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Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024; 200:553-567. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
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Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
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de Leeuw ALMP, Giralt J, Tao Y, Benavente S, France Nguyen TV, Hoebers FJP, Hoeben A, Terhaard CHJ, Wai Lee L, Friesland S, Steenbakkers RJHM, Tans L, Heukelom J, Kayembe MT, van Kranen SR, Bartelink H, Rasch CRN, Sonke JJ, Hamming-Vrieze O. A multicentric randomized controlled phase III trial of adaptive and 18F-FDG-PET-guided dose-redistribution in locally advanced head and neck squamous cell carcinoma (ARTFORCE). Radiother Oncol 2024; 196:110281. [PMID: 38636708 DOI: 10.1016/j.radonc.2024.110281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/16/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND PURPOSE This multicenter randomized phase III trial evaluated whether locoregional control of patients with LAHNSCC could be improved by fluorodeoxyglucose-positron emission tomography (FDG-PET)-guided dose-escalation while minimizing the risk of increasing toxicity using a dose-redistribution and scheduled adaptation strategy. MATERIALS AND METHODS Patients with T3-4-N0-3-M0 LAHNSCC were randomly assigned (1:1) to either receive a dose distribution ranging from 64-84 Gy/35 fractions with adaptation at the 10thfraction (rRT) or conventional 70 Gy/35 fractions (cRT). Both arms received concurrent three-cycle 100 mg/m2cisplatin. Primary endpoints were 2-year locoregional control (LRC) and toxicity. Primary analysis was based on the intention-to-treat principle. RESULTS Due to slow accrual, the study was prematurely closed (at 84 %) after randomizing 221 eligible patients between 2012 and 2019 to receive rRT (N = 109) or cRT (N = 112). The 2-year LRC estimate difference of 81 % (95 %CI 74-89 %) vs. 74 % (66-83 %) in the rRT and cRT arm, respectively, was not found statistically significant (HR 0.75, 95 %CI 0.43-1.31,P=.31). Toxicity prevalence and incidence rates were similar between trial arms, with exception for a significant increased grade ≥ 3 pharyngolaryngeal stenoses incidence rate in the rRT arm (0 versus 4 %,P=.05). In post-hoc subgroup analyses, rRT improved LRC for patients with N0-1 disease (HR 0.21, 95 %CI 0.05-0.93) and oropharyngeal cancer (0.31, 0.10-0.95), regardless of HPV. CONCLUSION Adaptive and dose redistributed radiotherapy enabled dose-escalation with similar toxicity rates compared to conventional radiotherapy. While FDG-PET-guided dose-escalation did overall not lead to significant tumor control or survival improvements, post-hoc results showed improved locoregional control for patients with N0-1 disease or oropharyngeal cancer treated with rRT.
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Affiliation(s)
- Anna Liza M P de Leeuw
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Jordi Giralt
- Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Sergi Benavente
- Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Frank J P Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ann Hoeben
- Division of Medical Oncology, Department of Internal Medicine, GROW-School of Oncology and Developmental Biology Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lip Wai Lee
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Signe Friesland
- Department of Radiation Oncology, Karolinska Institute, Stockholm, Sweden
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisa Tans
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolien Heukelom
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mutamba T Kayembe
- Department of Bioinformatics and Statistics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Harry Bartelink
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Garrido-Hernandez G, Henjum H, Winter RM, Alsaker MD, Danielsen S, Boer CG, Ytre-Hauge KS, Redalen KR. Interim 18F-FDG-PET based response-adaptive dose escalation of proton therapy for head and neck cancer: a treatment planning feasibility study. Phys Med 2024; 123:103404. [PMID: 38852365 DOI: 10.1016/j.ejmp.2024.103404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/06/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Image-driven dose escalation to tumor subvolumes has been proposed to improve treatment outcome in head and neck cancer (HNC). We used 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) acquired at baseline and into treatment (interim) to identify biologic target volumes (BTVs). We assessed the feasibility of interim dose escalation to the BTV with proton therapy by simulating the effects to organs at risk (OARs). METHODS We used the semiautomated just-enough-interaction (JEI) method to identify BTVs in 18F-FDG-PET images from nine HNC patients. Between baseline and interim FDG-PET, patients received photon radiotherapy. BTV was identified assuming that high standardized uptake value (SUV) at interim reflected tumor radioresistance. Using Eclipse (Varian Medical Systems), we simulated a 10% (6.8 Gy(RBE1.1)) and 20% (13.6 Gy(RBE1.1)) dose escalation to the BTV with protons and compared results with proton plans without dose escalation. RESULTS At interim 18F-FDG-PET, radiotherapy resulted in reduced SUV compared to baseline. However, spatial overlap between high-SUV regions at baseline and interim allowed for BTV identification. Proton therapy planning demonstrated that dose escalation to the BTV was feasible, and except for some 20% dose escalation plans, OAR doses did not significantly increase. CONCLUSION Our in silico analysis demonstrated the potential for interim 18F-FDG-PET response-adaptive dose escalation to the BTV with proton therapy. This approach may give more efficient treatment to HNC with radioresistant tumor subvolumes without increasing normal tissue toxicity. Studies in larger cohorts are required to determine the full potential for interim 18F-FDG-PET-guided dose escalation of proton therapy in HNC.
