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Helsen N, Van den Wyngaert T, Carp L, De Bree R, VanderVeken OM, De Geeter F, Maes A, Cambier JP, Spaepen K, Martens M, Hakim S, Beels L, Hoekstra OS, Van den Weyngaert D, Stroobants S, Van Laer C, Specenier P, Maes A, Debruyne P, Hutsebaut I, Van Dinter J, Homans F, Goethals L, Lenssen O, Deben K. Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study. Eur J Nucl Med Mol Imaging 2020; 47:1075-1082. [PMID: 32040611 DOI: 10.1007/s00259-020-04710-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed. METHODS SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127). RESULTS In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant). CONCLUSION FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria. TRIAL REGISTRATION US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
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Affiliation(s)
- Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Remco De Bree
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olivier M VanderVeken
- Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.,Department Otorhinolaryngology, and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | | | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Michel Martens
- Department of radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Sara Hakim
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Otto S Hoekstra
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
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2
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Stieb S, Kiser K, van Dijk L, Livingstone NR, Elhalawani H, Elgohari B, McDonald B, Ventura J, Mohamed ASR, Fuller CD. Imaging for Response Assessment in Radiation Oncology: Current and Emerging Techniques. Hematol Oncol Clin North Am 2019; 34:293-306. [PMID: 31739950 DOI: 10.1016/j.hoc.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Imaging in radiation oncology is essential for the evaluation of treatment response in tumors and organs at risk. This influences further treatment decisions and could possibly be used to adapt therapy. This review article focuses on the currently used imaging modalities for response assessment in radiation oncology and gives an overview of new and promising techniques within this field.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Kendall Kiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Lisanne van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Nadia Roxanne Livingstone
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Juan Ventura
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Abdallah Sherif Radwan Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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3
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Elicin O, Putora PM, Siano M, Broglie MA, Simon C, Zwahlen D, Huber GF, Ballerini G, Beffa L, Giger R, Rothschild S, Negri SV, Dulguerov P, Henke G. A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study-Part 2 (Radiation Oncology). Front Oncol 2019; 9:1126. [PMID: 31709186 PMCID: PMC6822015 DOI: 10.3389/fonc.2019.01126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer. Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51–74%), moderate (75–84%), and high (≥85%). Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate, and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively. Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Siano
- Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Medical Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland.,Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Ballerini
- Department of Radiation Oncology, Clinica Luganese SA, Lugano, Switzerland
| | - Lorenza Beffa
- Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sacha Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Sandro V Negri
- Department of Otorhinolaryngology, Lindenhofspital, Bern, Switzerland
| | - Pavel Dulguerov
- Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Arunsingh M, Vaidyanathan S, Dyker K, Sen M, Scarsbrook A, Prestwich R. Accuracy of Response Assessment Positron Emission Tomography-Computed Tomography Following Definitive Radiotherapy Without Chemotherapy for Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2019; 31:212-218. [DOI: 10.1016/j.clon.2018.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 12/26/2022]
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5
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Emerging Functional Imaging Biomarkers of Tumour Responses to Radiotherapy. Cancers (Basel) 2019; 11:cancers11020131. [PMID: 30678055 PMCID: PMC6407112 DOI: 10.3390/cancers11020131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/11/2022] Open
Abstract
Tumour responses to radiotherapy are currently primarily assessed by changes in size. Imaging permits non-invasive, whole-body assessment of tumour burden and guides treatment options for most tumours. However, in most tumours, changes in size are slow to manifest and can sometimes be difficult to interpret or misleading, potentially leading to prolonged durations of ineffective treatment and delays in changing therapy. Functional imaging techniques that monitor biological processes have the potential to detect tumour responses to treatment earlier and refine treatment options based on tumour biology rather than solely on size and staging. By considering the biological effects of radiotherapy, this review focusses on emerging functional imaging techniques with the potential to augment morphological imaging and serve as biomarkers of early response to radiotherapy.
