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Chang CC, Chen CJ, Hsu WL, Chang SM, Huang YF, Tyan YC. Prognostic Significance of Metabolic Parameters and Textural Features on 18F-FDG PET/CT in Invasive Ductal Carcinoma of Breast. Sci Rep 2019; 9:10946. [PMID: 31358786 PMCID: PMC6662792 DOI: 10.1038/s41598-019-46813-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/25/2019] [Indexed: 12/19/2022] Open
Abstract
To investigate the prognostic significance of metabolic parameters and texture analysis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast invasive ductal carcinoma (IDC), from August 2005 to May 2015, IDC patients who had undergone pre-treatment FDG PET/CT were enrolled. The metabolic parameters, including maximal standardized uptake value of breast tumor (SUVbt) and ipsilateral axillary lymph node (SUVln), metabolic tumor volume (MTVbt) and total lesion glycolysis (TLGbt) of breast tumor, whole-body MTV (MTVwb) and whole-body TLG (TLGwb) were recorded. Nine textural features of tumor (four co-occurrence matrices and five SUV-based statistics) were measured. The prognostic significance of above parameters and clinical factors was assessed by univariate and multivariate analyses. Thirty-five patients were enrolled. Patients with low and high MTVwb had 5-year progression-free survival (PFS) of 81.0 and 14.3% (p < 0.0001). The 5-year overall survival for low and high MTVwb was 88.5% and 43.6% (p = 0.0005). Multivariate analyses showed MTVwb was an independent prognostic factor for PFS (HR: 8.29, 95% CI: 2.17–31.64, p = 0.0020). The SUV, TLG and textural features were not independently predictive. Elevated MTVwb was an independent predictor for shorter PFS in patients with breast IDC.
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Affiliation(s)
- Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Jung Chen
- Departments of Nuclear Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.,Department of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Wen-Ling Hsu
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Min Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Fong Huang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chang Tyan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Comelli A, Stefano A, Bignardi S, Russo G, Sabini MG, Ippolito M, Barone S, Yezzi A. Active contour algorithm with discriminant analysis for delineating tumors in positron emission tomography. Artif Intell Med 2019; 94:67-78. [PMID: 30871684 DOI: 10.1016/j.artmed.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/18/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
In the context of cancer delineation using positron emission tomography datasets, we present an innovative approach which purpose is to tackle the real-time, three-dimensional segmentation task in a full, or at least nearly full automatized way. The approach comprises a preliminary initialization phase where the user highlights a region of interest around the cancer on just one slice of the tomographic dataset. The algorithm takes care of identifying an optimal and user-independent region of interest around the anomalous tissue and located on the slice containing the highest standardized uptake value so to start the successive segmentation task. The three-dimensional volume is then reconstructed using a slice-by-slice marching approach until a suitable automatic stop condition is met. On each slice, the segmentation is performed using an enhanced local active contour based on the minimization of a novel energy functional which combines the information provided by a machine learning component, the discriminant analysis in the present study. As a result, the whole algorithm is almost completely automatic and the output segmentation is independent from the input provided by the user. Phantom experiments comprising spheres and zeolites, and clinical cases comprising various body districts (lung, brain, and head and neck), and two different radio-tracers (18 F-fluoro-2-deoxy-d-glucose, and 11C-labeled Methionine) were used to assess the algorithm performances. Phantom experiments with spheres and with zeolites showed a dice similarity coefficient above 90% and 80%, respectively. Clinical cases showed high agreement with the gold standard (R2 = 0.98). These results indicate that the proposed method can be efficiently applied in the clinical routine with potential benefit for the treatment response assessment, and targeting in radiotherapy.
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Affiliation(s)
- Albert Comelli
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA, 30332, USA; Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, PA, Italy; Department of Industrial and Digital Innovation (DIID) - University of Palermo, PA, Italy
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, PA, Italy.
