1
|
Nemeth Z, Wijker W, Lengyel Z, Hitre E, Borbely K. Metabolic Parameters as Predictors for Progression Free and Overall Survival of Patients with Metastatic Colorectal Cancer. Pathol Oncol Res 2020; 26:2683-2691. [PMID: 32661836 PMCID: PMC7772167 DOI: 10.1007/s12253-020-00865-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 01/17/2023]
Abstract
We tested the prognostic relevance of metabolic parameters and their relative changes in patients with metastatic colorectal cancer (mCRC) treated with monoclonal antibody and chemotherapy. SUVmax (standardized uptake volume), SAM (standardized added metabolic activity) and TLG (total lesion glycolysis) are assessed with 18F-fluorodeoxyglucosepositron emission tomography and computed tomography (FDG-PET/CT) to evaluate total metabolic activity of malignant processes. Our purpose was to investigate the change of glucose metabolism in relation to PFS (progression free survival) and OS (overall survival). Fifty-three patients with mCRC with at least one measurable liver metastasis were included in this prospective, multi-center, early exploratory study. All patients were treated with first-line chemotherapy and targeted therapy. Metabolic parameters, like SUVmax, SAM, normalized SAM (NSAM) and TLG were assessed by FDG-PET/CT, carried out at baseline (scan-1) and after two therapeutic cycle (scan-2). Our results suggested neither SUVmax nor TLG have such prognostic value as NSAM in liver metastases of colorectal cancer. The parameters after the two cycles of chemotherapy proved to be better predictors of the clinical outcome. NSAM after two cycles of treatment has a statistically significant predictive value on OS, while SAM was predictive to the PFS. The follow up normalized SAM after 2 cycles of first line oncotherapy was demonstrated to be useful as prognostic biomarkers for OS in metastatic colorectal cancer. We should introduce this measurement in metastatic colorectal cancer if there is at least one metastasis in the liver.
Collapse
Affiliation(s)
- Zsuzsanna Nemeth
- Chemotherapy B and Clinical Pharmacological Department of National Institute of Oncology, Ráth György utca 7-9, Budapest, 1122 Hungary
- Oncology Department of Szent Margit Hospital, Bécsi út 132, Budapest, H-1032 Hungary
| | - Wouter Wijker
- Auxiliis Pharma Ltd, Bokor utca 17, Budapest, H-1037 Hungary
| | - Zsolt Lengyel
- Pozitron Diagnostic Ltd, Hunyadi ut 9-11, Budapest, 1117 Hungary
| | - Erika Hitre
- Chemotherapy B and Clinical Pharmacological Department of National Institute of Oncology, Ráth György utca 7-9, Budapest, 1122 Hungary
| | - Katalin Borbely
- PET Ambulatory Department of National Institute of Oncology, Rath Gyorgy utca 7-9, Budapest, 1122 Hungary
| |
Collapse
|
2
|
Advanced imaging to predict response to chemotherapy in colorectal liver metastases - a systematic review. HPB (Oxford) 2018; 20:120-127. [PMID: 29196021 DOI: 10.1016/j.hpb.2017.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The assessment of colorectal liver metastases (CRLM) after treatment with chemotherapy is challenging due to morphological and/or functional change without changes in size. The aim of this review was to assess the value of FDG-PET, FDG-PET-CT, CT and MRI in predicting response to chemotherapy in CRLM. METHODS A systematic review was undertaken based on PRISMA statement. PubMed and Embase were searched up to October 2016 for studies on the accuracy of PET, PET-CT, CT and MRI in predicting RECIST or metabolic response to chemotherapy and/or survival in patients with CRLM. Articles evaluating the assessment of response after chemotherapy were excluded. RESULTS Sixteen studies met the inclusion criteria and were included for further analysis. Study results were available for 6 studies for FDG-PET(-CT), 6 studies for CT and 9 studies for MRI. Generally, features predicting RECIST or metabolic response often predicted shorter survival. The ADC (apparent diffusion coefficient, on MRI) seems to be the most promising predictor of response and survival. In CT-related studies, few attenuation-related parameters and texture features show promising results. In FDG-PET(-CT), findings were ambiguous. CONCLUSION Radiological data on the prediction of response to chemotherapy for CRLM is relatively sparse and heterogeneous. Despite that, a promising parameter might be ADC. Second, there seems to be a seemingly counterintuitive correlation between parameters that predict a good response and also predict poor survival.