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Affiliation(s)
| | - Helge Henjum
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - René Mario Winter
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirjam Delange Alsaker
- Department of Radiotherapy, Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Signe Danielsen
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | | | - Kathrine Røe Redalen
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
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Caldarella C, De Risi M, Massaccesi M, Miccichè F, Bussu F, Galli J, Rufini V, Leccisotti L. Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications. Cancers (Basel) 2024; 16:1905. [PMID: 38791983 PMCID: PMC11119768 DOI: 10.3390/cancers16101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
This article provides an overview of the use of 18F-FDG PET/CT in various clinical scenarios of head-neck squamous cell carcinoma, ranging from initial staging to treatment-response assessment, and post-therapy follow-up, with a focus on the current evidence, debated issues, and innovative applications. Methodological aspects and the most frequent pitfalls in head-neck imaging interpretation are described. In the initial work-up, 18F-FDG PET/CT is recommended in patients with metastatic cervical lymphadenectomy and occult primary tumor; moreover, it is a well-established imaging tool for detecting cervical nodal involvement, distant metastases, and synchronous primary tumors. Various 18F-FDG pre-treatment parameters show prognostic value in terms of disease progression and overall survival. In this scenario, an emerging role is played by radiomics and machine learning. For radiation-treatment planning, 18F-FDG PET/CT provides an accurate delineation of target volumes and treatment adaptation. Due to its high negative predictive value, 18F-FDG PET/CT, performed at least 12 weeks after the completion of chemoradiotherapy, can prevent unnecessary neck dissections. In addition to radiomics and machine learning, emerging applications include PET/MRI, which combines the high soft-tissue contrast of MRI with the metabolic information of PET, and the use of PET radiopharmaceuticals other than 18F-FDG, which can answer specific clinical needs.
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Affiliation(s)
- Carmelo Caldarella
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Marina De Risi
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Mariangela Massaccesi
- Radiation Oncology Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Miccichè
- Radiation Oncology Unit, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Bussu
- Otorhinolaryngology Operative Unit, Azienda Ospedaliero Universitaria Sassari, 07100 Sassari, Italy;
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jacopo Galli
- Otorhinolaryngology Unit, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Otolaryngology, Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucia Leccisotti
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Fujimoto K, Shiinoki T, Kawazoe Y, Yuasa Y, Mukaidani W, Manabe Y, Kajima M, Tanaka H. Biomechanical imaging biomarker during chemoradiotherapy predicts treatment response in head and neck squamous cell carcinoma. Phys Med Biol 2024; 69:055033. [PMID: 38359451 DOI: 10.1088/1361-6560/ad29b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024]
Abstract
Objective. For response-adapted adaptive radiotherapy (R-ART), promising biomarkers are needed to predict post-radiotherapy (post-RT) responses using routine clinical information obtained during RT. In this study, a patient-specific biomechanical model (BM) of the head and neck squamous cell carcinoma (HNSCC) was proposed using the pre-RT maximum standardized uptake value (SUVmax) of18F-fluorodeoxyglucose (FDG) and tumor structural changes during RT as evaluated using computed tomography (CT). In addition, we evaluated the predictive performance of BM-driven imaging biomarkers for the treatment response of patients with HNSCC who underwent concurrent chemoradiotherapy (CCRT).Approach. Patients with histologically confirmed HNSCC treated with definitive CCRT were enrolled in this study. All patients underwent CT two times as follows: before the start of RT (pre-RT) and 3 weeks after the start of RT (mid-RT). Among these patients, 67 patients who underwent positron emission tomography/CT during the pre-RT period were included in the final analysis. The locoregional control (LC), progression-free survival (PFS), and overall survival (OS) prediction performances of whole tumor stress change (TS) between pre- and mid-RT computed using BM were assessed using univariate, multivariate, and Kaplan-Meier survival curve analyses, respectively. Furthermore, performance was compared with the pre and post-RT SUVmax, tumor volume reduction rate (TVRR) during RT, and other clinical prognostic factors.Main results. For both univariate, multivariate, and survival curve analyses, the significant prognostic factors were as follows (p< 0.05): TS and TVRR for LC; TS and pre-RT FDG-SUVmaxfor PFS; and TS only for OS. In addition, for 2 year LC, PFS, and OS prediction, TS showed a comparable predictive performance to post-RT FDG-SUVmax.Significance. BM-driven TS is an effective prognostic factor for tumor treatment response after CCRT. The proposed method can be a feasible functional imaging biomarker that can be acquired during RT using only routine clinical data and may provide useful information for decision-making during R-ART.
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Affiliation(s)
- Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yusuke Kawazoe
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Yuki Yuasa
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Wataru Mukaidani
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Yuki Manabe
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Miki Kajima
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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Trada Y, Lee MT, Jameson MG, Chlap P, Keall P, Moses D, Lin P, Fowler A. Mid-treatment 18F-FDG PET imaging changes in parotid gland correlates to radiation-induced xerostomia. Radiother Oncol 2023; 186:109745. [PMID: 37330056 DOI: 10.1016/j.radonc.2023.109745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The aim of this study was to measure functional changes in parotid glands using mid-treatment FDG-PET/CT and correlate early imaging changes to subsequent xerostomia in mucosal head and neck squamous cell carcinoma patients undergoing radiotherapy. MATERIALS AND METHODS 56 patients from two prospective imaging biomarker studies underwent FDG-PET/CT at baseline and during radiotherapy (week 3). Both parotid glands were volumetrically delineated at each time point. PET parameter SUVmedian were calculated for ipsilateral and contralateral parotid glands. Absolute and relative change (Δ) in SUVmedian were correlated to moderate-severe xerostomia (CTCAE grade ≥ 2) at 6 months. Four predictive models were subsequently created using multivariate logistic regression using clinical and radiotherapy planning parameters. Model performance was calculated using ROC analysis and compared using Akaike information criterion (AIC) RESULTS: 29 patients (51.8%) developed grade ≥ 2 xerostomia. Compared to baseline, there was an increase in SUVmedian at week 3 in ipsilateral (8.4%) and contralateral (5.5%) parotid glands. Increase in ipsilateral parotid Δ SUVmedian (p = 0.04) and contralateral mean parotid dose (p = 0.04) were correlated to xerostomia. The reference 'clinical' model correlated to xerostomia (AUC 0.667, AIC 70.9). Addition of ipsilateral parotid Δ SUVmedian to the clinical model resulted in the highest correlation to xerostomia (AUC 0.777, AIC 65.4). CONCLUSION Our study shows functional changes occurring in the parotid gland early during radiotherapy. We demonstrate that integration of baseline and mid-treatment FDG-PET/CT changes in the parotid gland with clinical factors has the potential to improve xerostomia risk prediction which could be utilised for personalised head and neck radiotherapy.
