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Mohan V, Bruin NM, van de Kamer JB, Sonke JJ, Vogel WV. The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments. Eur J Nucl Med Mol Imaging 2021; 48:3762-3775. [PMID: 33687522 PMCID: PMC8484246 DOI: 10.1007/s00259-021-05284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
Radiation therapy is an effective treatment modality for a variety of cancers. Despite several advances in delivery techniques, its main drawback remains the deposition of dose in normal tissues which can result in toxicity. Common practices of evaluating toxicity, using questionnaires and grading systems, provide little underlying information beyond subjective scores, and this can limit further optimization of treatment strategies. Nuclear medicine imaging techniques can be utilised to directly measure regional baseline function and function loss from internal/external radiation therapy within normal tissues in an in vivo setting with high spatial resolution. This can be correlated with dose delivered by radiotherapy techniques to establish objective dose-effect relationships, and can also be used in the treatment planning step to spare normal tissues more efficiently. Toxicity in radionuclide therapy typically occurs due to undesired off-target uptake in normal tissues. Molecular imaging using diagnostic analogues of therapeutic radionuclides can be used to test various interventional protective strategies that can potentially reduce this normal tissue uptake without compromising tumour uptake. We provide an overview of the existing literature on these applications of nuclear medicine imaging in diverse normal tissue types utilising various tracers, and discuss its future potential.
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Affiliation(s)
- V Mohan
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B van de Kamer
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J-J Sonke
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Jain TK, Singh G, Goyal S, Yadav A, Yadav D, Khunteta N, Malhotra H. Should fluorodeoxyglucose positron emission tomography/computed tomography be the first-line imaging investigation for restaging the laryngeal carcinoma patients? World J Nucl Med 2021; 20:164-171. [PMID: 34321969 PMCID: PMC8286000 DOI: 10.4103/wjnm.wjnm_95_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022] Open
Abstract
Posttreatment detection of residual/recurrence disease in the head and neck cancers is not an easy task. Treatment induces changes create difficulties in diagnosis on conventional imaging (computed tomography [CT], magnetic resonance imaging) as well as macroscopic inspection (direct laryngoscopy). Hence, we evaluate the diagnostic performance of contract-enhanced F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/CT in restaging of laryngeal carcinoma Postchemotherapy-surgery and/or radiation therapy. We retrospectively analyzed patients of carcinoma larynx (n = 100) who has completed treatment and were referred for FDG PET/CT. Two reviewers performed image analysis to determine recurrence at primary site and/lymph nodes and distant metastases. Receiver operating characteristic (ROC) was used to determine the maximum standardized uptake value (SUVmax) cut off for disease detection. Histopathological examination and clinical or imaging follow-up were taken as gold standard for recurrence. One hundred laryngeal carcinoma patients with mean age of 57.2 years (range of 40–76) were included in the present study. Among the 100 patients, 96 were male and remaining 4 were female. The average interval between completion of treatment and FDG PET/CT scan was 8.5 months (minimum 6 months). Of the 100 patients, FDG PET/CT detected FDG avid lesions in 66 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of FDG PET/CT for residual/recurrence disease detection was 90.3%, 73.7%, 84.8%, 82.3%, and 84.0%, respectively (P < 0.05). In addition, in 10 patients, metachronous primaries were detected (lung-4, thyroid-2, tongue, colon, esophagus, and lymphoma-one each). On ROC curve analysis, SUVmax >6.1 had sensitivity and specificity of 80.6% and 94.7% respectively for detection of recurrent/metastatic disease. FDG PET/CT demonstrates high diagnostic accuracy for detection of residual/recurrent disease in treated laryngeal cancer patients and our findings suggest that this imaging modality should be the first-line diagnostic investigation in this cohort of patients.
