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

Journal of Nuclear Medicine

Francesco Perrone¹  Giovanni Romano¹  Cecilia Arrichiello¹  Luigi Aloj¹  Pasqualina Giordano¹  Ciro Gallo¹  Elisabetta de Lutio di Castelguidone¹  Guglielmo Nasti¹  Maria Carmela Piccirillo¹  Fabiana Tatangelo¹  Francesco Izzo¹  Corradina Caracò¹  Rosario Vincenzo Iaffaioli¹  Alessandro Ottaiano¹  Secondo Lastoria¹  Simona Signoriello¹ 

关键词: early PET/CT;    predictive factor;    colorectal cancer;    liver metastases;    preoperative treatment;   

DOI  :  10.2967/jnumed.113.119909

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

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 18F-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.

【 授权许可】

Unknown