• Secondo Lastoria, Maria Carmela Piccirillo, Corradina Caracò, Guglielmo Nasti, Luigi Aloj, Cecilia Arrichiello, Elisabetta de Lutio di Castelguidone, Fabiana Tatangelo, Alessandro Ottaiano, Rosario Vincenzo Iaffaioli, Francesco Izzo, Giovanni Romano, Pasqualina Giordano, Simona Signoriello, Ciro Gallo, and Francesco Perrone.
• Nuclear Medicine Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
• J. Nucl. Med. 2013 Dec 1; 54 (12): 2062-9.

UnlabelledMarkers predictive of treatment effect might be useful to improve the treatment of patients with metastatic solid tumors. Particularly, early changes in tumor metabolism measured by PET/CT with (18)F-FDG could predict the efficacy of treatment better than standard dimensional Response Evaluation Criteria In Solid Tumors (RECIST) response.MethodsWe performed PET/CT evaluation before and after 1 cycle of treatment in patients with resectable liver metastases from colorectal cancer, within a phase 2 trial of preoperative FOLFIRI plus bevacizumab. For each lesion, the maximum standardized uptake value (SUV) and the total lesion glycolysis (TLG) were determined. On the basis of previous studies, a ≤ -50% change from baseline was used as a threshold for significant metabolic response for maximum SUV and, exploratively, for TLG. Standard RECIST response was assessed with CT after 3 mo of treatment. Pathologic response was assessed in patients undergoing resection. The association between metabolic and CT/RECIST and pathologic response was tested with the McNemar test; the ability to predict progression-free survival (PFS) and overall survival (OS) was tested with the Log-rank test and a multivariable Cox model.ResultsThirty-three patients were analyzed. After treatment, there was a notable decrease of all the parameters measured by PET/CT. Early metabolic PET/CT response (either SUV- or TLG-based) had a stronger, independent and statistically significant predictive value for PFS and OS than both CT/RECIST and pathologic response at multivariate analysis, although with different degrees of statistical significance. The predictive value of CT/RECIST response was not significant at multivariate analysis.ConclusionPET/CT response was significantly predictive of long-term outcomes during preoperative treatment of patients with liver metastases from colorectal cancer, and its predictive ability was higher than that of CT/RECIST response after 3 mo of treatment. Such findings need to be confirmed by larger prospective trials.

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