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6
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Liu HYH, Milne R, Lock G, Panizza BJ, Bernard A, Foote M, McGrath M, Brown E, Gandhi M, Porceddu SV. Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy. Oral Oncol 2018; 88:153-159. [PMID: 30616786 DOI: 10.1016/j.oraloncology.2018.11.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the utility of a repeat positron emission tomography/computed tomography (PET/CT) instead of immediate neck dissection (ND) for incomplete nodal response (IR) in Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC) following chemoradiotherapy/radiotherapy [(chemo)RT]. MATERIALS AND METHODS Patients with non-distant metastatic, node positive (N+) disease treated between Jan/2005 to Jan/2016, achieved complete response at the primary with no distant relapse on a 12-week re-staging PET/CT were evaluated. Patients underwent surveillance after complete nodal response (CR). Patients with IR underwent repeat PET/CT at 16 weeks to direct neck management. Primary endpoints were CR conversion rate and subsequent regional failure following a 16-week PET/CT directed ND. Secondary endpoints were predictive values (PV) of the 12- and 16-week PET/CT for residual nodal disease, predictors for requiring the 16-week PET/CT, 5 year regional, locoregional failure free survival (FFS) and overall survival (OS). RESULTS 235 patients were evaluated. Median follow up was 56 (range 19-60) months. 41 patients underwent 16-week re-staging PET/CT, 29 (71%) converted to CR. No subsequent regional failures occurred following a 16-week PET/CT directed ND. Positive and negative PV of the 12- and 16-week PET/CT for residual nodal disease was 12% & 98%, and 33% & 97%, respectively. N-category (AJCC/UICC 7th edition) predicted for requiring a 16-week PET/CT on univariate analysis (P-value 0.02). 5 year regional, locoregional FFS and OS was 95.8%, 93.4% and 90.8%, respectively. CONCLUSION For N+ HPV-associated OPC achieving IR on the 12-week re-staging PET/CT following (chemo)RT, a repeat 16-week PET/CT can spare patients from unnecessary surgery.
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Affiliation(s)
- Howard Yu-Hao Liu
- Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia.
| | - Robin Milne
- Faculty of Medicine, University of Queensland, St. Lucia, Australia
| | - Gregory Lock
- Department of Medical Imaging, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Benedict James Panizza
- Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Matthew Foote
- Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Margaret McGrath
- Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Elizabeth Brown
- Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Mitesh Gandhi
- Department of Medical Imaging, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia
| | - Sandro Virgilio Porceddu
- Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
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7
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Taylor A, Sen M, Prestwich RJD. Assessment of the Impact of Deformable Registration of Diagnostic MRI to Planning CT on GTV Delineation for Radiotherapy for Oropharyngeal Carcinoma in Routine Clinical Practice. Healthcare (Basel) 2018; 6:healthcare6040135. [PMID: 30477209 PMCID: PMC6316469 DOI: 10.3390/healthcare6040135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Aim of study was to assess impact of deformable registration of diagnostic MRI to planning CT upon gross tumour volume (GTV) delineation of oropharyngeal carcinoma in routine practice. Methods: 22 consecutive patients with oropharyngeal squamous cell carcinoma treated with definitive (chemo)radiotherapy between 2015 and 2016, for whom primary GTV delineation had been performed by a single radiation oncologist using deformable registration of diagnostic MRI to planning CT, were identified. Separate GTVs were delineated as part of routine clinical practice (all diagnostic imaging available side-by-side for each delineation) using: CT (GTVCT), MRI (GTVMR), and CT and MRI (GTVCTMR). Volumetric and positional metric analyses were undertaken using contour comparison metrics (Dice conformity index, centre of gravity distance, mean distance to conformity). Results: Median GTV volumes were 13.7 cm3 (range 3.5–41.7), 15.9 cm3 (range 1.6–38.3), 19.9 cm3 (range 5.5–44.5) for GTVCT, GTVMR and GTVCTMR respectively. There was no significant difference in GTVCT and GTVMR volumes; GTVCTMR was found to be significantly larger than both GTVMR and GTVCT. Based on positional metrics, GTVCT and GTVMR were the least similar (mean Dice similarity coefficient (DSC) 0.71, 0.84, 0.82 for GTVCT–GTVMR, GTVCTMR–GTVCT and GTVCTMR–GTVMR respectively). Conclusions: These data suggest a complementary role of MRI to CT to reduce the risk of geographical misses, although they highlight the potential for larger target volumes and hence toxicity.
