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Abraham AG, Riauka T, Hudson M, Ghosh S, Zebak S, Alba V, Vaihenberg E, Warkentin H, Tankel K, Severin D, Bedard E, Spratlin J, Mulder K, Joseph K. 18F-Fluorodeoxyglucose Positron Emission Tomography Parameters can Predict Long-Term Outcome Following Trimodality Treatment for Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2023; 35:177-187. [PMID: 36402622 DOI: 10.1016/j.clon.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
AIMS 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) is routinely used for the pre-treatment staging of oesophageal or gastro-oesophageal junction cancers (EGEJC). The aim of this study was to identify objective 18FDG-PET/CT-derived parameters that can aid in predicting the patterns of recurrence and prognostication in patients with EGEJC. PATIENTS AND METHODS EGEJC patients referred for consideration of preoperative chemoradiation therapy were identified and clinicopathological data were collected. 18FDG-PET/CT imaging data were reviewed and correlated with treatment outcomes. Maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis were assessed and association with recurrence-free survival (RFS), locoregional recurrence-free survival (LR-RFS), oesophageal cancer-specific survival (ECSS) and overall survival were evaluated using receiver operating characteristic curves, as well as Cox regression and Kaplan-Meier models. RESULTS In total, 191 EGEJC patients completed trimodality treatment and 164 with 18FDG-PET/CT data were included in this analysis. At the time of analysis, 15 (9.1%), 70 (42.7%) and two (1.2%) patients were noted to have locoregional, distant and both locoregional and distant metastases, respectively. The median RFS was 30 months (9.6-50.4) and the 5-year RFS was 31.1%. The 5-year overall survival and ECSS were both noted to be 34.8%. Pre-treatment MTV25 > 28.5 cm3 (P = 0.029), MTV40 > 12.4 cm3 (P = 0.018) and MTV50 > 10.2 cm3 (P = 0.005) predicted for worse LR-RFS, ECSS and overall survival for MTV definition of voxels ≥25%, 40% and 50% of SUVmax. CONCLUSION 18FDG-PET/CT parameters MTV and total lesion glycolysis are useful prognostic tools to predict for LR-RFS, ECSS and overall survival in EGEJC. MTV had the highest accuracy in predicting clinical outcomes. The volume cut-off points we identified for different MTV thresholds predicted outcomes with significant accuracy and may potentially be used for decision making in clinical practice.
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Affiliation(s)
- A G Abraham
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - T Riauka
- Department of Nuclear Medicine, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, Canada
| | - M Hudson
- Department of Nuclear Medicine, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - S Ghosh
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - S Zebak
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - V Alba
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - E Vaihenberg
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - H Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, Canada
| | - K Tankel
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - D Severin
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - E Bedard
- Department of Thoracic Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - J Spratlin
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - K Mulder
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - K Joseph
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.
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Bridges S, Thomas B, Radhakrishna G, Hawkins M, Holborow A, Hurt C, Mukherjee S, Nixon L, Crosby T, Gwynne S. SCOPE 2 - Still Answering the Unanswered Questions in Oesophageal Radiotherapy? SCOPE 2: a Randomised Phase II/III Trial to Study Radiotherapy Dose Escalation in Patients with Oesophageal Cancer Treated with Definitive Chemoradiation with an Embedded Phase II Trial for Patients with a Poor Early Response using Positron Emission Tomography/Computed Tomography. Clin Oncol (R Coll Radiol) 2022; 34:e269-e280. [PMID: 35466013 DOI: 10.1016/j.clon.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
Abstract
The SCOPE 2 trial of definitive chemoradiotherapy in oesophageal cancer investigates the benefits of radiotherapy dose escalation and systemic therapy optimisation. The trial opened in 2016. The landscape of oesophageal cancer treatment over the lifetime of this trial has changed significantly and the protocol has evolved to reflect this. However, with the recent results of the Dutch phase III ART DECO study showing no improvement in local control or overall survival with radiotherapy dose escalation in a similar patient group, we sought to determine if the SCOPE 2 trial is still answering the key unanswered questions for oesophageal radiotherapy. Here we discuss the rationale behind the SCOPE 2 trial, outline the trial schema and review current data on dose escalation and outline recommendations for future areas of research.
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Affiliation(s)
- S Bridges
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - B Thomas
- Velindre University NHS Trust, Cardiff, UK.
