AUTHOR=Barnes Chad A. , Aldakkak Mohammed , Clarke Callisia N. , Christians Kathleen K. , Bucklan Daniel , Holt Michael , Tolat Parag , Ritch Paul S. , George Ben , Hall William A. , Erickson Beth A. , Evans Douglas B. , Tsai Susan 

TITLE=Value of Pretreatment 18F-fluorodeoxyglucose Positron Emission Tomography in Patients With Localized Pancreatic Cancer Treated With Neoadjuvant Therapy

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00500

DOI=10.3389/fonc.2020.00500

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold><sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging is not routine in patients with localized pancreatic cancer (PC). We evaluated the prognostic value of PET/CT in patients who received neoadjuvant therapy.</p><p><bold>Methods:</bold> Patients with localized PC underwent pretreatment PET/CT with or without posttreatment (preop) PET/CT. Maximum standardized uptake values (SUV) were classified as high or low based on a cut point of 7.5 at diagnosis (SUV<sub>dx</sub>) and 3.5 after neoadjuvant therapy (preoperative; SUV<sub>preop</sub>). Preop carbohydrate antigen 19-9 (CA19-9) was classified as normal ( ≤ 35 U/mL) or elevated.</p><p><bold>Results:</bold> Pretreatment PET/CT imaging was performed on 201 consecutive patients; SUV<sub>dx</sub> was high in 98 (49%) and low in 103 (51%). Preop PET/CT was available in 104 (52%) of the 201 patients; SUV<sub>preop</sub> was high in 60 (58%) and low in 44 (42%). Following neoadjuvant therapy, preop CA19-9 was normal in 90 (45%) patients and elevated in 111 (55%). Median overall survival (OS) of all patients was 27 months; 33 months for the 103 patients with a low SUV<sub>dx</sub> and 22 months for the 98 patients with a high SUV<sub>dx</sub> (<italic>p</italic> = 0.03). Median OS for patients with low SUV<sub>dx</sub>/normal preop CA19-9, high SUV<sub>dx</sub>/normal preop CA19-9, low SUV<sub>dx</sub>/elevated preop CA19-9, and high SUV<sub>dx</sub>/elevated preop CA19-9 were 66, 34, 23, and 17 months, respectively (<italic>p</italic> &lt; 0.0001). OS was 44 months for the 148 (74%) patients who completed all intended neoadjuvant therapy and surgery and 13 months for the 53 (26%) who did not undergo surgery (<italic>p</italic> &lt; 0.001).</p><p><bold>Conclusion:</bold> Pretreatment PET/CT avidity and preop CA19-9 are clinically significant prognostic markers in patients with PC.</p>