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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2011

01-11-2011 | Gastrointestinal Oncology

Molecular Imaging of Proliferation and Glucose Utilization: Utility for Monitoring Response and Prognosis after Neoadjuvant Therapy in Locally Advanced Gastric Cancer

Authors: Katja Ott, MD, Ken Herrmann, MD, Tibor Schuster, PhD, Rupert Langer, MD, Karen Becker, MD, Hinrich A. Wieder, MD, Hans-Jürgen Wester, PhD, Jörg-Rüdiger Siewert, MD, Christian Meyer zum Büschenfelde, MD, Andreas K. Buck, MD, Dirk Wilhelm, MD, Matthias P. A. Ebert, MD, Christian Peschel, MD, Markus Schwaiger, MD, Florian Lordick, MD, Bernd Joachim Krause, MD

Published in: Annals of Surgical Oncology | Issue 12/2011

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Abstract

Background

Metabolic imaging of gastric cancer is limited due to the 30% of primary tumors that are not 18F-fluorodeoxyglucose (FDG) avid. In contrast, the proliferation marker 18F-fluorothymidine (FLT) has been shown to visualize also non-FDG-avid gastric tumors. In this study we tested whether FLT-positron emission tomography (PET) can improve the predictive potential of molecular imaging for assessing response to neoadjuvant therapy in gastric cancer compared with FDG-PET.

Methods

45 patients with gastric cancer underwent FDG- and FLT-PET before and 2 weeks after initiation of chemotherapy. FDG/FLT-PET findings and Ki67 immunohistochemistry were correlated with clinical and histopathological response and survival.

Results

14 patients had non-FDG-avid tumors, whereas all tumors could be visualized by FLT-PET. No significant association of clinical or histopathological response with any of the analyzed metabolic parameters [initial standardized uptake value (SUV), SUV after 2 weeks, change of SUV for FDG/FLT] was found. Univariate Cox regression analysis for Ki67 and metabolic parameters revealed significant prognostic impact for survival only for FLT SUVmean day 14 (p = 0.048) and Ki67 (p = 0.006). Multivariate Cox regression analysis (including clinical response, Lauren type, ypN category, and FLT SUVmean day 14) revealed Lauren type and FLT SUVmean day 14 as the only significant prognostic factors (p = 0.006, p = 0.002).

Conclusions

FLT uptake 2 weeks after initiation of therapy was shown to be the only imaging parameter with significant prognostic impact. Neither FLT-PET nor FDG-PET were correlated with histopathological or clinical response. However, these data must be interpreted with caution due to the single-center trial study design, relatively short follow-up, poor response rates, and unfavorable prognosis.
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Metadata
Title
Molecular Imaging of Proliferation and Glucose Utilization: Utility for Monitoring Response and Prognosis after Neoadjuvant Therapy in Locally Advanced Gastric Cancer
Authors
Katja Ott, MD
Ken Herrmann, MD
Tibor Schuster, PhD
Rupert Langer, MD
Karen Becker, MD
Hinrich A. Wieder, MD
Hans-Jürgen Wester, PhD
Jörg-Rüdiger Siewert, MD
Christian Meyer zum Büschenfelde, MD
Andreas K. Buck, MD
Dirk Wilhelm, MD
Matthias P. A. Ebert, MD
Christian Peschel, MD
Markus Schwaiger, MD
Florian Lordick, MD
Bernd Joachim Krause, MD
Publication date
01-11-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1743-y

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