Aim: PET/CT has been provided to be useful in staging of colorectal cancer for detecting extra‐hepatic disease in high risk patients and for examine for postoperative recurrence of disease. We aimed to evaluate the additional information provided by FDG PET/CT from qualitative and quantitative analysis in patients with advanced rectal cancer. Materials and methods: at our Institution, we prospectively evaluated 30 patients (21 males; mean age: 65±12 years) with rectal cancer, who underwent FDG PET/CT for initial staging. PET/CT findings and the maximum standardized uptake value (SUVmax) obtained by the analysis of the images were compared with clinical stage of disease and with response to neoadjuvant treatment (chemotherapy plus radiotherapy). A patient‐based analysis was used. A p value <0.05 was considered statistically significant. Results: at initial staging, 3 (10%) patients were at stage I, 6 (20%) at stage II, 14 (47%) at stage III and finally 7 (23%) at stage IV. PET/CT correctly staged 11 patients, in particular in 4 patients localized visceral secondary metastases, whereas in the remnant 15 patients understaged the lymph node involvement. In these latter patients, SUVmax at primary lesion was 21±8 (range: 9‐36). SUVmax of primary lesion was similar among the different stage of disease (25±13, 17±6, 21±7 e 19±10, respectively at stage I, II, III e IV; ANOVA test p=0.551). After neoadjuvant therapy, 17 (57%) patients have had a complete or partial response to treatment, while 6 patients had not. The value of SUVmax at primary lesion was similar between responder and no‐responder subset (19±7 vs. 25±11; t‐Student test p=0.131). Conclusions: PET/CT can yield useful information for the initial evaluation of rectal cancer, in particular for the distant metastases. From our results, we did not find any correlation between metabolic aggressiveness and responsiveness to neoadjuvant therapy, but a larger study population is warranted to confirm this finding.
Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET/CT) and metabolic features in advanced rectal cancer: additional information at initial staging and after neoadjuvant therapy
POMERRI, FABIO;
2012
Abstract
Aim: PET/CT has been provided to be useful in staging of colorectal cancer for detecting extra‐hepatic disease in high risk patients and for examine for postoperative recurrence of disease. We aimed to evaluate the additional information provided by FDG PET/CT from qualitative and quantitative analysis in patients with advanced rectal cancer. Materials and methods: at our Institution, we prospectively evaluated 30 patients (21 males; mean age: 65±12 years) with rectal cancer, who underwent FDG PET/CT for initial staging. PET/CT findings and the maximum standardized uptake value (SUVmax) obtained by the analysis of the images were compared with clinical stage of disease and with response to neoadjuvant treatment (chemotherapy plus radiotherapy). A patient‐based analysis was used. A p value <0.05 was considered statistically significant. Results: at initial staging, 3 (10%) patients were at stage I, 6 (20%) at stage II, 14 (47%) at stage III and finally 7 (23%) at stage IV. PET/CT correctly staged 11 patients, in particular in 4 patients localized visceral secondary metastases, whereas in the remnant 15 patients understaged the lymph node involvement. In these latter patients, SUVmax at primary lesion was 21±8 (range: 9‐36). SUVmax of primary lesion was similar among the different stage of disease (25±13, 17±6, 21±7 e 19±10, respectively at stage I, II, III e IV; ANOVA test p=0.551). After neoadjuvant therapy, 17 (57%) patients have had a complete or partial response to treatment, while 6 patients had not. The value of SUVmax at primary lesion was similar between responder and no‐responder subset (19±7 vs. 25±11; t‐Student test p=0.131). Conclusions: PET/CT can yield useful information for the initial evaluation of rectal cancer, in particular for the distant metastases. From our results, we did not find any correlation between metabolic aggressiveness and responsiveness to neoadjuvant therapy, but a larger study population is warranted to confirm this finding.
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