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Affiliation(s)
- Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Mark T Lee
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University NSW, Australia
| | - Phillip Chlap
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul Keall
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Image X Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia; Department of Medical Imaging, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Peter Lin
- South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia
| | - Allan Fowler
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
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Kaanders JHAM, Bussink J, Aarntzen EHJG, Braam P, Rütten H, van der Maazen RWM, Verheij M, van den Bosch S. [18F]FDG-PET-Based Personalized Radiotherapy Dose Prescription. Semin Radiat Oncol 2023; 33:287-297. [PMID: 37331783 DOI: 10.1016/j.semradonc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PET imaging with 2'-deoxy-2'-[18F]fluoro-D-glucose ([18F]FDG) has become one of the pillars in the management of malignant diseases. It has proven value in diagnostic workup, treatment policy, follow-up, and as prognosticator for outcome. [18F]FDG is widely available and standards have been developed for PET acquisition protocols and quantitative analyses. More recently, [18F]FDG-PET is also starting to be appreciated as a decision aid for treatment personalization. This review focuses on the potential of [18F]FDG-PET for individualized radiotherapy dose prescription. This includes dose painting, gradient dose prescription, and [18F]FDG-PET guided response-adapted dose prescription. The current status, progress, and future expectations of these developments for various tumor types are discussed.
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Affiliation(s)
- Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands..
| | - Johan Bussink
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Pètra Braam
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Marcel Verheij
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sven van den Bosch
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Witek ME, Kimple RJ, Avey GD, Burr AR, Chandereng T, Yu M, Hu R, Wieland AM, Labby ZE, Bruce JY, Brower JV, Hartig GK, Harari PM. Prospective Study of PET/MRI Tumor Response During Chemoradiotherapy for Patients With Low-risk and Intermediate-risk p16-positive Oropharynx Cancer. Am J Clin Oncol 2022; 45:202-207. [PMID: 35446279 PMCID: PMC9623610 DOI: 10.1097/coc.0000000000000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine tumor response with positron emission tomography (PET)/magnetic resonance imaging (MRI) during chemoradiotherapy as a predictor of outcome in patients with p16-positive oropharynx cancer. MATERIALS AND METHODS Patients with p16-positive oropharynx cancer were treated with chemoradiotherapy. Low-risk (LR) disease was defined as T1-T3 and N0-2b and ≤10 pack-years and intermediate-risk (IR) disease as T4 or N2c-3 or >10 pack-years. Patients underwent a PET/MRI scan pretreatment and at fraction 10. Change in value of imaging means were analyzed by analysis of variance. K-means clustering with Euclidean distance functions were used for patient clustering. Silhouette width was used to determine the optimal number of clusters. Linear regression was performed on all radiographic metrics using patient and disease characteristics. RESULTS Twenty-four patients were enrolled with 7 LR and 11 IR patients available for analysis. Pretreatment imaging characteristics between LR and IR patients were similar. Patients with LR disease exhibited a larger reduction in maximum standardized uptake value (SUV) compared with IR patients (P<0.05). Cluster analysis defined 2 cohorts that exhibited a similar intratreatment response. Cluster 1 contained 7 of 7 LR patients and 8 of 11 IR patients. Cluster 2 contained 3 of 11 IR patients. Cluster 2 exhibited significant differences compared with cluster 1 in the change in primary tumor peak SUV and largest lymph node median SUV. CONCLUSIONS We identified that IR p16-positive oropharynx cancers exhibit heterogeneity in their PET/MRI response to chemoradiotherapy. These data support further study of intratreatment imaging response as a potential mechanism to identify patients with IR oropharynx cancer suitable for treatment deintensification.
