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Muxí A, Vidal-Sicart S, Vilaseca I. Refining the staging of head and neck tumors. The role of Nuclear Medicine. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Muxí A, Vidal-Sicart S, Vilaseca I. Refining the staging in head & neck tumors. Role of nuclear medicine. Rev Esp Med Nucl Imagen Mol 2019; 38:137-139. [PMID: 30992199 DOI: 10.1016/j.remn.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Africa Muxí
- Comité Multidisciplinar de Tumores de Cabeza y Cuello, Servicio de Medicina Nuclear, Hospital Clínic. Grupo de Investigación «Diagnòstic i Terapèutica en Oncologia» de AGAUR y Centre d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, España.
| | - Sergi Vidal-Sicart
- Grupo de Trabajo de Cirugía Radioguiada de la SEMNIM, Servicio de Medicina Nuclear, Hospital Clínic. Grupo de Investigación «Diagnòstic i Terapèutica en Oncologia» de AGAUR y Centre d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, España
| | - Isabel Vilaseca
- Comité Multidisciplinar de Tumores de Cabeza y Cuello, Servicio de Otorrinolaringología, Hospital Clínic. Facultad de Medicina, Universitat de Barcelona. Head Neck Clínic AGAUR y Centre d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, España
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Pedraza S, Ruiz-Alonso A, Hernández-Martínez AC, Cabello E, Lora D, Pérez-Regadera JF. 18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. Rev Esp Med Nucl Imagen Mol 2019; 38:154-159. [PMID: 30655026 DOI: 10.1016/j.remn.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/07/2018] [Accepted: 08/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.
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Affiliation(s)
- S Pedraza
- Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, España.
| | - A Ruiz-Alonso
- Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, España
| | | | - E Cabello
- Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, España
| | - D Lora
- Clinical Epidemiology Unit, CIBERESP, University Hospital 12 de Octubre, Madrid, España
| | - J F Pérez-Regadera
- Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, España
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Stromberger C, Ghadjar P, Marnitz S, Thieme AH, Jahn U, Raguse JD, Karaj-Rossbacher E, Böttcher A, Jamil B, Budach V. Comparative treatment planning study on sequential vs. simultaneous integrated boost in head and neck cancer patients: Differences in dose distributions and potential implications for clinical practice. Strahlenther Onkol 2016; 192:17-24. [PMID: 26462675 DOI: 10.1007/s00066-015-0913-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/25/2015] [Indexed: 11/25/2022]
Abstract
AIM The purpose of this work was to compare sequential (SeqB) versus simultaneous integrated boost (SIB) radiotherapy plans delivered with volumetric modulated arc therapy (VMAT) for patients with locally advanced squamous cell cancer of the head and neck (HNSCC). PATIENTS AND METHODS SeqB and SIB plans using VMAT for 10 HNSCC patients given definitive chemoradiation were generated and analysed for differences in dose distribution, coverage, conformity and homogeneity to the planning target volumes (PTV) 1-3 and sparing of organs at risk (OAR). RESULTS The mean delineated volumes ± standard deviations were 137.7 ± 44.8, 351.3 ± 83.9 and 895.6 ± 120.5 cm3 for PTV1-3. The mean volumes encompassed by the corresponding 95 % isodoses were 281 (+ 110 %) ± 73.4, 712.2 (+ 115 %) ± 146.4 and 1381.1 (+ 54 %) ± 217.3 cm3 with SeqB and 138.2 (+ 7 %) ± 40.1, 380.4 (+ 11 %) ± 91.9 and 1057.3 (+ 21 %) ± 161.4 cm3 with SIB for PTV1-3, respectively. Both strategies achieved excellent PTV coverage. SeqB provided significantly better coverage of PTV1 and 3, worse conformity for PTV1-3 and a higher mean dose than prescribed (111-115 %) to PTV2 and 3 (p ≤ 0.007). Both strategies provided satisfactory OAR sparing. CONCLUSION This study showed significant dosimetric differences with potential clinical relevance between two VMAT boost strategies regarding coverage, conformity and dose to the PTVs. SIB might cause less toxicity. A clinical phase III/IV trial endorsed by the German Head and Neck Clinical Trials Group (IAG-KHT) will evaluate differences in acute/late toxicity as well as in locoregional recurrences between the two boost techniques.
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Reis I, Aguiar A, Alzamora C, Ferreira C, Castro V, Soares A, Lobão M. Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation. Radiol Bras 2016; 49:21-5. [PMID: 26929457 PMCID: PMC4770393 DOI: 10.1590/0100-3984.2015.0018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Objective The present study was aimed at describing a single-institution experience in
the curative treatment of patients diagnosed with locally advanced
hypopharyngeal squamous cell carcinoma. Materials and Methods Data concerning all patients treated for locally advanced hypopharyngeal
squamous cell carcinoma between January 2006 and June 2012 were
reviewed. Results A total of 144 patients were included in the present study. The median
follow-up period was 36.6 months. Median survival was 26 months, and 2-year
and 5-year overall survival rates were, 51% and 30.5%, respectively. Median
recurrence-free survival was 18 months and 2-year and 5-year recurrence-free
survival rates were 42.8% and 28.5%, respectively. Conclusion The outcomes in the present series are in line with the literature.
