Annals of Oncology Advance Access published online on January 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdn744
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Early prediction of response to first-line chemotherapy by sequential [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography in patients with advanced colorectal cancer
1 Department of Oncology and Pathology, Karolinska Institute, Stockholm
2 Department of Oncology, Radiology and Clinical Immunology, Uppsala University, Uppsala
3 Department of Medical Sciences, Nuclear Medicine, University Hospital, Uppsala
4 Department of Nuclear Medicine, Karolinska Institute, Stockholm, Sweden
* Correspondence to: Dr P. Byström, Department of Oncology and Pathology, Karolinska Hospital, SE 171 76 Stockholm, Sweden. Tel: +46-(0)8-517-700 00; Fax: +46-8-517-760-96; E-mail: per.bystrom{at}karolinska.se
Background: To evaluate [18F]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET), for early evaluation of response to palliative chemotherapy and for prediction of long-term outcome, in patients with metastatic colorectal cancer (mCRC).
Patients and methods: In a randomized trial, patients with mCRC received irinotecan-based combination chemotherapy. FDG–PET was carried out before treatment and after two cycles in 51 patients at two centers. Visual changes in tumor FDG uptake and changes measured semi-automatically, as standard uptake values (SUVs), were compared with radiological response after four and eight cycles.
Results: The mean baseline SUV for all tumor lesions per patient was higher in nonresponders than in responders (mean 7.4 versus 5.6, P = 0.02). There was a strong correlation between metabolic response (changes in SUV) and objective response (r = 0.57, P = 0.00001), with a sensitivity of 77% and a specificity of 76%. There was no significant correlation between metabolic response and time to progression (P = 0.5) or overall survival (P = 0.1).
Conclusions: Although metabolic response assessed by FDG–PET reflects radiological tumor volume changes, the sensitivity and specificity are too low to support the routine use of PET in mCRC. Furthermore, PET failed to reflect long-term outcome and can, thus, not be used as surrogate end point for hard endpoint benefit.
colorectal cancer, FDG–PET, palliative chemotherapy, prediction, response evaluation
Received for publication June 18, 2008. Revision received November 9, 2008. Accepted for publication November 11, 2008.
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