TY - JOUR
T1 - Molecular imaging of proliferation and glucose utilization
T2 - Utility for monitoring response and prognosis after neoadjuvant therapy in locally advanced gastric cancer
AU - Ott, Katja
AU - Herrmann, Ken
AU - Schuster, Tibor
AU - Langer, Rupert
AU - Becker, Karen
AU - Wieder, Hinrich A.
AU - Wester, Hans Jürgen
AU - Siewert, Jörg Rüdiger
AU - Zum Büschenfelde, Christian Meyer
AU - Buck, Andreas K.
AU - Wilhelm, Dirk
AU - Ebert, Matthias P.A.
AU - Peschel, Christian
AU - Schwaiger, Markus
AU - Lordick, Florian
AU - Krause, Bernd Joachim
N1 - Funding Information:
ACKNOWLEDGMENT K.H. and M.P.A.E. were supported by the collaborative research center SFB 824, TP B1, German Research Foundation (DFG) ‘‘Imaging for Selection, Monitoring and Individualization of Cancer Therapies’’.
PY - 2011/11
Y1 - 2011/11
N2 - Background: Metabolic imaging of gastric cancer is limited due to the 30% of primary tumors that are not 18F-fluorodeoxyglucose (FDG) avid. In contrast, the proliferation marker 18F-fluorothymidine (FLT) has been shown to visualize also non-FDG-avid gastric tumors. In this study we tested whether FLT-positron emission tomography (PET) can improve the predictive potential of molecular imaging for assessing response to neoadjuvant therapy in gastric cancer compared with FDG-PET. Methods: 45 patients with gastric cancer underwent FDG-and FLT-PET before and 2 weeks after initiation of chemotherapy. FDG/FLT-PET findings and Ki67 immunohistochemistry were correlated with clinical and histopathological response and survival. Results: 14 patients had non-FDG-avid tumors, whereas all tumors could be visualized by FLT-PET. No significant association of clinical orhistopathological response with any of the analyzed metabolic parameters [initial standardized uptake value (SUV), SUV after 2 weeks, change of SUV for FDG/FLT] was found. Univariate Cox regression analysis for Ki67 and metabolic parameters revealed significant prognostic impact for survival only for FLT SUV mean day 14 (p = 0.048) and Ki67 (p = 0.006). Multivariate Cox regression analysis (including clinical response, Lauren type, ypN category, and FLT SUV mean day 14) revealed Lauren type and FLT SUV mean day 14 as the only significant prognostic factors (p = 0.006, p = 0.002). Conclusions: FLT uptake 2 weeks after initiation of therapy was shown to be the only imaging parameter with significant prognostic impact. Neither FLT-PET nor FDG-PET were correlated with histopathological or clinical response. However, these data must be interpreted with caution due to the single-center trial study design, relatively short follow-up, poor response rates, and unfavorable prognosis.
AB - Background: Metabolic imaging of gastric cancer is limited due to the 30% of primary tumors that are not 18F-fluorodeoxyglucose (FDG) avid. In contrast, the proliferation marker 18F-fluorothymidine (FLT) has been shown to visualize also non-FDG-avid gastric tumors. In this study we tested whether FLT-positron emission tomography (PET) can improve the predictive potential of molecular imaging for assessing response to neoadjuvant therapy in gastric cancer compared with FDG-PET. Methods: 45 patients with gastric cancer underwent FDG-and FLT-PET before and 2 weeks after initiation of chemotherapy. FDG/FLT-PET findings and Ki67 immunohistochemistry were correlated with clinical and histopathological response and survival. Results: 14 patients had non-FDG-avid tumors, whereas all tumors could be visualized by FLT-PET. No significant association of clinical orhistopathological response with any of the analyzed metabolic parameters [initial standardized uptake value (SUV), SUV after 2 weeks, change of SUV for FDG/FLT] was found. Univariate Cox regression analysis for Ki67 and metabolic parameters revealed significant prognostic impact for survival only for FLT SUV mean day 14 (p = 0.048) and Ki67 (p = 0.006). Multivariate Cox regression analysis (including clinical response, Lauren type, ypN category, and FLT SUV mean day 14) revealed Lauren type and FLT SUV mean day 14 as the only significant prognostic factors (p = 0.006, p = 0.002). Conclusions: FLT uptake 2 weeks after initiation of therapy was shown to be the only imaging parameter with significant prognostic impact. Neither FLT-PET nor FDG-PET were correlated with histopathological or clinical response. However, these data must be interpreted with caution due to the single-center trial study design, relatively short follow-up, poor response rates, and unfavorable prognosis.
UR - http://www.scopus.com/inward/record.url?scp=83055179761&partnerID=8YFLogxK
U2 - 10.1245/s10434-011-1743-y
DO - 10.1245/s10434-011-1743-y
M3 - Article
C2 - 21537865
AN - SCOPUS:83055179761
SN - 1068-9265
VL - 18
SP - 3316
EP - 3323
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 12
ER -