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Yea JW, Park JW, Oh SA, Park J. Chemoradiotherapy with hyperthermia versus chemoradiotherapy alone in locally advanced cervical cancer: a systematic review and meta-analysis. Int J Hyperthermia 2021; 38:1333-1340. [PMID: 34477028 DOI: 10.1080/02656736.2021.1973584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy (CCRT) is recommended as the standard treatment for locally advanced cervical cancer (LACC). However, the synergistic effect of hyperthermia (HT) with CCRT remains unclear. Therefore, we performed a meta-analysis to evaluate the effect of HT with CCRT on LACC patients. METHODS AND MATERIALS A systematic literature search was conducted on the MEDLINE, PubMed, Embase, Cochrane library and SCOPUS databases for articles that compared CCRT with HT and CCRT alone as treatments for LACC. Hazard ratios (HRs) and risk ratios (RRs) were used to compare five-year overall survival (OS), local relapse-free survival (LRFS) and incidence of acute and chronic toxicity between the two treatments. RESULTS Two articles out of 2860 were finally selected for analysis. A total of 536 patients were evaluated (CCRT with HT group: 268, CCRT group: 268). FIGO stages I-II and III-IV were found in 295 (55.0%) and 241 patients (45.0%), respectively. The CCRT with HT group had significantly better five-year OS than the CCRT group (HR 0.67, 95% confidence interval [CI] 0.47-0.96, p = 0.03). LRFS of patients was superior in the CCRT with HT group than in the CCRT group, but without significance (HR 0.74, 95% CI 0.49-1.12; p = 0.16). Moreover, there was no difference between the two groups regarding acute and chronic toxicity. CONCLUSION This systematic review and meta-analysis showed that CCRT with HT significantly improved OS in LACC patients without increasing acute and chronic toxicity. Therefore, tri-modality treatment could be a feasible approach for patients with LACC.
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Affiliation(s)
- Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Se An Oh
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jaehyeon Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, South Korea
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Lee JW, Lee SM. Radiomics in Oncological PET/CT: Clinical Applications. Nucl Med Mol Imaging 2018; 52:170-189. [PMID: 29942396 PMCID: PMC5995782 DOI: 10.1007/s13139-017-0500-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely used for staging, evaluating treatment response, and predicting prognosis in malignant diseases. FDG uptake and volumetric PET parameters such as metabolic tumor volume have been used and are still used as conventional PET parameters to assess biological characteristics of tumors. However, in recent years, additional features derived from PET images by computational processing have been found to reflect intratumoral heterogeneity, which is related to biological tumor features, and to provide additional predictive and prognostic information, which leads to the concept of radiomics. In this review, we focus on recent clinical studies of malignant diseases that investigated intratumoral heterogeneity on PET/CT, and we discuss its clinical role in various cancers.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Gil 25, Seo-gu, Incheon, 22711 South Korea
- Institute for Integrative Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
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Prognostic Value of Fluorine-18 Fluorodeoxyglucose Uptake of Bone Marrow on Positron Emission Tomography/Computed Tomography for Prediction of Disease Progression in Cervical Cancer. Int J Gynecol Cancer 2018; 27:776-783. [PMID: 28333846 DOI: 10.1097/igc.0000000000000949] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the prognostic value of fluorine-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography (PET)/computed tomography in patients with uterine cervical cancer. METHODS One hundred forty-five patients with cervical cancer who underwent staging FDG PET/computed tomography and subsequent surgical resection or chemoradiotherapy were retrospectively enrolled in the study. Mean BM FDG uptake (BM standardized uptake value [SUV]) and BM-to-liver uptake ratio of FDG uptake (BLR) were measured. Relationships of BM SUV and BLR with hematologic and inflammatory markers were evaluated. Prognostic values of PET parameters for predicting disease progression-free survival and distant recurrence-free survival (DRFS) were assessed with a Cox proportional hazards regression model. RESULTS Bone marrow SUV and BLR were significantly correlated with white blood cell count and neutrophil-to-lymphocyte ratio. In the multivariate Cox regression analysis, International Federation of Gynecology and Obstetrics stage (P = 0.048), neutrophil-to-lymphocyte ratio (P = 0.028), platelet-to-lymphocyte ratio (PLR; P = 0.004), maximum SUV of cervical cancer (P = 0.030), and BLR (P = 0.031) were significantly associated with progression-free survival, whereas lymph node metastasis (P = 0.041), PLR (P = 0.002), and BLR (P = 0.025) were significantly associated with DRFS. In a patient subgroup with chemoradiotherapy, BLR (P = 0.044) was still an independent prognostic factor for predicting DRFS in multivariate analysis along with PLR (P = 0.004). CONCLUSIONS In patients with cervical cancer, BLR is associated with an increased risk of disease progression and distant recurrence.