| | - Samuel Bignardi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA, 30332, USA
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, PA, Italy; Medical Physics Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Massimo Ippolito
- Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy
| | - Stefano Barone
- Department of Industrial and Digital Innovation (DIID) - University of Palermo, PA, Italy
| | - Anthony Yezzi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA, 30332, USA
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Comelli A, Stefano A, Benfante V, Russo G. Normal and Abnormal Tissue Classification in Positron Emission Tomography Oncological Studies. PATTERN RECOGNITION AND IMAGE ANALYSIS 2018. [DOI: 10.1134/s1054661818010054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Berthon B, Evans M, Marshall C, Palaniappan N, Cole N, Jayaprakasam V, Rackley T, Spezi E. Head and neck target delineation using a novel PET automatic segmentation algorithm. Radiother Oncol 2017; 122:242-247. [PMID: 28126329 DOI: 10.1016/j.radonc.2016.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the feasibility and impact of using a novel advanced PET auto-segmentation method in Head and Neck (H&N) radiotherapy treatment (RT) planning. METHODS ATLAAS, Automatic decision Tree-based Learning Algorithm for Advanced Segmentation, previously developed and validated on pre-clinical data, was applied to 18F-FDG-PET/CT scans of 20 H&N patients undergoing Intensity Modulated Radiation Therapy. Primary Gross Tumour Volumes (GTVs) manually delineated on CT/MRI scans (GTVpCT/MRI), together with ATLAAS-generated contours (GTVpATLAAS) were used to derive the RT planning GTV (GTVpfinal). ATLAAS outlines were compared to CT/MRI and final GTVs qualitatively and quantitatively using a conformity metric. RESULTS The ATLAAS contours were found to be reliable and useful. The volume of GTVpATLAAS was smaller than GTVpCT/MRI in 70% of the cases, with an average conformity index of 0.70. The information provided by ATLAAS was used to grow the GTVpCT/MRI in 10 cases (up to 10.6mL) and to shrink the GTVpCT/MRI in 7 cases (up to 12.3mL). ATLAAS provided complementary information to CT/MRI and GTVpATLAAS contributed to up to 33% of the final GTV volume across the patient cohort. CONCLUSIONS ATLAAS can deliver operator independent PET segmentation to augment clinical outlining using CT and MRI and could have utility in future clinical studies.
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Affiliation(s)
- B Berthon
- Wales Research & Diagnostic PET Imaging Centre, Cardiff, UK.
| | - M Evans
- Velindre Cancer Centre, Cardiff, UK
| | - C Marshall
- Wales Research & Diagnostic PET Imaging Centre, Cardiff, UK
| | | | - N Cole
- Velindre Cancer Centre, Cardiff, UK
| | | | | | - E Spezi
- Velindre Cancer Centre, Cardiff, UK; School of Engineering, Cardiff University, Cardiff, UK
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An enhanced random walk algorithm for delineation of head and neck cancers in PET studies. Med Biol Eng Comput 2016; 55:897-908. [PMID: 27638108 DOI: 10.1007/s11517-016-1571-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 09/07/2016] [Indexed: 01/09/2023]
Abstract
An algorithm for delineating complex head and neck cancers in positron emission tomography (PET) images is presented in this article. An enhanced random walk (RW) algorithm with automatic seed detection is proposed and used to make the segmentation process feasible in the event of inhomogeneous lesions with bifurcations. In addition, an adaptive probability threshold and a k-means based clustering technique have been integrated in the proposed enhanced RW algorithm. The new threshold is capable of following the intensity changes between adjacent slices along the whole cancer volume, leading to an operator-independent algorithm. Validation experiments were first conducted on phantom studies: High Dice similarity coefficients, high true positive volume fractions, and low Hausdorff distance confirm the accuracy of the proposed method. Subsequently, forty head and neck lesions were segmented in order to evaluate the clinical feasibility of the proposed approach against the most common segmentation algorithms. Experimental results show that the proposed algorithm is more accurate and robust than the most common algorithms in the literature. Finally, the proposed method also shows real-time performance, addressing the physician's requirements in a radiotherapy environment.
