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Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using 18FDG-PET/CT

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathologic complete response (pCR) after neoadjuvant chemoradiation (CRT) has been observed in 15–30% of patients with locally advanced rectal cancer (LARC). The objective of this study was to determine whether PET/CT can predict pCR and disease-free survival in patients receiving CRT with LARC.

Methods

This is a retrospective review of patients with EUS-staged T3–T4, N + rectal tumors treated with CRT, who underwent pre/post-treatment PET/CT from 2002–2009. All patients were treated with CRT and surgical resection. Standardized uptake value (SUV) of each tumor was recorded. Logistic regression was used to analyze the association of pre-CRT SUV, post-CRT SUV, %SUV change, and time between CRT and surgery, compared with pCR. Kaplan–Meier estimation evaluated significant predictors of survival.

Results

Seventy patients (age 62 years; 42M:28F) with preoperative stage T3 (n = 61) and T4 (n = 9) underwent pre- and post-CRT PET/CT followed by surgery. The pCR rate was 26%. Median pre-CRT SUV was 10.8, whereas the median post-CRT SUV was 4 (P = 0.001). Patients with pCR had a lower median post-CRT SUV compared with those without (2.7 vs. 4.5, P = 0.01). Median SUV decrease was 63% (7.5–95.5%) and predicted pCR (P = 0.002). Patients with a pCR had a greater time interval between CRT and surgery (median, 58 vs. 50 days) than those without (P = 0.02). Patients with post-CRT SUV < 4 had a lower recurrence compared with those without (P = 0.03). Patients with SUV decrease ≥63% had improved overall survival at median follow-up of 40 months than those without (P = 0.006).

Conclusions

PET/CT can predict response to CRT in patients with LARC. Posttreatment SUV, %SUV decrease, and greater time from CRT to surgery correlate with pCR. Post-CRT, SUV < 4, and SUV decrease ≥63% were predictive of recurrence-free and overall survival.

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Authors and Affiliations

  1. Department of Surgery, Temple University, Philadelphia, PA, USA

    Skandan Shanmugan

  2. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Rodrigo Arrangoiz, James R. Nitzkorski, Jeffrey M. Farma & Elin R. Sigurdson

  3. Department of Nuclear Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA

    Jian Q. Yu

  4. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA

    Tianyu Li

  5. Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Harry Cooper

  6. Department of Radiation, Oncology Karmanos Cancer Institute, Detroit, MI, USA

    Andre Konski

Authors
  1. Skandan Shanmugan
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  2. Rodrigo Arrangoiz
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  9. Elin R. Sigurdson
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Correspondence to Skandan Shanmugan.

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Shanmugan, S., Arrangoiz, R., Nitzkorski, J.R. et al. Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using 18FDG-PET/CT. Ann Surg Oncol 19, 2178–2185 (2012). https://doi.org/10.1245/s10434-012-2248-z

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  • DOI: https://doi.org/10.1245/s10434-012-2248-z

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