Positron Emission Tomography Imaging of Pancreatic Cancer
Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is increasingly used for the staging of solid malignancies, including lung and esophagus. However, controversy still exists in relation to the application of PET in pancreatic cancer. The authors review seven studies (Abstracts #183, #189, #190, #254, #357, #375, #378) presented at the 2014 ASCO Gastrointestinal Cancers Symposium and discuss on the role of PET in this disease. As the limitations of the Response Evaluation Criteria In Solid Tumors (RECIST) continue to become evident, FDG-PET may identify changes in the metabolic activity within pancreatic adenocarcinoma, and can provide both diagnostic and prognostic information.
Image: Multiple metastases in the liver (Figure 1c)
Siegel R, Ma J, Zou Z, Jamal A. Cancer Statistics 2014. CA Cancer J Clin 2014;64(1):9-29.
Prithviraj GK, Kothari N, Yue B, Kim J, Springett GM, Malafa MP, Hodul PJ, Kim RD. Utility of PET/CT as initial staging work up for early pancreatic cancer. J Clin Oncol 32, 2014 (suppl 3; abstr 183)
Dholakia AS, Chaudhry MA, Leal JP, Chang DT, Raman SP, SU Z, Hacker-Prietz A, Pai J, Griffith ME, Wahl RL, Tryggestad E, Pawlik TM, Laheru DA, Wolfgang CL, Koong A, Hermman JM. Pre-SBRT metabolic tumor volume and total lesion glycolysis to predict survival in patients with locally advanced pancreatic cancer receiving stereotactic body radiation therapy. J Clin Oncol 32, 2014 (suppl 3; abstr 189)
Lee JW, Kang CM, Lee SM, Lee J, Lee JD. Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with pancreatic cancer. J Clin Oncol 32, 2014 (suppl 3; abstr 190)
Ramanathan RK, Von Hoff DD, Moore MJ, Teixeira L, Siena S, Tabernero J, Goldstein D, Wei X, Lu B. Analysis of metabolic response (MR) by positron emission tomography (PET) compared with tumor response by computed tomography (CT) from MPACT, a phase III trial comparing nab-paclitaxel (nab-P) plus gemcitabine (G) versus G alone for patients (pts) with metastatic adenocarcinoma of the pancreas. J Clin Oncol 32, 2014 (suppl 3; abstr 254)
Khawandanah MO, Kurkjian C, Penaroza S, Arnold C, Herman TS, Talbert M, Postier R, Pant S. Utility of 18F-flourodeoxyglucose positron emission tomography (FDG-PET) to predict resectability after neoadjuvant therapy in patients with unresectable pancreatic cancer on CT scans. J Clin Oncol 32, 2014 (suppl 3; abstr 357)
Tuli R, Fraass B, Yang W, Sandler HM, Hendifar A, Nissen NN, Yue Y, Oschin S. Pretreatment 18F-FDG-PET texture analysis to predict local response of pancreatic cancer to radiotherapy. J Clin Oncol 32, 2014 (suppl 3; abstr 375).
Galavis PE, Hollensen C, Jallow N, Paliwal B, Jeraj R. Variability of textural features in FDG PET images due to different acquisition modes and reconstruction parameters. Acta Oncol. 2010 Oct;49(7):1012-6.
Dong X, Xing L, Wu P, Fu Z, Wan H, Li D, Yin Y, Sun X, Yu J. Three-dimensional positron emission tomography image texture analysis of esophageal squamous cell carcinoma: relationship between tumor 18F-fluorodeoxyglucose uptake heterogeneity, maximum standardized uptake value, and tumor stage. Nucl Med Commun. 2013 Jan;34(1):40-6.
Bagci U, Yao J, Miller-Jaster K, Chen X, Mollura DJ. Predicting future morphological changes of lesions from radiotracer uptake in 18F-FDG-PET images. PLoS One. 2013;8(2):e57105.
Tuli R, Yang W, Tighiouart M, Yue Y, Fraass B, Sandler HM Hendifar AE, Nissen NN, Oschin S. 18F-FDG PET as a predictor of resectability and clinical outcomes in locally advanced pancreatic cancer patients treated with radiotherapy. J Clin Oncol 32, 2014 (suppl 3; abstr 378)
Vanderhoek M, Perlman SB, Jeraj R. Impact of the definition of peak standardized uptake value on quantification of treatment response. J Nucl Med. 2012 Jan;53(1):4-11.
Nascente CM, Dhani NC, Vines D, Yeung I, Metser U, Serra S, et al. Clinical characterization of hypoxia in pancreatic ductal adenocarcinoma (PDAC) by 18F-FAZA PET and pimonidazole. J Clin Oncol 31, 2013 (Suppl.): Abstract #4049.
Vecchiarelli S, Macchini M, Grassi E, Ferroni F, Ciccarese F, Calculli L, et al. Comparing RECIST and Choi’s criteria to evaluate radiological response to chemotherapy in patients with advanced pancreatic cancer. J Clin Oncol 31, 2013 (Suppl.): Abstract #e15069.
Tixier F, Le Rest CC, Hatt M, Albarghach N, Pradier O, Metges JP, Corcos L, Visvikis D. Intratumor heterogeneity characterized by textural features on baseline 18F-FDG PET images predicts response to concomitant radiochemotherapy in esophageal cancer. J Nucl Med. 2011 Mar;52(3):369-78.
Viswanath SE, Bloch NB, Chappelow JC, Toth R, Rofsky NM, Genega EM, Lenkinski RE, Madabhushi A. Central gland and peripheral zone prostate tumors have significantly different quantitative imaging signatures on 3 Tesla endorectal, in vivo T2-weighted MR imagery. J Magn Reson Imaging. 2012 Jul;36(1):213-24.
Ahn SJ, Park MS, Kim KA, Park JY, Kim I, Kang WJ, Lee SK, Kim MJ. ¹⁸F-FDG PET metabolic parameters and MRI perfusion and diffusion parameters in hepatocellular carcinoma: a preliminary study. PLoS One. 2013 Aug 5;8(8):e71571
Heusch P, Köhler J, Wittsack HJ, Heusner TA, Buchbender C, Poeppel TD, Nensa F, Wetter A, Gauler T, Hartung V, Lanzman RS. Hybrid ¹⁸F-FDG PET/MRI including non-Gaussian diffusion-weighted imaging (DWI): preliminary results in non-small cell lung cancer (NSCLC). Eur J Radiol. 2013 Nov;82(11):2055-60.
Copyright (c) 2014 Saravanan Kokila Krishnamoorthy, Sachin Jambawaliker, Muhammad Wasif Saif
This work is licensed under a Creative Commons Attribution 4.0 International License.As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.