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Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases

Jeroen Mertens (UGent) , SYLVIE DE BRUYNE (UGent) , Nancy Van Damme (UGent) , Peter Smeets (UGent) , Wim Ceelen (UGent) , Roberto Troisi (UGent) , Stéphanie Laurent (UGent) , Karen Geboes (UGent) , Marc Peeters (UGent) , Ingeborg Goethals (UGent) , et al.
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Abstract
Standardized added metabolic activity (SAM) is a PET parameter for assessing the total metabolic load of malignant processes, avoiding partial volume effects and lesion segmentation. The potential role of this parameter in the assessment of response to chemotherapy and bevacizumab was tested in patients with metastatic colorectal cancer with potentially resectable liver metastases (mCRC). F-18-FDG PET/CT was performed in 18 mCRC patients with liver metastases before treatment and after five cycles of FOLFOX/FOLFIRI and bevacizumab. Of the 18 patients, 16 subsequently underwent resection of liver metastases. Baseline and follow-up SUVmax, and SAM as well as reduction in SUVmax (a dagger SUVmax) and SAM (a dagger SAM) of all liver metastases were correlated with morphological response, and progression-free and overall survival (PFS and OS). A significant reduction in metabolic activity of the liver metastases was seen after chemotherapy with a median a dagger SUVmax of 25.3 % and a dagger SAM of 94.5 % (p = 0.033 and 0.003). Median baseline SUVmax and SAM values were significantly different between morphological responders and nonresponders (3.8 vs. 7.2, p = 0.021; and 34 vs. 211, p = 0.002, respectively), but neither baseline PET parameters nor morphological response was correlated with PFS or OS. Follow-up SUVmax and SAM as well as a dagger SAM were found to be prognostic factors. The median PFS and OS in the patient group with a high follow-up SUVmax were 10.4 months and 32 months, compared to a median PFS of 14.7 months and a median OS which had not been reached in the group with a low follow-up SUVmax (p = 0.01 and 0.003, respectively). The patient group with a high follow-up SAM and a low a dagger SAM had a median PFS and OS of 9.4 months and 32 months, whereas the other group had a median PFS of 14.7 months and a median OS which had not been reached (p = 0.002 for both PFS and OS). F-18-FDG PET imaging is a useful tool to assess treatment response and predict clinical outcome in patients with mCRC who undergo chemotherapy before liver metastasectomy. Follow-up SUVmax, follow-up SAM and a dagger SAM were found to be significant prognostic factors for PFS and OS.
Keywords
F-18-FDG PET, Standardized added metabolic activity (SAM), Treatment monitoring, Colorectal cancer, Liver metastases, Bevacizumab, VOLUME INDEPENDENT MARKER, TOTAL LESION GLYCOLYSIS, MONITORING RESPONSE, HEPATIC RESECTION, PLUS IRINOTECAN, FDG-PET, CANCER, CHEMOTHERAPY, BEVACIZUMAB, CARCINOMA

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Chicago
Mertens, Jeroen, SYLVIE DE BRUYNE, Nancy Van Damme, Peter Smeets, Wim Ceelen, Roberto Troisi, Stéphanie Laurent, et al. 2013. “Standardized Added Metabolic Activity (SAM) IN 18F-FDG PET Assessment of Treatment Response in Colorectal Liver Metastases.” European Journal of Nuclear Medicine and Molecular Imaging 40 (8): 1214–1222.
APA
Mertens, Jeroen, DE BRUYNE, S., Van Damme, N., Smeets, P., Ceelen, W., Troisi, R., Laurent, S., et al. (2013). Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases. EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, 40(8), 1214–1222.
Vancouver
1.
Mertens J, DE BRUYNE S, Van Damme N, Smeets P, Ceelen W, Troisi R, et al. Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases. EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. 2013;40(8):1214–22.
MLA
Mertens, Jeroen, SYLVIE DE BRUYNE, Nancy Van Damme, et al. “Standardized Added Metabolic Activity (SAM) IN 18F-FDG PET Assessment of Treatment Response in Colorectal Liver Metastases.” EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 40.8 (2013): 1214–1222. Print.
@article{4223481,
  abstract     = {Standardized added metabolic activity (SAM) is a PET parameter for assessing the total metabolic load of malignant processes, avoiding partial volume effects and lesion segmentation. The potential role of this parameter in the assessment of response to chemotherapy and bevacizumab was tested in patients with metastatic colorectal cancer with potentially resectable liver metastases (mCRC).
F-18-FDG PET/CT was performed in 18 mCRC patients with liver metastases before treatment and after five cycles of FOLFOX/FOLFIRI and bevacizumab. Of the 18 patients, 16 subsequently underwent resection of liver metastases. Baseline and follow-up SUVmax, and SAM as well as reduction in SUVmax (a dagger SUVmax) and SAM (a dagger SAM) of all liver metastases were correlated with morphological response, and progression-free and overall survival (PFS and OS).
A significant reduction in metabolic activity of the liver metastases was seen after chemotherapy with a median a dagger SUVmax of 25.3 \% and a dagger SAM of 94.5 \% (p = 0.033 and 0.003). Median baseline SUVmax and SAM values were significantly different between morphological responders and nonresponders (3.8 vs. 7.2, p = 0.021; and 34 vs. 211, p = 0.002, respectively), but neither baseline PET parameters nor morphological response was correlated with PFS or OS. Follow-up SUVmax and SAM as well as a dagger SAM were found to be prognostic factors. The median PFS and OS in the patient group with a high follow-up SUVmax were 10.4 months and 32 months, compared to a median PFS of 14.7 months and a median OS which had not been reached in the group with a low follow-up SUVmax (p = 0.01 and 0.003, respectively). The patient group with a high follow-up SAM and a low a dagger SAM had a median PFS and OS of 9.4 months and 32 months, whereas the other group had a median PFS of 14.7 months and a median OS which had not been reached (p = 0.002 for both PFS and OS). 
F-18-FDG PET imaging is a useful tool to assess treatment response and predict clinical outcome in patients with mCRC who undergo chemotherapy before liver metastasectomy. Follow-up SUVmax, follow-up SAM and a dagger SAM were found to be significant prognostic factors for PFS and OS.},
  author       = {Mertens, Jeroen and DE BRUYNE, SYLVIE and Van Damme, Nancy and Smeets, Peter and Ceelen, Wim and Troisi, Roberto and Laurent, St{\'e}phanie and Geboes, Karen and Peeters, Marc and Goethals, Ingeborg and Van De Wiele, Christophe},
  issn         = {1619-7070},
  journal      = {EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING},
  keyword      = {F-18-FDG PET,Standardized added metabolic activity (SAM),Treatment monitoring,Colorectal cancer,Liver metastases,Bevacizumab,VOLUME INDEPENDENT MARKER,TOTAL LESION GLYCOLYSIS,MONITORING RESPONSE,HEPATIC RESECTION,PLUS IRINOTECAN,FDG-PET,CANCER,CHEMOTHERAPY,BEVACIZUMAB,CARCINOMA},
  language     = {eng},
  number       = {8},
  pages        = {1214--1222},
  title        = {Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases},
  url          = {http://dx.doi.org/10.1007/s00259-013-2421-z},
  volume       = {40},
  year         = {2013},
}

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