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Affiliation(s)
- Alice Taylor
- School of Medicine, Worsley Building, University of Leeds, Leeds LS2 9JT, UK.
| | - Mehmet Sen
- Department of Clinical Oncology, St. James's University Hospital, Leeds Cancer Centre, Beckett Street, Leeds LS9 7TF, UK.
| | - Robin J D Prestwich
- Department of Clinical Oncology, St. James's University Hospital, Leeds Cancer Centre, Beckett Street, Leeds LS9 7TF, UK.
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8
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Jeong Y, Jung IH, Kim JS, Chang SK, Lee SW. Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma. Br J Radiol 2018; 92:20180045. [PMID: 30102562 PMCID: PMC6774585 DOI: 10.1259/bjr.20180045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: The aim of the present study was to evaluate the clinical significance of the post-radiotherapy 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) response for detecting residual disease and predicting survival outcome in patients with nasopharyngeal cancer. Methods: We reviewed 143 patients with nasopharyngeal cancer who underwent 18F-FDG PET within 6 months after completion of radiotherapy between 2001 and 2012. 18F-FDG PET findings at the primary tumor (T–) and regional lymph nodes (N–) were separately assessed and considered negative [PET (–)] or positive [PET (+)] depending on the remaining focal increased uptake of 18F-FDG that was greater than that of the surrounding muscle or blood vessels. The standard of reference was histopathological confirmation or clinical/imaging follow-up. Overall survival (OS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRRFS) rates were estimated from the date of the start of radiotherapy. Results: The median follow-up period was 73 months (range, 9–182 months). Overall, 83 and 66% of patients achieved T–PET (-) and N–PET (-) responses, and the negative-predictive values (NPVs) for T– and N– were 100 and 99%, respectively. The sensitivity, specificity, and positive-predictive value were 100, 84, and 8% for T–, and 67, 80, and 7% for N–, respectively. The 5-year OS, DMFS, and LRRFS rates were 83, 83, and 87%, respectively, and patients with N–PET (+) with SUVmax >2.5 showed significantly inferior 5-year OS and DMFS rates than patients with N–PET (-) or N–PET (+) with SUVmax ≤2.5 (44 vs 86%, p = 0.004; 36 vs 85%, p < 0.001). Conclusion: In patients that have received definitive (chemo)radiotherapy for nasopharyngeal cancer, 18F-FDG PET within 6 months of completion of treatment has a high NPV for predicting residual disease and is prognostic for long-term treatment outcomes. Patients with remaining focal increased uptake of 18F-FDG at lymph nodes may benefit from more aggressive treatments, and further studies are needed to validate the clinical significance of post-radiotherapy 18F-FDG PET. Advances in knowledge: We found that post-radiotherapy 18F-FDG PET findings have a high NPV for detecting residual disease and are a significant prognostic factor for treatment outcomes.
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Affiliation(s)
- Yuri Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Hye Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei Kyung Chang
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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9
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Cristaudo A, Hickman M, Fong C, Sanghera P, Hartley A. Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E65. [PMID: 29954154 PMCID: PMC6163293 DOI: 10.3390/medicines5030065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/21/2023]
Abstract
Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of such guidelines to all cases. Similarly, a lack of consensus exists concerning both the definition of the organ at risk for oral mucositis and the most appropriate endpoint to measure for this critical toxicity. Finally, the correlation between early markers of efficacy such as complete response on PET CT following treatment and subsequent survival needs elucidation for biological subsets of oropharyngeal cancer.