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Affiliation(s)
- Matthew E. Witek
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Randall J. Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory D. Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Adam R. Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
| | | | - Menggang Yu
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rong Hu
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron M. Wieland
- Deparmtent of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Zacariah E. Labby
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
| | - Justine Y. Bruce
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey V. Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
| | - Gregory K. Hartig
- Deparmtent of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI, USA
- UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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10
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Koyasu N, Hyodo F, Iwasaki R, Eto H, Elhelaly AE, Tomita H, Shoda S, Takasu M, Mori T, Murata M, Hara A, Noda Y, Kato H, Matsuo M. Spatiotemporal imaging of redox status using in vivo dynamic nuclear polarization magnetic resonance imaging system for early monitoring of response to radiation treatment of tumor. Free Radic Biol Med 2022; 179:170-180. [PMID: 34968704 DOI: 10.1016/j.freeradbiomed.2021.12.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022]
Abstract
In general, the effectiveness of radiation treatment is evaluated through the observation of morphological changes with computed tomography (CT) or magnetic resonance imaging (MRI) images after treatment. However, the evaluation of the treatment effects can be very time consuming, and thus can delay the verification of patient cases where treatment has not been fully effective. It is known that the treatment efficacy depends on redox modulation in tumor tissues, which is an indirect effect of oxidizing redox molecules such as hydroxyl radicals and of reactive oxygen species generated by radiation treatment. In vivo dynamic nuclear polarization-MRI (DNP-MRI) using carbamoyl-PROXYL (CmP) as a redox sensitive DNP probe enables the accurate monitoring of the anatomical distribution of free radicals based on interactions of electrons and nuclear spin, known as Overhauser effect. However, spatiotemporal response of the redox status in tumor tissues post-irradiation remains unknown. In this study, we demonstrate the usefulness of spatiotemporal redox status as an early imaging biomarker of tumor response after irradiation using in vivo DNP-MRI. Our results highlight that in vivo DNP-MRI/CmP allowed us to visualize the tumor redox status responses significantly faster and earlier compared to the verification of morphological changes observed with 1.5 T MRI and cancer metabolism (Warburg effect) obtained by hyperpolarized 13C pyruvate MRS. Our findings suggest that the early assessment of redox status alterations with in vivo DNP-MRI/CmP probe may provide very efficient information regarding the effectiveness of the subsequent radiation treatment.
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Affiliation(s)
| | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, School of Medicine, Gifu University, Gifu, Japan.
| | - Ryota Iwasaki
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Hinako Eto
- Center for Advanced Medical Open Innovation, Kyushu University, Fukuoka, Japan
| | - Abdelazim Elsayed Elhelaly
- Department of Radiology, Frontier Science for Imaging, School of Medicine, Gifu University, Gifu, Japan; Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | | | | | - Masaki Takasu
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Takashi Mori
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Masaharu Murata
- Center for Advanced Medical Open Innovation, Kyushu University, Fukuoka, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University, Gifu, Japan
| | | | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
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11
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Lin P, Min M, Lai K, Lee M, Holloway L, Xuan W, Bray V, Fowler A, Lee CS, Yong J. Mid-treatment Fluorodeoxyglucose Positron Emission Tomography in Human Papillomavirus-related Oropharyngeal Squamous Cell Carcinoma Treated with Primary Radiotherapy: Nodal Metabolic Response Rate can Predict Treatment Outcomes. Clin Oncol (R Coll Radiol) 2021; 33:e586-e598. [PMID: 34373179 DOI: 10.1016/j.clon.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate whether biomarkers derived from fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) performed prior to (prePET) and during the third week (interim PET; iPET) of radiotherapy can predict treatment outcomes in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPC). MATERIALS AND METHODS This retrospective analysis included 46 patients with newly diagnosed OPC treated with definitive (chemo)radiation and all patients had confirmed positive HPV status (HPV+OPC) based on p16 immunohistochemistry. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary, index node (node with the highest TLG) and total lymph nodes and their median percentage (≥50%) reductions in iPET were analysed, and correlated with 5-year Kaplan-Meier and multivariable analyses (smoking, T4, N2b-3 and AJCC stage IV), including local failure-free survival, regional failure-free survival, locoregional failure-free survival (LRFFS), distant metastatic failure-free survival (DMFFS), disease-free survival (DFS) and overall survival. RESULTS There was no association of outcomes with prePET parameters observed on multivariate analysis. A complete metabolic response of primary tumour was seen in 13 patients; the negative predictive value for local failure was 100%. More than a 50% reduction in total nodal MTV provided the best predictor of outcomes, including LRFFS (88% versus 47.1%, P = 0.006, hazard ratio = 0.153) and DFS (78.2% versus 41.2%, P = 0.01, hazard ratio = 0.234). More than a 50% reduction in index node TLG was inversely related to DMFFS: a better nodal response was associated with a higher incidence of distant metastatic failure (66.7% versus 100%, P = 0.009, hazard ratio = 3.0). CONCLUSION The reduction (≥50%) of volumetric nodal metabolic burden can potentially identify a subgroup of HPV+OPC patients at low risk of locoregional failure but inversely at higher risk of distant metastatic failure and may have a role in individualised adaptive radiotherapy and systemic therapy.
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Affiliation(s)
- P Lin
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia.
