Memon Sameer, Lynch A Craig, Akhurst Timothy, Ngan Samuel Y, Warrier Satish K, Michael Michael, Heriot Alexander G
Department of Colorectal Surgery, Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, University of Melbourne, Parkville, Australia.
Ann Surg Oncol. 2014 Oct;21(11):3598-607. doi: 10.1245/s10434-014-3753-z. Epub 2014 May 7.
Advances in the management of rectal cancer have resulted in an increased application of multimodal therapy with the aim of tailoring therapy to individual patients. Complete pathological response (pCR) is associated with improved survival and may be potentially managed without radical surgical resection. Over the last decade, there has been increasing interest in the ability of functional imaging to predict complete response to treatment. The aim of this review was to assess the role of (18)F-flurordeoxyglucose positron emission tomography (FDG-PET) in prediction of pCR and prognosis in resectable locally advanced rectal cancer.
A search of the MEDLINE and Embase databases was conducted, and a systematic review of the literature investigating positron emission tomography (PET) in the prediction of pCR and survival in rectal cancer was performed.
Seventeen series assessing PET prediction of pCR were included in the review. Seven series assessed postchemoradiation SUVmax, which was significantly different between response groups in all six studies that assessed this. Nine series assessed the response index (RI) for SUVmax, which was significantly different between response groups in seven series. Thirteen studies investigated PET response for prediction of survival. Metabolic complete response assessed by SUV2max or visual response and RISUVmax showed strong associations with disease-free survival (DFS) and overall survival (OS).
SUV2max and RISUVmax appear to be useful FDG-PET markers for prediction of pCR and these parameters also show strong associations with DFS and OS. FDG-PET may have a role in outcome prediction in patients with advanced rectal cancer.
直肠癌管理方面的进展使得多模式治疗的应用增加，目的是为个体患者量身定制治疗方案。完全病理缓解（pCR）与生存率提高相关，并且可能无需进行根治性手术切除即可得到有效管理。在过去十年中，人们对功能成像预测治疗完全缓解的能力越来越感兴趣。本综述的目的是评估18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在可切除的局部晚期直肠癌pCR预测及预后评估中的作用。
检索MEDLINE和Embase数据库，并对研究正电子发射断层扫描（PET）在直肠癌pCR预测和生存评估中的文献进行系统综述。
本综述纳入了17项评估PET对pCR预测的研究系列。7项研究系列评估了放化疗后的SUVmax，在所有评估此项的6项研究中，反应组之间存在显著差异。9项研究系列评估了SUVmax的反应指数（RI），在7项研究系列中，反应组之间存在显著差异。13项研究调查了PET反应对生存的预测情况。通过SUV2max或视觉反应及RISUVmax评估的代谢完全缓解与无病生存（DFS）和总生存（OS）密切相关。
SUV2max和RISUVmax似乎是预测pCR的有用FDG-PET标志物，并且这些参数也与DFS和OS密切相关。FDG-PET可能在晚期直肠癌患者的预后预测中发挥作用。