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Affiliation(s)
- Agostino Cristaudo
- Department of Radiation Oncology, University of Pisa, 56100 Pisa PI, Italy.
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Mitchell Hickman
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Charles Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Paul Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Andrew Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
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10
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FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging 2018; 45:1063-1071. [PMID: 29478080 DOI: 10.1007/s00259-018-3978-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/12/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE 18-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is increasingly used to evaluate treatment response in head and neck squamous cell carcinoma (HNSCC). This analysis assessed the diagnostic value of FDG-PET/CT in detecting nodal disease within 6 months after treatment, considering patient and disease characteristics. METHODS A systematic review was performed using the MEDLINE and Web of Knowledge databases. The results were pooled using a bivariate random effects model of the sensitivity and specificity. RESULTS Out of 22 identified studies, a meta-analysis of 20 studies (1293 patients) was performed. The pooled estimates of sensitivity, specificity and diagnostic odds ratio (with 95% CI) were 85% (76-91%), 93% (89-96%) and 76 (35-165), respectively. With the prevalence set at 10%, the positive and negative predictive values were 58% and 98%. There was significant heterogeneity between the trials (p < 0.001). HPV positive tumors were associated with lower sensitivity (75% vs 89%; p = 0.01) and specificity (87% vs 95%; p < 0.005). CONCLUSION FDG-PET/CT within 6 months after (chemo)radiotherapy in HNSCC patients is a reliable method for ruling out residual/recurrent nodal disease and obviates the need for therapeutic intervention. However, FDG-PET/CT may be less reliable in HPV positive tumors and the optimal surveillance strategy remains to be determined.
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12
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Alves WEFM, Pitella FA, da Rocha ET, Wichert-Ana L. The Role of PET/CT with 18F-FDG in the Assessment of Therapeutic Response of Head and Neck Cancer. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Philip J, Ermiş E, Slevin F, Vaidyanathan S, Sen M, Scarsbrook AF, Prestwich RJD. Accuracy of FDG PET-CT response assessment following radiotherapy alone for head and neck squamous cell carcinoma: Retrospective analysis of 45 patients. Clin Otolaryngol 2018; 43:931-934. [PMID: 29325231 DOI: 10.1111/coa.13063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 12/30/2022]
Affiliation(s)
- J Philip
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - E Ermiş
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - F Slevin
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - S Vaidyanathan
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - M Sen
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - A F Scarsbrook
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - R J D Prestwich
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
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14
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Korn RL, Von Hoff DD, Borad MJ, Renschler MF, McGovern D, Curtis Bay R, Ramanathan RK. 18F-FDG PET/CT response in a phase 1/2 trial of nab-paclitaxel plus gemcitabine for advanced pancreatic cancer. Cancer Imaging 2017; 17:23. [PMID: 28774338 PMCID: PMC5543580 DOI: 10.1186/s40644-017-0125-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) is poised to become a useful imaging modality in staging and evaluating therapeutic responses in patients with metastatic pancreatic cancer (mPC). This analysis from a phase 1/2 study examined the utility of early PET imaging in patients with mPC treated with nab-paclitaxel plus gemcitabine. METHODS Tumors were measured by [18F]2-fluoro-2-deoxyglucose PET/computed tomography (CT) in patients who