| | | | - M Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - A Holborow
- South West Wales Cancer Centre, Swansea, UK
| | - C Hurt
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - S Mukherjee
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - L Nixon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre University NHS Trust, Cardiff, UK
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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Shi J, Li J, Li F, Zhang Y, Guo Y, Wang W, Wang J. Comparison of the Gross Target Volumes Based on Diagnostic PET/CT for Primary Esophageal Cancer. Front Oncol 2021; 11:550100. [PMID: 33718127 PMCID: PMC7947883 DOI: 10.3389/fonc.2021.550100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Clinically, many esophageal cancer patients who planned for radiation therapy have already undergone diagnostic Positron-emission tomography/computed tomography (PET/CT) imaging, but it remains unclear whether these imaging results can be used to delineate the gross target volume (GTV) of the primary tumor for thoracic esophageal cancer (EC). Methods Seventy-two patients diagnosed with thoracic EC had undergone prior PET/CT for diagnosis and three-dimensional CT (3DCT) for simulation. The GTV3D was contoured on the 3DCT image without referencing the PET/CT image. The GTVPET-ref was contoured on the 3DCT image referencing the PET/CT image. The GTVPET-reg was contoured on the deformed registration image derived from 3DCT and PET/CT. Differences in the position, volume, length, conformity index (CI), and degree of inclusion (DI) among the target volumes were determined. Results The centroid distance in the three directions between two different GTVs showed no significant difference (P > 0.05). No significant difference was found among the groups in the tumor volume (P > 0.05). The median DI values of the GTVPET-reg and GTVPET-ref in the GTV3D were 0.82 and 0.86, respectively (P = 0.006). The median CI values of the GTV3D in the GTVPET-reg and GTVPET-ref were 0.68 and 0.72, respectively (P = 0.006). Conclusions PET/CT can be used to optimize the definition of the target volume in EC. However, no significant difference was found between the GTVs delineated based on visual referencing or deformable registration whether using the volume or position. So, in the absence of planning PET–CT images, it is also feasible to delineate the GTV of primary thoracic EC with reference to the diagnostic PET–CT image.
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Affiliation(s)
- Jingzhen Shi
- School of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yanluan Guo
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Accuracy of target delineation by positron emission tomography-based auto-segmentation methods after deformable image registration: A phantom study. Phys Med 2020; 76:194-201. [DOI: 10.1016/j.ejmp.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/19/2020] [Accepted: 07/12/2020] [Indexed: 11/21/2022] Open
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Radiotherapy volume delineation using 18F-FDG-PET/CT modifies gross node volume in patients with oesophageal cancer. Clin Transl Oncol 2018; 20:1460-1466. [PMID: 29721766 DOI: 10.1007/s12094-018-1879-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/16/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Evidence supporting the use of 18F-FDG-PET/CT in the segmentation process of oesophageal cancer for radiotherapy planning is limited. Our aim was to compare the volumes and tumour lengths defined by fused PET/CT vs. CT simulation. MATERIALS AND METHODS Twenty-nine patients were analyzed. All patients underwent a single PET/CT simulation scan. Two separate GTVs were defined: one based on CT data alone and another based on fused PET/CT data. Volume sizes for both data sets were compared and the spatial overlap was assessed by the Dice similarity coefficient (DSC). RESULTS The gross tumour volume (GTVtumour) and maximum tumour diameter were greater by PET/CT, and length of primary tumour was greater by CT, but differences were not statistically significant. However, the gross node volume (GTVnode) was significantly greater by PET/CT. The DSC analysis showed excellent agreement for GTVtumour, 0.72, but was very low for GTVnode, 0.25. CONCLUSIONS Our study shows that the volume definition by PET/CT and CT data differs. CT simulation, without taking into account PET/CT information, might leave cancer-involved nodes out of the radiotherapy-delineated volumes.
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Grassi E, Fioroni F, Berenato S, Patterson N, Ferri V, Braglia L, Filice A, Versari A, Iori M, Spezi E. Effect of image registration on 3D absorbed dose calculations in 177 Lu-DOTATOC peptide receptor radionuclide therapy. Phys Med 2018; 45:177-185. [DOI: 10.1016/j.ejmp.2017.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/18/2017] [Accepted: 11/26/2017] [Indexed: 11/29/2022] Open
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Impact of Positron Emission Tomography and Endoscopic Ultrasound Length of Disease Difference on Treatment Planning in Patients with Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2017; 29:760-766. [DOI: 10.1016/j.clon.2017.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
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Batumalai V, Holloway L, Walker A, Jameson M, Delaney GP. Assessment of dose variation for accelerated partial-breast irradiation using rigid and deformable image registrations. Pract Radiat Oncol 2016; 7:e9-e17. [PMID: 27552811 DOI: 10.1016/j.prro.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to estimate the delivered dose to the target and organs at risk (OAR) for external beam accelerated partial-breast irradiation (APBI) accounting for day-to-day setup uncertainties, using rigid and deformable image registration. METHODS AND MATERIALS One planning computed tomography (CT) scan and 5 cone beam CT scans for each of 25 patients previously treated with tangential breast radiation therapy were used. All cone beam CT scans were registered to the planning CT scan using 3 techniques: (1) rigid registration based on bony anatomy only, (2) rigid registration based on soft-tissue only, and (3) deformable image registration. For each patient, 4 dose distributions were calculated for APBI. The first dose distribution was the original plan. The other 3 were "dose-of-the-day" for each of the registration approaches. The effects of image registrations on estimating delivered dose to targets and OAR were determined. RESULTS The average reductions in V95 (percentage of the PTV that received 95% of the prescribed dose) were 6%, 7%, and 5% for bone, soft-tissue, and deformable registrations, respectively. The average increase in mean dose to the heart were 9%, 9%, and 18% for bone, soft-tissue, and deformable registrations, respectively, whereas the average increase in maximum dose to the contralateral breast were 19%, 20%, and 28%, respectively. CONCLUSIONS The results of this study have shown that there are differences between the planned and estimated delivered dose for APBI because of day-to-day setup uncertainties that may need to be accounted for. Estimated dosimetric impact of setup variation and breast deformation assessed using deformable registration was greater for OARs and smaller for target volumes compared to rigid registration.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia.
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, New South Wales, Australia
| | - Amy Walker
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Michael Jameson
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia
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