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Davis CA, Thomas C, Abdolell M, Day A, Hollenhorst H, Rajaraman M, Mulroy L, Bowes D, Cwajna S, Rheaume D, Patil N, Burrell S, Wilke D. Investigating the Impact of Positron Emission Tomography–Computed Tomography Versus Computed Tomography Alone for High-risk Volume Selection in Head and Neck and Lung Patients Undergoing Radiotherapy: Interim Findings. J Med Imaging Radiat Sci 2015; 46:148-155. [DOI: 10.1016/j.jmir.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/13/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Son SH, Kim DH, Hong CM, Kim CY, Jeong SY, Lee SW, Lee J, Ahn BC. Prognostic implication of intratumoral metabolic heterogeneity in invasive ductal carcinoma of the breast. BMC Cancer 2014; 14:585. [PMID: 25112709 PMCID: PMC4148559 DOI: 10.1186/1471-2407-14-585] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this study was to evaluate the prognostic implication of findings of intratumoral metabolic heterogeneity on pretreatment 18F-FDG PET/CT scans in patients with invasive ductal carcinoma (IDC) of the breast. Methods One hundred and twenty-three female IDC patients who underwent pretreatment 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) scans were retrospectively evaluated in this study. The heterogeneity factor (HF) defined as the derivative (dV/dT) of a volume threshold function from 40% to 80%, was computed for each primary tumor. Other metabolic PET parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were measured. The HF was compared with clinicopathologic factors and other PET parameters. Univariate and multivariate analyses for the overall survival (OS) were performed. Results The HF ranged from 0.02 to 6.72 (mean, 0.35 ± 0.82) and significantly correlated with MTV (r = 0.955; p < 0.0001) and TLG (r = 0.354; p = 0.0001). The HF was significantly higher (implying more heterogeneity) in tumors with higher T and N stages. The optimal cut-off values for the OS determined using a receiver operating characteristic (ROC) curve were 0.34 for the HF, 5.6 for SUVmax, 8.55 cm3 for MTV, and 14.43 for TLG. The OS rate among the 123 patients was 86.2%. T stage (1, 2 vs. 3, 4), N stage (0, 1 vs. 2, 3), M stage (0 vs. 1), ER status (+ vs. –), SUVmax (≤ 5.6 vs. > 5.6), MTV (≤ 8.55 cm3 vs. > 8.55 cm3), TLG (≤ 14.43 vs. > 14.43), and HF (< 0.34 vs. ≥ 0.34) affected the OS on univariate analysis. After adjustment for the effects of TNM stage and ER status, the HF and MTV were significant predictors of OS. Among the PET parameters, the best prognostic factor for OS was the HF. Conclusions Intratumoral metabolic heterogeneity correlated closely with the MTV and significantly affected the OS in IDC patients. The HF may act as a robust surrogate marker for the prediction of OS in IDC patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50 Samduk-dong 2-ga, Jung-gu, Daegu 700-721, Republic of Korea.
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Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy. Strahlenther Onkol 2013; 189:197-201. [PMID: 23329277 DOI: 10.1007/s00066-012-0283-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Reliable tumor staging is a fundamental pre-requisite for efficient tumor therapy and further prognosis. The aim of this study was to compare head and neck cancer (HNC) staging before and after FDG-PET/CT, evaluating the stage modifications for radiotherapy (RT) planning. PATIENTS AND METHODS A total of 102 patients with untreated primary HNC, who underwent conventional staging and staging including FDG-PET/CT before RT, were enrolled in this retrospective study. Blinded pre-FDG-PET/CT and post-FDG-PET/CT staging data were compared. The impact on patient management was tested by comparing the intention before and after FDG-PET/CT. RESULTS Significant modifications of T, N, and M stage as well as clinical stage were detected after inclusion of FDG-PET/CT data (p = 0.002, 0.0006, 0.001, 0.03, respectively). Overall, the implementation of FDG-PET/CT led to modification of RT intention decision in 14 patients. CONCLUSIONS FDG-PET/CT demonstrates essential influence on tumor staging in HNC patients scheduled for irradiation. Implementation of FDG-PET/CT in imaging protocol improves selection of candidates for curative and palliative RT and allows further optimization of treatment management and therapy intention.
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Newbold K, Powell C. PET/CT in Radiotherapy Planning for Head and Neck Cancer. Front Oncol 2012; 2:189. [PMID: 23233906 PMCID: PMC3518254 DOI: 10.3389/fonc.2012.00189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/20/2012] [Indexed: 11/25/2022] Open
Abstract
The use of PET/CT as an adjunct in radiotherapy planning is an attractive option in head and neck cancer (HNC) for several reasons. First, with potentially better identification of the disease extent, i.e., staging, the risk of geographical miss of radiation delivery to the gross tumor volume is reduced. Second, in characterizing the biological behavior of the disease for example, areas of hypoxia, rich or poor vascularity, or high cell proliferation, PET/CT can identify biological target volumes either for escalation of radiation dose or to predict the requirement for the addition of a radiosensitizer or alternative treatment strategies. 18F-FDG is the most common tracer used in oncology studies, but many other tracers have been investigated with several entering clinical practice, although these remain predominantly in the research domain in HNC.