received nab-paclitaxel 100 (n = 13), 125 (n = 38), or 150 (n = 1) mg/m2 plus gemcitabine 1000 mg/m2 on days 1, 8, and 15 of a 28-day cycle. Lesion metabolic activity was evaluated at baseline and 6 and 12 weeks postbaseline. RESULTS Fifty-two patients had baseline and ≥1 follow-up PET scan. The median maximum standardized uptake values per pancreatic lesion in the nab-paclitaxel 100 mg/m2 and 125 mg/m2 cohorts were 5.1 and 6.5, respectively. Among patients who had a metabolic response by PET, those who received nab-paclitaxel 125 mg/m2 had a 4-month survival advantage over those who received 100 mg/m2. All patients in the nab-paclitaxel 125 mg/m2 cohort experienced an early complete metabolic response (CMR; 34%) or partial metabolic response (PMR; 66%). In the nab-paclitaxel 125 mg/m2 cohort, investigator-assessed objective response rates were 77% and 44% among patients with a CMR and PMR, respectively, with no correlation between PET and CT response (Spearman r s = 0.22; P = 0.193). Patients in the nab-paclitaxel 125 mg/m2 cohort with a CMR experienced a significantly longer overall survival vs those with a PMR (median, 23.0 vs 11.2 months; P = 0.011), and a significant correlation was found between best percentage change in tumor burden by PET and survival: for each 1% decrease in PET score, the risk of death decreased by 2%. CONCLUSIONS The majority of primary pancreatic tumors and their metastases were PET avid, and PET effectively measured changes in tumor metabolic activity at 6 and 12 weeks. These results support the antitumor activity of nab-paclitaxel 125 mg/m2 plus gemcitabine 1000 mg/m2 for treating mPC and the utility of PET for measuring treatment response. Treatment response by PET analysis may be considered when evaluating investigational agents in mPC. TRIAL REGISTRATION NCT00398086.
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Affiliation(s)
- Ronald L Korn
- Imaging Endpoints Core Lab, 9700 N 91st St, B-200, Scottsdale, AZ, 85258, USA.
| | - Daniel D Von Hoff
- Translational Genomics Research Institute and HonorHealth, 445 North Fifth St, Suite 600, Phoenix, AZ, 85004, USA
| | - Mitesh J Borad
- Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | | | | | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, A. T. Still University, 5850 E Still Circle, Mesa, AZ 85206, USA
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15
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Nelissen C, Sherriff J, Jones T, Guest P, Colley S, Sanghera P, Hartley A. The Role of Positron Emission Tomography/Computed Tomography Imaging in Head and Neck Cancer after Radical Chemoradiotherapy: a Single Institution Experience. Clin Oncol (R Coll Radiol) 2017; 29:753-759. [PMID: 28780008 DOI: 10.1016/j.clon.2017.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022]
Abstract
AIMS Positron emission tomography/computed tomography (PET/CT) is used to restage head and neck cancer 3 months after chemoradiotherapy. The purpose of this study was to determine the negative predictive value (NPV) of a scan reported as having no abnormal uptake and the positive predictive values (PPV) for different maximum standardised uptake value (SUVmax) thresholds. MATERIALS AND METHODS Patients with squamous cell carcinoma of the oro-/hypopharynx/larynx (n = 206) were included. SUVmax and subsequent locoregional recurrence were documented. RESULTS The median SUVmax was 11.2 (range 4-33)/4.6 (range 2-30), respectively, in patients with/without definite primary site recurrence (P = 0.004). The median SUVmax was 4.4 (range 2.6-15.6)/3.1 (range 2.1-4.6), respectively, in patients with/without definite nodal recurrence (P = 0.003). The NPV for a scan reported as having no abnormal uptake was 92%. The PPV for the SUVmax thresholds 4, 6 and 8, respectively, were 53, 65 and 92% (primary site) and 93, 100 and 100% (nodes). CONCLUSIONS The NPV of PET/CT after chemoradiation is consistent with the literature and underlines the importance of PET/CT in restaging the primary site if salvage neck dissection is considered. The overall PPV of PET/CT remains low but is high for nodal SUVmax > 4. These data could be used to design risk-stratified follow-up schedules.
