PET in rectal cancerBlood glucose level normalization and accurate timing improves the accuracy of PET-based treatment response predictions in rectal cancer
Section snippets
Patient characteristics
Thirty patients diagnosed with non-metastasized locally advanced-rectal-cancer (LARC) were included in this study from which the clinical TN staging was evaluated on a pre-treatment magnetic resonance (MR) scan (Table 1). All patients were referred to pre-operative treatment with radiotherapy (28 fractions of 1.8 Gy daily) and concomitant chemotherapy (capecitabine 825 mg/m2 BID), followed by a total mesorectal excision (TME). According to the Dutch law, the medical ethics committee approved the
Intra-patient BGL-fluctuations
For the included patients, large intra-patient BGL-fluctuations were observed, ranging from −38.7 to 95.6% (average: 5.2 ± 20.9%) when compared to the pre-treatment-measured BGL (Table 1). BGL-normalization of the sequential PET-data resulted in an average increase of SUVmax of 9.7 ± 14.1% (range: −54.7 to 34.7%) when comparing the maximum SUVs before and after BGL-normalization (p < 0.001) (Table 2). Large individual differences were noticed in the magnitude of the intra-patient BGL-fluctuations,
Discussion
Over the last years, sequential FDG–PET–CT imaging has been shown to be of promise for the prediction of pathological treatment response in an increasing number of malignancies [1], [2], [3], [5], [6], [7], [8], [9], [10], [11], [12], [13], [15], [16]. However, a diversity of factors are known to influence the results of PET-imaging, for instance the used equipment and protocol, uptake time of the FDG and the patients BGL at the time of PET-imaging [5], [19], [20]. When performing sequential
Conflict of interest notification
We are not aware of any actual or potential conflicts of interest.
Acknowledgements
The authors would like to thank Siemens MI for technical and financial support. We acknowledge financial support from the Netherlands Organization for Health Research and Development (ZonMw; clinical fellowship awarded to G.L.).
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These authors are equally contributed.