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Affiliation(s)
- Tarun Kumar Jain
- Department of Nuclear Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Guman Singh
- Department of Radiation Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sumit Goyal
- Department of Radiation Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ajay Yadav
- Department of Medical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Dinesh Yadav
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Nitin Khunteta
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Applications of Fluorodeoxyglucose PET/Computed Tomography in the Assessment and Prediction of Radiation Therapy–related Complications. PET Clin 2015; 10:555-71. [DOI: 10.1016/j.cpet.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Malnutrition assessment in patients with cancers of the head and neck: A call to action and consensus. Crit Rev Oncol Hematol 2013; 88:459-76. [DOI: 10.1016/j.critrevonc.2013.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/02/2013] [Accepted: 06/05/2013] [Indexed: 01/01/2023] Open
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Vainshtein J, Eisbruch A. Function, muscles, and sparing by IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2013; 85:577-8. [PMID: 23374990 DOI: 10.1016/j.ijrobp.2012.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
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Treatment Deintensification Strategies for HPV-Associated Head and Neck Carcinomas. Otolaryngol Clin North Am 2012; 45:845-61. [DOI: 10.1016/j.otc.2012.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Truong MT, Lee R, Saito N, Qureshi MM, Ozonoff A, Romesser PB, Wang J, Sakai O. Correlating computed tomography perfusion changes in the pharyngeal constrictor muscles during head-and-neck radiotherapy to dysphagia outcome. Int J Radiat Oncol Biol Phys 2011; 82:e119-27. [PMID: 21669502 DOI: 10.1016/j.ijrobp.2011.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. METHODS AND MATERIALS Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. RESULTS With a median follow-up of 28 months (range, 6-44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0-2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0-2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). CONCLUSIONS Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.
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Affiliation(s)
- Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
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Gielda BT, Millunchick CH, Smart JP, Marsh JC, Turian JV, Coleman JL. Helical Tomotherapy and Larynx Sparing in Advanced Oropharyngeal Carcinoma: A Dosimetric Study. Med Dosim 2010; 35:214-9. [DOI: 10.1016/j.meddos.2009.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/28/2009] [Accepted: 06/08/2009] [Indexed: 11/16/2022]
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Gomez D, Cahlon O, Mechalakos J, Lee N. An investigation of intensity-modulated radiation therapy versus conventional two-dimensional and 3D-conformal radiation therapy for early stage larynx cancer. Radiat Oncol 2010; 5:74. [PMID: 20796303 PMCID: PMC2940770 DOI: 10.1186/1748-717x-5-74] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 08/26/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction Intensity modulated radiation therapy (IMRT) has been incorporated at several institutions for early stage laryngeal cancer (T1/T2N0M0), but its utility is controversial. Methods In three representative patients, multiple plans were generated: 1) Conventional 2D planning, with the posterior border placed at either the anterior aspect ("tight" plan) or the mid-vertebral body ("loose" plan), 2) 3D planning, utilizing both 1.0 and 0.5 cm margins for the planning target volume (PTV), and 3) IMRT planning, utilizing the same margins as the 3D plans. A dosimetric comparison was performed for the target volume, spinal cord, arytenoids, and carotid arteries. The prescription dose was 6300 cGy (225 cGy fractions), and the 3D and IMRT plans were normalized to this dose. Results For PTV margins of 1.0 cm and 0.5 cm, the D95 of the 2D tight/loose plans were 3781/5437 cGy and 5372/5869 cGy, respectively (IMRT/3D plans both 6300 cGy). With a PTV margin of 1.0 cm, the mean carotid artery dose was 2483/5671/5777/4049 cGy in the 2D tight, 2D loose, 3D, and IMRT plans, respectively. When the PTV was reduced to 0.5 cm, the the mean carotid artery dose was 2483/5671/6466/2577 cGy to the above four plans, respectively. The arytenoid doses were similar between the four plans, and spinal cord doses were well below tolerance. Conclusions IMRT provides a more ideal dose distribution compared to 2D treatment and 3D planning in regards to mean carotid dose. We therefore recommend IMRT in select cases when the treating physician is confident with the GTV.
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Affiliation(s)
- Daniel Gomez
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Popovtzer A, Cao Y, Feng FY, Eisbruch A. Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationships: MRI-based study. Radiother Oncol 2009; 93:510-5. [PMID: 19520446 PMCID: PMC2787803 DOI: 10.1016/j.radonc.2009.05.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 05/12/2009] [Accepted: 05/17/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Dysfunction of pharyngeal constrictors (PCs) after chemo-irradiation of head and neck (HN) cancer has been proposed as major cause of dysphagia. We conducted prospective MRI study to evaluate anatomical changes in the PCs after chemo-irradiation, to gain insight of the mechanism of their dysfunction and their dose-effect relationships. The PCs were compared to the sternocleidomastoid muscles (SCMs), which receive high doses but do not relate to swallowing. PATIENTS AND METHODS Twelve patients with stage III-IV HN cancer underwent MRI before and 3 months after completing chemo-irradiation. T1- and T2-weighted signals and muscle thickness were evaluated for PCs (superior, middle, and inferior), and SCMs. Mean muscle doses were determined after registration with the planning CT. RESULTS T1-weighted signals decreased in both PCs and SCMs receiving >50 Gy (p<0.03), but not in muscles receiving lower doses. T2-weighted signals in the PCs increased significantly as the dose increased (R(2)=0.34, p=0.01). The T2 signal changes in the PCs were significantly higher than the T2 changes in the SCMs (p<0.001). Increased thickness was noted in all PCs, with muscles receiving >50 Gy gaining significantly more thickness than PCs receiving lesser doses (p=0.02). In contrast, the SCM thickness decreased post-therapy (p=0.002). CONCLUSIONS These MRI-based findings, notably the differences between PCs and SCMs, suggest that underlying causes of PC dysfunction are inflammation and edema, likely consequential to acute mucositis affecting the submucosa-lying PCs. These results support reducing mean PC doses to 50 Gy, as well as reducing acute mucositis, to improve long-term dysphagia.