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Affiliation(s)
- C Nelissen
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
| | - J Sherriff
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - T Jones
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - P Guest
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - S Colley
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
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16
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Slevin F, Ermiş E, Vaidyanathan S, Sen M, Scarsbrook AF, Prestwich RJ. Accuracy of [ 18Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917713005. [PMID: 28659717 PMCID: PMC5476423 DOI: 10.1177/1179554917713005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The accuracy of response assessment positron emission tomography (PET)-computed tomography (CT) following radiotherapy with or without chemotherapy for laryngeal/hypopharyngeal squamous cell carcinoma is uncertain. METHODS In all, 35 patients with laryngeal or hypopharyngeal squamous cell carcinoma who were treated between 2009 and 2014 with (chemo)radiotherapy were identified. The accuracy of response assessment PET-CT was made by correlation with clinical follow-up and pathological findings. RESULTS Of the 35 patients, 20 (57%) had an overall complete metabolic response. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for response assessment [18Fluorine]-fluoro-2-deoxy-d-glucose (FDG) PET-CT for primary and nodal sites, respectively, were 100%, 73%, 46%, and 100% and 83%, 95%, 83%, and 95%. CONCLUSIONS Response assessment FDG PET-CT following (chemo)radiotherapy for laryngeal and hypopharyngeal carcinomas has a high NPV for both primary site and lymph nodes and can be used to guide treatment decisions. The PPV of residual FDG uptake at the primary tumour site is limited and requires examination and biopsy confirmation.
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Affiliation(s)
- Finbar Slevin
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Ekin Ermiş
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Sriram Vaidyanathan
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - Mehmet Sen
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Andrew F Scarsbrook
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
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17
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Cliffe H, Patel C, Prestwich R, Scarsbrook A. Radiotherapy response evaluation using FDG PET-CT-established and emerging applications. Br J Radiol 2017; 90:20160764. [PMID: 28008773 DOI: 10.1259/bjr.20160764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases, salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon the anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy. Combined positron emission tomography (PET) and CT imaging employs radioactive tracers to identify molecular characteristics of tissues. PET imaging exploits the fact that malignancies have characteristic molecular profiles which differ compared with surrounding tissues. The complementary anatomical and functional information facilitates accurate non-invasive assessment of surrogate biomarkers of disease activity.
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Affiliation(s)
- Helen Cliffe
- 1 Department of Radiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Chirag Patel
- 1 Department of Radiology, Leeds Teaching Hospitals NHS Trust, UK.,2 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, UK
| | - Robin Prestwich
- 3 Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, UK
| | - Andrew Scarsbrook
- 1 Department of Radiology, Leeds Teaching Hospitals NHS Trust, UK.,2 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, UK.,4 Leeds Institute of Cancer and Pathology, University of Leeds, UK
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18
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Cammaroto G, Quartuccio N, Sindoni A, Di Mauro F, Caobelli F. The role of PET/CT in the management of patients affected by head and neck tumors: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:1961-73. [PMID: 25971995 DOI: 10.1007/s00405-015-3651-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
The management of head and neck tumor (HNSCC) has been changing over the years, especially due to the aid of imaging techniques that help physicians to attain a correct diagnosis. These techniques represent a valuable tool to help tailor treatment and during follow-up of patients affected by malignancies. The aim of this review is to summarize the results of the most recent and relevant studies about the use of PET imaging in HNSCCs. This review is divided into six chapters: (1) The role of PET/CT in the pre-treatment phase; (2) PET/CT and radiotherapy planning; (3) PET/CT in the post-treatment setting; (4) PET/CT and SUVmax for prediction of prognosis; (5) miscellanea on the utility of PET in specific HNSCCs; (6) non-FDG PET tracers used in HNSCC. Promising results have been obtained so far. Despite the encouraging outcomes, more investigations are needed to warrant the value of this technique, especially in the pre-treatment setting.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Sindoni
