Value of Pretreatment 18F-fluorodeoxyglucose Positron Emission Tomography in Patients With Localized Pancreatic Cancer Treated With Neoadjuvant Therapy

• Published in: Frontiers in oncology Vol. 10; p. 500
• Main Authors: Barnes, Chad A., Aldakkak, Mohammed, Clarke, Callisia N., Christians, Kathleen K., Bucklan, Daniel, Holt, Michael, Tolat, Parag, Ritch, Paul S., George, Ben, Hall, William A., Erickson, Beth A., Evans, Douglas B., Tsai, Susan
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 17.04.2020
• Subjects: 18F-fluorodeoxyglucose positron emission tomography; carbohydrate antigen 19-9; neoadjuvant therapy; Oncology; pancreatic cancer; SUV
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2020.00500

Background: 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging is not routine in patients with localized pancreatic cancer (PC). We evaluated the prognostic value of PET/CT in patients who received neoadjuvant therapy. Methods: Patients with localized PC underwent pretreatment PET/CT with or without posttreatment (preop) PET/CT. Maximum standardized uptake values (SUV) were classified as high or low based on a cut point of 7.5 at diagnosis (SUV dx ) and 3.5 after neoadjuvant therapy (preoperative; SUV preop ). Preop carbohydrate antigen 19-9 (CA19-9) was classified as normal ( ≤ 35 U/mL) or elevated. Results: Pretreatment PET/CT imaging was performed on 201 consecutive patients; SUV dx was high in 98 (49%) and low in 103 (51%). Preop PET/CT was available in 104 (52%) of the 201 patients; SUV preop was high in 60 (58%) and low in 44 (42%). Following neoadjuvant therapy, preop CA19-9 was normal in 90 (45%) patients and elevated in 111 (55%). Median overall survival (OS) of all patients was 27 months; 33 months for the 103 patients with a low SUV dx and 22 months for the 98 patients with a high SUV dx ( p = 0.03). Median OS for patients with low SUV dx /normal preop CA19-9, high SUV dx /normal preop CA19-9, low SUV dx /elevated preop CA19-9, and high SUV dx /elevated preop CA19-9 were 66, 34, 23, and 17 months, respectively ( p < 0.0001). OS was 44 months for the 148 (74%) patients who completed all intended neoadjuvant therapy and surgery and 13 months for the 53 (26%) who did not undergo surgery ( p < 0.001). Conclusion: Pretreatment PET/CT avidity and preop CA19-9 are clinically significant prognostic markers in patients with PC.