Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer

Tonke L. de Jong, Daniëlle Koopman, Corné A.J. van der Worp, Henk Stevens, Floris A. Vuijk, Alexander L. Vahrmeijer, J. Sven D. Mieog, Jan Willem B. de Groot, Maarten A.C. Meijssen, Vincent B. Nieuwenhuijs, de Geus Oei Lioe-Fee, Pieter L. Jager, Gijs A. Patijn*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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%). Conclusion: 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.

Original languageEnglish
Article number101909
JournalSurgical Oncology
Volume47
Early online date1 Feb 2023
DOIs
Publication statusPublished - Apr 2023

Keywords

  • n/a OA procedure
  • Digital FDG-PET/CT
  • Disease staging
  • FOLFIRINOX
  • LAPC
  • Neo-adjuvant therapy
  • Nuclear medicine
  • Pancreatectomy
  • Pancreatic cancer
  • Pancreatic surgery
  • Pancreaticoduodenectomy
  • PDAC
  • Tumor response evaluation
  • Chemoradiotherapy

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