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18F-FDG PET Is an Early Predictor of Pathologic Tumor Response to Preoperative Radiochemotherapy in Locally Advanced Rectal Cancer

Giuseppe Lucio Cascini1, Antonio Avallone2, Paolo Delrio3, Cesare Guida4, Fabiana Tatangelo5, Pietro Marone6, Luigi Aloj1, Francesco De Martinis1, Pasquale Comella2, Valerio Parisi3 and Secondo Lastoria1

1 Nuclear Medicine, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy; 2 Medical Oncology A, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy; 3 Surgical Oncology C, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy; 4 Radiotherapy, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy; 5 Pathology, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy; and 6 Surgical Endoscopy, IRCCS National Cancer Institute, Fondazione "G. Pascale," Naples, Italy


Figure 1
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  		FIGURE 1.  Relative reductions of 18F-FDG uptake, measured either by SUV-max (black boxes) or SUV-mean (white boxes), during the study. Boxes represent interquartile distribution. Horizontal bars within boxes are median values. Error bars are 10th and 90th percentiles.

 

Figure 2
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  		FIGURE 2.  Early changes of SUV-max (A) and of SUV-mean (B) relative to TRG values.

 

Figure 3
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  		FIGURE 3.  Time course of 18F-FDG PET in a nonresponder patient (patient 1). (A) Intense 18F-FDG uptake in baseline study clearly depicts irregular tumor mass. (B) Tumor uptake is roughly unchanged in intermediate study (early SUV change, –15%). (C) In presurgical study, tumor volume is reduced but considerable tumor uptake is still present (late SUV change, –23%). This case was graded TRG4.

 

Figure 4
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  		FIGURE 4.  Time course of 18F-FDG PET in a responder patient (patient 31). (A) Intense 18F-FDG uptake is evident on baseline scan in a T2 lesion. (B) Significant decrease of SUV is observed on the intermediate scan. Early SUV change was –62%. (C) Complete tumor disappearance is noted on presurgical scan. Subtotal tumor regression (TRG2) was achieved. Activity in left ureter can be seen on transaxial images. n.m. = not measurable.

 

Figure 5
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  		FIGURE 5.  ROC curve analysis for early SUV changes in discriminating responder and nonresponder patients. Cutoff value in SUV-mean (closed circles) change of –52% yields values of 100% in sensitivity and specificity, whereas cutoff value in SUV-max (open boxes) of –42% gives a sensitivity of 100% and a specificity of 87% (area under curve, 0.95; confidence interval, 95%).

 




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