Collapse
|
3
|
Ma B, King AD, Leung L, Wang K, Poon A, Ho WM, Mo F, Chan CML, Chan ATC, Wong SCC. Identifying an early indicator of drug efficacy in patients with metastatic colorectal cancer-a prospective evaluation of circulating tumor cells, 18F-fluorodeoxyglucose positron-emission tomography and the RECIST criteria. Ann Oncol 2018; 28:1576-1581. [PMID: 28379285 DOI: 10.1093/annonc/mdx149] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 12/20/2022] Open
Abstract
Background This study investigated the predictive and prognostic significance of assessing early drug response with both positron-emission computerized tomography (PET-CT) and circulating tumor cells (CTCs) in patients receiving first-line chemotherapy for metastatic colorectal cancer. Patients and methods Eligible patients had PET-CT and CTC analysis at baseline and 4-6 weeks after starting chemotherapy, and then a CT scan at 10-12 weeks to assess the Response Evaluation Criteria In Solid Tumors (RECIST) response. Early response was defined as achieving a dual-endpoint consisting of PET-CT (30% drop in the sum of maximum standard uptake values-SUVmax-of target lesions) and CTC response (CTC < 3 cells/7.5 ml blood) at 4-6 weeks after starting chemotherapy. Results About 84 patients were enrolled with a median follow-up of 32.9 months (95% confidence interval, CI, 24.5 months-not reached, NR), and 70 patients (84.3%) completed all assessments. Achieving an early response based on the dual-endpoint was independently associated with progression-free survival (hazard ratio, HR = 0.452, 95% CI 0.267-0.765). The median progression-free survival of early responders was 7.41 months (95% CI, 6.05-9.11) compared with 5.37 months (95% CI, 4.68-6.24) in non-responders (log-rank, P = 0.0167). RECIST response at 10 weeks was independently associated with overall survival (OS) (HR = 0.484, 95% CI, 0.275-0.852). Early response based on the dual-endpoint could predict the subsequent RECIST response with a sensitivity, specificity and positive predictive value of 64%, 70% and 74%, respectively. Conclusions Early response based on both PET-CT and CTC analysis has prognostic and probably predictive significance in patients undergoing first-line chemotherapy for metastatic colorectal cancer. Its utility as a new tool for assessing early drug response should be further validated.
Collapse
Affiliation(s)
- B Ma
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - A D King
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - L Leung
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - K Wang
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - A Poon
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - W M Ho
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - F Mo
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - C M L Chan
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - A T C Chan
- State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute
| | - S C C Wong
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
4
|
Elevated tumor-to-liver uptake ratio (TLR) from 18F-FDG-PET/CT predicts poor prognosis in stage IIA colorectal cancer following curative resection. Eur J Nucl Med Mol Imaging 2017; 44:1958-1968. [PMID: 28812134 PMCID: PMC5656694 DOI: 10.1007/s00259-017-3779-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
Purpose The prognostic value of the tumor-to-liver uptake ratio (TLR) from 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F–FDG-PET/CT) in the early stage of colorectal cancer (CRC) is unclear. Notably, some stage IIA CRC patients experience early recurrence even after curative resection and might benefit from neoadjuvant or adjuvant chemotherapy. This study aims to evaluate whether elevated TLR from 18F–FDG-PET/CT can predict poor prognosis in stage IIA CRC patients undergoing curative resection. Methods From April 2010 to December 2013, 504 consecutive CRC patients with different TNM stages (I-IV) underwent 18F–FDG-PET/CT scans at the 6th Affiliated Hospital of Sun Yat-Sen University. Among the patients, 118 with stage IIA CRC who accepted preoperative 18F–FDG-PET/CT scanning and were treated with curative surgery alone were reviewed retrospectively. The maximum standardized uptake value (SUVmax) in the primary tumor, TLR, and