Correlation of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography Parameters with Patterns of Disease Progression in Locally Advanced Pancreatic Cancer after Definitive Chemoradiotherapy

Abstract

Aims

A proportion of patients with pancreatic cancer never develop metastatic disease. We evaluated a role for ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) in identifying a subset of patients with locally advanced pancreatic cancer (LAPC) who never develop metastatic disease and only experience local disease and may therefore benefit from local treatment intensification.

Material and methods

Patients with histologically confirmed LAPC entered a single-centre phase II study of definitive upfront chemoradiotherapy (CRT). All patients underwent FDG-PET/CT before and 6 weeks after CRT. Tumour volume, standardised uptake values (SUV _max, SUV _peak, SUV _mean, SUV _median) and total lesion glycolysis (TLG) were measured on each scan and the response in each parameter was evaluated. The presence or absence of metastatic disease was noted on contrast-enhanced CT carried out every 3 months for 1 year and then at clinician discretion.

Results

Twenty-three patients with LAPC were recruited; 17/23 completed treatment and had interpretable sequential imaging. Twenty-four per cent of patients only ever experienced local disease. Median pre-CRT FDG-PET parameters were significantly lower in patients with local disease only during follow-up compared with those who developed metastatic disease: SUV _max 3.8 versus 8.6 ( P = 0.006), SUV _peak 2.5 versus 7.5 ( P = 0.002), SUV _mean 1.8 versus 3.3 ( P = 0.001), SUV _median 1.7 versus 3.0 ( P = 0.002), TLG 26.9 versus 115.9 ( P = 0.006). Tumour volume, post-CRT FDG-PET values and their relative change were not statistically different between local disease and metastatic disease groups. Receiver operating characteristic curves for pre-CRT FDG-PET parameters to predict those who never develop metastatic disease all had areas under the curve (AUCs) ≥ 0.932. Pre-CRT FDG-PET SUV _max < 6.2 predicted patients with local disease only during follow-up with 100.0% sensitivity and 92.3% specificity, 80.0% positive predictive value and 100% negative predictive value.

Conclusions

Our findings suggest that patients with less FDG-avid tumours are less likely to metastasise and may therefore benefit from upfront local treatment intensification.

Highlights

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  A proportion of patients with locally advanced pancreatic cancer do not develop detectable metastatic disease.

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  Locally advanced pancreatic tumours that are not FDG-avid tend not to metastasise and patients die because of locally progressive disease.

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  This subgroup of patients may benefit from treatment interventions that aim to optimise local control.

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  FDG-PET SUV _max offers a good summary of the metabolic activity of pancreatic tumours.