Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer (2024)

de Jong, T. L., Koopman, D., van der Worp, C. A. J., Stevens, H., Vuijk, F. A., Vahrmeijer, A. L., Mieog, J. S. D., de Groot, J. W. B., Meijssen, M. A. C., Nieuwenhuijs, V. B., Lioe-Fee, D. G. O., Jager, P. L., & Patijn, G. A. (2023). Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer. Surgical Oncology, 47, Article 101909. https://doi.org/10.1016/j.suronc.2023.101909

de Jong, Tonke L. ; Koopman, Daniëlle ; van der Worp, Corné A.J. et al. / Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer. In: Surgical Oncology. 2023 ; Vol. 47.

@article{83d75285a36944a29375f38dbcd4e4ac,

title = "Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer",

abstract = "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.",

keywords = "n/a OA procedure, Digital FDG-PET/CT, Disease staging, FOLFIRINOX, LAPC, Neo-adjuvant therapy, Nuclear medicine, Pancreatectomy, Pancreatic cancer, Pancreatic surgery, Pancreaticoduodenectomy, PDAC, Tumor response evaluation, Chemoradiotherapy",

author = "{de Jong}, {Tonke L.} and Dani{\"e}lle Koopman and {van der Worp}, {Corn{\'e} A.J.} and Henk Stevens and Vuijk, {Floris A.} and Vahrmeijer, {Alexander L.} and Mieog, {J. Sven D.} and {de Groot}, {Jan Willem B.} and Meijssen, {Maarten A.C.} and Nieuwenhuijs, {Vincent B.} and Lioe-Fee, {de Geus Oei} and Jager, {Pieter L.} and Patijn, {Gijs A.}",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = apr,

doi = "10.1016/j.suronc.2023.101909",

language = "English",

volume = "47",

journal = "Surgical Oncology",

issn = "0960-7404",

publisher = "Elsevier",

}

de Jong, TL, Koopman, D, van der Worp, CAJ, Stevens, H, Vuijk, FA, Vahrmeijer, AL, Mieog, JSD, de Groot, JWB, Meijssen, MAC, Nieuwenhuijs, VB, Lioe-Fee, DGO, Jager, PL & Patijn, GA 2023, 'Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer', Surgical Oncology, vol. 47, 101909. https://doi.org/10.1016/j.suronc.2023.101909

Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer. / de Jong, Tonke L.; Koopman, Daniëlle; van der Worp, Corné A.J. et al.
In: Surgical Oncology, Vol. 47, 101909, 04.2023.

Research output: Contribution to journal › Article › Academic › peer-review

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 - Lioe-Fee, de Geus Oei

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 -

de Jong TL, Koopman D, van der Worp CAJ, Stevens H, Vuijk FA, Vahrmeijer AL et al. Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer. Surgical Oncology. 2023 Apr;47:101909. Epub 2023 Feb 1. doi: 10.1016/j.suronc.2023.101909