demographic, clinical, histopathological, and laboratory data were analyzed. Receiver operating characteristic (ROC) curve, univariate and multivariate analyses were performed to identify prognostic factors associated with patient disease-free survival (DFS) and overall survival (OS). Results ROC curve analysis demonstrated that TLR was superior to primary tumor SUVmax in predicting the risk of recurrence in stage IIA CRC. The optimal TLR cutoff was 6.2. Univariate analysis indicated that elevated TLR, tumor size, and lymphovascular/neural invasion correlated with DFS (P = 0.001, P = 0.002, and P = 0.001, respectively) and OS (P = 0.001, P = 0.003, and P < 0.001, respectively). The 1-, 3-, and 5-year DFS rates were 98.4%, 96.9%, and 96.9% for stage IIA CRC patients with lower TLR (≤6.2) versus 77.8%, 60.6%, and 60.6% for those with elevated TLR (>6.2), respectively. The 1-, 3-, and 5-year OS rates were 100.0%, 100.0%, and 98.3% for the patients with lower TLR versus 98.1%, 83.3%, and 74.3% for those with elevated TLR. Cox regression analysis showed that elevated TLR [>6.2; hazard ratio (HR): 3.109–57.463; P < 0.001] and tumor size (>4.4 cm; HR: 1.636–19.155; P = 0.006) were independent risk factors for DFS. Meanwhile, elevated TLR (>6.2; HR: 1.398–84.945; P = 0.023) and lymphovascular/neural invasion (positive; HR: 1.278–12.777; P = 0.017) were independent risk factors for OS. Conclusion Elevated TLR predicted worse DFS and OS for stage IIA CRC patients and might serve as a potential radiological index to identify candidates for neoadjuvant or adjuvant chemotherapy. Stage IIA CRC patients with elevated TLR should be monitored carefully for early detection of possible recurrence.
Collapse
|
5
|
Woff E, Hendlisz A, Garcia C, Deleporte A, Delaunoit T, Maréchal R, Holbrechts S, Van den Eynde M, Demolin G, Vierasu I, Lhommel R, Gauthier N, Guiot T, Ameye L, Flamen P. Monitoring metabolic response using FDG PET-CT during targeted therapy for metastatic colorectal cancer. Eur J Nucl Med Mol Imaging 2016; 43:1792-801. [PMID: 27072811 PMCID: PMC4969337 DOI: 10.1007/s00259-016-3365-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/08/2016] [Indexed: 12/19/2022]
Abstract
Introduction The introduction of targeted drugs has had a significant impact on the approach to assessing tumour response. These drugs often induce a rapid cytostatic effect associated with a less pronounced and slower tumoural volume reduction, thereby impairing the correlation between the absence of tumour shrinkage and the patient’s unlikelihood of benefit. The aim of the study was to assess the predictive value of early metabolic response (mR) evaluation after one cycle, and its interlesional heterogeneity to a later metabolic and morphological response assessment performed after three cycles in metastatic colorectal cancer (mCRC) patients treated with combined sorafenib and capecitabine. Methods This substudy was performed within the framework of a wider prospective multicenter study on the predictive value of early FDG PET-CT response assessment (SoMore study). A lesion-based response analysis was performed, including all measurable lesions identified on the baseline PET. On a per-patient basis, a descriptive 4-class response categorization was applied based upon the presence and proportion of non-responding lesions. For dichotomic response comparison, all patients with at least one resistant lesion were classified as non-responding. Results On baseline FDG PET-CT, 124 measurable “target” lesions were identified in 38 patients. Early mR assessments showed 18 patients (47 %) without treatment resistant lesions and 12 patients (32 %) with interlesional response heterogeneity. The NPV and PPV of early mR were 85 % (35/41) and 84 % (70/83), respectively, on a per-lesion basis and 95 % (19/20) and 72 % (13/18), respectively, on a dichotomized per-patient basis. Conclusions Early mR assessment performed after one cycle of sorafenib-capecitabine in mCRC is highly predictive of non-response at a standard response assessment time. The high NPV (95 %) of early mR could be useful as the basis for early treatment discontinuation or adaptation to spare patients from exposure to non-effective drugs.
Collapse
Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium.
