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Background  Locally recurrent rectal cancer (LRRC) remains a major problem after curative resection of primary rectal cancer. A noninvasive, prognostic biomarker with which to accurately evaluate disease status and assess the treatment response is critically needed to optimize treatment plans. This study assesses the effectiveness of PET/CT evaluation of preoperative chemoradiation therapy (CRT) in patients with LRRC.    Methods  Since 2004, we have been performing preoperative CRT to improve local tumor control and survival. Between 2004 and 2013, 40 patients with LRRC underwent preoperative CRT (radiation: 50 Gy/25 fractions; chemotherapy: irinotecan plus UFT [tegafur and uracil]/leucovorin) and radical surgery, and underwent  18 F-FDG-PET/CT before and 3 weeks after the completion of CRT. The maximum standardized uptake values (SUVmax) of the pre-CRT scan (Pre-SUV) and the post-CRT scan (Post-SUV) were measured. The predictive value of the  18 F-FDG-PET and CT/MRI response assessments was evaluated.    Results  The mean Pre-SUV was significantly higher than the Post-SUV (8.2 ± 6.1, vs. 3.8 ± 4.0;  P  < 0.0001). Following CRT, 17/40 patients (42.5%) were classified as responders according to the Mandard tumor regression grade (TRG1–2). The mean Post-SUV was significantly lower in responders than in nonresponders (2.0 ± 1.7 vs. 5.1 ± 3.9;  P  = 0.0038). Pathological response was not correlated with the response as evaluated by CT ( P  > 0.9999) or MRI ( P  > 0.9999). Multivariate regression analysis identified Post-SUV as an independent predictor of local re-recurrence-free survival ( P  = 0.0383) and for overall survival ( P  = 0.0195).    Conclusions  PET/CT is useful in assessing tumor response to preoperative CRT for LRRC and predicting prognosis after surgery.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12885-021-08873-7.

The efficiency of 18F-FDG-PET/CT in the assessment of tumor response to preoperative chemoradiation therapy for locally recurrent rectal cancer