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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2012

01-12-2012 | Original Article

Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome

Authors: Antonio Avallone, Luigi Aloj, Corradina Caracò, Paolo Delrio, Biagio Pecori, Fabiana Tatangelo, Nigel Scott, Rossana Casaretti, Francesca Di Gennaro, Massimo Montano, Lucrezia Silvestro, Alfredo Budillon, Secondo Lastoria

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2012

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Abstract

Purpose

The aim of the present study is to prospectively evaluate the prognostic value of previously defined [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) criteria of early metabolic response in patients with locally advanced rectal cancer (LARC) after long-term follow-up.

Methods

Forty-two patients with poor prognosis LARC underwent three biweekly courses of chemotherapy with oxaliplatin, raltitrexed and 5-fluorouracil modulated by levofolinic acid during pelvic radiotherapy. FDG PET studies were performed before and 12 days after the beginning of the chemoradiotherapy (CRT) treatment. Total mesorectal excision (TME) was carried out 8 weeks after completion of CRT. A previously identified cutoff value of ≥52 % reduction of the baseline mean FDG standardized uptake value (SUVmean) was applied to differentiate metabolic responders from non-responders and correlated to tumour regression grade (TRG) and survival.

Results

Twenty-two metabolic responders showed complete (TRG1) or subtotal tumour regression (TRG2) and demonstrated a statistically significantly higher 5-year relapse-free survival (RFS) compared with the 20 non-responders (86 vs 55 %, p = .014) who showed TRG3 and TRG4 pathologic responses. A multivariate analysis demonstrated that early ∆SUVmean was the only pre-surgical parameter correlated to the likelihood of recurrence (p = .05).

Conclusion

This study is the first prospective long-term evaluation demonstrating that FDG PET is not only an early predictor of pathologic response but is also a valuable prognostic tool. Our results indicate the potential of FDG PET for optimizing multidisciplinary management of patients with LARC.
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Metadata
Title
Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome
Authors
Antonio Avallone
Luigi Aloj
Corradina Caracò
Paolo Delrio
Biagio Pecori
Fabiana Tatangelo
Nigel Scott
Rossana Casaretti
Francesca Di Gennaro
Massimo Montano
Lucrezia Silvestro
Alfredo Budillon
Secondo Lastoria
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2012
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-012-2229-2

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