The predictive value of PET/CT for distant recurrences in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy.
PET
locally advanced rectal cancer
prognostication
Journal
Journal of medical imaging and radiation oncology
ISSN: 1754-9485
Titre abrégé: J Med Imaging Radiat Oncol
Pays: Australia
ID NLM: 101469340
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
17
01
2021
accepted:
26
07
2021
pubmed:
27
8
2021
medline:
15
12
2021
entrez:
26
8
2021
Statut:
ppublish
Résumé
It is well recognized that pathological complete response (pCR) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT) confers a positive survival advantage. Despite this, a small proportion of patients can develop distant recurrence, and these are the patients that will likely benefit from adjuvant therapy. This study aims to investigate the role of PET/CT as a functional imaging to stratify patients according to their risk of distant recurrence. This is a retrospective analysis of a prospectively maintained database in a single quaternary teaching hospital from 2010 to 2019. All consecutive cases of locally advanced rectal cancer with restaging PET/CT were included. The primary outcome measure was 5-year OS and distant recurrence-free survival. A pCR and complete metabolic response (CMR) were identified in 47 (18%) patients and 73 (27.4%) patients respectively. Of these, 26 patients had both pCR and CMR and these patients remained free of local and distant recurrence at their last censored date. Patients with both pCR and CMR achieved the highest 5-year overall survival of 96.2%, followed by those with pCR and incomplete CMR (iCMR) of 85.7%, non-pCR and CMR of 85.1% and non-pCR and iCMR of 83.1%. Independent predictors for 5-year distant recurrence-free survival were pathological and PET metabolic response, nodal staging and lymphovascular invasion (LVI). In conclusion, a PET/CT has the potential to better stratify patients of their risk of distant metastasis. However, a larger validation cohort is required before these findings can be translated to clinical utility.
Identifiants
pubmed: 34435447
doi: 10.1111/1754-9485.13315
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
917-924Informations de copyright
© 2021 The Royal Australian and New Zealand College of Radiologists.
Références
Heald RJ. The 'Holy Plane' of rectal surgery. J R Soc Med 1988; 81: 503-8.
Sauer R, Becker H, Hohenberger W et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731-40.
Poulsen L, Qvortrup C, Pfeiffer P, Yilmaz M, Falkmer U, Sorbye H. Review on adjuvant chemotherapy for rectal cancer - why do treatment guidelines differ so much? Acta Oncol 2015; 54: 437-46.
Sun Y, Wu X, Zhang Y et al. Pathological complete response may underestimate distant metastasis in locally advanced rectal cancer following neoadjuvant chemoradiotherapy and radical surgery: incidence, metastatic pattern, and risk factors. Eur J Surg Oncol 2019; 45: 1225-31.
Lim YJ, Kim Y, Kong M. Adjuvant chemotherapy in rectal cancer patients who achieved a pathological complete response after preoperative chemoradiotherapy: a systematic review and meta-analysis. Sci Rep 2019; 9: 10008.
Breugom AJ, van Gijn W, Muller EW et al. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol 2015; 26: 696-701.
Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 2007; 370: 2020-9.
Moertel CG, Fleming TR, Macdonald JS et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990; 322: 352-8.
Hong YS, Kim SY, Lee JS et al. Oxaliplatin-Based Adjuvant Chemotherapy for Rectal Cancer After Preoperative Chemoradiotherapy (ADORE): long-term results of a randomized controlled trial. J Clin Oncol 2019; 37: 3111-23.
Kong JC, Guerra GR, Warrier SK et al. Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis. Colorectal Dis 2018; 20: 574-85.
Choi M, Kollepara SLS, Heilbrun LK, Smith D, Shields AF, Philip PA. PET scans as a predictive marker of survival in advanced colorectal cancer. Clin Colorectal Cancer 2015; 14: 35-40.
Okuno T, Kawai K, Koyama K et al. Value of FDG-PET/CT volumetry after chemoradiotherapy in rectal cancer. Dis Colon Rectum 2018; 61: 320-7.
Petrelli F, Coinu A, Lonati V, Barni S. A systematic review and meta-analysis of adjuvant chemotherapy after neoadjuvant treatment and surgery for rectal cancer. Int J Colorectal Dis 2015; 30: 447-57.
Habr-Gama A, Perez RO, Nadalin W et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240: 711-7; discussion 7-8.
Kong JC, Guerra GR, Warrier SK, Ramsay RG, Heriot AG. Outcome and salvage surgery following "watch and wait" for rectal cancer after neoadjuvant therapy: a systematic review. Dis Colon Rectum 2017; 60: 335-45.
Perez RO, Habr-Gama A, Gama-Rodrigues J et al. Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation: long-term results of a prospective trial (National Clinical Trial 00254683). Cancer 2012; 118: 3501-11.
Ryan JE, Warrier SK, Lynch AC, Heriot AG. Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review. Colorectal Dis 2015; 17: 849-61.
Flavell RR, Naeger DM, Aparici CM, Hawkins RA, Pampaloni MH, Behr SC. Malignancies with low fluorodeoxyglucose uptake at PET/CT: pitfalls and prognostic importance: resident and fellow education feature. Radiographics 2016; 36: 293-4.
Bujko K, Glimelius B, Valentini V, Michalski W, Spalek M. Postoperative chemotherapy in patients with rectal cancer receiving preoperative radio(chemo)therapy: a meta-analysis of randomized trials comparing surgery +/- a fluoropyrimidine and surgery + a fluoropyrimidine +/- oxaliplatin. Eur J Surg Oncol 2015; 41: 713-23.
Benson AB, Venook AP, Al-Hawary MM et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 2018; 16: 874-901.