| | - M Min
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - K Lai
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia
| | - M Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - L Holloway
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - V Bray
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - A Fowler
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - C S Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia; Central Clinical School, University of Sydney, New South Wales, Australia
| | - J Yong
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
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12
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Benjamin J, Hephzibah J, Shanthly N, Oommen R, Mathew D, Pavamani S, Rajnikanth J. F-18 FDG PET-CT for response evaluation in head and neck malignancy: Experience from a tertiary level hospital in south India. Cancer Rep (Hoboken) 2021; 4:e1333. [PMID: 33660434 PMCID: PMC8222552 DOI: 10.1002/cnr2.1333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) accounts for 90% of head and neck cancers. There has been no established qualitative system of interpretation for therapy response assessment using PET-CT for HNSCC. AIM To assess response evaluation of nodal status in post-treatment PET-CT scans in HNSCC using a 5-point Likert scale (Deauville score [DS]). METHODS AND RESULTS Retro-prospective analysis was performed of the nodal status of pre and post-RT PET-CT in patients diagnosed with HNSCC (n = 43) from May 2013 to March 2018. All eligible patients underwent a pre-RT PET-CT scan before the start of RT. Another post-RT PET-CT scan was performed 12 weeks after the completion of RT. The median time from completion of radiotherapy (RT) to post-RT PET-CT was 92 days; 80% of the patients had their post-RT PET-CT scan between 77 and 147 days after therapy. Of 43 patients (M/33, F/10, age range 18 to 80 years (median 54 years) selected for the study, good concordance was noted between DS and clinical response in these patients. The change in SUV from pre-RT PET to post-RT PET was analyzed using a paired t-test. The P-value was found to be statistically significant while comparing pre and post-RT SUVmax levels showing that RT had significantly reduced the SUVmax levels of the nodes in DS 2-3 groups whereas the number of patients was too small to allow a reliable calculation in DS 4-5 groups. It was found that 36/39 patients with DS 1-3 had no nodal recurrence showing a high NPV of 92.3%. Of the four patients with DS 4-5, all had active disease showing PPV of 100%. Applying Fisher's exact test, the P-value was found to be .004. CONCLUSION DS seems to satisfy the requirements for a simple qualitative method of interpreting PET scans and for identifying patients requiring neck dissection. Consensus regarding qualitative assessment would facilitate standardization of PET reporting in clinical practice and enable comparative multicentric studies.
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Affiliation(s)
- Justin Benjamin
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - Julie Hephzibah
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | | | - Regi Oommen
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - David Mathew
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - Simon Pavamani
- Department of Radiation Oncology, Christian Medical College & Hospital, Vellore, India
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13
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Flaus A, Nevesny S, Guy JB, Sotton S, Magné N, Prévot N. Positron emission tomography for radiotherapy planning in head and neck cancer: What impact? Nucl Med Commun 2021; 42:234-243. [PMID: 33252513 DOI: 10.1097/mnm.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PET-computed tomography (CT) plays a growing role to guide target volume delineation for head and neck cancer in radiation oncology. Pretherapeutic [18F]FDG PET-CT adds information to morphological imaging. First, as a whole-body imaging modality, it reveals regional or distant metastases that induce major therapeutic changes in more than 10% of the cases. Moreover, it allows better pathological lymph node selection which improves overall regional control and overall survival. Second, locally, it allows us to define the metabolic tumoral volume, which is a reliable prognostic feature for survival outcome. [18F]FDG PET-CT-based gross tumor volume (GTV) is on average significantly smaller than GTV based on CT. Nevertheless, the overlap is incomplete and more evaluation of composite GTV based on PET and GTV based on CT are needed. However, in clinical practice, the study showed that using GTV PET alone for treatment planning was similar to using GTVCT for local control and dose distribution was better as a dose to organs at risk significantly decreased. In addition to FDG, pretherapeutic PET could give access to different biological tumoral volumes - thanks to different tracers - guiding heterogeneous dose delivery (dose painting concept) to resistant subvolumes. During radiotherapy treatment, follow-up [18F]FDG PET-CT revealed an earlier and more important diminution of GTV than other imaging modality. It may be a valuable support for adaptative radiotherapy as a new treatment plan with a significant impact on dose distribution became possible. Finally, additional studies are required to prospectively validate long-term outcomes and lower toxicity resulting from the use of PET-CT in treatment planning.
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Affiliation(s)
- Anthime Flaus
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
| | - Stéphane Nevesny
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
| | - Jean-Baptiste Guy
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Sandrine Sotton
- Department of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, University Departement of Research and Teaching
| | - Nicolas Magné
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Nathalie Prévot
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France
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14
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Paterson C, Hargreaves S, Rumley CN. Functional Imaging to Predict Treatment Response in Head and Neck Cancer: How Close are We to Biologically Adaptive Radiotherapy? Clin Oncol (R Coll Radiol) 2020; 32:861-873. [PMID: 33127234 DOI: 10.1016/j.clon.2020.10.004] [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: 06/03/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
It is increasingly recognised that head and neck cancer represents a spectrum of disease with a differential response to standard treatments. Although prognostic factors are well established, they do not reliably predict response. The ability to predict response early during radiotherapy would allow adaptation of treatment: intensifying treatment for those not responding adequately or de-intensifying remaining therapy for those likely to achieve a complete response. Functional imaging offers such an opportunity. Changes in parameters obtained with functional magnetic resonance imaging or positron emission tomography-computed tomography during treatment have been found to be predictive of disease control in head and neck cancer. Although many questions remain unanswered regarding the optimal implementation of these techniques, current, maturing and future studies may provide the much-needed homogeneous cohorts with larger sample sizes and external validation of parameters. With a stepwise and collaborative approach, we may be able to develop imaging biomarkers that allow us to deliver personalised, biologically adaptive radiotherapy for head and neck cancer.
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Affiliation(s)
- C Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | | | - C N Rumley
- Department of Radiation Oncology, Townsville University Hospital, Douglas, Australia; South Western Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
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15
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Thureau S, Briens A, Decazes P, Castelli J, Barateau A, Garcia R, Thariat J, de Crevoisier R. PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit. Cancer Radiother 2020; 24:635-644. [PMID: 32859466 DOI: 10.1016/j.canrad.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Adaptive radiotherapy (ART) corresponds to various replanning strategies aiming to correct for anatomical variations occurring during the course of radiotherapy. The goal of the article was to report the rational, feasibility and benefit of using PET and/or MRI to guide this ART strategy in various tumor localizations. The anatomical modifications defined by scanner taking into account tumour mobility and volume variation are not always sufficient to optimise treatment. The contribution of functional imaging by PET or the precision of soft tissue by MRI makes it possible to consider optimized ART. Today, the most important data for both PET and MRI are for lung, head and neck, cervical and prostate cancers. PET and MRI guided ART appears feasible and safe, however in a very limited clinical experience. Phase I/II studies should be therefore performed, before proposing cost-effectiveness comparisons in randomized trials and before using the approach in routine practice.
