title: Volumetric parameters changes of sequential 18F-FDG PET/CT for early prediction of recurrence and death in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy.
abstract: : The goal of the present study was to determine whether volumetric parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by sequential F-FDG PET/CT imaging could be used as prognostic factors in patients with locally advanced rectal cancer (LARC) who received preoperative concurrent chemoradiotherapy.
  
  
  METHODS
  A total 64 patients with LARC patients were included in the current study. All patients were evaluated by F-FDG PET/CT before and after 45 Gy of radiotherapy with concurrent oral capecitabine chemotherapy. Initial, second, and the percent changes ([INCREMENT], %) of semiquantitative and volumetric parameters were used to calculate recurrence-free survival (RFS) and overall survival (OS). The cutoff values of semiquantitative and volumetric parameters were determined by receiver operating characteristic curve analysis. The prognostic significance was assessed using univariate and multivariate Cox proportional hazard regression analysis.
  
  
  RESULTS
  For RFS, American Joint Committee on Cancer (AJCC) stage (χ = 10.7, P = 0.002), surgical margin (+) (χ = 3.39, P = 0.037), lymphatic invasion (+) (χ = 6.8, P = 0.0078), RECIST (Response Evaluation Criteria in Solid Tumors) (χ = 46.3, P < 0.0001), SUVmax1 (χ = 10.1, P = 0.025), ΔSUVmax (χ = 20.4, P < 0.0001), ΔSUVmean (χ = 28.8, P < 0.0001), MTV1 (χ = 24.1, P < 0.0001), ΔMTV (χ = 27.4, P < 0.0001), TLG1 (χ = 21.9, P < 0.0001), TLG2 (χ = 23.3, P < 0.0001), and ΔTLG (χ = 55.6, P < 0.0001) are associated prognostic factors. For OS, AJCC stage (χ = 6.0, P = 0.021), surgical margin (+) (χ = 3.2, P = 0.042), lymphatic invasion (+) (χ = 3.8, P = 0.048), RECIST (χ = 10.4, P = 0.0015), ΔSUVmax (χ = 6.0, P = 0.013), ΔSUVmean (χ = 10.5, P = 0.0009), MTV1 (χ = 14.5, P = 0.0008), ΔMTV (χ = 14.7, P = 0.0002), TLG1 (χ = 15.8, P = 0.0002), TLG2 (χ = 13.5, P = 0.0006), and ΔTLG (χ = 17.5, P < 0.0001) are potent predictors. Multivariate Cox proportional hazard regression analyses revealed that the initial MTV (MTV1) and ΔTLG were the potent predictors for RFS and OS.
  
  
  CONCLUSIONS
  Our data suggest that MTV on initial pretreatment F-FDG PET/CT and ΔTLG of sequential F-FDG PET/CT after preoperative concurrent chemoradiotherapy in LARC patients could provide prognostic information.
authors.affiliation: From the *Department of Nuclear Medicine and †Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; and ‡Department of Radiology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D054893:Cone-Beam Computed Tomography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18