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Affiliation(s)
- Isabel Reis
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Artur Aguiar
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Cristiana Alzamora
- MDs, Radiation Oncology Residents, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Carolina Ferreira
- MDs, Radiation Oncology Residents, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Vera Castro
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - André Soares
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Marisa Lobão
- MDs, Radiation Oncologists, Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
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Influence of the type of imaging on the delineation process during the treatment planning. Rep Pract Oncol Radiother 2015; 20:351-7. [PMID: 26549992 DOI: 10.1016/j.rpor.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 02/27/2015] [Accepted: 05/24/2015] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of this study was to compare the intra- and interobserver contouring variability for structures with density of organ at risk in two types of tomography: kilovoltage computed tomography (KVCT) versus megavoltage computed tomography (MVCT). The intra- and interobserver differences were examined on both types of tomography for structures which simulate human tissue or organs. MATERIALS AND METHODS Six structures with density of the liver, bone, trachea, lung, soft tissue and muscle were created and used. For the measurements, the special water phantom with all structures was designed. To evaluate interobserver variability, five observers delineated the structures in both types of computed tomography (CT). RESULTS Intraobserver variability was in the range of 1-14% and was the largest for the liver. The observers segmented larger volumes on MVCT compared with KVCT for the trachea (79.56 ccm vs.74.91 ccm), lung (87.61 vs. 82.50), soft tissue (154.24 vs. 145.47) and muscle (164.01 vs. 157.89). For the liver (98.13 vs. 99.38) and bone (51.86 vs. 67.97), the volume on MVCT was smaller than KVCT. The statistically significant differences between observers were observed for structures with density of the liver, bone and soft tissue on KVCT and for the liver, lung and soft tissue on MVCT. For the structures with density of the trachea and muscles, there were no significant differences for both types of tomography. CONCLUSIONS During the contouring process the interobserver and intraobserver contouring uncertainty was larger on MVCT, especially for structures with HU near 80, compared with KVCT.
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FDG PET/CT for Management and Assessing Outcomes of Squamous Cell Cancer of the Oral Cavity. AJR Am J Roentgenol 2015; 205:W150-61. [DOI: 10.2214/ajr.14.13830] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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González Ferreira JA, Jaén Olasolo J, Azinovic I, Jeremic B. Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: Review of the literature. Rep Pract Oncol Radiother 2015; 20:328-39. [PMID: 26549990 DOI: 10.1016/j.rpor.2015.05.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/31/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022] Open
Abstract
Treatment delays in completing radiotherapy (RT) for many neoplasms are a major problem affecting treatment outcome, as increasingly shown in the literature. Overall treatment time (OTT) could be a critical predictor of local tumor control and/or survival. In an attempt to establish a protocol for managing delays during RT, especially for heavily overloaded units, we have extensively reviewed the available literature on head and neck cancer. We confirmed a large deleterious effect of prolonged OTT on both local control and survival of these patients.
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Affiliation(s)
| | - Javier Jaén Olasolo
- Comprehensive Cancer Care Unit, Puerta del Mar and Puerto Real University Hospitals, Ana de Viya Avenue 21, 11009 Cádiz, Spain
| | - Ignacio Azinovic
- IMO-Group Medical Director, República Argentina Square 7, 28002 Madrid, Spain
| | - Branislav Jeremic
- Institute of Lung Diseases, Sremska Kamenica, Serbia ; BioIRC Centre for Biomedical Research, Kragujevac, Serbia
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Multimodality functional imaging in radiation therapy planning: relationships between dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:103843. [PMID: 25788972 PMCID: PMC4350945 DOI: 10.1155/2015/103843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/15/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Biologically guided radiotherapy needs an understanding of how different functional imaging techniques interact and link together. We analyse three functional imaging techniques that can be useful tools for achieving this objective. MATERIALS AND METHODS The three different imaging modalities from one selected patient are ADC maps, DCE-MRI, and 18F-FDG PET/CT, because they are widely used and give a great amount of complementary information. We show the relationship between these three datasets and evaluate them as markers for tumour response or hypoxia marker. Thus, vascularization measured using DCE-MRI parameters can determine tumour hypoxia, and ADC maps can be used for evaluating tumour response. RESULTS ADC and DCE-MRI include information from 18F-FDG, as glucose metabolism is associated with hypoxia and tumour cell density, although 18F-FDG includes more information about the malignancy of the tumour. The main disadvantage of ADC maps is the distortion, and we used only low distorted regions, and extracellular volume calculated from DCE-MRI can be considered equivalent to ADC in well-vascularized areas. CONCLUSION A dataset for achieving the biologically guided radiotherapy must include a tumour density study and a hypoxia marker. This information can be achieved using only MRI data or only PET/CT studies or mixing both datasets.
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