title: Correlation of18F-Fluorodeoxyglucose Positron Emission Tomography Parameters with Patterns of Disease Progression in Locally Advanced Pancreatic Cancer after Definitive Chemoradiotherapy.
abstract: OBJECTIVE
  A proportion of patients with pancreatic cancer never develop metastatic disease. We evaluated a role for18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in identifying a subset of patients with locally advanced pancreatic cancer (LAPC) who never develop metastatic disease and only experience local disease and may therefore benefit from local treatment intensification.
  
  
  METHODS
  Patients with histologically confirmed LAPC entered a single-centre phase II study of definitive upfront chemoradiotherapy (CRT). All patients underwent FDG-PET/CT before and 6 weeks after CRT. Tumour volume, standardised uptake values (SUVmax, SUVpeak, SUVmean, SUVmedian) and total lesion glycolysis (TLG) were measured on each scan and the response in each parameter was evaluated. The presence or absence of metastatic disease was noted on contrast-enhanced CT carried out every 3 months for 1 year and then at clinician discretion.
  
  
  RESULTS
  Twenty-three patients with LAPC were recruited; 17/23 completed treatment and had interpretable sequential imaging. Twenty-four per cent of patients only ever experienced local disease. Median pre-CRT FDG-PET parameters were significantly lower in patients with local disease only during follow-up compared with those who developed metastatic disease: SUVmax3.8 versus 8.6 (P=0.006), SUVpeak2.5 versus 7.5 (P=0.002), SUVmean1.8 versus 3.3 (P=0.001), SUVmedian1.7 versus 3.0 (P=0.002), TLG 26.9 versus 115.9 (P=0.006). Tumour volume, post-CRT FDG-PET values and their relative change were not statistically different between local disease and metastatic disease groups. Receiver operating characteristic curves for pre-CRT FDG-PET parameters to predict those who never develop metastatic disease all had areas under the curve (AUCs) ≥ 0.932. Pre-CRT FDG-PET SUVmax< 6.2 predicted patients with local disease only during follow-up with 100.0% sensitivity and 92.3% specificity, 80.0% positive predictive value and 100% negative predictive value.
  
  
  CONCLUSIONS
  Our findings suggest that patients with less FDG-avid tumours are less likely to metastasise and may therefore benefit from upfront local treatment intensification.
authors.affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, Oxford, UK. Electronic address: james.wilson@icr.ac.uk.
authors.forename: J M
authors.initials: JM
authors.lastname: Wilson
authors.affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of Radiation Oncology, University Hospitals Freiburg, Freiburg im Breisgau, Germany.
authors.forename: T B
authors.initials: TB
authors.lastname: Brunner
authors.affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Partridge
authors.affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, Oxford, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Hawkins
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D059248:Chemoradiotherapy; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Chemoradiotherapy; FDG-PET; pancreatic cancer; treatment strategy selection