Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer
We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor respon...
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| Veröffentlicht in: | Surgical oncology 2023-04, Vol.47, p.101909, Article 101909 |
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| creator | de Jong, Tonke L. Koopman, Daniëlle van der Worp, Corné A.J. Stevens, Henk Vuijk, Floris A. Vahrmeijer, Alexander L. Mieog, J. Sven D. de Groot, Jan-Willem B. Meijssen, Maarten A.C. Nieuwenhuijs, Vincent B. de Geus-Oei, Lioe-Fee Jager, Pieter L. Patijn, Gijs A. |
| description | We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor response compared to ceCT and CA19.9 as well as the ability to detect distant metastatic disease.
35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retrospectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.
CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p |
| doi_str_mv | 10.1016/j.suronc.2023.101909 |
| format | Article |
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35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retrospectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.
CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p < 0.0001). The change in FDG-uptake values showed a strong positive correlation with the change in CT tumor diameter and change in CA19-9 (R = 0.75 and R = 0.73, respectively). In addition, small-volume liver lesions were detected on digital PET/CT in 5/35 patients (14%), 4 of which were pathology confirmed at laparotomy. Only one of these five cases was detected on baseline staging ceCT (3%).
We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy based on the observed strong correlation with ceCT tumor diameter and Ca19.9. Also, digital PET/CT was found to detect occult metastatic disease not visualized on ceCT, that would have resulted in altered disease staging and therapeutic strategy in a substantial proportion of patients.
•Neoadjuvant therapy is playing an increasing role in the treatment of pancreatic cancer.•Traditional ceCT/MRI are ineffective as restaging modalities for neoadjuvant therapy response evaluation.•Emerging evidence is showing promise for PET/CT as improved restaging modality, in adjunct to CA 19–9.•In this prospective study we investigated the added value of a new generation digital PET-CT with improved accuracy as compared to analog PET/CT.•We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy.•In addition, digital PET/CT was found to detect occult metastases not visualized on ceCT in 11% of patients.</description><identifier>ISSN: 0960-7404</identifier><identifier>ISSN: 1879-3320</identifier><identifier>EISSN: 1879-3320</identifier><identifier>DOI: 10.1016/j.suronc.2023.101909</identifier><identifier>PMID: 36739788</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>CA-19-9 Antigen - therapeutic use ; Chemoradiotherapy ; Digital FDG-PET/CT ; Disease staging ; Fluorodeoxyglucose F18 ; FOLFIRINOX ; Humans ; LAPC ; Neo-adjuvant therapy ; Neoplasm Staging ; Nuclear medicine ; Pancreatectomy ; Pancreatic cancer ; Pancreatic Neoplasms ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatic Neoplasms - drug therapy ; Pancreatic Neoplasms - surgery ; Pancreatic surgery ; Pancreaticoduodenectomy ; PDAC ; Positron Emission Tomography Computed Tomography - methods ; Positron-Emission Tomography - methods ; Prospective Studies ; Radiopharmaceuticals - therapeutic use ; Retrospective Studies ; Tumor response evaluation</subject><ispartof>Surgical oncology, 2023-04, Vol.47, p.101909, Article 101909</ispartof><rights>2023 Elsevier Ltd</rights><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-5a9f331559d44181f4347729fc8245f147d1db592b74419d0cc598436bb5975a3</citedby><cites>FETCH-LOGICAL-c408t-5a9f331559d44181f4347729fc8245f147d1db592b74419d0cc598436bb5975a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0960740423000099$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36739788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Jong, Tonke L.</creatorcontrib><creatorcontrib>Koopman, Daniëlle</creatorcontrib><creatorcontrib>van der Worp, Corné A.J.</creatorcontrib><creatorcontrib>Stevens, Henk</creatorcontrib><creatorcontrib>Vuijk, Floris A.</creatorcontrib><creatorcontrib>Vahrmeijer, Alexander L.</creatorcontrib><creatorcontrib>Mieog, J. Sven D.</creatorcontrib><creatorcontrib>de Groot, Jan-Willem B.</creatorcontrib><creatorcontrib>Meijssen, Maarten A.C.</creatorcontrib><creatorcontrib>Nieuwenhuijs, Vincent B.</creatorcontrib><creatorcontrib>de Geus-Oei, Lioe-Fee</creatorcontrib><creatorcontrib>Jager, Pieter L.</creatorcontrib><creatorcontrib>Patijn, Gijs A.</creatorcontrib><title>Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer</title><title>Surgical oncology</title><addtitle>Surg Oncol</addtitle><description>We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor response compared to ceCT and CA19.9 as well as the ability to detect distant metastatic disease.
