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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 3/2015

Open Access 01-04-2015 | Original Article

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer

Authors: Gundula Rendl, Lukas Rettenbacher, Johannes Holzmannhofer, Lidwina Datz, Cornelia Hauser-Kronberger, Gerd Fastner, Dietmar Öfner, Felix Sedlmayer, Christian Pirich

Published in: Annals of Nuclear Medicine | Issue 3/2015

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Abstract

Objective

The comparison of 2-deoxy-2-[18F]fluoro-d-glucose (F-18 FDG) and 3′-deoxy-3′-[18F]fluorothymidine (F-18 FLT) imaging in patients with rectal cancer before and after neoadjuvant radiochemotherapy (RCT) in relation to histopathology and immunohistochemistry obtained from surgery.

Methods

20 consecutive patients (15 m, 5 f), mean age of 65 ± 10 years were included into this prospective study with a mean follow-up of 4.1 ± 0.8 years.

Results

Among histopathological responders (n = 8 out of 20), posttreatment F-18 FLT and F-18 FDG scans were negative in 75 % (n = 6) and 38 % (n = 3), respectively. The mean response index (RI) was 61.0 % ± 14.0 % for F-18 FLT and 58.7 % ± 14.6 % for F-18 FDG imaging. Peritumoral lymphocytic infiltration (CD3 positive cells) was significantly related to posttreatment SUVmax in F-18 FDG but not F-18 FLT studies.

