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Pasciuto T, Moro F, Collarino A, Gambacorta MA, Zannoni GF, Oradei M, Ferrandina MG, Gui B, Testa AC, Rufini V. The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery. Cancers (Basel) 2023; 15:3071. [PMID: 37370682 DOI: 10.3390/cancers15123071] [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: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. METHODS Patients with histologically proven LACC, stage IB2-IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment ("baseline", "early" and "final", respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. RESULTS Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT "baseline" and "final" examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at "final" evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71-0.90) and 0.81 (0.72-0.90), respectively). CONCLUSION The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.
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Affiliation(s)
- Tina Pasciuto
- Data Collection G-STeP Research Core Facility, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Francesca Moro
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Maria Antonietta Gambacorta
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Radiology, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gian Franco Zannoni
- Gynecopathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Pathology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Marco Oradei
- ALTEMS (Graduate School of Health Economics and Management), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Maria Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Benedetta Gui
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Antonia Carla Testa
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Budak A, Budak E, Kanmaz AG, Inan AH, Tosun G, Beyan E, Aldemir OS, Ileri A. Volumetric PET parameters are predictive for the prognosis of locally advanced cervical cancer. 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... 2023; 67:69-74. [PMID: 33686848 DOI: 10.23736/s1824-4785.21.03324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study evaluates the relationship between PET/CT findings and survival in patients with locally advanced cervical cancer (LACC) with a squamous cell histology. METHODS The study included 70 patients with LACC (FIGO stage IB2-IVA). The relationship between pretreatment PET/CT parameters, age, stage, lymph node metastasis and survival was evaluated using the univariate and multivariate Cox proportional hazards model. RESULTS The mean age of the 70 patients was 57.4 years and the mean duration of follow-up was 33.6 months. Disease progression occurred in 36 patients and 32 patients died during the follow-up period. In the univariate analysis, MTV-P and TLG-P were found to be related to progression-free survival (PFS), and stage, MTV-P, TLG-P and SUV<inf>max</inf>-Ps were found to be related to overall survival (OS). However, only MTV-P and TLG-P were found to be independent prognostic factors for both PFS and OS. CONCLUSIONS The present findings suggest that volumetric PET parameters (MTV-P, TLG-P) predict the progression and survival of the patients with LACC.
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Affiliation(s)
- Adnan Budak
- Department of Obstetrics and Gynecology, Tepecik Hospital, Izmir, Türkiye
| | - Emine Budak
- Department of Nuclear Medicine, Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye -
| | - Ahkam G Kanmaz
- Department of Obstetrics and Gynecology, Tepecik Hospital, Izmir, Türkiye
| | - Abdurrahman H Inan
- Department of Obstetrics and Gynecology, Tepecik Hospital, Izmir, Türkiye
| | - Gökhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Hospital, Izmir, Türkiye
| | - Emrah Beyan
- Department of Obstetrics and Gynecology, Su Hospital, Izmir, Türkiye
| | - Onur S Aldemir
- Department of Obstetrics and Gynecology, Çınarlı Hospital, Izmir, Türkiye
| | - Alper Ileri
- Department of Obstetrics and Gynecology, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Türkiye
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Kidd EA. Imaging to optimize gynecological radiation oncology. Int J Gynecol Cancer 2022; 32:358-365. [DOI: 10.1136/ijgc-2021-002460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/27/2021] [Indexed: 01/09/2023] Open
Abstract
Gynecological cancers have particularly benefited from the increasing use of imaging to guide radiation treatment planning for both external beam radiation and brachytherapy. While the different gynecological cancers have varying use of imaging, certain trends predominate. CT represents an economical choice for evaluating initial disease extent or potential metastasis at follow-up, particularly for endometrial and ovarian cancers. F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is particularly useful for assessing the initial disease extent and longer term treatment response of squamous predominant cancers, including cervical, vaginal, and vulvar cancers. With its excellent pelvic soft tissue discrimination, MRI provides the greatest assistance in evaluating the local extent of gynecological tumors, including initial evaluation for non-operative endometrial and vulvar cancer, and assessment before, after and during brachytherapy for cervix, locally recurrent endometrial, and primary vaginal cancers. With more limited availability of MRI, ultrasound can also help guide brachytherapy, particularly during procedures. The benefits of using imaging to better spare bone marrow or earlier assessment of treatment response are topics still being explored, in particular for cervical cancer. As imaging along with radiation oncology technologies continue to evolve and develop, such as with MRI-linacs and ultra high dose rate (FLASH) radiation, we may continue to see increasing use of imaging for advancing gynecological radiation oncology.