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Prognostic value of fluorine-18-fluorodeoxyglucose positron emission tomography or PET-computed tomography in cervical cancer: a meta-analysis. Int J Gynecol Cancer 2014; 23:1184-90. [PMID: 23851677 DOI: 10.1097/igc.0b013e31829ee012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE We pooled the data from published studies to estimate the prognostic value of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/computed tomography (CT) in cervical cancer patients. METHODS We searched MEDLINE, EMBASE, and PUBMED to identify studies investigating the association of 18F-FDG PET or PET/CT with clinical survival outcomes of patients with cervical cancer. The summarized hazard ratio (HR) was estimated by using fixed- or random-effect model according to heterogeneity between trails. RESULTS We analyzed a total number of 1854 patients from 16 studies and found that positive pretreatment FDG-PET images were significantly associated with poorer event-free survival (hazard ratio [HR], 2.681; 95% confidence interval [CI], 2.059-3.490) and overall survival (HR, 2.063; 95% CI, 1.023-4.158). Furthermore, metabolic response of therapy as shown on posttreatment PET images was also capable of predicting event-free survival and overall survival with statistical significance, and the HR was 2.030 (95% CI, 1.537-2.681) and 2.322 (95% CI, 1.485-3.630), respectively. CONCLUSIONS Uptake of 18F-FDG on PET or PET/CT either before or after treatment has a promising value of both predicting survival outcomes for patients with cervical cancer and identifying patients for more aggressive treatment.
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Prognostic significance of volume-based metabolic parameters in uterine cervical cancer determined using 18F-fluorodeoxyglucose positron emission tomography. Int J Gynecol Cancer 2013; 22:1226-33. [PMID: 22810970 DOI: 10.1097/igc.0b013e318260a905] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We compared the prognostic value of volume-based metabolic parameters determined using fluorine 18 (F) fluorodeoxyglucose (FDG) positron emission tomography (PET) (F-FDG PET) (with other prognostic parameters in uterine cervical cancer. METHODS The subjects were 73 female patients who had an initial diagnosis of uterine cervical cancer and who underwent F-FDG PET. Various metabolic or volume-based PET parameters including maximum and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in primary cervical tumors. Survival analysis for disease-free survival or progression-free survival was performed with a Kaplan-Meier method using PET parameters and other clinical variables. For determining independent prognostic factors, Cox regression analysis was performed. RESULTS Recurrence or disease progression occurred in 23 patients (31.5%). In univariate analysis, patient age (cutoff, 57 years, P < 0.05), International Federation of Gynecology and Obstetrics stage (P = 0.07), primary tumor size (cutoff, 6.7 cm; P < 0.05), lymph node status on PET (P < 0.005), treatment method (P < 0.01), metabolic tumor volume (cutoff, 82 cm; P = 0.001), and TLG (cutoff, 7600; P = 0.005) were significant predictors of recurrence or progression. In multivariate analysis, both lymph node status on PET (hazard ratio, 1.042 [negative vs intrapelvic metastasis only], 7.008 [negative vs extrapelvic metastasis]; P < 0.001) and TLG (cutoff, 7600; hazard ratio, 2.981; P < 0.05) were independent prognostic factors for predicting recurrence. CONCLUSIONS In uterine cervical cancer, TLG, a volume-based metabolic parameter, and lymph node status on PET may be significant independent prognostic factors for event-free survival.
