TY - JOUR
T1 - Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer
AU - de Jong, Tonke L.
AU - Koopman, Daniëlle
AU - van der Worp, Corné A.J.
AU - Stevens, Henk
AU - Vuijk, Floris A.
AU - Vahrmeijer, Alexander L.
AU - Mieog, J. Sven D.
AU - de Groot, Jan Willem B.
AU - Meijssen, Maarten A.C.
AU - Nieuwenhuijs, Vincent B.
AU - de Geus Oei, Lioe-Fee
AU - Jager, Pieter L.
AU - Patijn, Gijs A.
N1 - Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - n/a OA procedure
KW - Digital FDG-PET/CT
KW - Disease staging
KW - FOLFIRINOX
KW - LAPC
KW - Neo-adjuvant therapy
KW - Nuclear medicine
KW - Pancreatectomy
KW - Pancreatic cancer
KW - Pancreatic surgery
KW - Pancreaticoduodenectomy
KW - PDAC
KW - Tumor response evaluation
KW - Chemoradiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85149752435&partnerID=8YFLogxK
U2 - 10.1016/j.suronc.2023.101909
DO - 10.1016/j.suronc.2023.101909
M3 - Article
C2 - 36739788
AN - SCOPUS:85149752435
SN - 0960-7404
VL - 47
JO - Surgical Oncology
JF - Surgical Oncology
M1 - 101909
ER -