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The value of metabolic parameters and textural analysis in predicting prognosis in locally advanced cervical cancer treated with chemoradiotherapy. Strahlenther Onkol 2022; 198:792-801. [PMID: 35072751 PMCID: PMC9402502 DOI: 10.1007/s00066-022-01900-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Objective The aim of the study was to assess the impact of clinical and metabolic parameters derived from 18F-FDG PET/CT (positron emission tomography–computed tomography) in patients with locally advanced cervical cancer (LACC) on prognosis. Methods Patients with LACC of stage IB2-IVA treated by primary radiochemotherapy followed by brachytherapy were enrolled in this retrospective study. Indexes derived from standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and textural features of the primary tumor were measured for each patient. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated according to Kaplan–Meier and survival curves were compared using the log-rank test. Uni- and multivariate analyses were performed using the Cox regression model. Results A total of 116 patients were included. Median follow-up was 58 months (range: 1–129). A total of 36 (31%) patients died. Five-year OS and RFS rates were 69 and 60%, respectively. Univariate analyses indicated that FIGO stage, the presence of hydronephrosis, high CYFRA 21.1 levels, and textural features had a significant impact on OS and RFS. MTV as well as SCC-Ag concentration were also significantly associated with OS. On multivariate analysis, the presence of hydronephrosis, CYFRA 21.1, and sphericity were independent prognostics factors for OS and RFS. Also, SCC-Ag level, MTV, and GLZLM (gray-level zone length matrix) ZLNU (zone length non-uniformity) were significantly associated with OS. Conclusion Classical prognostic factors and tumor heterogeneity on pretreatment PET/CT were significantly associated with prognosis in patients with LACC.
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Burchardt E, Warenczak-Florczak Z, Cegła P, Piotrowski A, Cybulski Z, Burchardt W, Roszak A, Cholewiński W. Differences between [18F]FLT and [18F]FDG Uptake in PET/CT Imaging in CC Depend on Vaginal Bacteriology. Diagnostics (Basel) 2021; 12:diagnostics12010070. [PMID: 35054237 PMCID: PMC8774914 DOI: 10.3390/diagnostics12010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to investigate if vaginal bacteriology obtained prior to treatment influences the 3′-deoxy-3 18F-fluorothymidine (FLT) [18F]FLT and 2-deoxy-2-[18F]fluoro-d-glucose (2-[18F]FDG) [18F]FDG parameters in positron emission tomography (PET/CT) in cervical cancer (CC) patients. Methods: Retrospective analysis was performed on 39 women with locally advanced histologically confirmed cervical cancer who underwent dual tracer PET/CT examinations. The [18F]FLT and [18F]FDG PET parameters in the primary tumor, including SUVmax, SUVmean, MTV, heterogeneity, before radiotherapy (RT) were analyzed, depending on the bacteriology. The p-values < 0.05 were considered statistically significant. Results: In the vaginal and/or cervical smears, there were 27 (79.4%) positive results. In seven (20.6%) cases, no opportunistic pathogen growth was observed (No Bacteria Group). In positive bacteriology, eleven (32%) Gram-negative bacilli (Bacteria group 2) and fifteen (44%) Gram-positive bacteria (Bacteria group 1) were detected. Five patients with unknown results were excluded from the analysis. Data analysis shows a statistically significant difference between the SUVmax, and SUVmin values for three independent groups for the [18F]FLT. Conclusions: The lowest values of SUVmax and SUVmin for [18F]FLT are registered in Gram-negative bacteria, higher are in Gram-positive, and the absence of bacteria causes the highest [18F]FLT values.
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Affiliation(s)
- Ewa Burchardt
- Department of Radiotherapy and Oncological Gynecology, Greater Poland Cancer Center, 61-866 Poznan, Poland; (Z.W.-F.); (A.R.)
- Department of Electroradiology, University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Correspondence:
| | - Zaneta Warenczak-Florczak
- Department of Radiotherapy and Oncological Gynecology, Greater Poland Cancer Center, 61-866 Poznan, Poland; (Z.W.-F.); (A.R.)
- Department of Electroradiology, University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
| | - Paulina Cegła
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Adam Piotrowski
- Faculty of Physics, Adam Mickiewicz University, 61-614 Poznan, Poland;
| | - Zefiryn Cybulski
- Greater Poland Cancer Center, Microbiology Laboratorium, 61-866 Poznan, Poland;
| | - Wojciech Burchardt
- Department of Electroradiology, University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
| | - Andrzej Roszak
- Department of Radiotherapy and Oncological Gynecology, Greater Poland Cancer Center, 61-866 Poznan, Poland; (Z.W.-F.); (A.R.)
