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Findings on ¹⁸F-FDG PET Scans After Neoadjuvant Chemoradiation Provides Prognostic Stratification in Patients with Locally Advanced Rectal Carcinoma Subsequently Treated by Radical Surgery

¹ Center For Molecular Imaging, The Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; ² Department of Nuclear Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia; ³ Division of Surgery, The Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; ⁴ Center for Biostatistics and Clinical Trials, The Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; and ⁵ Department of Medicine, St Vincent's Medical School, Melbourne University, Melbourne, Victoria, Australia

View larger version (68K): [in a new window]   FIGURE 1.  Coregistered and normalized pre- (top) and post- (bottom) chemoradiation 18F-FDG PET scans show complete resolution of metabolic activity at site of this T3 N0 M0 tumor. Reference maximum-intensity-projection images demonstrate normalization of scan appearances. Corresponding transaxial (middle left), sagittal (middle right), and coronal (right) planes through the level of the tumor demonstrate no residual metabolic abnormality and were graded as CMR. Note appearance of mildly increased uptake distal to initial tumor site but within the radiation volume. This was reported as probable radiation proctitis and was consistent with sigmoidoscopy findings. This patient is FFD at 4 y. ANT = anterior; POS = posterior.

View larger version (13K): [in a new window]   FIGURE 2.  Kaplan–Meier survival curves illustrate highly significant effect of PET-determined metabolic response to chemoradiation on overall survival in the 30 T3/4 Nx M0 patients who underwent radical surgery. (X) = number of patients in each group.

View larger version (13K): [in a new window]   FIGURE 3.  Very significant effect of PET metabolic response to chemoradiation on time-to-disease progression is demonstrated in Kaplan–Meier plot. (X) = number of patients in each group.

View larger version (15K): [in a new window]   FIGURE 4.  Kaplan–Meier survival curves show significant effect of degree of residual tumor at laparotomy on overall survival in the 30 Tx Nx M0 patients who underwent radical surgery. Note small number of patients with no evidence of residual tumor in this patient population. (X) = number of patients in each group.

View larger version (12K): [in a new window]   FIGURE 5.  Kaplan–Meier survival curves show effect of initial tumor T stage on overall survival in the 30 Tx Nx M0 patients who underwent radical surgery. Small number of patients with T4 limits evaluation of the prognostic power of this parameter. (X) = number of patients in each group.

View larger version (11K): [in a new window]   FIGURE 6.  Kaplan–Meier curves illustrate effect of CT/MRI response to chemoradiation on overall survival. There were no deaths before the closeout date in the complete response (CR) subgroup, but there were only 5 patients in this category. (X) = number of patients in each group.