35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retrospectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.
CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p < 0.0001). The change in FDG-uptake values showed a strong positive correlation with the change in CT tumor diameter and change in CA19-9 (R = 0.75 and R = 0.73, respectively). In addition, small-volume liver lesions were detected on digital PET/CT in 5/35 patients (14%), 4 of which were pathology confirmed at laparotomy. Only one of these five cases was detected on baseline staging ceCT (3%).
We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy based on the observed strong correlation with ceCT tumor diameter and Ca19.9. Also, digital PET/CT was found to detect occult metastatic disease not visualized on ceCT, that would have resulted in altered disease staging and therapeutic strategy in a substantial proportion of patients.
•Neoadjuvant therapy is playing an increasing role in the treatment of pancreatic cancer.•Traditional ceCT/MRI are ineffective as restaging modalities for neoadjuvant therapy response evaluation.•Emerging evidence is showing promise for PET/CT as improved restaging modality, in adjunct to CA 19–9.•In this prospective study we investigated the added value of a new generation digital PET-CT with improved accuracy as compared to analog PET/CT.•We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy.•In addition, digital PET/CT was found to detect occult metastases not visualized on ceCT in 11% of patients.</description><subject>CA-19-9 Antigen - therapeutic use</subject><subject>Chemoradiotherapy</subject><subject>Digital FDG-PET/CT</subject><subject>Disease staging</subject><subject>Fluorodeoxyglucose F18</subject><subject>FOLFIRINOX</subject><subject>Humans</subject><subject>LAPC</subject><subject>Neo-adjuvant therapy</subject><subject>Neoplasm Staging</subject><subject>Nuclear medicine</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms</subject><subject>Pancreatic Neoplasms - diagnostic imaging</subject><subject>Pancreatic Neoplasms - drug therapy</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>PDAC</subject><subject>Positron Emission Tomography Computed Tomography - methods</subject><subject>Positron-Emission Tomography - methods</subject><subject>Prospective Studies</subject><subject>Radiopharmaceuticals - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Tumor response evaluation</subject><issn>0960-7404</issn><issn>1879-3320</issn><issn>1879-3320</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UUFOwzAQtBAISuEHCPnIJcWOnTi-IFWFFiQkOJSz5dib4ipNip2AeAK_xlUo4sTJ69mZXe0MQheUTCih-fV6EnrfNmaSkpTtIEnkARrRQsiEsZQcohGROUkEJ_wEnYawJoTkIqXH6ITlgklRFCP0NbUWLH7XdQ-4rbB1K9fpGs9vF8nz3fJ6tsSuiWgAHQCHTq9cs8K6sdjD_hcJW905aLqAP1z3umuB6XRZx5Eel6234GvXwN_GVjfGQ5QZbGIJ_gwdVboOcP7zjtHL_G45u08enxYPs-ljYjgpuiTTsmKMZpm0nNOCVpxxIVJZmSLlWUW5sNSWmUxLEfvSEmMyWXCWlxEUmWZjdDXM3fr2rY9HqI0LBupaN9D2QaVCMEEzFjVjxAeq8W0IHiq19W6j_aeiRO1CUGs1hKB2IaghhCi7_NnQlxuwv6K965FwMxAg3vnuwKtgon0GrPPRH2Vb9_-GbwE8mk8</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>de Jong, Tonke L.</creator><creator>Koopman, Daniëlle</creator><creator>van der Worp, Corné A.J.</creator><creator>Stevens, Henk</creator><creator>Vuijk, Floris A.</creator><creator>Vahrmeijer, Alexander L.</creator><creator>Mieog, J. Sven D.</creator><creator>de Groot, Jan-Willem B.</creator><creator>Meijssen, Maarten A.C.</creator><creator>Nieuwenhuijs, Vincent B.</creator><creator>de Geus-Oei, Lioe-Fee</creator><creator>Jager, Pieter L.</creator><creator>Patijn, Gijs A.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202304</creationdate><title>Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer</title><author>de Jong, Tonke L. ; Koopman, Daniëlle ; van der Worp, Corné A.J. ; Stevens, Henk ; Vuijk, Floris A. ; Vahrmeijer, Alexander L. ; Mieog, J. Sven D. ; de Groot, Jan-Willem B. ; Meijssen, Maarten A.C. ; Nieuwenhuijs, Vincent B. ; de Geus-Oei, Lioe-Fee ; Jager, Pieter L. ; Patijn, Gijs A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-5a9f331559d44181f4347729fc8245f147d1db592b74419d0cc598436bb5975a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>CA-19-9 Antigen - therapeutic use</topic><topic>Chemoradiotherapy</topic><topic>Digital FDG-PET/CT</topic><topic>Disease