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Affiliation(s)
- Katie Newbold
- The Royal Marsden National Health Service Trust London, UK
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Nasopharyngeal carcinoma: investigation of intratumoral heterogeneity with FDG PET/CT. AJR Am J Roentgenol 2012; 199:169-74. [PMID: 22733909 DOI: 10.2214/ajr.11.7336] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to quantitatively evaluate the role of intratumoral heterogeneity of (18)F-FDG uptake in characterizing nasopharyngeal carcinoma (NPC). SUBJECTS AND METHODS Forty consecutively registered patients with newly diagnosed NPC underwent PET/CT. The heterogeneity factor, defined as the derivative of a volume threshold function, was computed for each tumor. The relations between heterogeneity factor and maximum standardized uptake value (SUV(max)), tumor volume, and TNM category were determined by two-tailed Spearman correlation. Factors that potentially affect outcome determined by disease-free survival were studied by Kaplan-Meier analysis with a log-rank test for univariate analysis and the Cox proportional hazard model for multivariate analysis. RESULTS The heterogeneity factor ranged from -1.80 to -0.13 (mean, -0.40 [SD, 0.40]) and significantly correlated with SUV(max) (r = -0.372; p = 0.018), tumor volume (r = -0.983; p < 0.001), and T category (r = -0.457; p = 0.003) but not with N and M categories. There was a significant difference in heterogeneity factor between T1 and T2 tumors and T3 and T4 tumors (p = 0.012). The 2-year disease-free survival rate among the 38 patients was 67.4%. According to the results of Kaplan-Meier analysis with the log-rank test, heterogeneity factor and M category significantly affected disease-free survival. Patients with tumors that had a heterogeneity factor greater than -0.24 (less-heterogeneous group) (p = 0.0498) or M0 status (p < 0.001) had better disease-free survival rates. Multivariate analysis showed only M category to be an independent predictor of disease-free survival (p < 0.001). CONCLUSION The intratumoral heterogeneity of FDG uptake varies across NPC tumors, significantly correlates with tumor aggressiveness, and is predictive of patient outcome. These findings may be useful for characterizing NPC, predicting survival, and improving patient care.
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Perez-Romasanta LA, Bellon-Guardia M, Torres-Donaire J, Lozano-Martin E, Sanz-Martin M, Velasco-Jimenez J. Tumor volume delineation in head and neck cancer with 18-fluor-fluorodeoxiglucose positron emission tomography: adaptive thresholding method applied to primary tumors and metastatic lymph nodes. Clin Transl Oncol 2012; 15:283-93. [PMID: 22865325 DOI: 10.1007/s12094-012-0914-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/04/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE There are several potential advantages of using 18-fluor-fluorodeoxiglucose (18F-FDG) PET for target volume contouring, but before PET-based gross tumor volumes (GTVs) can reliably and reproducibly be incorporated into high-precision radiotherapy planning, operator-independent segmentation tools have to be developed and validated. The purpose of the present work was to apply the adaptive to the signal/background ratio (R(S/B)) thresholding method for head and neck tumor delineation, and compare these GTV(PET) to reference GTV(CT) volumes in order to assess discrepancies. MATERIALS AND METHODS A cohort of 19 patients (39 lesions) with a histological diagnosis of head and neck cancer who would undergo definitive concurrent radiochemotherapy or radical radiotherapy with intensity-modulated radiotherapy technique (IMRT), were enrolled in this prospective study. Contouring on PET images was accomplished through standardized uptake value (SUV)-threshold definition. The threshold value was adapted to R(S/B). To determine the relationship between the threshold and the R(S/B), we performed a phantom study. A discrepancy index (DI) between both imaging modalities, overlap fraction (OF) and mismatch fraction (MF) were calculated for each lesion and imaging modality. RESULTS The median DI value for lymph nodes was 2.67 and 1.76 for primary lesions. The OF values were larger for CT volumes than for PET volumes (p < 0.001), for both types of lesions. The MF values were smaller for CT volumes than for PET volumes (p < 0.001), for both types of lesions. The GTV(PET) coverage (OF(PET)) was strongly correlated with the lesion volume (GTV(CT)) for metastatic lymph nodes (Pearson correlation = 0.665; p < 0.01). For smaller lesions, despite the GTV volumes were relatively larger on PET than in CT contours, the coverage was poorer. Accordingly, the MF(PET/CT) was negatively correlated with the lesion volume for metastatic lymph nodes. CONCLUSIONS The present study highlights the considerable challenges involved in using FDG PET imaging for the delineation of GTV in head and neck neoplasms. The methods that rely mainly on SUV(max) for thresholding, as the RS/B method, are very sensitive to partial volume effects and may provide unreliable results when applied on small lesions.