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, QuantIF EA 4108, université de Rouen, 76000 Rouen, France.
| | - A Briens
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Decazes
- Département de médecine nucléaire, center Henri-Becquerel, QuantIF EA 4108, université de Rouen, Rouen, France
| | - J Castelli
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - A Barateau
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - R Garcia
- Service de physique médicale, institut Sainte-Catherine, 84918 Avignon, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie université, 14000 Caen, France; ARCHADE Research Community, 14000 Caen, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
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16
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Early 18F-FDG-PET Response During Radiation Therapy for HPV-Related Oropharyngeal Cancer May Predict Disease Recurrence. Int J Radiat Oncol Biol Phys 2020; 108:969-976. [PMID: 32800802 DOI: 10.1016/j.ijrobp.2020.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and 18F-fluorodeoxyglucose positron emission tomography (PET) parameters before and during definitive radiation therapy with treatment outcomes. METHODS AND MATERIALS Patients undergoing definitive (chemo)radiation for HPV-related/p16-positive OPC were prospectively enrolled on an institutional review board-approved study. 18F-fluorodeoxyglucose PET/computed tomography scans were performed at simulation and after 2 weeks at a dose of ∼20 Gy. Tumor volume and standardized uptake value (SUV) characteristics were measured. SUV was normalized to blood pool uptake. Tumor volume and PET parameters associated with recurrence were identified through recursive partitioning (RPART). Recurrence-free survival (RFS) and overall survival (OS) curves between RPART-identified cohorts were estimated using the Kaplan-Meier method, and Cox models were used to estimate the hazard ratios (HRs). RESULTS From 2012 to 2016, 62 patients with HPV-related OPC were enrolled. Median follow-up was 4.4 years. RPART identified patients with intratreatment SUVmax (normalized to blood pool SUVmean) <6.7 or SUVmax (normalized to blood pool SUVmean) ≥6.7 with intratreatment SUV40% ≥2.75 as less likely to recur. For identified subgroups, results of Cox models showed unadjusted HRs for RFS and OS (more likely to recur vs less likely) of 7.33 (90% confidence interval [CI], 2.97-18.12) and 6.09 (90% CI, 2.22-16.71), respectively, and adjusted HRs of 6.57 (90% CI, 2.53-17.05) and 5.61 (90% CI, 1.90-16.54) for RFS and OS, respectively. CONCLUSIONS PET parameters after 2 weeks of definitive radiation therapy for HPV-related OPC are associated with RFS and OS, thus potentially informing an adaptive treatment approach.
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17
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Is 68Ga-DOTA-FAPI a new arrow in the quiver of dose painting in radiation dose planning in head and neck cancers? Eur J Nucl Med Mol Imaging 2020; 47:2718-2720. [PMID: 32488339 PMCID: PMC7567717 DOI: 10.1007/s00259-020-04895-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Decazes P, Thureau S, Modzelewski R, Damilleville-Martin M, Bohn P, Vera P. Benefits of positron emission tomography scans for the evaluation of radiotherapy. Cancer Radiother 2020; 24:388-397. [PMID: 32448741 DOI: 10.1016/j.canrad.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/23/2022]
Abstract
The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (18F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.
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Affiliation(s)
- P Decazes
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France.
| | - S Thureau
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France; Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - R Modzelewski
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
| | - M Damilleville-Martin
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - P Bohn
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
| | - P Vera
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
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19
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Shen LF, Zhou SH, Yu Q. Predicting response to radiotherapy in tumors with PET/CT: when and how? Transl Cancer Res 2020; 9:2972-2981. [PMID: 35117653 PMCID: PMC8798842 DOI: 10.21037/tcr.2020.03.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
Radiotherapy is one of the main methods for tumor treatment, with the improved radiotherapy delivery technique to combat cancer, there is a growing interest for finding effective and feasible ways to predict tumor radiosensitivity. Based on a series of changes in metabolism, microvessel density, hypoxic microenvironment, and cytokines of tumors after radiotherapy, a variety of radiosensitivity detection methods have been studied. Among the detection methods, positron emission tomography-computed tomography (PET/CT) is a feasible tool for response evaluation following definitive radiotherapy for cancers with a high negative predictive value. The prognostic or predictive value of PET/CT is currently being studied widely. However, there are many unresolved issues, such as the optimal probe of PET/CT for radiosensitivity prediction, the selection of the most useful PET/CT parameters and their optimal cut-offs such as total lesion glycolysis (TLG), metabolic tumor volume (MTV) and standardized uptake value (SUV), and the optimal timing of PET/CT pre-treatment, during or following RT. Different radiosensitivity of tumors, modes of radiotherapy action and fraction scheduling may complicate the appropriate choice. In this study, we will discuss the diverse methods for evaluating radiosensitivity, and will also focus on the selection of the optimal probe, timing, cut-offs and parameters of PET/CT for evaluating the radiotherapy response.
