Cancer Res Treat.  2020 Oct;52(4):1211-1218. 10.4143/crt.2019.506.

Early Assessment of Response to Neoadjuvant Chemotherapy with ¹⁸F-FDG-PET/CT in Patients with Advanced-Stage Ovarian Cancer

• Chung YS
• Kim HS
• Lee JY
• Kang WJ
• Nam EJ
• Kim S
• Kim SW
• Kim YT

• KMID: 2507946
• DOI: http://doi.org/10.4143/crt.2019.506

Abstract

Purpose
The aim of this study was to evaluate the ability of sequential 18F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) after one cycle of neoadjuvant chemotherapy (NAC) to predict chemotherapy response before interval debulking surgery (IDS) in advanced-stage ovarian cancer patients.
Materials and Methods
Forty consecutive patients underwent ¹⁸F-FDG-PET/CT at baseline and after one cycle of NAC. Metabolic responses were assessed by quantitative decrease in the maximum standardized uptake value (SUV_max) with PET/CT. Decreases in SUV_max were compared with cancer antigen 125 (CA-125) level before IDS, response rate by Response Evaluation Criteria in Solid Tumors criteria before IDS, residual tumor at IDS, and I chemotherapy response score (CRS) at IDS.
Results
A 40% cut-off for the decrease in SUVmax provided the best performance to predict CRS 3 (compete or near-complete pathologic response), with sensitivity, specificity, and accuracy of 81.8%, 72.4%, and 72.4%, respectively. According to this 40% cut-off, there were 17 (42.5%) metabolic responders (≥ 40%) and 23 (57.5%) metabolic non-responders (< 40%). Metabolic responders had higher rate of CRS 3 (52.9% vs. 8.7%, p=0.003), CA-125 normalization (< 35 U/mL) before IDS (76.5% vs. 39.1%, p=0.019), and no residual tumor at IDS (70.6% vs. 31.8%, p=0.025) compared with metabolic non-responders. There were significant associations with progression-free survival (p=0.021) between metabolic responders and non-responders, but not overall survival (p=0.335).
Conclusion
Early assessment with ¹⁸F-FDG-PET/CT after one cycle of NAC can be useful to predic response to chemotherapy before IDS in patients with advanced-stage ovarian cancer.

Keyword

Ovarian neoplasms; Neoadjuvant therapy; Positron emission tomography computed tomography; Treatment outcome

Figure

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  Fig. 1. Overall flow chart of positron emission tomography/computed tomography (PET/CT), neoadjuvant chemotherapy (NAC), and interval debulking surgery (IDS). SUVmax, maximum standardized uptake value; CRS, chemotherapy response score; CA-125, cancer antigen 125. a)Two patients received four cycles of NAC.

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  Fig. 2. Receiver operating characteristic analysis of ΔSUVmax (maximum standardized uptake value) for the identification of chemotherapy response score 3 after one cycle of neoadjuvant chemotherapy. AUC, area under the curve.

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  Fig. 3. Scatter plots showing the decrease in maximum standardized uptake value (SUVmax) and cancer antigen 125 (CA-125) level before interval debulking surgery (IDS). Chemotherapy response score (CRS) 1 or 2 are indicated by blue circles, CRS 3 by red triangles. NAC, neoadjuvant chemotherapy.

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  Fig. 4. Examples of metabolic responder and non-responder. 18F-fluorodeoxyglucose positron emission tomography/computed tomography images, at baseline and after one cycle of neoadjuvant chemotherapy (NAC) in metabolic responder (A) and non-responder (B). Surgical findings of diagnostic laparoscopy and interval debulking surgery (IDS) in metabolic responder (C) and non-responder (D).

Reference

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