Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer
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ORIGINAL ARTICLE
Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer Gundula Rendl • Lukas Rettenbacher • Johannes Holzmannhofer • ¨ fner Lidwina Datz • Cornelia Hauser-Kronberger • Gerd Fastner • Dietmar O • Felix Sedlmayer Christian Pirich
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Received: 14 September 2014 / Accepted: 26 November 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Objective The comparison of 2-deoxy-2-[18F]fluoro-Dglucose (F-18 FDG) and 30 -deoxy-30 -[18F]fluorothymidine (F-18 FLT) imaging in patients with rectal cancer before and after neoadjuvant radiochemotherapy (RCT) in relation to histopathology and immunohistochemistry obtained from surgery. Methods 20 consecutive patients (15 m, 5 f), mean age of 65 ± 10 years were included into this prospective study with a mean follow-up of 4.1 ± 0.8 years. Results Among histopathological responders (n = 8 out of 20), posttreatment F-18 FLT and F-18 FDG scans were negative in 75 % (n = 6) and 38 % (n = 3), respectively. The mean response index (RI) was 61.0 % ± 14.0 % for
EudraCT-Number: 2006-003828-11. G. Rendl (&) L. Rettenbacher J. Holzmannhofer C. Pirich Department of Nuclear Medicine and Endocrinology, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria e-mail: [email protected] L. Datz Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria C. Hauser-Kronberger Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria G. Fastner F. Sedlmayer Department of Radiotherapy and Radiooncology, Paracelsus Medical University, Salzburg, Austria ¨ fner D. O Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
F-18 FLT and 58.7 % ± 14.6 % for F-18 FDG imaging. Peritumoral lymphocytic infiltration (CD3 positive cells) was significantly related to posttreatment SUVmax in F-18 FDG but not F-18 FLT studies. Conclusion A significant decrease of SUVmax in F-18 FDG and F-18 FLT studies could be seen after RCT. Negative posttreatment F-18 FLT studies identified more histopathological responders. Keywords 18F-FDG 18F-FLT PET/CT Rectal cancer Radiochemotherapy
Introduction The assessment of response to neoadjuvant radiochemotherapy (RCT) in patients with rectal cancer is of potential clinical importance for the selection of the appropriate therapeutic strategy aiming for cure. This is achieved most commonly by surgery, but in selected cases with documented complete response to RCT, a wait-and-see strategy might be applied [1]. Many studies investigated the impact of imaging with positron emission tomography/computer tomography (PET/CT) using 2-deoxy-2-[18F]fluoro-D-glucose (F-18 FDG) to monitor the efficacy of RCT in rectal cancer. Some studies related long-term outcome to the course of F-18 FDG PET performed at baseline and about 2 weeks after start of therapy [2, 3]. Other study designs employed F-18 FDG studies before and after RCT to define response criteria and relate them to long-term outco
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