staging</topic><topic>Fluorodeoxyglucose F18</topic><topic>FOLFIRINOX</topic><topic>Humans</topic><topic>LAPC</topic><topic>Neo-adjuvant therapy</topic><topic>Neoplasm Staging</topic><topic>Nuclear medicine</topic><topic>Pancreatectomy</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms</topic><topic>Pancreatic Neoplasms - diagnostic imaging</topic><topic>Pancreatic Neoplasms - drug therapy</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>PDAC</topic><topic>Positron Emission Tomography Computed Tomography - methods</topic><topic>Positron-Emission Tomography - methods</topic><topic>Prospective Studies</topic><topic>Radiopharmaceuticals - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Tumor response evaluation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Jong, Tonke L.</creatorcontrib><creatorcontrib>Koopman, Daniëlle</creatorcontrib><creatorcontrib>van der Worp, Corné A.J.</creatorcontrib><creatorcontrib>Stevens, Henk</creatorcontrib><creatorcontrib>Vuijk, Floris A.</creatorcontrib><creatorcontrib>Vahrmeijer, Alexander L.</creatorcontrib><creatorcontrib>Mieog, J. 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Sven D.</au><au>de Groot, Jan-Willem B.</au><au>Meijssen, Maarten A.C.</au><au>Nieuwenhuijs, Vincent B.</au><au>de Geus-Oei, Lioe-Fee</au><au>Jager, Pieter L.</au><au>Patijn, Gijs A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer</atitle><jtitle>Surgical oncology</jtitle><addtitle>Surg Oncol</addtitle><date>2023-04</date><risdate>2023</risdate><volume>47</volume><spage>101909</spage><pages>101909-</pages><artnum>101909</artnum><issn>0960-7404</issn><issn>1879-3320</issn><eissn>1879-3320</eissn><abstract>We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor response compared to ceCT and CA19.9 as well as the ability to detect distant metastatic disease.
35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retrospectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.
CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p < 0.0001). The change in FDG-uptake values showed a strong positive correlation with the change in CT tumor diameter and change in CA19-9 (R = 0.75 and R = 0.73, respectively). In addition, small-volume liver lesions were detected on digital PET/CT in 5/35 patients (14%), 4 of which were pathology confirmed at laparotomy. Only one of these five cases was detected on baseline staging ceCT (3%).
We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy based on the observed strong correlation with ceCT tumor diameter and Ca19.9. Also, digital PET/CT was found to detect occult metastatic disease not visualized on ceCT, that would have resulted in altered disease staging and therapeutic strategy in a substantial proportion of patients.
•Neoadjuvant therapy is playing an increasing role in the treatment of pancreatic cancer.•Traditional ceCT/MRI are ineffective as restaging modalities for neoadjuvant therapy response evaluation.•Emerging evidence is showing promise for PET/CT as improved restaging modality, in adjunct to CA 19–9.•In this prospective study we investigated the added value of a new generation digital PET-CT with improved accuracy as compared to analog PET/CT.•We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy.•In addition, digital PET/CT was found to detect occult metastases not visualized on ceCT in 11% of patients.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>36739788</pmid><doi>10.1016/j.suronc.2023.101909</doi><oa>free_for_read</oa></addata></record> |
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| subjects | CA-19-9 Antigen - therapeutic use Chemoradiotherapy Digital FDG-PET/CT Disease staging Fluorodeoxyglucose F18 FOLFIRINOX Humans LAPC Neo-adjuvant therapy Neoplasm Staging Nuclear medicine Pancreatectomy Pancreatic cancer Pancreatic Neoplasms Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - drug therapy Pancreatic Neoplasms - surgery Pancreatic surgery Pancreaticoduodenectomy PDAC Positron Emission Tomography Computed Tomography - methods Positron-Emission Tomography - methods Prospective Studies Radiopharmaceuticals - therapeutic use Retrospective Studies Tumor response evaluation |
| title | Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer |
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