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Collan J, Kapanen M, Mäkitie A, Nyman H, Joensuu H, Tenhunen M, Saarilahti K. Submandibular gland-sparing intensity modulated radiotherapy in the treatment of head and neck cancer: sites of locoregional relapse and survival. Acta Oncol 2012; 51:735-42. [PMID: 22150115 DOI: 10.3109/0284186x.2011.640348] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the patterns of locoregional relapse and survival following submandibular gland (SMG)-sparing intensity modulated radiotherapy (IMRT). PATIENTS AND METHODS Eighty patients with laryngeal (n = 15), oropharyngeal (n = 50), hypopharyngeal (n = 11) or nasopharyngeal cancer (n = 4) were treated by submandibular gland-sparing IMRT for head and neck squamous cell cancer between July 2000 and December 2008. All patients were treated by bilateral IMRT. Thirty-nine (49%) received definitive radiotherapy (RT) and 41 (51%) postoperative RT. The contralateral parotid gland (PG) and SMG were included in the dose optimization planning program with intent to keep the mean doses for PG and SMG below 23 Gy and 28-30 Gy, respectively. The ipsilateral glands were also spared when considered feasible. RESULTS During a median follow-up time of 51 months (range, 24-117 months) nine local recurrent tumors were observed. Four of these nine patients were salvaged by surgery with no further recurrence. All local recurrences were located within the high-dose CTVs. None of the locally recurrent cancers were located at the vicinity of the spared PGs or SMGs. No recurrent tumors were observed in the contralateral neck. The Kaplan-Meier estimate for local control at five years following IMRT was 88% for the whole cohort and the corresponding figure for local control following salvage surgery was 94%. The estimates for five-year overall survival and disease-specific survival were 85% and 90%, respectively. CONCLUSION In selected head and neck cancer patients who are estimated to have a low risk of cancer recurrence at the nodal levels I-II and who are treated with SMG-sparing IMRT the risk of cancer recurrence at the vicinity of the spared salivary glands is low.
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Affiliation(s)
- Juhani Collan
- Department of Oncology, Helsinki University Central Hospital, Finland
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Zhu A, Marcus DM, Shu HKG, Shim H. Application of metabolic PET imaging in radiation oncology. Radiat Res 2012; 177:436-48. [PMID: 22339451 DOI: 10.1667/rr2702.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides functional or metabolic assessment of normal tissue or disease conditions and is playing an increasing role in cancer radiotherapy planning. (18)F-Fluorodeoxyglucose PET imaging (FDG-PET) is widely used in the clinic for tumor imaging due to increased glucose metabolism in most types of tumors; its role in radiotherapy management of various cancers is reviewed. In addition, other metabolic PET imaging agents at various stages of preclinical and clinical development are reviewed. These agents include radiolabeled amino acids such as methionine for detecting increased protein synthesis, radiolabeled choline for detecting increased membrane lipid synthesis, and radiolabeled acetate for detecting increased cytoplasmic lipid synthesis. The amino acid analogs choline and acetate are often more specific to tumor cells than FDG, so they may play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with either low FDG uptake or high background FDG uptake. PET imaging with FDG and other metabolic PET imaging agents is playing an increasing role in complementary radiotherapy planning.
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Affiliation(s)
- Aizhi Zhu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Haerle SK, Soyka MB, Schmid DT, Ahmad N, Huber GF, Crook DW, Hany TF. Improved treatment outcomes with 18F-FDG PET/CT for patients with advanced head and neck squamous cell carcinoma. Head Neck 2011; 34:1205-11. [DOI: 10.1002/hed.21887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/13/2011] [Accepted: 06/27/2011] [Indexed: 11/11/2022] Open
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Abstract
Testicular cancer is a rare tumor, subdivided into seminomatous and nonseminomatous tumors. Whereas there are no serum tumor markers in the first group, they are present in nonseminomatous tumors, and are also important prognostic factors. Overall, the prognosis for testicular cancers is good, which makes the choice of accurate treatment intensity between under- and overtreatment often difficult. Residual masses in advanced clinical stages occur frequently but are nonvital tissue. PET with F-18 FDG has no defined role in imaging of primary tumors where CT is the first-choice imaging modality. For assessing the success of chemotherapy in the presence of residual masses, especially in pure seminoma, F-18 FDG PET is an important tool. In nonseminomatous tumors, it is hampered by the false-negative results in mature teratoma, for which reason false-negative results are a common problem. F-18 FDG PET performs best in predicting relapse in seminoma residuals larger than 3 cm. So far, no alternative to F-18 FDG for PET imaging of testicular cancer has been found. PET-CT has not yet been proven to be superior to PET alone in testicular cancer.
