- The efficiency of 18 F-FDG-PET/CT in the assessment of tumor response to. - preoperative chemoradiation therapy for locally recurrent rectal cancer. - Background: Locally recurrent rectal cancer (LRRC) remains a major problem after curative resection of primary rectal cancer. - This study assesses the effectiveness of PET/CT evaluation of preoperative chemoradiation therapy (CRT) in patients with LRRC.. - chemotherapy: irinotecan plus UFT [tegafur and uracil]/leucovorin) and radical surgery, and underwent 18 F-FDG- PET/CT before and 3 weeks after the completion of CRT. - The predictive value of the 18 F-FDG-PET and CT/MRI response assessments was evaluated.. - Results: The mean Pre-SUV was significantly higher than the Post-SUV vs. - The mean Post-SUV was significantly lower in responders than in nonresponders vs. - Multivariate regression analysis identified Post-SUV as an independent predictor of local re-recurrence-free survival ( P = 0.0383) and for overall survival ( P = 0.0195).. - Conclusions: PET/CT is useful in assessing tumor response to preoperative CRT for LRRC and predicting prognosis after surgery.. - Keywords: Locally recurrent rectal cancer (LRRC), PET-CT, Chemoradiation, Response assessment, Pathologic response. - The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. - Locally recurrent rectal cancer (LRRC) remains a major problem after curative resection of primary advanced rectal cancer [1]. - Since 20 to 50% of these patients have local recurrence in the absence of distant metastasis, surgical intervention is one of the best curative treatment choices [3, 4]. - Assessment of the tumor response is clinically import- ant, but evaluation of the extent of LRRC by abdomino- pelvic computed tomography (CT) and pelvic magnetic resonance imaging (MRI) is sometimes difficult due to the main characteristics of LRRC, such as infiltrating growth, tissue scarring, and fibrosis [5].. - The semiquan- titative assessment of glucose metabolism by evaluation of the standardized uptake value (SUV) has been shown to have clinical relevance in evaluation of the response to CRT in several tumor types, including esophageal and advanced rectal cancer [8–10].. - The objective of this study was to assess the effective- ness of 18 F-FDG-PET/CT (PET-CT) evaluation of pre- operative chemoradiation therapy (CRT) in patients with LRRC.. - Of these, 40 patients (26 male and 14 female) under- went preoperative CRT and radical surgery with pre- and postoperative PET-CT evaluation. - The ex- tent of the recurrent tumor was evaluated by abdomino- pelvic CT, MRI, and colonoscopy. - Patients with apparent invasion to bone paren- chyma of the side pelvic wall were also excluded from rad- ical surgery. - Pet/CT. - All patients received an PET/CT scan before CRT and another scan 3 weeks after completion of CRT.. - In a pilot phase of the study, 12 patients received an additional PET scan 2 weeks after the beginning of CRT as an interim assessment.. - The SUV- max values of the pre-CRT scan (Pre-SUV), interim scan (Mid-SUV), and the post-CRT scan (Post-SUV) were measured. - ΔSUV was defined by calculating the Pre- SUV–Post-SUV difference, and the percentage decrease between the Pre-SUV and the Post-SUV is presented as the decreasing rate (DR. - (ΔSUV/Pre-SUV. - Cor- relations between each of the SUV parameters (Pre- SUV, Post-SUV, ΔSUV, and DR) and pathologic tumor responses were analyzed.. - The TRG has been reported useful also for the assessment of tumor regression of rectal cancer [12].. - TRG3, increase in the number of residual cancer cells, with fibrosis predomin- ant. - Clinical characteristics of the patients are described in Table 1. - Post-SUV to 18.7. - Response assessment by PET-CT. - Twelve patients underwent PET-CT after the initial 2 weeks of CRT. - Post-SUVs in the responder (TRG1–2, n = 17) group were significantly lower than those in the nonresponder (TGR3–5, n = 23) group vs. - was significantly higher in the responder group than in the nonresponders vs. - Most of the patients were classified in the nonresponder group by CT or MRI evaluation and 28/40:. - Local re-recurrence-free survival. - The resection status and post-SUV were significant prognostic factors for local re- recurrence-free survival (P = 0.0299 and P = 0.0102, re- spectively). - The median local re-recurrence-free time and 5-year local re-recurrence-free survival rate in the post-SUV low group was 9.4 years and 73.8%, respect- ively. - In the post-SUV high group, it was 2.7 years and 25.3%, respectively (Fig. - Pre-SUV . - Post-SUV . - 1 Kaplan-Meier local re-recurrence-free survival curve (A) and overall survival curve (B) for patients with LRRC, separated according to high and low Post-SUV. - statistically significant parameters by univariate analysis, multivariate Cox regression analysis revealed that post- SUV was a significant