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Affiliation(s)
- Li-Fang Shen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qi Yu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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20
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Das SK, McGurk R, Miften M, Mutic S, Bowsher J, Bayouth J, Erdi Y, Mawlawi O, Boellaard R, Bowen SR, Xing L, Bradley J, Schoder H, Yin FF, Sullivan DC, Kinahan P. Task Group 174 Report: Utilization of [ 18 F]Fluorodeoxyglucose Positron Emission Tomography ([ 18 F]FDG-PET) in Radiation Therapy. Med Phys 2019; 46:e706-e725. [PMID: 31230358 DOI: 10.1002/mp.13676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 02/03/2023] Open
Abstract
The use of positron emission tomography (PET) in radiation therapy (RT) is rapidly increasing in the areas of staging, segmentation, treatment planning, and response assessment. The most common radiotracer is 18 F-fluorodeoxyglucose ([18 F]FDG), a glucose analog with demonstrated efficacy in cancer diagnosis and staging. However, diagnosis and RT planning are different endeavors with unique requirements, and very little literature is available for guiding physicists and clinicians in the utilization of [18 F]FDG-PET in RT. The two goals of this report are to educate and provide recommendations. The report provides background and education on current PET imaging systems, PET tracers, intensity quantification, and current utilization in RT (staging, segmentation, image registration, treatment planning, and therapy response assessment). Recommendations are provided on acceptance testing, annual and monthly quality assurance, scanning protocols to ensure consistency between interpatient scans and intrapatient longitudinal scans, reporting of patient and scan parameters in literature, requirements for incorporation of [18 F]FDG-PET in treatment planning systems, and image registration. The recommendations provided here are minimum requirements and are not meant to cover all aspects of the use of [18 F]FDG-PET for RT.
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Affiliation(s)
- Shiva K Das
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ross McGurk
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - James Bowsher
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - John Bayouth
- Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Yusuf Erdi
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Osama Mawlawi
- Department of Imaging Physics, University of Texas, M D Anderson Cancer Center, Houston, TX, USA
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Heiko Schoder
- Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Daniel C Sullivan
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Paul Kinahan
- Department of Radiology, University of Washington, Seattle, WA, USA
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21
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Alterio D, Marvaso G, Ferrari A, Volpe S, Orecchia R, Jereczek-Fossa BA. Modern radiotherapy for head and neck cancer. Semin Oncol 2019; 46:233-245. [PMID: 31378376 DOI: 10.1053/j.seminoncol.2019.07.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
Radiation therapy (RT) plays a key role in curative-intent treatments for head and neck cancers. Its use is indicated as a sole therapy in early stage tumors or in combination with surgery or concurrent chemotherapy in advanced stages. Recent technologic advances have resulted in both improved oncologic results and expansion of the indications for RT in clinical practice. Despite this, RT administered to the head and neck region is still burdened by a high rate of acute and late side effects. Moreover, about 50% of patients with high-risk disease experience loco-regional recurrence within 3 years of follow-up. Therefore, in recent decades, efforts have been dedicated to optimize the cost/benefit ratio of RT in this subset of patients. The aim of the present review was to highlight modern concepts of RT for head and neck cancers considering both the technological advances that have been achieved and recent knowledge that has informed the biological interaction between radiation and both tumor and healthy tissues.
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Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - Annamaria Ferrari
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefania Volpe
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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22
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Hargreaves S, Johnstone E, Parkinson C, Rackley T, Spezi E, Staffurth J, Evans M. Interim 18F-FDG Positron Emission Tomography/Computed Tomography During Chemoradiotherapy in the Management of Cancer Patients: a Response. Clin Oncol (R Coll Radiol) 2019; 31:669-670. [PMID: 31151841 DOI: 10.1016/j.clon.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/24/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - E Johnstone
- Department of Engineering, Cardiff University, Cardiff, UK
| | - C Parkinson
- Department of Engineering, Cardiff University, Cardiff, UK
| | | | - E Spezi
- Department of Engineering, Cardiff University, Cardiff, UK
| | - J Staffurth
- Velindre Cancer Centre, Cardiff, UK; Department of Engineering, Cardiff University, Cardiff, UK
| | - M Evans
- Velindre Cancer Centre, Cardiff, UK
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23
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Wright CL, Washington IR, Bhatt AD, Knopp MV. Emerging Opportunities for Digital PET/CT to Advance Locoregional Therapy in Head and Neck Cancer. Semin Radiat Oncol 2019; 29:93-101. [PMID: 30827458 DOI: 10.1016/j.semradonc.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this article is to present the recent imaging advancements enabled by digital photon counting positron emission tomography detector technology and discuss its potential applications in the clinical management of head and neck cancer (HNC) and nodal metastases. 18F-fluorodeoxyglucose positron-emission tomography is a clinically useful biomarker for the detection, targeted biopsy, treatment planning, and therapeutic response assessment of HNC. This article highlights the current state of 18F-fluorodeoxyglucose positron-emission tomography imaging in HNC management as well as the emerging capabilities of the recently introduced digital photon counting positron emission tomography/computed tomography platform for more effective molecular and functional HNC imaging.
