Yonsei Med J.  2014 Nov;55(6):1498-1506. 10.3349/ymj.2014.55.6.1498.

Prognostic Significance of Volume-Based FDG PET/CT Parameters in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation Therapy

• Choi HJ
• Lee JW
• Kang B
• Song SY
• Lee JD
• Lee JH

• KMID: 2070196
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1498

Abstract

PURPOSE
We investigated the prognostic role of volume-based parameters measured on 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scans in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiation therapy (CRT).
MATERIALS AND METHODS
We enrolled 60 patients with LAPC who underwent FDG PET/CT before CRT. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary pancreatic cancers were measured on FDG PET/CT scans. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard models were used to determine independent prognostic factors.
RESULTS
The progression-free survival (PFS), locoregional progression-free survival (LRFPS), and overall survival (OS) for this population were 6.2, 10.9, and 13.2 months, respectively. The overall treatment response rate was 16.7% at 4 weeks after CRT, and the disease control rate (DCR) was 80.0%. DCR was significantly higher in patients with low SUVmax, MTV, or TLG, and showed strong correlation with longer survival times. On univariate analysis, MTV and TLG were significant prognostic factors for PFS, LRPFS, and OS, together with pre-CRT and post-CRT CA19-9 levels. Multivariate analyses demonstrated that MTV together with the pre-CRT CA19-9 level were independent prognostic factors for PFS, LRPFS, and OS, as was TLG for LRPFS and OS.
CONCLUSION
MTV and the pre-CRT CA19-9 level provided independent prognostic information in patients with LAPC treated with CRT. Volume-based PET/CT parameters may be useful in identifying which subgroup of patients would benefit from radiation therapy as a part of CRT.

Keyword

Locally advanced pancreatic cancer; FDG; PET; metabolic tumor volume; prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
*Chemoradiotherapy
Disease-Free Survival
Female
Fluorodeoxyglucose F18/*diagnostic use
Glycolysis
Humans
Male
Middle Aged
Multimodal Imaging
Multivariate Analysis
Neoplasm Staging
Pancreatic Neoplasms/*diagnosis/*therapy
*Positron-Emission Tomography
Prognosis
Proportional Hazards Models
Radiopharmaceuticals
Retrospective Studies
Severity of Illness Index
Survival Analysis
*Tomography, X-Ray Computed
Tumor Burden
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

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  Fig. 1 (A) Cumulative progression-free survival, (B) locoregional progression-free survival, and (C) overall survival according to the metabolic tumor volume (MTV) of pancreatic cancer lesions.

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  Fig. 2 (A) Cumulative progression-free survival, (B) locoregional progression-free survival, and (C) overall survival according to the total lesion glycolysis (TLG) of pancreatic cancer lesions.

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