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

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish
Pages (from-to)2062-2069
Number of pages8
JournalJournal of Nuclear Medicine
Volume54
Issue number12
DOIs
Publication statusPublished - Dec 1 2013

Fingerprint

Colorectal Neoplasms
Neoplasm Metastasis
Drug Therapy
Liver
Glycolysis
Survival
Therapeutics
Multivariate Analysis
Fluorodeoxyglucose F18
Positron Emission Tomography Computed Tomography
Bevacizumab
Response Evaluation Criteria in Solid Tumors
Proportional Hazards Models
Neoplasms

Keywords

  • Colorectal cancer
  • Early PET/CT
  • Liver metastases
  • Predictive factor
  • Preoperative treatment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

@article{6c6a1d6c36914379bbe1d988a67fe5e7,
title = "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",
abstract = "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",
keywords = "Colorectal cancer, Early PET/CT, Liver metastases, Predictive factor, Preoperative treatment",
author = "Secondo Lastoria and Piccirillo, {Maria Carmela} and Corradina Carac{\`o} and Guglielmo Nasti and Luigi Aloj and Cecilia Arrichiello and {De Lutio Di Castelguidone}, Elisabetta and Fabiana Tatangelo and Alessandro Ottaiano and Iaffaioli, {Rosario Vincenzo} and Francesco Izzo and Giovanni Romano and Pasqualina Giordano and Simona Signoriello and Ciro Gallo and Francesco Perrone",
year = "2013",
month = "12",
day = "1",
doi = "10.2967/jnumed.113.119909",
language = "English",
volume = "54",
pages = "2062--2069",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "12",

}

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

VL - 54

SP - 2062

EP - 2069

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 12

ER -