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Kang S, Nam BH, Park JY, Seo SS, Ryu SY, Kim JW, Kim SC, Park SY, Nam JH. Risk Assessment Tool for Distant Recurrence After Platinum-Based Concurrent Chemoradiation in Patients With Locally Advanced Cervical Cancer: A Korean Gynecologic Oncology Group Study. J Clin Oncol 2012; 30:2369-74. [PMID: 22614984 DOI: 10.1200/jco.2011.37.5923] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Our study aimed to develop a model to predict distant recurrence in locally advanced cervical cancer, which can be used to select high-risk patients in enriched clinical trials. Patients and Methods Our study was a retrospective analysis of a multi-institutional cohort of patients treated between 2001 and 2009. According to the order of data submission, data from three institutions were allocated to a model development cohort (n = 434), and data from the remaining two institutions were allocated to an external validation cohort (n = 115). Patient information including [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) data and clinical outcome was modeled using competing risk regression analysis to predict 5-year cumulative incidence of distant recurrence. Results The competing risk analysis revealed that the following four parameters were significantly associated with distant recurrence: pelvic and para-aortic nodal positivity on FDG-PET, nonsquamous cell histology, and pretreatment serum squamous cell carcinoma antigen levels. This four-parameter model showed good discrimination and calibration, with a bootstrap-adjusted concordance index of 0.70. Also, the validation set showed good discrimination with a bootstrap-adjusted concordance index of 0.73. A user-friendly Web-based nomogram predicting 5-year probability of distant recurrence was developed. Conclusion We have developed a robust model to predict the risk of distant recurrence in patients with locally advanced cervical cancer. Further, we discussed how the selective enrichment of the patient population could facilitate clinical trials of systemic chemotherapy in locally advanced cervical cancer.
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Affiliation(s)
- Sokbom Kang
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Byung-Ho Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jeong-Yeol Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Young Ryu
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jae Weon Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Seung-Cheol Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Yoon Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
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Molecular imaging in the management of cervical cancer. J Formos Med Assoc 2012; 111:412-20. [PMID: 22939658 DOI: 10.1016/j.jfma.2012.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/10/2012] [Accepted: 02/17/2012] [Indexed: 12/19/2022] Open
Abstract
Positron emission tomography (PET), magnetic resonance imaging (MRI), and integrated 18-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography are valuable techniques for assessing prognosis, treatment response after the completion of concurrent chemoradiation, suspicious or documented recurrence, unexplained post therapy elevations in tumor markers, and the response to salvage treatment when managing cervical cancer. However, PET plays a limited role in the primary staging of MRI-defined node-negative patients. Currently, (18)F-FDG is still the only tracer approved for routine use, but several novel targeting PET compounds, high-Tesla MRI machines, diffusion-weighted imaging without contrast, and dynamic nuclear polarized-enhanced (13)C-MR spectroscopic imaging may hold promising applications.
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Mochizuki Y, Omura K, Nakamura S, Harada H, Shibuya H, Kurabayashi T. Preoperative predictive model of cervical lymph node metastasis combining fluorine-18 fluorodeoxyglucose positron-emission tomography/computerized tomography findings and clinical factors in patients with oral or oropharyngeal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:274-82. [PMID: 22668784 DOI: 10.1016/j.tripleo.2011.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 08/07/2011] [Accepted: 08/17/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study aimed to construct a preoperative predictive model of cervical lymph node metastasis using fluorine-18 fluorodeoxyglucose positron-emission tomography/computerized tomography ((18)F-FDG PET/CT) findings in patients with oral or oropharyngeal squamous cell carcinoma (SCC). STUDY DESIGN Forty-nine such patients undergoing preoperative (18)F-FDG PET/CT and neck dissection or lymph node biopsy were enrolled. Retrospective comparisons with spatial correlation between PET/CT and the anatomical sites based on histopathological examinations of surgical specimens were performed. We calculated a logistic regression model, including the SUVmax-related variable. RESULTS When using the optimal cutoff point criterion of probabilities calculated from the model that included either clinical factors and delayed-phase SUVmax ≥0.087 or clinical factors and maximum standardized uptake (SUV) increasing rate (SUV-IR) ≥ 0.100, it significantly increased the sensitivity, specificity, and accuracy (87.5%, 65.7%, and 75.2%, respectively). CONCLUSIONS The use of predictive models that include clinical factors and delayed-phase SUVmax and SUV-IR improve preoperative nodal diagnosis.
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Affiliation(s)
- Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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