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Affiliation(s)
- Chadwick L Wright
- Wright Center of Innovation in Biomedical Imaging, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Aashish D Bhatt
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Division of Imaging Science, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
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24
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Garibaldi C, Ferrari M, Grana CM, Jereczek-Fossa BA, Cremonesi M. Interim 18F-FDG Positron Emission Tomography/Computed Tomography During Chemoradiotherapy in the Management of Cancer Patients. Clin Oncol (R Coll Radiol) 2019; 31:267-268. [PMID: 30718088 DOI: 10.1016/j.clon.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/03/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- C Garibaldi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Ferrari
- Medical Physic Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C M Grana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Cremonesi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
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25
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Hamming-Vrieze O, Navran A, Al-Mamgani A, Vogel WV. Biological PET-guided adaptive radiotherapy for dose escalation in head and neck cancer: a systematic review. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:349-368. [DOI: 10.23736/s1824-4785.18.03087-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Bonomo P, Merlotti A, Olmetto E, Bianchi A, Desideri I, Bacigalupo A, Franco P, Franzese C, Orlandi E, Livi L, Caini S. What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2018; 45:2122-2138. [PMID: 29948105 PMCID: PMC6182396 DOI: 10.1007/s00259-018-4065-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/10/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Evidence is conflicting on the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease. METHODS A systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures. RESULTS The analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08-3.21), PFS (summary RR 1.81, 95% CI 1.14-2.89) and LRC (summary RR 3.49, 95% CI 1.65-7.35). Given the large heterogeneity (I2 > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUVmax and any of the outcome measures. CONCLUSION FDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.
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Affiliation(s)
- Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy.
| | - A Merlotti
- Radiation Oncology, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - E Olmetto
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - A Bianchi
- Nuclear Medicine Department, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - I Desideri
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - A Bacigalupo
- Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy
| | - P Franco
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - C Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - E Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Livi
- Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - S Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
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27
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Kim S, Oh S, Kim JS, Kim YK, Kim KH, Oh DH, Lee DH, Jeong WJ, Jung YH. Prognostic value of FDG PET/CT during radiotherapy in head and neck cancer patients. Radiat Oncol J 2018; 36:95-102. [PMID: 29983029 PMCID: PMC6074065 DOI: 10.3857/roj.2017.00577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (FDG PET) with computed tomography (CT) before and during radiotherapy (RT) in patients with head and neck cancer. METHODS Twenty patients with primary head and neck squamous cell carcinoma were enrolled in this study, of whom 6 had oropharyngeal cancer, 10 had hypopharyngeal cancer, and 4 had laryngeal cancer. Fifteen patients received concurrent cisplatin and 2 received concurrent cetuximab chemotherapy. FDG PET/CT was performed before RT and in the 4th week of RT. The parameters of maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor were measured, and the prognostic significance of each was analyzed with the Cox proportional hazards model. RESULTS Higher TLG (>19.0) on FDG PET/CT during RT was a poor prognostic factor for overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.007). In the multivariate analysis, TLG during RT as a continuous variable was significantly associated with OS and PFS rate (p = 0.023 and p = 0.016, respectively). Tumor response worse than partial remission at 1 month after RT was another independent prognostic factor for PFS (p = 0.024). Conclusions: Higher TLG of the primary tumor on FDG PET/CT during RT was a poor prognostic factor for OS and PFS in patients with head and neck cancer.
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Affiliation(s)
- Suzy Kim
- Department of Radiation Oncology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sowon Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Otolaryngology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Chung-Ang University Hostpial, Seoul, Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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28
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Kabarriti R, Brodin NP, Lundgren G, Ohri N, Tomé WA, Kalnicki S, Garg MK. Early Response Assessment on Mid-treatment Computed Tomography Predicts for Locoregional Recurrence in Oropharyngeal Cancer Patients Treated With Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1036-1045. [PMID: 29779936 DOI: 10.1016/j.ijrobp.2018.03.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/19/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate whether a response assessment using mid-treatment computed tomography (CT) scans during definitive radiation therapy (RT) for oropharyngeal head and neck cancer can predict for locoregional recurrence (LRR). METHODS AND MATERIALS Head and neck cancer patients who receive RT at our institution undergo CT repeat scans at the 15th fraction, with treatment replanning in the case of an inadequate dose to gross disease or an increased dose to organs at risk. A retrospective cohort analysis was performed of 96 consecutive patients with oropharyngeal cancer treated from 2007 to 2015 with mid-treatment repeat CT scans available. The primary disease volume and involved lymph node volume were delineated on the pre- and mid-treatment CT scans. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate the efficacy of the mid-treatment reduction in tumor volume as a predictor of LRR. Risk stratification was performed by dichotomizing the patients into high- and low-risk groups according to the mid-treatment response and p16 status and smoking history. RESULTS With a median follow-up of 34 months, 14 patients experienced LRR. The median reduction in the total tumor volume was 18.7% (interquartile range 8.4%-30.9%). A reduction in total tumor volume greater than the median was an independent predictor of LRR (hazard ratio 0.22, 95% confidence interval 0.05-0.89; P = .020). The reduction in primary tumor volume was an even stronger predictor of LRR (hazard ratio 0.11, 95% confidence interval 0.02-0.57; P = .002). Stratifying patients into a high-risk group for those with a reduction in the total tumor volume at mid-treatment at or less than the median, p16 negative status, and smoking status of >10 pack-years and a low-risk group for those without these factors, we found a clear separation in Kaplan-Meier curves, with actuarial 3-year locoregional control, progression-free survival, and overall survival rates for the high-risk patients of 45.7%, 38.2%, and 71.8% compared with 90.7%, 70.6%, and 89.8% for low-risk patients, respectively (P ≤ .021 for all). CONCLUSIONS Our results have shown that the treatment response from an early assessment using mid-treatment CT scans is an independent predictor of LRR and can be used to effectively distinguish high- and low-risk patients, allowing for risk-adaptive treatment stratification at the midway point.
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Affiliation(s)
- Rafi Kabarriti
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - N Patrik Brodin
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York; Institute for Onco-Physics, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - George Lundgren
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York; Institute for Onco-Physics, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York
| | - Madhur K Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York.
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