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Francesca Di Mauro
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
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19
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20
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Blatt S, Ziebart T, Krüger M, Pabst AM. Diagnosing oral squamous cell carcinoma: How much imaging do we really need? A review of the current literature. J Craniomaxillofac Surg 2016; 44:538-49. [DOI: 10.1016/j.jcms.2016.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022] Open
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21
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Chen SH, Wang HM, Lin CY, Chang JTC, Hsieh CH, Liao CT, Kang CJ, Yang LY, Yen TC. RGD-K5 PET/CT in patients with advanced head and neck cancer treated with concurrent chemoradiotherapy: Results from a pilot study. Eur J Nucl Med Mol Imaging 2016; 43:1621-9. [PMID: 26922351 DOI: 10.1007/s00259-016-3345-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM We prospectively investigated the potential usefulness of PET using a new tracer targeting integrin αvβ3 (termed RGD-K5) in patients with head and neck cancer (HNC) undergoing definitive concurrent chemoradiotherapy (CCRT). PATIENTS AND METHODS Newly diagnosed patients with locally advanced HNC scheduled for definitive CCRT were eligible. RDG-K5 PET and FDG PET scans were performed at three different time points (baseline, 2 weeks, and 3 months post-treatment). RESULTS Nine patients completed all of the three scans, whereas two patients withdrew after two scans only. Uptake of both RGD-K5 and FDG generally decreased following CCRT. However, the observed decrease did not differ significantly between complete responders and non-responders. At 3 months post-treatment, the uptake of both RGD-K5 and FDG at the main tumors was significantly lower in those who achieved complete responses than in those with residual tumors. CONCLUSION RGD-K5 PET has the potential to identify patients with incomplete responses to CCRT.
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Affiliation(s)
- Shih-Hsin Chen
- Department of Nuclear Medicine, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Hung-Ming Wang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Chia-Hsun Hsieh
- Division of Hematology/Oncology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Chun-Ta Liao
- Departments of Otorhinolaryngology, Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Chung-Jan Kang
- Departments of Otorhinolaryngology, Head and Neck Surgery, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Lan-Yan Yang
- Clinical Trial Center, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang-Gung Memorial Hospital, Linkou, 5, Fu-Shin St., Kwei-Shan Township, TaoYuan County, Taiwan, 333.
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22
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Slevin F, Subesinghe M, Ramasamy S, Sen M, Scarsbrook AF, Prestwich RJD. Assessment of outcomes with delayed (18)F-FDG PET-CT response assessment in head and neck squamous cell carcinoma. Br J Radiol 2015; 88:20140592. [PMID: 26081447 DOI: 10.1259/bjr.20140592] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess the accuracy of a 4-month post-(chemo)radiotherapy 18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)-CT for head and neck squamous cell carcinoma (HNSCC). METHODS 105 patients who underwent a baseline and response assessment (18)F-FDG PET-CT scan between 2008 and April 2013 were identified. (18)F-FDG PET-CT outcomes were analysed with reference to clinicopathological outcomes. RESULTS 79 of 105 (75%) (18)F-FDG PET-CT scans demonstrated a complete metabolic response; 19 of 101 (19%) for assessable primary tumours were positive; and 19 of 93 (20%) for patients with nodal disease were equivocal (n = 10) or positive (n = 9). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for primary and nodal disease were 90%, 89%, 47%, 99% and 91%, 89%, 53% and 99%, respectively. Eight of nine patients with a positive nodal response scan had clinicopathological evidence of residual nodal disease (PPV, 89%). 2 of 10 patients with equivocal nodal responses had clinicopathological evidence of residual nodal disease (PPV, 20%). CONCLUSION (18)F-FDG PET-CT 4 months post treatment has a very high NPV. A positive (18)F-FDG PET-CT has a high PPV for residual nodal disease. By contrast, patients who have an equivocal nodal response have a low PPV. ADVANCES IN KNOWLEDGE Response assessment (18)F-FDG PET-CT is a valuable tool in guiding the selective use of neck dissection following (chemo)radiotherapy for HNSCC. An equivocal lymph node response has a limited predictive value for persistent disease, and optimal management remains a clinical challenge.
