title: Blood glucose level normalization and accurate timing improves the accuracy of PET-based treatment response predictions in rectal cancer.
abstract: OBJECTIVE
  To quantify the influence of fluctuating blood glucose level (BGLs) and the timing of PET acquisition on PET-based predictions of the pathological treatment response in rectal cancer.
  
  
  METHODS
  Thirty patients, diagnosed with locally advanced-rectal-cancer (LARC), were included in this prospective study. Sequential FDG-PET-CT investigations were performed at four time points during and after pre-operative radiochemotherapy (RCT). All PET-data were normalized for the BGL measured shortly before FDG injection. The metabolic treatment response of the tumor was correlated with the pathological treatment response.
  
  
  RESULTS
  During RCT, strong intra-patient BGL-fluctuations were observed, ranging from -38.7 to 95.6%. BGL-normalization of the SUVs revealed differences ranging from -54.7 to 34.7% (p < 0.001). Also, a SUV(max) time-dependency of 1.30 +/- 0.66 every 10 min (range: 0.39-2.58) was found during the first 60 min of acquisition. When correlating the percent reduction of SUV(max) after 2 weeks of RCT with the pathological treatment response, a significant increase (p = 0.027) in the area under the curve of ROC-curve analysis was found when normalizing the PET-data for the measured BGLs, indicating an increase of the predictive strength.
  
  
  CONCLUSIONS
  This study strongly underlines the necessity of BGL-normalization of PET-data and a precise time-management between FDG injection and the start of PET acquisition when using sequential FDG-PET-CT imaging for the prediction of pathological treatment response.
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht, The Netherlands. marco.janssen@maastro.nl
authors.forename: Marco H M
authors.initials: MH
authors.lastname: Janssen
authors.forename: Michel C
authors.initials: MC
authors.lastname: Ollers
authors.forename: Ruud G P M
authors.initials: RG
authors.lastname: van Stiphout
authors.forename: Robert G
authors.initials: RG
authors.lastname: Riedl
authors.forename: Jørgen
authors.initials: J
authors.lastname: van den Bogaard
authors.forename: Jeroen
authors.initials: J
authors.lastname: Buijsen
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
authors.forename: Guido
authors.initials: G
authors.lastname: Lammering
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D049268:Positron-Emission Tomography; D012004:Rectal Neoplasms / Q000097:blood* / Q000175:diagnosis*; D013997:Time Factors
chemical_list: D001786:Blood Glucose