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Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer.

Publication ,  Journal Article
Guillem, JG; Moore, HG; Akhurst, T; Klimstra, DS; Ruo, L; Mazumdar, M; Minsky, BD; Saltz, L; Wong, WD; Larson, S
Published in: J Am Coll Surg
July 2004

BACKGROUND: We have previously demonstrated that fluorodeoxyglucose-positron emission tomography (FDG-PET) can assess extent of pathologic response of primary rectal cancer to preoperative chemoradiation. Our goal was to determine the prognostic significance of FDG-PET assessment of rectal cancer response to preoperative chemoradiation. STUDY DESIGN: Fifteen patients with locally advanced primary rectal cancer (clinically bulky or tethered, or ultrasound evidence of T3-4 disease, N1 disease, or both) deemed eligible for preoperative radiation and 5-FU-based chemotherapy (5,040 cGy to the pelvis and 2 cycles of bolus 5-FU/leucovorin) were prospectively enrolled from May 1997 to September 1998. FDG-PET was performed before and 4 to 5 weeks after completion of preoperative chemoradiation. FDG-PET parameters included maximum standard uptake value (SUV(max)), total lesion glycolysis (TLG), and visual response score. Patients were prospectively followed after operation, and disease status was determined. RESULTS: All patients demonstrated some degree of response to preoperative therapy based on pathologic examination. At a median followup of 42 months (range 23 to 54 months), 11 patients had no evidence of disease and 4 had died of disease. The mean percentage decrease in SUV(max) (DeltaSUV(max)) was 69% for patients free from recurrence and 37% for patients with recurrence (p = 0.004). DeltaSUV(max) >or= 62.5 and deltaTLG >or= 69.5 were the best predictors of no-evidence-of-disease status and freedom from recurrence. Patients with DeltaSUV(max) >or= 62.5 and deltaTLG >or= 69.5 had significantly improved disease-specific and recurrence-free survival (p = 0.08, 0.02 and p = 0.03, 0.01, respectively). CONCLUSIONS: Our results indicate that FDG-PET assessment of locally-advanced rectal cancer response to preoperative chemoradiation may predict longterm outcomes.

Duke Scholars

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

July 2004

Volume

199

Issue

1

Start / End Page

1 / 7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, Emission-Computed
  • Survival Analysis
  • Surgery
  • Remission Induction
  • Rectal Neoplasms
  • Radiotherapy, Adjuvant
  • Radiopharmaceuticals
  • Prospective Studies
  • Prognosis
 

Citation

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Guillem, J. G., Moore, H. G., Akhurst, T., Klimstra, D. S., Ruo, L., Mazumdar, M., … Larson, S. (2004). Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer. J Am Coll Surg, 199(1), 1–7. https://doi.org/10.1016/j.jamcollsurg.2004.02.024
Guillem, Jose G., Harvey G. Moore, Timothy Akhurst, David S. Klimstra, Leyo Ruo, Madhu Mazumdar, Bruce D. Minsky, Leonard Saltz, W Douglas Wong, and Steven Larson. “Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer.J Am Coll Surg 199, no. 1 (July 2004): 1–7. https://doi.org/10.1016/j.jamcollsurg.2004.02.024.
Guillem, Jose G., et al. “Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer.J Am Coll Surg, vol. 199, no. 1, July 2004, pp. 1–7. Pubmed, doi:10.1016/j.jamcollsurg.2004.02.024.
Guillem JG, Moore HG, Akhurst T, Klimstra DS, Ruo L, Mazumdar M, Minsky BD, Saltz L, Wong WD, Larson S. Sequential preoperative fluorodeoxyglucose-positron emission tomography assessment of response to preoperative chemoradiation: a means for determining longterm outcomes of rectal cancer. J Am Coll Surg. 2004 Jul;199(1):1–7.
Journal cover image

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

July 2004

Volume

199

Issue

1

Start / End Page

1 / 7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, Emission-Computed
  • Survival Analysis
  • Surgery
  • Remission Induction
  • Rectal Neoplasms
  • Radiotherapy, Adjuvant
  • Radiopharmaceuticals
  • Prospective Studies
  • Prognosis