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Camilo Garcia
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
| | - Amelie Deleporte
- Medical Oncology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | | | - Raphaël Maréchal
- Gastroenterology Medico-Surgical Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | | | - Marc Van den Eynde
- Oncology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Irina Vierasu
- Nuclear Medicine Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Renaud Lhommel
- Nuclear Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Namur Gauthier
- Nuclear Medicine Department, CHC Saint-Joseph, Liège, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
| | - Lieveke Ameye
- Data center Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
| |
Collapse
|
6
|
Gebhart G, Lamberts LE, Wimana Z, Garcia C, Emonts P, Ameye L, Stroobants S, Huizing M, Aftimos P, Tol J, Oyen WJG, Vugts DJ, Hoekstra OS, Schröder CP, Menke-van der Houven van Oordt CW, Guiot T, Brouwers AH, Awada A, de Vries EGE, Flamen P. Molecular imaging as a tool to investigate heterogeneity of advanced HER2-positive breast cancer and to predict patient outcome under trastuzumab emtansine (T-DM1): the ZEPHIR trial. Ann Oncol 2015; 27:619-24. [PMID: 26598545 DOI: 10.1093/annonc/mdv577] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/17/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Only human epidermal growth factor receptor (HER)2 status determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) has been validated to predict efficacy of HER2-targeting antibody-drug-conjugate trastuzumab emtansine (T-DM1). We propose molecular imaging to explore intra-/interpatient heterogeneity in HER2 mapping of metastatic disease and to identify patients unlikely to benefit from T-DM1. PATIENTS AND METHODS HER2-positive mBC patients with IHC3+ or FISH ≥ 2.2 scheduled for T-DM1 underwent a pretreatment HER2-positron emission tomography (PET)/computed tomography (CT) with (89)Zr-trastuzumab. [(18)F]2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT was performed at baseline and before T-DM1 cycle 2. Patients were grouped into four HER2-PET/CT patterns according to the proportion of FDG-avid tumor load showing relevant (89)Zr-trastuzumab uptake (>blood pool activity): patterns A and B were considered positive (>50% or all of the tumor load 'positive'); patterns C and D were considered negative (>50% or all of the tumor load 'negative'). Early FDG-PET/CT was defined as nonresponding when >50% of the tumor load showed no significant reduction of FDG uptake (<15%). Negative (NPV) and positive predictive values (PPV) of HER2-PET/CT, early FDG response and their combination were assessed to predict morphological response (RECIST 1.1) after three T-DM1 cycles and time-to-treatment failure (TTF). RESULTS In the 56 patients analyzed, 29% had negative HER2-PET/CT while intrapatient heterogeneity (patterns B and C) was found in 46% of patients. Compared with RECIST1.1, respective NPV/PPV for HER2-PET/CT were 88%/72% and 83%/96% for early FDG-PET/CT. Combining HER2-PET/CT and FDG-PET/CT accurately predicted morphological response (PPV and NPV: 100%) and discriminated patients with a median TTF of only 2.8 months [n = 12, 95% confidence interval (CI) 1.4-7.6] from those with a TTF of 15 months (n = 25, 95% CI 9.7-not calculable). CONCLUSIONS Pretreatment imaging of HER2 targeting, combined with early metabolic response assessment holds great promise for improving the understanding of tumor heterogeneity in mBC and for selecting patients who will/will not benefit from T-DM1. CLINICALTRIALSGOV IDENTIFIER NCT01565200.
