18F‐labeled fluorouracil positron emission tomography and the prognoses of colorectal carcinoma patients with metastases to the liver treated with 5‐fluorouracil

• Published in: Cancer Vol. 83; no. 2; pp. 245 - 253
• Main Authors: Moehler, Markus, Dimitrakopoulou‐Strauss, Antonia, Gutzler, Frank, Raeth, Ulrich, Strauss, Ludwig G., Stremmel, Wolfgang
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.07.1998; Wiley-Liss
• Subjects: 5‐fluorouracil; Aged; Antidotes - administration & dosage; Antimetabolites, Antineoplastic - pharmacokinetics; Antimetabolites, Antineoplastic - therapeutic use; Biological and medical sciences; Carcinoma - diagnostic imaging; Carcinoma - drug therapy; chemotherapy; Colon and Rectum; colorectal carcinoma; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - drug therapy; Digestion. Liver. Biliary tract. Spleen. Pancreas; Drug Interactions; Female; Fluorodeoxyglucose F18; Fluorouracil - pharmacokinetics; Fluorouracil - therapeutic use; Humans; Investigative techniques, diagnostic techniques (general aspects); Leucovorin - administration & dosage; Liver - metabolism; liver metastases; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Male; Medical sciences; Middle Aged; positron emission tomography; Prognosis; Radionuclide investigations; Radiopharmaceuticals; survival; Tomography, Emission-Computed; Radionuclide study; Antineoplastic agent; Human; Rectal disease; Carcinoma; Prognosis; Radiolabelling; Fluoropyrimidine derivatives; Liver; Hepatic disease; Malignant tumor; Metastasis; Colonic disease; Chemotherapy; Treatment; Rectum; Digestive diseases; Intestinal disease; Colon; Fluorine Organic compounds; Fluorouracil; Positron; Emission tomography
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980715)83:2<245::AID-CNCR7>3.0.CO;2-P

BACKGROUND Although many factors have been investigated in connection with the prognoses of colorectal carcinoma patients with metastases to the liver, a means for evaluating response and prognosis prior to the administration of standard chemotherapy has not been available. Positron emission tomography (PET) is a noninvasive means of measuring the distribution of radiolabeled cytostatic agents in tumor regions. METHODS Prior to the administration of 5‐fluorouracil chemotherapy, the authors examined 14 colorectal carcinoma patients with unresectable liver metastases using a single PET scan and 18F‐labeled fluorouracil (18F‐FU). Clinical response and survival time were correlated with 18F‐FU uptake values (SUV) measured in liver metastases 120 minutes after tracer infusion. RESULTS Trapping of 18F‐FU varied even among different metastases in the same patient. The range of SUV was 0.9‐4.3 (mean, 2.20). Four patients with SUV exceeding 2.8 had stable disease for longer than 12 months and survived longer than 21 months. Three patients with SUV less than 1.2 had progressive disease and survived less than 12 months. The 6 patients with partial remission or stable disease had a mean SUV of 2.96 and a mean survival of 31.6 months. Eight patients with progressive disease had a mean SUV of 1.59 and a mean survival of 14.5 months (Student's t test, P < 0.012). In scatterplot analysis, there was a statistically significant correlation between SUV and survival time. CONCLUSIONS Patients with high 18F‐FU uptake values are more likely to achieve at least stabilization of disease with planned chemotherapy. 18F‐FU PET may be a valuable new tool for determining, prior to 5‐FU‐based chemotherapy, which patients are likely to have good responses and prolonged survival. Cancer 1998;83:245‐253. © 1998 American Cancer Society. Positron emission tomography (PET) is a noninvasive means of measuring the distribution and metabolism of radiolabeled cytostatic agents in tumor regions. Therefore, 18F‐labeled fluorouracil (18F‐FU) PET may be a new tool for predicting the therapeutic responses and prognoses of patients with colorectal carcinoma metastases to the liver prior to the administration of 5‐fluorouracil (5‐FU)‐ based chemotherapy, allowing these patients to be selected for other treatment protocols if necessary.