prognostic factor (P Table 5).. - In univariate analysis, resection status, pathologic tumor response, and Post-SUV were significantly associated with overall survival (P = 0.0035, P = 0.0411, and P = 0.0009, respectively). - The median overall survival time and 5-year overall survival rate in the post-SUV low group was 8.4 years and 80.8%, respectively. - In the post- SUV high group, it was 2.6 years and 27.2%, respectively (Fig. - Multivariate Cox regression analysis demon- strated that Post-SUV was a significant prognostic factor for overall survival (P Table 6).. - We observed that Post-SUV was especially useful in the assessment of LRRC survival, whereas CT and MRI less accurately reflected the pathological tumor response. - Our data indicate that PET-CT is a useful im- aging modality for the detection and evaluation of LRRC.. - PET-CT can distinguish cancer recurrence from postop- erative scarring tissues or fibrosis [15–17] because it re- ports the metabolic activity of the region of interest.. - In the current study, the Post-SUV was statistically lower in histopathologic responders than in nonre- sponders, suggesting that the effect of CRT can be pre- dicted by the SUVmax. - Moreover, the Post-SUV was a significant independent prognostic factor with respect to both local re-recurrence-free survival and overall LRRC. - In these studies, multivariate regression analysis identified Post-SUV as an independ- ent predictor of local re-recurrence-free survival and overall survival. - These findings conclude that a low Post-SUV results from a decrease in the number of vi- able esophageal tumor cells, which may lead to better prognosis. - Likewise, we find that low a Post-SUV in the treatment of LRRC is a sign of therapeutic response and indicative of better prognosis.. - There is no current consensus regarding the best time to perform PET-CT to achieve optimal assessment of LRRC tumor response. - Several reports have suggested the utility of early PET-CT assessment during treatment, due to the potential for modification of the subsequent treatment strategy [18–20]. - Post-SUV. - Second, the cohort was relatively small, though this is the first report discussing the usefulness of PET-CT for patients with LRRC.. - In conclusion, PET-CT is useful in the assessment of tumor response to preoperative CRT for patients with LRRC. - Post-SUV and DR were significantly associated with a pathological treatment response. - Post-SUV is es- pecially valuable as an independent prognostic indicator for patients with LRRC.. - LRRC: Locally recurrent rectal cancer. - org/10.1186/s . - fluorodeoxyglucose measured in patients included in the pilot phase of the study ( n = 12), in which Pre-SUV, Mid-SUV (2 weeks after initiation of. - CRT), and Post-SUV (3 weeks after completion of CRT) were determined.. - Mid-SUV was not significantly different from Pre-SUV and Post-SUV ( P = 0.215 and P = 0.4068, respectively).. - Surgical management of locally recurrent rectal cancer. - https://doi.org/10.1002/bjs . - https://doi.org/10.1007/BF02070705.. - Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. - doi.org/10.1245/s z.. - Prevention of severe pelvic abscess formation following extended radical surgery for locally recurrent rectal Cancer. - https://doi.org/10.1245/s . - Diagnostic value of (1)(8)F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma. - https://doi.org/10.1007/s z.. - https://doi.. - 18Fluoro-deoxy- glucose positron emission tomography in assessing tumor response to preoperative chemoradiation therapy for locally advanced rectal cancer. - https://doi.org/10.1002/jso.21736.. - Advantages of FDG-PET/CT over CT alone in the preoperative assessment of lymph node metastasis in patients with esophageal cancer. - https://doi.org/10.1007/s . - https://doi.org lt;2680::aid-cncr2820731105>3.0.co;2-c.. - doi.org/10.1016/j.clon . - https://doi.org/10.1093/jnci/92.3.205.. - MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer. - https://doi.org/10.1038/nrgastro.2014.41.. - Recurrent rectal cancer and scar: differentiation with PET and MR imaging. - https://doi.org/10.1148/radiology . - https://doi.org/10.1046/j x.. - PET to assess early metabolic response and to guide treatment of adenocarcinoma of the. - https://doi.org/10.1016/S . - Early prediction of response by F-FDG PET/CT during preoperative therapy in locally advanced rectal cancer: a systematic review. - https://doi.org/10.1016/j.ejso . - PET-CT for response assessment and treatment adaptation in head and neck cancer. - https://doi.org/10.1200/JCO . - Positron emission tomography for predicting pathologic response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer. - https://doi.org/10.1097/COC.0b013e3182118d12.. - Rectal cancer: primary staging and assessment after chemoradiotherapy. - org/10.1016/j.semradonc
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