Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Usefulness of $^{18}F$-FDG PET/CT for Predicting the Response of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiation Therapy

국소 진행된 직장암의 $^{18}F$-FDG PET/CT를 이용한 항암방사선치료의 반응성 예측

  • Kang, Jin-Kyu (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Kim, Mi-Sook (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Choi, Chul-Won (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Jeong, Su-Young (Departments of Nuclear Medicine, Korea Institute of Radiological & Medical Sciences) ;
  • Yoo, Seong-Yul (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Cho, Chul-Koo (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Yang, Kwang-Mo (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Yoo, Hyung-Jun (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Cheon, Gi-Jeong (Departments of Nuclear Medicine, Korea Institute of Radiological & Medical Sciences) ;
  • Shin, Young-Joo (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Seo, Young-Seok (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences)
  • 강진규 (한국원자력의학원 방사선종양학과) ;
  • 김미숙 (한국원자력의학원 방사선종양학과) ;
  • 최철원 (한국원자력의학원 방사선종양학과) ;
  • 정수영 (한국원자력의학원 핵의학과) ;
  • 류성렬 (한국원자력의학원 방사선종양학과) ;
  • 조철구 (한국원자력의학원 방사선종양학과) ;
  • 양광모 (한국원자력의학원 방사선종양학과) ;
  • 유형준 (한국원자력의학원 방사선종양학과) ;
  • 천기정 (한국원자력의학원 핵의학과) ;
  • 신영주 (한국원자력의학원 방사선종양학과) ;
  • 서영석 (한국원자력의학원 방사선종양학과)
  • Received : 2009.06.25
  • Accepted : 2009.08.03
  • Published : 2009.09.30
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Abstract

Purpose: This study aimed at assessing the value of fluorine-18 fluorodeoxyglucose positron emission tomography ($^{18}F$-FDG PET) for predicting the response of locally advanced rectal cancer to neoadjuvant CRT. Materials and Methods: Between August 2006 and January 2008, we prospectively enrolled 20 patients with locally advanced rectal cancer and who were treated with neoadjuvant CRT at the Korea Institute of Radiological and Medical Sciences. The treatment consisted of radiation therapy and chemotherapy, and this was followed by curative resection 6 weeks later. All the patients underwent $^{18}F$-FDG PET/CT both before CRT and 6 weeks after completing CRT. The measurements of the FDG uptake ($SUV_{max}$), the absolute difference (${\Delta}SUV_{max}$) and the percent $SUV_{max}$ difference (response index, $RI_{SUV}$) between the pre- and post-CRT $^{18}F$-FDG PET/CT scans were assessed. The measurements of the metabolic volume, the absolute difference (${\Delta}$metabolic volume) and the percent metabolic volume difference (response index, $RI_{metabolic\;volume}$) were also assessed. Results: Of the 20 patients who underwent surgery, 11 patients (55%) were classified as responders according to Dworak's classification. The post-CRT $SUV_{max}$ was significantly lower than the pre-CRT $SUV_{max}$. However, there were no significant differences in the $SUV_{max}$ and the metabolic volume reduction between the responders and non-responders. We used a minimum $SUV_{max}$ reduction of 67% as the cut-off value for defining a response, with a sensitivity of 45.5%, a specificity of 88.9%, a positive predictive value of 77% and a negative predictive value of 53.8%. Conclusion: Although there were no statistically significant results in this study, other studies have revealed that $^{18}F$-FDG PET/CT has the potential to assess the tumor response to neoadjuvant CRT in patients with locally advanced rectal cancer.

목 적: 국소 진행된 직장암에서 수술 전 동시항암방사선치료 후 정확한 치료 반응 평가는 매우 중요하다. 본 연구는 국소 진행된 직장암에서 $^{18}F$-FDG PET/CT를 이용한 수술 전 항암방사선치료의 반응성 예측에 대해 알아보고자 하였다. 대상 및 방법: 2006년 8월부터 2008년 1월까지 원자력의학원에서 국소 진행된 직장암으로 수술 전 항암방사선치료를 시행한 20명의 환자를 대상으로 전향적 연구를 시행하였다. 방사선 치료는 한 회에 1.8 Gy씩 하루 1회 주 5회의 일정으로 총 50.4 Gy 시행되었고, 항암 치료는 3주 간격으로 3회 시행되었다. 모든 환자는 치료 전과 항암방사선치료 종료 6주 후에 각각 $^{18}F$-FDG PET/CT 촬영을 하였다. 모든 환자는 수술을 시행 받았고 수술 후 절제된 조직을 통해 Dworak 분류에 따른 종양의 치료에 대한 반응 정도를 평가하였다. 결 과: 20명 중 11명의 환자가 Dworak 분류에 따라 반응군에 속했으며, 나머지 9명은 비반응군으로 분류되었다. 수술 후 $SUV_{max}$값과 metabolic volume (SUV가 2.5 이상인 병변의 용적)은 수술 전 $SUV_{max}$값과 metabolic volume보다 현저히 낮았다. 그러나 반응군에서 metabolic volume의 변화를 제외하고는 통계적으로 유의한 차이는 보이지 않았다. 이 연구에서는 치료 후 반응군과 비반응군을 구분하는 cut-off value는 $SUV_{max}$가 67% 감소하는 지점으로 나타났다. 이 cut-off value를 이용하여 반응군과 비반응군을 구분하는 경우 민감도는 45.5%, 특이도는 88.9%였으며, 양성 예측률과 음성 예측률은 각각 71.4% 및 53.8%였다. 결 론: 비록 본 연구에서는 통계적으로 유의한 결과를 얻지 못하였지만, 다른 연구들을 통해 봤을 때 국소 진행된 직장암 환자에서 수술 전 방사선 및 항암 병합 요법의 효과를 판정하고 예측하는데 있어서 $^{18}F$-FDG PET/CT를 이용한 검사가 유용할 것으로 생각된다.

Keywords

References

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