Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer.
BACKGROUND
Pancreatic cancer ranks as the fourth leading cause of cancer death in the United States with 5-year survival ranging from 1% to 5%. Positron emission tomography (PET) is a metabolic imaging system that is widely used for the initial staging of cancer and detecting residual disease after treatment. There are limited data, however, on the use of this molecular imaging technique to assess early tumor response after treatment in pancreatic cancer.


METHODS
The objective of the study was to explore the relationship of early treatment response using the F-fluorodeoxyglucose (FDG) PET with surgical outcome and overall survival in patients with locally advanced pancreatic cancer. FDG-PET measurements of maximum standardized uptake value and kinetic parameters were compared with the clinical outcome.


RESULTS
Twenty patients were enrolled in the study evaluating neoadjuvant induction chemotherapy followed by concurrent chemoradiotherapy (chemo-RT) for locally advanced pancreatic cancer. All 20 patients had prestudy PET scans and a total of fifty PET scans were performed. Among patients who were PET responders (> or =50% decrease in standardized uptake value after cycle 1), 100% (2/2) had complete surgical resection. Only 6% (1/16) had surgical resection in the PET nonresponders (<50% decrease). Two patients did not have the second PET scan because of clinical progression or treatment toxicity. Mean survival was 23.2 months for PET responders and 11.3 months for nonresponders (P = 0.234). Similar differences in survival were also noted when response was measured using Patlak analysis.


CONCLUSIONS
FDG-PET can aid in monitoring the clinical outcome of patients with locally advanced pancreatic cancer treated with neoadjuvant chemo-RT. FDG-PET may be used to aid patients who could have complete surgical resection as well as prognosticate patients' survival.
Choi
Minsig
M
University of Mississippi, GV Montgomery VA Medical Center, Jackson, MS, USA.
Heilbrun
Lance K
LK
Venkatramanamoorthy
Raghu
R
Lawhorn-Crews
Jawana M
JM
Zalupski
Mark M
MM
Shields
Anthony F
AF
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D016903:Drug Monitoring / Q000379:methods*; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D020360:Neoadjuvant Therapy; D009502:Neutrons / Q000627:therapeutic use; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017785:Photons / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D003561:Cytarabine; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin; D005472:Fluorouracil