. Conclusion Vascular and metabolic imaging using FDG-PET/CT can be used to synergise prognostic markers. The hazard ratios suggest that the technique may have clinical utility.

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Volumetric Parameters Changes of Sequential 18F-FDG PET/CT for Early Prediction of Recurrence and Death in Patients With Locally Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy

Abstract: Our data suggest that MTV on initial pretreatment F-FDG PET/CT and ΔTLG of sequential F-FDG PET/CT after preoperative concurrent chemoradiotherapy in LARC patients could provide prognostic information.

Cited by 19 publications

References 37 publications

Prognostic utility of serial 18F-FDG-PET/CT in patients with locally advanced rectal cancer who underwent tri-modality treatment

Prognostic utility of serial 18F-FDG-PET/CT in patients with locally advanced rectal cancer who underwent tri-modality treatment

Predictive Value of [18F]FDG PET/CT for Lymph Node Metastasis in Rectal Cancer

FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis

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