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Published in: Annals of Surgical Oncology 6/2014

01-06-2014 | Colorectal Cancer

MRI and FDG-PET for Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer

Authors: Toshisada Aiba, MD, Keisuke Uehara, MD, PhD, Takashi Nihashi, MD, PhD, Toyonori Tsuzuki, MD, PhD, Hiroshi Yatsuya, MD, PhD, Yuichiro Yoshioka, MD, PhD, Katsuhiko Kato, MD, PhD, Masato Nagino, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2014

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Abstract

Background

The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC).

Methods

Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder.

Results

Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846).

Conclusions

MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 % volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.
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Metadata
Title
MRI and FDG-PET for Assessment of Response to Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer
Authors
Toshisada Aiba, MD
Keisuke Uehara, MD, PhD
Takashi Nihashi, MD, PhD
Toyonori Tsuzuki, MD, PhD
Hiroshi Yatsuya, MD, PhD
Yuichiro Yoshioka, MD, PhD
Katsuhiko Kato, MD, PhD
Masato Nagino, MD, PhD
Publication date
01-06-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3538-4

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