Volumetric parameters of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography can predict histopathologic treatment response after neoadjuvant chemoradiotherapy in pancreatic adenocarcinoma

Makoto Sakane; Mitsuaki Tatsumi; Masatoshi Hori; Hiromitsu Onishi; Takahiro Tsuboyama; Atsushi Nakamoto; Takashi Ota; Hidetoshi Eguchi; Kenichi Wakasa; Jun Hatazawa; Noriyuki Tomiyama

doi:10.1016/j.ejrad.2017.05.021

Volumetric parameters of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography can predict histopathologic treatment response after neoadjuvant chemoradiotherapy in pancreatic adenocarcinoma

Eur J Radiol. 2017 Sep:94:64-69. doi: 10.1016/j.ejrad.2017.05.021. Epub 2017 Jun 23.

Authors

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: m-sakane@radiol.osaka-u.ac.jp.
² Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan; Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan. Electronic address: m-tatsumi@radiol.med.osaka-u.ac.jp.
³ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: mhori@radiol.med.osaka-u.ac.jp.
⁴ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: h-onishi@radiol.med.osaka-u.ac.jp.
⁵ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: ttsuboyama@gmail.com.
⁶ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: rad117@osaka-med.ac.jp.
⁷ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: t-ota@radiol.med.osaka-u.ac.jp.
⁸ Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan. Electronic address: heguchi@gesurg.med.osaka-u.ac.jp.
⁹ Department of Diagnostic Pathology, Ishikiriseiki Hospital, Japan.
¹⁰ Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan. Electronic address: hatazawa@tracer.med.osaka-u.ac.jp.
¹¹ Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan. Electronic address: tomiyama@radiol.med.osaka-u.ac.jp.

PMID: 28712692
DOI: 10.1016/j.ejrad.2017.05.021

Abstract

Purpose: The purpose of this study was to investigate the clinical potential of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (FDG PET/CT) to evaluate histopathologic effects of preoperative chemoradiotherapy (CRT) in pancreatic adenocarcinoma, with particular focus on volumetric PET/CT parameters.

Material and methods: This study included 25 patients with pancreatic adenocarcinoma who underwent radical surgery after gemcitabine- and S-1-based preoperative-CRT. The extent of residual tumor was graded using the Evans grading systems, and patients with more than 50% destruction of tumor cells were defined as responder. Peak SUV corrected for lean body mass (SUL_peak), metabolic tumor volume (MTV) with a threshold of SUV=2.0, total lesion glycolysis (TLG) of pre- and post-CRT, and reduction rates of SUL_peak in those parameters were assessed by PET/CT. These parameters were compared using the student's t-test between responder and non-responder. The treatment effect was also assessed by contingency table analysis divided with median value of each parameter using chi-square tests.

Results: Eight patients (32%) showed histopathologic poor response (Evans grade I), 11 cases (44%) had mild response (Evans grade IIa), and six cases (24%) had moderate response (Evans grade IIb); therefore, six cases (24%) were assigned to responders and others 19 cases (76%) were non-responders. With regards to volumetric PET parameters, post-CRT SUL_peak of responders was significantly lower than that of non-responders (p=0.013). Post-CRT MTV and TLG were negative for all six cases of responders. There were significant differences between responder and non-responder on the contingency table analysis of post-CRT MTV and TLG status (p=0.014 for both).

Conclusions: This study demonstrated that the volumetric PET/CT parameters, higher post-treatment SUL_peak and positive MTV/TLG could predict the unfavorable histopathological effects of CRT in patients with pancreatic adenocarcinoma.

Keywords: Metabolic tumor volume (MTV); SUV corrected for lean body mass (SUL); Total lesion glycolysis (TLG).

MeSH terms

Adenocarcinoma / diagnostic imaging
Adenocarcinoma / pathology
Adenocarcinoma / therapy*
Adult
Aged
Aged, 80 and over
Chemoradiotherapy / methods*
Female
Fluorodeoxyglucose F18*
Humans
Male
Middle Aged
Neoadjuvant Therapy / methods*
Pancreas / diagnostic imaging
Pancreas / pathology
Pancreatic Neoplasms / diagnostic imaging
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / therapy*
Positron Emission Tomography Computed Tomography / methods*
Predictive Value of Tests
Radiopharmaceuticals
Retrospective Studies
Treatment Outcome
Tumor Burden

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18