A systematic review of the predictive value of 18F‐fluoro‐2‐deoxyglucose positron emission tomography on survival in locally advanced rectal cancer after neoadjuvant chemoradiation. (November 2013)

• Record Type: Journal Article
• Authors: Krug, B.; Crott, R.; de, L.; D'Hondt, L.; Vander Borght, T.
• Is Part Of: Colorectal disease. Volume 15:Number 11(2013)
• Page Start: e627
• Page End: e633
• Publication Date: 2013-11
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12295
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12295-abs-0001"> <title>Abstract</title> <sec id="codi12295-sec-0001" sec-type="section"> <title>Aim</title> <p>Treatment of locally advanced rectal cancer (LARC) includes preoperative radiation therapy with or without chemotherapy followed by radical surgery, but the clinical outcome is uncertain. A systemic review was carried out to determine the predictive value of <sup>18</sup>F‐fluoro‐2‐deoxyglucose positron emission tomography (<sup>18</sup>FDG‐PET) for assessing disease‐free (DFS) and overall survival (OS) in LARC.</p> </sec> <sec id="codi12295-sec-0002" sec-type="section"> <title>Method</title> <p>A literature search (PubMed/MEDLINE, EMBASE, Cochrane) up to January 2012 to identify full papers with sequential <sup>18</sup>FDG‐PET and survival data, using indexing terms and free text words. The inclusion criteria were: a study of at least 10 patients, having sequential <sup>18</sup>FDG‐PET imaging before and after adjuvant chemoradiation and a minimal follow‐up of 24 months. Studies were selected by two of the authors. A meta‐analysis was performed for DFS and OS using the hazard ratio (HR) as the primary outcome.</p> </sec> <sec id="codi12295-sec-0003" sec-type="section"> <title>Results</title> <p>Five eligible studies were identified including 330 patients (mean age 63 years, 64% men), in which PET‐CT or PET imaging was used. The American Joint Committee on Cancer stage distribution was as follows: Stage I, 2%; Stage II, 44%; Stage III, 52%; Stage IV, 1%. The pooled HRs for complete metabolic response versus partial or no response were 0.39 (95% CI 0.18–0.86; <italic>P </italic>=<italic> </italic>0.02) for OS and 0.70 (95% CI 0.16–3.14; <italic>P </italic>=<italic> </italic>0.64) for DFS. The lack of significance for DFS might be explained by different follow‐up characteristics. There was also clinical heterogeneity among the different studies.</p> </sec> <sec id="codi12295-sec-0004" sec-type="section"> <title>Conclusion</title> <p>This systematic review indicates that complete metabolic response on sequential <sup>18</sup>FDG‐PET data after preoperative chemoradiation of LARC is predictive of OS, but not of DFS.</p> </sec> </abstract>