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Long-Term Prognostic Value of 18F-FDG PET in Patients with Locally Advanced Rectal Cancer Previously Treated with Neoadjuvant Radiochemotherapy

Carlo Capirci1, Domenico Rubello2, Franca Chierichetti3, Giorgio Crepaldi4, Stefano Fanti5, Giovanni Mandoliti1, Simonetta Salviato6, Giuseppe Boni7, Lucia Rampin2, Cesare Polico1 and Giuliano Mariani7

1 Radiotherapy Department, S. Maria della Misericordia Hospital, Rovigo, Italy.
2 Nuclear Medicine Service-PET Unit, S. Maria della Misericordia Hospital, Rovigo, Italy.
3 Nuclear Medicine Service-PET Center, Castelfranco Veneto General Hospital, Castelfranco Veneto, Italy.
4 Medical Oncology Department, S. Maria della Misericordia Hospital, Rovigo, Italy.
5 Nuclear Medicine Service-PET Unit, S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy.
6 Health Physics Service, S. Maria della Misericordia Hospital, Rovigo, Italy.
7 Regional Center of Nuclear Medicine, University of Pisa Medical School, Via Roma 67, Pisa, Italy I-56126.


Figure 1
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  		Fig. 1 —Representative examples of after-radiochemotherapy 18F-FDG PET scans (transaxial sections at perineal level) obtained in patients with rectal cancer after completion of neoadjuvant therapy. A-E Tracer uptake by tumor was scored as intense (SUVmax = 15.4) in 67-year-old man (A), moderate (SUVmax = 5.6) in 52-year-old man (B), mild (SUVmax = 2.3) in 55-year-old woman (C), faint (SUVmax = 1.2) in 50-year-old woman (D), and absent (SUVmax = 0.7) in 48-year-old man (E). Accumulation of radioactivity in bladder provides useful anatomic landmark for topographic reference. SUVmax = maximum standardized uptake value. Arrows are computer-generated and have no particular meaning.

 

Figure 2
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  		Fig. 2 —Kaplan-Meier plot of patterns of disease-free survival, overall survival, and survival free from local recurrences in whole group of 88 patients with advanced rectal cancer.

 

Figure 3
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  		Fig. 3 —Kaplan-Meier plot of pattern of disease-free survival as function of pathologic stage assessed at surgery.

 

Figure 4
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  		Fig. 4 —Kaplan-Meier plot of pattern of disease-free survival as function of after-radiochemotherapy 18F-FDG PET findings (54 patients with negative [•], 34 patients with positive [{circ}] PET findings after neoadjuvant radiochemotherapy).

 

Figure 5
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  		Fig. 5 —Kaplan-Meier plot of pattern of disease-free survival as function of combined after-radiochemotherapy 18F-FDG PET findings and pathologic stage.

 

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