TY - JOUR
T1 - 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
AU - Lastoria, Secondo
AU - Piccirillo, Maria Carmela
AU - Caracò, Corradina
AU - Nasti, Guglielmo
AU - Aloj, Luigi
AU - Arrichiello, Cecilia
AU - De Lutio Di Castelguidone, Elisabetta
AU - Tatangelo, Fabiana
AU - Ottaiano, Alessandro
AU - Iaffaioli, Rosario Vincenzo
AU - Izzo, Francesco
AU - Romano, Giovanni
AU - Giordano, Pasqualina
AU - Signoriello, Simona
AU - Gallo, Ciro
AU - Perrone, Francesco
PY - 2013/12/1
Y1 - 2013/12/1
N2 - 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 progressionfree survival (PFS) and overall survival (OS) was tested with the Log-rank test and a multivariable Cox model. Results: Thirtythree 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. COPYRIGHT
AB - 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 progressionfree survival (PFS) and overall survival (OS) was tested with the Log-rank test and a multivariable Cox model. Results: Thirtythree 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. COPYRIGHT
KW - Colorectal cancer
KW - Early PET/CT
KW - Liver metastases
KW - Predictive factor
KW - Preoperative treatment
UR - http://www.scopus.com/inward/record.url?scp=84893393164&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84893393164&partnerID=8YFLogxK
U2 - 10.2967/jnumed.113.119909
DO - 10.2967/jnumed.113.119909
M3 - Article
C2 - 24136935
AN - SCOPUS:84893393164
SN - 0161-5505
VL - 54
SP - 2062
EP - 2069
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 12
ER -