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Affiliation(s)
- F Slevin
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - M Subesinghe
- 2 Department of Radiology, St James's Institute of Oncology, Leeds, UK.,3 Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK
| | - S Ramasamy
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - M Sen
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - A F Scarsbrook
- 2 Department of Radiology, St James's Institute of Oncology, Leeds, UK.,3 Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK
| | - R J D Prestwich
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
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Shah K, te Marvelde L, Collins M, De Abreu Lourenco R, D’Costa I, Coleman A, Fua T, Liu C, Rischin D, Lau E, Corry J. Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation. Oral Oncol 2015; 51:529-35. [DOI: 10.1016/j.oraloncology.2015.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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25
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Lauridsen JK, Rohde M, Thomassen A. 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography in Malignancies of the Thyroid and in Head and Neck Squamous Cell Carcinoma. PET Clin 2015; 10:75-88. [DOI: 10.1016/j.cpet.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Prestwich R, Sen M, Scarsbrook A. Qualitative 18F-FDG PET/CT Response Evaluation After Chemotherapy or Radiotherapy for Head and Neck Squamous Cell Carcinoma: Is There an Equivocal Group? J Nucl Med 2014; 55:2081. [DOI: 10.2967/jnumed.114.148114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Gallamini A, Zwarthoed C, Borra A. Positron Emission Tomography (PET) in Oncology. Cancers (Basel) 2014; 6:1821-89. [PMID: 25268160 PMCID: PMC4276948 DOI: 10.3390/cancers6041821] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023] Open
Abstract
Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%-15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later.
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Affiliation(s)
- Andrea Gallamini
- Department of Research and Medical Innovation, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Colette Zwarthoed
- Department of Nuclear Medicine, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Anna Borra
- Hematology Department S. Croce Hospital, Via M. Coppino 26, Cuneo 12100, Italy.
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Uzel EK, Ekmekcioglu O, Elicin O, Halac M, Uzel OE. Is FDG -PET-CT a valuable tool in prediction of persistent disease in head and neck cancer. Asian Pac J Cancer Prev 2014; 14:4847-51. [PMID: 24083757 DOI: 10.7314/apjcp.2013.14.8.4847] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. MATERIALS AND METHODS Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. RESULTS After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. CONCLUSIONS FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.
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Affiliation(s)
- Esengul Kocak Uzel
- Radiation Oncology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey E-mail :
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29
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Pauwels EK, Coumou AW, Kostkiewicz M, Kairemo K. [¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography imaging in oncology: initial staging and evaluation of cancer therapy. Med Princ Pract 2013; 22:427-37. [PMID: 23363934 PMCID: PMC5586772 DOI: 10.1159/000346303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/05/2012] [Indexed: 12/16/2022] Open
Abstract
Positron emission tomography (PET) with [¹⁸F]fluoro-2-deoxy-D-glucose (FDG) has proven to be a valuable diagnostic modality in various diseases. Its accuracy has been improved with the hybrid PET/computed tomography (CT) technique because of precise anatomic location of areas of abnormal FDG accumulation. This integrated PET/CT modality has been widely adopted, particularly in oncology. This paper reviews the role of FDG-PET/CT imaging in breast cancer, non-small-cell lung cancer, colorectal cancer, head and neck cancer as well as lymphoma on the basis of recent key articles. Special attention is paid to preoperative diagnostic workup, evaluation of treatment response and survival prognosis. Experience from specialized centers indicates that there is strong evidence for the clinical effectiveness of FDG-PET/CT in staging, restaging and the prediction of response to therapy in the above-mentioned malignancies. It is concluded that this imaging modality contributes considerably to improved patient management and paves the way to personalize cancer treatment in a cost-effective way.
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Affiliation(s)
- Ernest K.J. Pauwels
- University Medical School Pisa, Pisa, Italy
- Leiden University Medical Center, Leiden, Finland
- *Prof. emer. Ernest K.J. Pauwels, Via di San Gennaro 79B, IT-55010 Capannori (Italy), E-Mail
| | - Annette W. Coumou
- Amsterdam University Medical Center, Amsterdam, The Netherlands, Finland
| | | | - Kalevi Kairemo
- International Comprehensive Cancer Center Docrates, Helsinki, Finland
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