Significance of 18F-Fluorodeoxyglucose (FDG) Uptake in Response to Chemoradiotherapy for Pancreatic Cancer

• Published in: Annals of surgical oncology Vol. 26; no. 2; pp. 644 - 651
• Main Authors: Kurahara, Hiroshi, Maemura, Kosei, Mataki, Yuko, Sakoda, Masahiko, Iino, Satoshi, Kawasaki, Yota, Arigami, Takaaki, Mori, Shinichiro, Kijima, Yuko, Ueno, Shinichi, Shinchi, Hiroyuki, Natsugoe, Shoji
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2019; Springer Nature B.V
• Subjects: Chemoradiotherapy; Chemotherapy; Glycolysis; Medical prognosis; Medicine; Medicine & Public Health; Multivariate analysis; Oncology; Pancreatic cancer; Pancreatic Tumors; Positron emission tomography; Radiation therapy; Radioresistance; Surgery; Surgical Oncology; Tumor Response Rate; Induction Chemotherapy; Pancreatic Cancer; High SUVmax Group; Borderline Resectable (BR)
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-07098-6

Background
A metabolic shift to glycolysis is reportedly involved in radioresistance. We examined whether pretreatment
18
F-fluorodeoxyglucose positron emission tomography (FDG-PET), which can detect enhanced glucose uptake, was able to predict the therapeutic response to chemoradiotherapy (CRT) in patients with pancreatic cancer (PC).
Methods
Of 125 PC patients (75 unresectable and 50 borderline resectable), 37 and 26 underwent induction chemotherapy before CRT and surgical resection after CRT, respectively. FDG-PET was performed at three different institutions.
Results
Of the 88 patients who underwent upfront CRT, 31 (35%), 34 (39%), and 23 (26%) showed a partial response (PR), stable disease, and progressive disease, respectively. The tumor PR rate was an independent factor associated with longer overall survival (OS) on multivariate analysis. We evaluated the optimal cut-off of maximum standardized uptake values (SUV
max
) at initial diagnosis to detect the tumor PR rate at the three institutions separately. The SUV
max
was independently associated with tumor response rate on multivariate analysis. In the low SUV
max
group, induction chemotherapy had no significant impact on OS. In contrast, induction chemotherapy was significantly associated with longer OS in the high SUV
max
group.
Conclusions
FDG-PET SUV
max
was significantly associated with the therapeutic response to CRT in PC patients. Moreover, induction chemotherapy may improve the prognosis of patients with a high SUV
max
tumor.