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Significance of 18F-Fluorodeoxyglucose (FDG) Uptake in Response to Chemoradiotherapy for Pancreatic Cancer

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A metabolic shift to glycolysis is reportedly involved in radioresistance. We examined whether pretreatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), which can detect enhanced glucose uptake, was able to predict the therapeutic response to chemoradiotherapy (CRT) in patients with pancreatic cancer (PC).

Methods

Of 125 PC patients (75 unresectable and 50 borderline resectable), 37 and 26 underwent induction chemotherapy before CRT and surgical resection after CRT, respectively. FDG-PET was performed at three different institutions.

Results

Of the 88 patients who underwent upfront CRT, 31 (35%), 34 (39%), and 23 (26%) showed a partial response (PR), stable disease, and progressive disease, respectively. The tumor PR rate was an independent factor associated with longer overall survival (OS) on multivariate analysis. We evaluated the optimal cut-off of maximum standardized uptake values (SUVmax) at initial diagnosis to detect the tumor PR rate at the three institutions separately. The SUVmax was independently associated with tumor response rate on multivariate analysis. In the low SUVmax group, induction chemotherapy had no significant impact on OS. In contrast, induction chemotherapy was significantly associated with longer OS in the high SUVmax group.

Conclusions

FDG-PET SUVmax was significantly associated with the therapeutic response to CRT in PC patients. Moreover, induction chemotherapy may improve the prognosis of patients with a high SUVmax tumor.

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Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan

    Hiroshi Kurahara MD, PhD, Kosei Maemura MD, PhD, Yuko Mataki MD, PhD, Masahiko Sakoda MD, PhD, Satoshi Iino MD, PhD, Yota Kawasaki MD, PhD, Takaaki Arigami MD, PhD, Shinichiro Mori MD, PhD, Yuko Kijima MD, PhD & Shoji Natsugoe MD, PhD

  2. Clinical Oncology, Kagoshima University, Kagoshima, Japan

    Shinichi Ueno MD, PhD

  3. Health Sciences, Kagoshima University, Kagoshima, Japan

    Hiroyuki Shinchi MD, PhD

Authors
  1. Hiroshi Kurahara MD, PhD
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  2. Kosei Maemura MD, PhD
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  3. Yuko Mataki MD, PhD
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  4. Masahiko Sakoda MD, PhD
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Corresponding author

Correspondence to Hiroshi Kurahara MD, PhD.

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Disclosure

Hiroshi Kurahara, Kosei Maemura, Yuko Mataki, Masahiko Sakoda, Satoshi Iino, Yota Kawasaki, Takaaki Arigami, Shinichiro Mori, Yuko Kijima, Shinichi Ueno, Hiroyuki Shinchi, and Shoji Natsugoe declare that they have no commercial interests.

Electronic supplementary material

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Supplementary material 1 (DOCX 19 kb)

Supplementary Figure 1. This study included 50 borderline resectable (BR) and 75 unresectable (UR) pancreatic cancer patients. Of the 125 patients, 37 underwent induction chemotherapy. During chemotherapy, two patients had distant metastasis, and the remaining 35 patients underwent subsequent CRT

Supplementary material 2 (JPEG 636 kb)

Supplementary Figure 2. Distribution of the SUVmax of all patients who underwent upfront CRT by institution

Supplementary material 3 (JPEG 550 kb)

Supplementary Figure 3. Kaplan–Meier survival curves of the PFS rates from the initial treatment. (A) Induction chemotherapy had no significant prognostic impact in the low SUVmax group (P = 0.204). (B) Induction chemotherapy was significantly associated with longer PFS in the high SUVmax group (P = 0.006). FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; SUV, standardized uptake value

Supplementary material 4 (JPEG 752 kb)

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Kurahara, H., Maemura, K., Mataki, Y. et al. Significance of 18F-Fluorodeoxyglucose (FDG) Uptake in Response to Chemoradiotherapy for Pancreatic Cancer. Ann Surg Oncol 26, 644–651 (2019). https://doi.org/10.1245/s10434-018-07098-6

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  • DOI: https://doi.org/10.1245/s10434-018-07098-6

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