Abstract
Purpose
To investigate the association between 18fluorine-2-deoxy-d-glucose positron emission tomography–computed tomography (18F-FDG PET/CT) parameters, serum carcinoembryonic antigen (CEA), and tumor response in patients with rectal cancer receiving neoadjuvant chemoradiotherapy (nCRT).
Methods
Sixty-four patients with T3-4 and/or node-positive rectal cancer receiving nCRT followed by surgery were prospectively studied. PET/CT was performed before, and in 28 patients, both before and after nCRT. The pre-/post-nCRT maximum standardized uptake (SUVmax) values, differences between pre-/post-nCRT SUVmax (∆SUVmax), response index of SUVmax (RI-SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and CEA were measured. The ability of PET/CT parameters and CEA to predict Mandard’s tumor regression grade (TRG) and pathological complete remission (pCR) were evaluated.
Results
31 patients were identified as responders (TRG 1–2), and 19 exhibited pCR. For responders, significant differences were found for ΔSUVmax (24.88 vs. 15.39 g/ml, p = 0.037), RI-SUVmax (0.76 vs. 0.63, p = 0.025), ΔSUVmean (14.43 vs. 8.65 g/ml, p = 0.029), RI-SUVmean (0.77 vs. 0.63, p = 0.011), CEA-pre (6.30 vs. 27.86 μg/L, p < 0.001), CEA-post (2.22 vs. 5.49 μg/L, p = 0.002), ΔCEA (4.08 vs. 23.13 μg/L, p < 0.001), and RI-CEA (0.25 vs. 0.55, p = 0.002). Differences between pCR and non-pCR patients were noted as RI-SUVmean (0.77 vs. 0.65, p = 0.043), MTV-pre (9.87 vs. 14.62 cm3, p = 0.045), CEA-pre (5.62 vs. 22.27 μg/L, p = 0.002), CEA-post (1.95 vs. 4.72 μg/L, p = 0.001), and ΔCEA (3.68 vs. 17.99 μg/L, p = 0.013). Receiver operating characteristic analysis revealed that RI-SUVmean exhibited the greatest accuracy in predicting responders, whereas CEA-post and ΔCEA exhibited the greatest accuracy in predicting pCR.
Conclusions
18F-FDG PET/CT parameters and CEA are accurate tools for predicting tumor response to nCRT in rectal cancer.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in this study.
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Qi-Wen Li and Rong-Liang Zheng contributed equally to this work.
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Li, QW., Zheng, RL., Ling, YH. et al. Prediction of tumor response after neoadjuvant chemoradiotherapy in rectal cancer using 18fluorine-2-deoxy-d-glucose positron emission tomography–computed tomography and serum carcinoembryonic antigen: a prospective study. Abdom Radiol 41, 1448–1455 (2016). https://doi.org/10.1007/s00261-016-0698-7
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DOI: https://doi.org/10.1007/s00261-016-0698-7