Collapse
Affiliation(s)
- G Gebhart
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L E Lamberts
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Z Wimana
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Garcia
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Emonts
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L Ameye
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - M Huizing
- Antwerp University Hospital, Antwerpen, Belgium
| | - P Aftimos
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - J Tol
- Radboud University Medical Center Nijmegen, Nijmegen
| | - W J G Oyen
- Radboud University Medical Center Nijmegen, Nijmegen
| | - D J Vugts
- VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - O S Hoekstra
- VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - T Guiot
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A H Brouwers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Awada
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - E G E de Vries
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Flamen
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
7
|
The Prognostic Significance of Metabolic Response Heterogeneity in Metastatic Colorectal Cancer. PLoS One 2015; 10:e0138341. [PMID: 26421426 PMCID: PMC4589397 DOI: 10.1371/journal.pone.0138341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022] Open
Abstract
Background Tumoral heterogeneity is a major determinant of resistance in solid tumors. FDG-PET/CT can identify early during chemotherapy non-responsive lesions within the whole body tumor load. This prospective multicentric proof-of-concept study explores intra-individual metabolic response (mR) heterogeneity as a treatment efficacy biomarker in chemorefractory metastatic colorectal cancer (mCRC). Methods Standardized FDG-PET/CT was performed at baseline and after the first cycle of combined sorafenib (600mg/day for 21 days, then 800mg/day) and capecitabine (1700 mg/m²/day administered D1-14 every 21 days). MR assessment was categorized according to the proportion of metabolically non-responding (non-mR) lesions (stable FDG uptake with SUVmax decrease <15%) among all measurable lesions. Results Ninety-two patients were included. The median overall survival (OS) and progression-free survival (PFS) were 8.2 months (95% CI: 6.8–10.5) and 4.2 months (95% CI: 3.4–4.8) respectively. In the 79 assessable patients, early PET-CT showed no metabolically refractory lesion in 47%, a heterogeneous mR with at least one non-mR lesion in 32%, and a consistent non-mR or early disease progression in 21%. On exploratory analysis, patients without any non-mR lesion showed a significantly longer PFS (HR 0.34; 95% CI: 0.21–0.56, P-value <0.001) and OS (HR 0.58; 95% CI: 0.36–0.92, P-value 0.02) compared to the other patients. The proportion of non-mR lesions within the tumor load did not impact PFS/OS. Conclusion The presence of at least one metabolically refractory lesion is associated with a poorer outcome in advanced mCRC patients treated with combined sorafenib-capecitabine. Early detection of treatment-induced mR heterogeneity may represent an important predictive efficacy biomarker in mCRC. Trial Registration ClinicalTrials.gov NCT01290926
Collapse
|
8
|
PET scans as a predictive marker of survival in advanced colorectal cancer. Clin Colorectal Cancer 2014; 14:35-40. [PMID: 25481195 DOI: 10.1016/j.clcc.2014.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/02/2014] [Accepted: 10/16/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The clinical utility of fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan in predicting the outcome of patients with metastatic colorectal cancer (mCRC) has not been well studied. We hypothesized that standardized uptake value (SUV) in FDG-PET scans after treatment predicts outcomes among patients with mCRC. PATIENTS AND METHODS We retrospectively reviewed mCRC patients who had FDG-PET scans before their treatment and measured their SUV on follow-up imaging at the Karmanos Cancer Institute. Primary end points of time to progression (TTP) and overall survival (OS) were compared in 2 groups: follow-up (posttreatment) SUV of 0 versus > 0. RESULTS The study population consisted of 44 patients (median age of 58.1 years). Forty (91%) of the patients were treated first-line, 34 (77%) received an oxaliplatin-based regimen, and 7 (16%) received an irinotecan-based regimen. Thirty-four (77%) patients received concurrent bevacizumab. Median pretreatment SUV was 9.2 (range, 1.7-46.3), and median posttreatment SUV (in n = 41) was 4.0 (range, 0-14). The median percent change in SUV was -68.5% (range, -9.2% to -100%). The median time interval between scans was 2.6 months. There was no statistically significant difference noted between metabolic responders and nonresponders with regard to TTP and OS. However, patients with a posttreatment SUV of 0 had significantly longer OS than those with posttreatment SUV of > 0 (median, 42 vs. 25.2 months, respectively), and slightly longer TTP (median, 8.2 vs. 6.9 months, respectively). CONCLUSION Systemic therapy significantly decreased SUV on follow-up PET scans in advanced colorectal cancer patients. Absence of FDG uptake on follow-up PET scans was associated with markedly longer OS and slightly longer TTP.
