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Title: Metabolic response to preoperative chemotherapy predicts prognosis for patients undergoing surgical resection of colorectal cancer metastatic to the liver.
Austin Authors: Lau, Lawrence F ;Williams, David S ;Lee, Sze Ting ;Scott, Andrew M ;Christophi, Christopher ;Muralidharan, Vijayaragavan 
Affiliation: Department of Surgery, Austin Hospital, University of Melbourne, Heidelberg, VIC, Australia,
Issue Date: 5-Mar-2014
Publication information: Annals of Surgical Oncology 2014; 21(7): 2420-8
Abstract: Biological characteristics of colorectal cancer liver metastases (CRCLM) are increasingly recognized as major determinants of patient outcome. The purpose of this study was to evaluate the prognostic value of metabolic response to preoperative chemotherapy as quantified by (18)F-FDG positron emission tomography (PET) for patients undergoing liver resection of CRCLM.All patients (n = 80) who had staging PET before liver resection for CRCLM at Austin Health in Melbourne between 2004 and 2011 were included. Thirty-seven patients had PET and CT imaging before and after preoperative chemotherapy. Semiquantitative PET parameters-maximum standardized uptake variable (SUVmax), metabolic tumour volume (MTV), and total glycolytic volume (TGV)-were derived. Metabolic response was determined by the proportional change in PET parameters (∆SUVmax, ∆MTV, ∆TGV). Prognostic scores, CT RECIST response, and tumour regression grading (TRG) were also assessed. Correlation to recurrence-free (RFS) and overall survival (OS) was assessed using Kaplan-Meier survival and multivariate analysis.Semiquantitative parameters on staging PET before chemotherapy were not predictive of prognosis, whereas all parameters after chemotherapy were prognostic for RFS and OS. Only ∆SUVmax was predictive of RFS and OS on multivariate analysis. Patients with metabolically responsive tumours had an OS of 86 % at 3 years vs. 38 % with nonresponsive or progressive tumours (p = 0.003). RECIST and TRG did not predict outcome.Tumour metabolic response to preoperative chemotherapy as quantified by PET is predictive of prognosis in patients undergoing resection of CRCLM. Assessing metabolic response uniquely characterizes tumour biology, which may allow future optimization of patient and treatment selection.
Gov't Doc #: 24595797
DOI: 10.1245/s10434-014-3590-0
Journal: Annals of surgical oncology
Type: Journal Article
Subjects: Adult
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols.therapeutic use
Colorectal Neoplasms.metabolism.mortality.pathology.therapy
Combined Modality Therapy
Fluorodeoxyglucose F18.diagnostic use
Fluorouracil.administration & dosage
Follow-Up Studies
Leucovorin.administration & dosage
Liver Neoplasms.metabolism.mortality.secondary.therapy
Middle Aged
Neoplasm Staging
Organoplatinum Compounds.administration & dosage
Positron-Emission Tomography
Prospective Studies
ROC Curve
Radiopharmaceuticals.diagnostic use
Survival Rate
Tomography, X-Ray Computed
Young Adult
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