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Molecular Imaging of Proliferation and Glucose Utilization: Utility for Monitoring Response and Prognosis after Neoadjuvant Therapy in Locally Advanced Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
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Abstract

Background

Metabolic imaging of gastric cancer is limited due to the 30% of primary tumors that are not 18F-fluorodeoxyglucose (FDG) avid. In contrast, the proliferation marker 18F-fluorothymidine (FLT) has been shown to visualize also non-FDG-avid gastric tumors. In this study we tested whether FLT-positron emission tomography (PET) can improve the predictive potential of molecular imaging for assessing response to neoadjuvant therapy in gastric cancer compared with FDG-PET.

Methods

45 patients with gastric cancer underwent FDG- and FLT-PET before and 2 weeks after initiation of chemotherapy. FDG/FLT-PET findings and Ki67 immunohistochemistry were correlated with clinical and histopathological response and survival.

Results

14 patients had non-FDG-avid tumors, whereas all tumors could be visualized by FLT-PET. No significant association of clinical or histopathological response with any of the analyzed metabolic parameters [initial standardized uptake value (SUV), SUV after 2 weeks, change of SUV for FDG/FLT] was found. Univariate Cox regression analysis for Ki67 and metabolic parameters revealed significant prognostic impact for survival only for FLT SUVmean day 14 (p = 0.048) and Ki67 (p = 0.006). Multivariate Cox regression analysis (including clinical response, Lauren type, ypN category, and FLT SUVmean day 14) revealed Lauren type and FLT SUVmean day 14 as the only significant prognostic factors (p = 0.006, p = 0.002).

Conclusions

FLT uptake 2 weeks after initiation of therapy was shown to be the only imaging parameter with significant prognostic impact. Neither FLT-PET nor FDG-PET were correlated with histopathological or clinical response. However, these data must be interpreted with caution due to the single-center trial study design, relatively short follow-up, poor response rates, and unfavorable prognosis.

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Acknowledgment

K.H. and M.P.A.E. were supported by the collaborative research center SFB 824, TP B1, German Research Foundation (DFG) “Imaging for Selection, Monitoring and Individualization of Cancer Therapies”.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Heidelberg, Heidelberg, Germany

    Katja Ott MD

  2. Department of Nuclear Medicine, Technische Universitaet Muenchen, Munich, Germany

    Ken Herrmann MD, Hans-Jürgen Wester PhD, Andreas K. Buck MD, Markus Schwaiger MD & Bernd Joachim Krause MD

  3. Institute of Medical Statistics and Epidemiology, Technische Universitaet Muenchen, Munich, Germany

    Tibor Schuster PhD

  4. Institute of Pathology, Technische Universitaet Muenchen, Munich, Germany

    Rupert Langer MD & Karen Becker MD

  5. Institute of Radiology, Technische Universitaet Muenchen, Munich, Germany

    Hinrich A. Wieder MD

  6. Directorate, University of Heidelberg, Heidelberg, Germany

    Jörg-Rüdiger Siewert MD

  7. Department of Internal Medicine III (Hematology/Oncology), Technische Universitaet Muenchen, Munich, Germany

    Christian Meyer zum Büschenfelde MD & Christian Peschel MD

  8. Department of Surgery, Technische Universitaet Muenchen, Munich, Germany

    Dirk Wilhelm MD

  9. Department of Internal Medicine II (Gastroenterology), Technische Universitaet Muenchen, Munich, Germany

    Matthias P. A. Ebert MD

  10. Department of Medicine II, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany

    Matthias P. A. Ebert MD

  11. Medizinische Klinik III, Klinikum Braunschweig, Brunswick, Germany

    Florian Lordick MD

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  1. Katja Ott MD
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  2. Ken Herrmann MD
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  16. Bernd Joachim Krause MD
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Corresponding author

Correspondence to Ken Herrmann MD.

Additional information

Katja Ott and Ken Herrmann contributed equally to this article.

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Ott, K., Herrmann, K., Schuster, T. et al. Molecular Imaging of Proliferation and Glucose Utilization: Utility for Monitoring Response and Prognosis after Neoadjuvant Therapy in Locally Advanced Gastric Cancer. Ann Surg Oncol 18, 3316–3323 (2011). https://doi.org/10.1245/s10434-011-1743-y

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  • DOI: https://doi.org/10.1245/s10434-011-1743-y

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