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Affiliation(s)
- Aron Popovtzer
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Krabbe CA, Pruim J, Dijkstra PU, Balink H, van der Laan BF, de Visscher JG, Roodenburg JL. 18F-FDG PET as a Routine Posttreatment Surveillance Tool in Oral and Oropharyngeal Squamous Cell Carcinoma: A ProspectiveStudy. J Nucl Med 2009; 50:1940-7. [DOI: 10.2967/jnumed.109.065300] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yao M, Smith RB, Hoffman HT, Funk GF, Lu M, Menda Y, Graham MM, Buatti JM. Clinical Significance of Postradiotherapy [18F]-Fluorodeoxyglucose Positron Emission Tomography Imaging in Management of Head-and-Neck Cancer—A Long-Term Outcome Report. Int J Radiat Oncol Biol Phys 2009; 74:9-14. [DOI: 10.1016/j.ijrobp.2008.07.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/16/2008] [Accepted: 07/20/2008] [Indexed: 01/02/2023]
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Schöder H, Fury M, Lee N, Kraus D. PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med 2009; 50 Suppl 1:74S-88S. [PMID: 19380408 DOI: 10.2967/jnumed.108.057208] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the Western world, more than 90% of head and neck cancers are head and neck squamous cell carcinomas (HNSCCs). The most appropriate treatment approach for HNSCC varies with the disease stage and disease site in the head and neck. Concurrent chemoradiotherapy has become a widely used means for the definitive treatment of locoregionally advanced HNSCC. Although this multimodality treatment provides higher response rates than radiotherapy alone, the detection of residual viable tumor after the end of therapy remains an important issue and is one of the major applications of (18)F-FDG PET. Studies have shown that negative (18)F-FDG PET or PET/CT results after concurrent chemoradiotherapy have a high negative predictive value (>95%), whereas the positive predictive value is only about 50%. However, when applied properly, FDG PET/CT can exclude residual disease in most patients, particularly patients with residual enlarged lymph nodes who would otherwise undergo neck dissection. In contrast to other malignancies, data are limited on the utility of (18)F-FDG PET for monitoring the response to induction chemotherapy in HNSCC or for assessing treatment response early during the course of definitive chemoradiotherapy. The proliferation marker (18)F-3'-deoxy-3'fluorothymidine is currently under study for this purpose. Beyond standard chemotherapy, newer treatment regimens in HNSCC take advantage of our improved understanding of tumor biology. Two molecules important in the progression of HNSCC are the epidermal growth factor receptor and the vascular endothelial growth factor (VEGF) and its receptor VEGF-R. Drugs attacking these molecules are now under study for HNSCC. PET probes have been developed for imaging the presence of these molecules in HNSCC and their inhibition by specific drug interaction; the relevance of these probes for response assessment in HNSCC will be discussed. Hypoxia is a common phenomenon in HNSCC and renders cancers resistant to chemo- and radiotherapy. Imaging and quantification of hypoxia with PET probes is under study and may become a prerequisite for overcoming chemo- and radioresistance using radiosensitizing drugs or hypoxia-directed irradiation techniques and for monitoring the response to these techniques in selected groups of patients. Although (18)F-FDG PET/CT will remain the major clinical tool for monitoring treatment in HNSCC, other PET probes may have a role in identifying patients who are likely to benefit from treatment strategies that include biologic agents such as epidermal growth factor receptor inhibitors or VEGF inhibitors.
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Affiliation(s)
- Heiko Schöder
- Department of Radiology, Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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