Collapse
|
9
|
Lastoria S, Piccirillo MC, Caracò C, Nasti G, Aloj L, Arrichiello C, de Lutio di Castelguidone E, Tatangelo F, Ottaiano A, Iaffaioli RV, Izzo F, Romano G, Giordano P, Signoriello S, Gallo C, Perrone F. Early PET/CT scan is more effective than RECIST in predicting outcome of patients with liver metastases from colorectal cancer treated with preoperative chemotherapy plus bevacizumab. J Nucl Med 2013; 54:2062-9. [PMID: 24136935 DOI: 10.2967/jnumed.113.119909] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Markers predictive of treatment effect might be useful to improve the treatment of patients with metastatic solid tumors. Particularly, early changes in tumor metabolism measured by PET/CT with (18)F-FDG could predict the efficacy of treatment better than standard dimensional Response Evaluation Criteria In Solid Tumors (RECIST) response. METHODS We performed PET/CT evaluation before and after 1 cycle of treatment in patients with resectable liver metastases from colorectal cancer, within a phase 2 trial of preoperative FOLFIRI plus bevacizumab. For each lesion, the maximum standardized uptake value (SUV) and the total lesion glycolysis (TLG) were determined. On the basis of previous studies, a ≤ -50% change from baseline was used as a threshold for significant metabolic response for maximum SUV and, exploratively, for TLG. Standard RECIST response was assessed with CT after 3 mo of treatment. Pathologic response was assessed in patients undergoing resection. The association between metabolic and CT/RECIST and pathologic response was tested with the McNemar test; the ability to predict progression-free survival (PFS) and overall survival (OS) was tested with the Log-rank test and a multivariable Cox model. RESULTS Thirty-three patients were analyzed. After treatment, there was a notable decrease of all the parameters measured by PET/CT. Early metabolic PET/CT response (either SUV- or TLG-based) had a stronger, independent and statistically significant predictive value for PFS and OS than both CT/RECIST and pathologic response at multivariate analysis, although with different degrees of statistical significance. The predictive value of CT/RECIST response was not significant at multivariate analysis. CONCLUSION PET/CT response was significantly predictive of long-term outcomes during preoperative treatment of patients with liver metastases from colorectal cancer, and its predictive ability was higher than that of CT/RECIST response after 3 mo of treatment. Such findings need to be confirmed by larger prospective trials.
Collapse
Affiliation(s)
- Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Maisonobe JA, Garcia CA, Necib H, Vanderlinden B, Hendlisz A, Flamen P, Buvat I. Comparison of PET metabolic indices for the early assessment of tumour response in metastatic colorectal cancer patients treated by polychemotherapy. Eur J Nucl Med Mol Imaging 2012; 40:166-74. [PMID: 23151911 PMCID: PMC3537000 DOI: 10.1007/s00259-012-2274-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/04/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE To compare the performance of eight metabolic indices for the early assessment of tumour response in patients with metastatic colorectal cancer (mCRC) treated with chemotherapy. METHODS Forty patients with advanced mCRC underwent two FDG PET/CT scans, at baseline and on day 14 after chemotherapy initiation. For each lesion, eight metabolic indices were calculated: four standardized uptake values (SUV) without correction for the partial volume effect (PVE), two SUV with correction for PVE, a metabolic volume (MV) and a total lesion glycolysis (TLG). The relative change in each index between the two scans was calculated for each lesion. Lesions were also classified as responding and nonresponding lesions using the Response Evaluation Criteria In Solid Tumours (RECIST) 1.0 measured by contrast-enhanced CT at baseline and 6-8 weeks after starting therapy. Bland-Altman analyses were performed to compare the various indices. Based on the RECIST classification, ROC analyses were used to determine how accurately the indices predicted lesion response to therapy later seen with RECIST. RESULTS RECIST showed 27 responding and 74 nonresponding lesions. Bland-Altman analyses showed that the four SUV indices uncorrected for PVE could not be used interchangeably, nor could the two SUV corrected for PVE. The areas under the ROC curves (AUC) were not significantly different between the SUV indices not corrected for PVE. The mean SUV change in a lesion better predicted lesion response without than with PVE correction. The AUC was significantly higher for SUV uncorrected for PVE than for the MV, but change in MV provided some information regarding the lesion response to therapy (AUC >0.5). CONCLUSION In these mCRC patients, all SUV uncorrected for PVE accurately predicted the tumour response on day 14 after starting therapy as assessed 4 to 6 weeks later (i.e. 6 to 8 weeks after therapy initiation) using the RECIST criteria. Neither correcting SUV for PVE nor measuring TLG improved the assessment of tumour response compared to SUV uncorrected for PVE. The change in MV was the least accurate index for predicting tumour response.
Collapse
Affiliation(s)
- Jacques-Antoine Maisonobe
- IMNC UMR 8165 CNRS - Paris 7 and Paris 11 Universities, Building 440, Orsay Campus, 91406 Orsay Cedex, France.
| | | | | | | | | | | | | |
Collapse
|