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Grau C, Olsen DR, Overgaard J, Høyer M, Lindegaard JC, Muren LP. Biology-guided adaptive radiation therapy - presence or future? Acta Oncol 2010; 49:884-7. [PMID: 20831476 DOI: 10.3109/0284186x.2010.516010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
MESH Headings
- Adaptation, Biological/physiology
- Adaptation, Biological/radiation effects
- Biology/methods
- Biology/trends
- Dose Fractionation, Radiation
- Fluorodeoxyglucose F18
- Humans
- Radiation Oncology/methods
- Radiation Oncology/trends
- Radiosurgery/methods
- Radiosurgery/trends
- Radiotherapy Dosage
- Radiotherapy, Computer-Assisted/methods
- Radiotherapy, Computer-Assisted/trends
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Conformal/trends
- Surgery, Computer-Assisted/methods
- Surgery, Computer-Assisted/trends
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Even-Sapir E, Keidar Z, Bar-Shalom R. Hybrid imaging (SPECT/CT and PET/CT)--improving the diagnostic accuracy of functional/metabolic and anatomic imaging. Semin Nucl Med 2010; 39:264-75. [PMID: 19497403 DOI: 10.1053/j.semnuclmed.2009.03.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In-line combined systems, single-photon emission computed tomography (SPECT)/computed tomography (CT) and positron emission tomography (PET)/CT, allow an instant generation of fused images of scintigraphy and CT data. The accumulated clinical data on the use of these systems in various clinical scenarios indicate that this hybrid technology improves the diagnostic accuracy as compared to scintigraphy and CT alone and even to side-by-side interpretation of scintigraphy and CT, which were acquired separately. The improved diagnostic accuracy is reflected by improving image quality of SPECT and PET, detection of more clinically relevant lesions, better localization of disease and differentiation between physiologic and pathologic uptake, characterization of disease by its functional and morphologic appearance before and after therapy and accurate delineation of disease, optimizing biopsy and therapy planning.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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18F-Fluorodeoxyglucose-PET/CT to evaluate tumor, nodal disease, and gross tumor volume of oropharyngeal and oral cavity cancer: comparison with MR imaging and validation with surgical specimen. Neuroradiology 2009; 51:677-86. [PMID: 19727695 DOI: 10.1007/s00234-009-0586-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 07/19/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The purpose of this paper is to evaluate the impact of adding combined 18F-PET/CT to MRI for T and N staging of the oral and oropharyngeal cancer and calculation of the gross tumor volume (GTV) having histopathology as reference standard. METHODS PET/CT and MRI were performed in 66 patients with suspected oral and oropharyngeal cancer (41 primary tumors/25 recurrent tumors) and nodal disease (114 nodes). Statistical analysis included the McNemar test, sensitivity, specificity for the diagnostic modalities as well as regression analysis, and Bland-Altman graphs for calculated tumor volumes. RESULTS There was no statistically significant difference between the two modalities compared to pathological findings regarding detection of disease (P > or =0.72). The sensitivity/specificity for tumor detection were 100/80% and 96.72/60% for MRI and PET/CT, respectively. The sensitivity/specificity for nodal metastases were 88.46/75% and 83.81/73.91% for MRI and PET/CT, respectively. In 18% of cases, the MRI-based T staging resulted in an overestimation of the pathologic tumor stage. The corresponding rate for PET/CT was 22%. Regarding the treated necks, both modalities showed 100% sensitivity for detection of the recurrent lesions. In necks with histologically N0 staging, MRI and PET/CT gave 22% and 26% false positive findings, respectively. The mean tumor volume in the pathologic specimen was 16.6 +/- 18.6 ml, the mean volume derived by the MR imaging was 17.6 +/- 19.1 ml while the estimated by PET/CT volume was 18.8 +/- 18.1 ml (P < or =0.007 between the three methods). The Bland-Altman analysis showed a better agreement between PET/CT and MRI. CONCLUSION The diagnostic performance of FDG-PET/CT in the local staging of oral cancer is not superior to MRI.
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Grau C, Muren LP, Høyer M, Lindegaard J, Overgaard J. Image-guided adaptive radiotherapy - integration of biology and technology to improve clinical outcome. Acta Oncol 2009; 47:1182-5. [PMID: 18654901 DOI: 10.1080/02841860802282802] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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