title: Metabolic tumour volume of anal carcinoma on (18)FDG PET/CT before combined radiochemotherapy is the only independant determinant of recurrence free survival.
abstract: OBJECTIVE
  to determine whether [(18)F]2-fluoro-2-deoxyglucose (FDG) positron emission tomography and X-ray computed tomography (PET/CT) findings and metabolic parameters before combined chemo- and radiotherapy (CRT) have a prognostic value in patients with anal carcinoma.
  
  
  METHODS
  45 patients with anal cancer who underwent pre-treatment FDG-PET/CT were included. Metabolic parameters, recurrence and anal carcinoma specific survival were analyzed.
  
  
  RESULTS
  SUV max and metabolic volume of the primary tumour were significantly higher in patients with lymph node or distant metastases than in those with locally confined disease (p=0.020 and p=0.015, respectively). The extent of disease (local tumour only, lymph node or distant metastases) was highly predictive of both for recurrence free and disease specific survival (p=0.010 and p<0.001, respectively). Recurrence free (p=0.010) and anal carcinoma specific survival (p=0.006) differed significantly between patients with a metabolic volume ≤45ml and >45ml. Multivariate analysis revealed that a metabolic volume >45ml was the only significant independent determinant (p=0.19) for recurrence free survival whereas for anal carcinoma specific survival the extent of disease was identified as the only significant independent determinant (p=0.002).
  
  
  CONCLUSIONS
  the extent of disease on FDG PET/CT before combined radio-chemotherapy is strongly predictive of prognosis in anal cancer. Furthermore, patients with a large metabolic volume of the primary tumour (>45ml) are at significantly higher risk of recurrence.
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadkhani Shali
authors.affiliation: RWTH Aachen University Hospital, Departments of Radiation therapy and Radiooncology, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schmitt
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany.
authors.forename: Florian F
authors.initials: FF
authors.lastname: Behrendt
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany.
authors.forename: Oliver H
authors.initials: OH
authors.lastname: Winz
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Heinzel
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany; Maastricht UMC+, Deparment of Nuclear Medicine, Maastricht, The Netherlands, The Netherlands.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.affiliation: RWTH Aachen University Hospital, Departments of Radiation therapy and Radiooncology, Germany.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
authors.affiliation: RWTH Aachen University Hospital, Departments of Nuclear Medicine, Germany; Maastricht UMC+, Deparment of Nuclear Medicine, Maastricht, The Netherlands, The Netherlands. Electronic address: fverburg@ukaachen.de.
authors.forename: Frederik A
authors.initials: FA
authors.lastname: Verburg
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D016685:Mitomycin; D005472:Fluorouracil
keywords: Anal carcinoma; FDG PET/CT; Prognosis; Radiation therapy planning; Radiochemotherapy