Conclusion

A significant decrease of SUVmax in F-18 FDG and F-18 FLT studies could be seen after RCT. Negative posttreatment F-18 FLT studies identified more histopathological responders.
Literature
1.
Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29:4633–40.CrossRefPubMed
2.
Avallone A, Aloj L, Caracó C, Delrio P, Pecori B, Tatangelo F, et al. Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome. Eur J Nucl Med Mol Imaging. 2012;39:1848–57.CrossRefPubMed
3.
Janssen MH, Öllers MC, van Stiphout R, Riedl RG, van den Bogaard J, Buijsen J, et al. PET-based treatment response evaluation in rectal cancer: prediction and validation. Int J Radiat Oncol Biol Phys. 2012;82:871–6.CrossRefPubMed
4.
Calvo FA, Sole CV, de la Mata D, Cabezón L, Gómez-Espí M, Alvarez E, et al. 18F-FDG PET/CT-based treatment response evaluation in locally advanced rectal cancer: a prospective validation of long-term outcomes. Eur J Nucl Med Mol Imaging. 2013;40:657–67.CrossRefPubMed
5.
Murcia Duréndez MJ, Frutos Esteban L, Luján J, Frutos MD, Valero G, Navarro Fernández JL, et al. The Value of 18F-FDG PET/CT for assessing the response to neoadjuvant therapy in locally advanced rectal cancer. Eur J Nucl Med Mol Imaging. 2013;40:91–7.CrossRefPubMed
6.
Shreve PD, Anzai Y, Wahl RL, Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.CrossRefPubMed
7.
Shields AF. Positron emission tomography measurement of tumor metabolism and growth: its expanding role in Oncology. Mol Imaging Biol. 2006;8:141–50.CrossRefPubMed
8.
Shields AF, Grierson JR, Dohmen BM, Machulla HJ, Stayanoff JC, Lawhorn-Crews JM, et al. Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med. 1998;4:1334–6.CrossRefPubMed
9.
Vesselle H, Grierson J, Muzi M, Pugsley JM, Schmidt RA, Rabinowitz P, et al. In vivo validation of 3′deoxy-3′-[(18)F]fluorothymidine ([(18)F]FLT) as a proliferation imaging tracer in humans: correlation of [(18)F]FLT uptake by positron emission tomography with Ki-67 immunohistochemistry and flow cytometry in human lung tumors. Clin Cancer Res. 2002;8:3315–23.PubMed
10.
van Waarde A, Cobben DC, Suurmeijer AJ, Maas B, Vaalburg W, de Vries EF, et al. Selectivity of F-18-FLT and F-18-FDG for differentiating tumor from inflammation in a rodent model. J Nucl Med. 2004;45:695–700.PubMed
11.
van Waarde A, Jager PL, Ishiwata K, Dierckx RA, Elsinga PH. Comparison of sigma-ligands and metabolic PET tracers for differentiating tumor from inflammation. J Nucl Med. 2006;47:150–4.PubMed
12.
Barthel H, Cleij MC, Collingridge DR, Hutchinson OC, Osman S, He Q, et al. 3′-deoxy-3′-[18F]fluorothymidine as a new marker for monitoring tumor response to antiproliferative therapy in vivo with positron emission tomography. Cancer Res. 2003;63:3791–8.PubMed
13.
Dittmann H, Dohmen BM, Kehlbach R, Bartusek G, Pritzkow M, Sarbia M, et al. Early changes in [18F]FLT uptake after chemotherapy: an experimental study. Eur J Nucl Med. 2002;29:1462–9.CrossRef
14.
Sanghera B, Wong WL, Sonoda LI, Beynon G, Makris A, Woolf D, et al. FLT PET-CT in evaluation of treatment response. Indian J Nucl Med. 2014;29:65–73.CrossRefPubMedCentralPubMed
15.
Francis DL, Visvikis D, Costa DC, Arulampalam TH, Townsend C, Luthra SK, et al. Potential impact of [18F]3′-deoxy-3′-fluorothymidine versus [18F]fluoro-2-deoxy-d-glucose in positron emission tomography for colorectal cancer. Eur J Nucl Med Mol Imaging. 2003;30:988–94.CrossRefPubMed
16.
Wieder HA, Geinitz H, Rosenberg R, Lordick F, Bekcer K, Stahl A, et al. PET imaging with [18F]3′-deoxy-3′-fluorothymidine for prediction of response to neoadjuvant treatment in patients with rectal cancer. Eur J Nucl Med Mol Imaging. 2007;34:878–83.CrossRefPubMed
17.
Dehdashti F, Grigsby PW, Myerson RJ, Nalbantoglu I, Ma C, Siegel BA. Positron emission tomography with [(18)F]-3′-deoxy-3′fluorothymidine (FLT) as a predictor of outcome in patients with locally advanced resectable rectal cancer: a pilot study. Mol Imaging Biol. 2013;15:106–13.CrossRefPubMedCentralPubMed
18.
Becker K, Müller JD, Schulmacher C, Ott K, Fink U, Busch R, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer. 2003;98:1521–30.CrossRefPubMed
19.
Öfner D, Devries AF, Schaberl-Moser R, Greil R, Rabl H, Tschmelitsch J, et al. Preoperative oxaliplatin, capecitabine, and external beam radiotherapy in patients with newly diagnosed, primary operable, cT3NxM0, low rectal cancer. Strahlenth Onkol. 2011;187:100–7.CrossRef
20.
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer staging Manual. 7th ed. New York: Springer; 2010.
21.
Kim CJ, Yeatman TJ, Coppola D, Trotti A, Williams B, Barthel JS, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001;234:352–8.CrossRefPubMedCentralPubMed
22.
Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet. 1996;348:1605–10.CrossRef
23.
Julien LA, Thorson AG. Current neoadjuvant strategies in rectal cancer. J Surg Oncol. 2010;104:321–6.CrossRef
24.
Yamamoto Y, Kameyama R, Izuishi K, Takebayashi R, Hagiike M, Asakura M, et al. Detection of colorectal cancer using 18F-FLT PET: comparison with 18F-FDG PET. Nucl Med Commun. 2009;30:841–5.CrossRefPubMed
25.
Dahnlin AM, Henriksson ML, Van Guelpen B, Stenling R, Öberg A, Rutegard J, et al. Colorectal cancer prognosis depends on T-cell infiltration and molecular characteristics of the tumor. Mod Pathol. 2011;24:671–82.CrossRef
26.
Chalkidou A. Landau DB, Odell EW, Cornelius VR, O`Doherty MJ, Marsden PK. Correlation between Ki-67 immunohistochemistry and 18F-fluorothymidine uptake in patients with cancer: a systematic review and meta-analysis. Eur J Cancer. 2012;48:3499–513.CrossRefPubMed
27.
Riedl CC, Akhurst T, Larson S, Stanziale SF, Tuorto S, Bhargva A, et al. 18F-FDG PET scanning correlates with tissue markers of poor prognosis and predicts mortality for patients after liver resection for colorectal metastases. J Nucl Med. 2007;48:771–5.CrossRefPubMed
28.
Jang J, Yue JB, Liu J, Yu JM. Repopulation of tumor cells during fractionated radiotherapy and detection methods. Oncol Lett. 2014;7:1755–60.
29.
30.
Stelzner F, von Mallek D, Ruhlmann J, Biersack HJ. PET-CT studies of metastasizing cancer of the colon and rectum. Variability of tumor aggressiveness as a micro-evolutionary process of cancer stem cells with predetermined prognosis. Chirurg. 2009;80:645–51 German.CrossRefPubMed
31.
Perez RO, Habr-Gama A, Sao Juliao GP, Proscurshim I, Ono CR, Lynn P, et al. Clinical relevance of PET/CT positive inguinal lymph nodes in rectal cancer after neoadjuvant chemoradiation. Colorectal Dis. 2013;15:674–82.CrossRefPubMed
32.
Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Agostini N, et al. Rectal cancer and inguinal metastases: prognostic role and therapeutic indications. Dis Colon Rectum. 1999;42:1464–6.CrossRefPubMed
33.
Troost EG, Vogel WV, Merkx MA, Slootweg PJ, Marres HA, Peeters WJ, et al. 18F-FLT PET does not discriminate between reactive and metastatic lymph nodes in primary head and neck cancer patients. J Nucl Med. 2007;48:726–35.CrossRefPubMed
34.
Vanderhoek M, Perlman SB, Jeraj R. Impact of different standardized uptake value measurements on PET-based quantification of treatment response. J Nucl Med. 2013;54:1188–94.CrossRefPubMed
35.
Boellard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.CrossRef
Metadata
Title
Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer
Authors
Gundula Rendl
Lukas Rettenbacher
Johannes Holzmannhofer
Lidwina Datz
Cornelia Hauser-Kronberger
Gerd Fastner
Dietmar Öfner
Felix Sedlmayer
Christian Pirich
Publication date
01-04-2015
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 3/2015
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-014-0938-2

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