title: Predictive value of metabolic 18FDG-PET response on outcomes in patients with locally advanced pancreatic carcinoma treated with definitive concurrent chemoradiotherapy.
abstract: BACKGROUND
  We aimed to study the predictive value of combined 18F-fluoro-deoxy-D-glucose positron emission tomography and computerized tomography (FDG-PET-CT), on outcomes in locally advanced pancreatic carcinoma (LAPC) patients treated with concurrent chemoradiotherapy (C-CRT).
  
  
  METHODS
  Thirty-two unresectable LAPC patients received 50.4 Gy (1.8 Gy/fr) of RT and concurrent 5-FU followed by 4 to 6 cycles of gemcitabine consolidation. Response was evaluated by FDG-PET-CT at post-C-CRT 12-week. Patients were stratified into two groups according to the median difference between pre- and post-treatment maximum standard uptake values (SUVmax) as an indicator of response for comparative analysis.
  
  
  RESULTS
  At a median follow-up of 16.1 months, 16 (50.0%) patients experienced local/regional failures, 6 of which were detected on the first follow-up FDG-PET-CT. There were no marginal or isolated regional failures. Median pre- and post-treatment SUVmax and median difference were 14.5, 3.9, and -63.7%, respectively. Median overall survival (OS), progression-free survival (PFS), and local-regional progression-free survival (LRPFS) were 14.5, 7.3, and 10.3 months, respectively. Median OS, PFS, and LRPFS for those with greater (N = 16) versus lesser (N = 16) SUVmax change were 17.0 versus 9.8 (p = 0.001), 8.4 versus 3.8 (p = 0.005), and 12.3 versus 6.9 months (p = 0.02), respectively. On multivariate analysis, SUVmax difference was predictive of OS, PFS, and LRPFS, independent of existing covariates.
  
  
  CONCLUSIONS
  Significantly higher OS, PFS, and LRPFS in patients with greater SUVmax difference suggest that FDG-PET-CT-based metabolic response assessment is an independent predictor of clinical outcomes in LAPC patients treated with definitive C-CRT.
authors.affiliation: Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey. docdretopkan@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Topkan
authors.forename: Cem
authors.initials: C
authors.lastname: Parlak
authors.forename: Ayşe
authors.initials: A
authors.lastname: Kotek
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Yapar
authors.forename: Berrin
authors.initials: B
authors.lastname: Pehlivan
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality* / Q000532:radiotherapy* / Q000628:therapy; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D019275:Radiopharmaceuticals; D003841:Deoxycytidine; D019788:Fluorodeoxyglucose F18; D000093542:Gemcitabine
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