- Department of Electroradiology, University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
| | - Witold Cholewiński
- Department of Electroradiology, University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
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A Systematic Review and Meta-Analysis of the Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters in Patients with Locally Advanced Cervical Cancer Treated with Concomitant Chemoradiotherapy. Diagnostics (Basel) 2021; 11:diagnostics11071258. [PMID: 34359345 PMCID: PMC8304455 DOI: 10.3390/diagnostics11071258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Backgrounds: The purpose of this paper is to investigate the prognostic value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in patients treated with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Methods: Studies that met the following criteria were retrieved from PubMed and Embase: patients treated with CCRT for LACC; FDG PET/CT scans performed before CCRT treatment; and a detected relationship between the parameters of FDG PET/CT and the prognosis of patients. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate the overall survival (OS) or event-free survival (EFS). Results: In total, 14 eligible studies with 1313 patients were included in this meta-analysis. Patients with a high maximum standardized uptake value (SUVmax) have a shorter OS than those with a low SUVmax (HR = 2.582, 95% = CI 1.936–3.443, p < 0.001). Primary tumor SUVmax values (HR = 1.938, 95% CI = 1.203–3.054, p = 0.004) were significantly correlated with EFS, with a relatively high heterogeneity (I2 = 84% and I2 = 69.4%, respectively). Based on the limited data, the combined HR for EFS with the highest primary tumor total lesion glycolysis (TLG) and metabolic tumor volume (MTV) was 1.843 (95% CI = 1.100–3.086, p = 0.02) and 2.06 (95% CI = 1.21–3.51, p = 0.007), respectively. Besides, the combined HR for OS with the highest nodal SUVmax was 2.095 (95% CI = 2.027–2.166, p < 0.001). Conclusion: A high primary SUVmax has a significant correlation with the OS and EFS of patients treated with CCRT for LACC and may therefore serve as a prognostic predictor. Due to the limited data, to explore the correlation between survival and TLG, MTV, and nodal SUVmax, further large-scale prospective studies are needed.
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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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Value of Intratumoral Metabolic Heterogeneity and Quantitative18F-FDG PET/CT Parameters in Predicting Prognosis for Patients With Cervical Cancer. AJR Am J Roentgenol 2020; 214:908-916. [DOI: 10.2214/ajr.19.21604] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Carpenter DJ, Jacobs CD, Wong TZ, Craciunescu O, Chino JP. Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis. Int J Radiat Oncol Biol Phys 2019; 105:356-366. [PMID: 31254659 DOI: 10.1016/j.ijrobp.2019.06.2506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/28/2019] [Accepted: 06/14/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess whether radiographic and metabolic changes on midchemoradiation therapy (CRT) fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for cervical cancer predict outcome. METHODS AND MATERIALS Women with International Federation of Gynecology and Obstetrics stage IB1-IVB cervical cancer treated with concurrent cisplatin-based CRT and brachytherapy were enrolled on a single-institution prospective clinical trial; FDG-PET/CT was obtained before CRT and at 30 to 36 Gy. Max and mean standard uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) for the primary tumor and clinically involved lymph nodes from the pre-CRT and intra-CRT FDG-PET/CT were recorded. Clinical endpoints analyzed include overall survival (OS), disease-free survival (DFS), and rates of cervical recurrence (CR), nodal recurrence (NR), and distant metastasis (DM). FDG-PET/CT variables and other prognostic factors associated with clinical endpoints were identified via univariate Cox proportional hazards modeling and competing risk analysis. RESULTS Thirty women were enrolled from 2012 to 2016. After a median follow-up of 24 months, 2-year rates of OS, DFS, DM, NR, and CR were 68% (95% confidence interval [CI], 51%-85%), 44% (95% CI, 26%-63%), 42% (95% CI, 23%-59%), 14% (95% CI, 4%-30%), and 10% (95% CI, 2%-24%), respectively. Intra-PET metrics and TLG across all PET scans were most consistently associated with OS, DFS, DM, and NR on univariate analysis. Intra-CRT TLG was associated with OS (hazard ratio [HR] 1.35; 95% CI, 1.15-1.55; P = .001), DFS (HR 1.19; 95% CI, 1.04-1.34; P = .018), and NR (HR 1.25; 95% CI, 1.10-1.40; P = .002). No absolute or relative changes between parameters of baseline and mid-CRT FDG-PET/CT were associated with disease outcomes on univariate analysis, with the exception of relative change in mean standard uptake values and CR (P = .004). CONCLUSIONS In this group of patients with high-risk cervical cancer treated with CRT and brachytherapy, TLG and metabolic tumor volume on intra-CRT FDG-PET/CT was associated with OS. These metrics may provide an early signal for selective treatment intensification with either dose escalation or adjuvant chemotherapy.
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Affiliation(s)
- David J Carpenter
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Corbin D Jacobs
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Terence Z Wong
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Oana Craciunescu
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Junzo P Chino
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina.
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Kumar T, Achkar S, Haie-Meder C, Chargari C. Curiethérapie guidée par imagerie multimodale : l’exemple du cancer du col utérin. Cancer Radiother 2019; 23:765-772. [DOI: 10.1016/j.canrad.2019.07.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
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Du S, Sun H, Gao S, Xin J, Lu Z. Metabolic parameters with different thresholds for evaluating tumor recurrence and their correlations with hematological parameters in locally advanced squamous cell cervical carcinoma: an observational 18F-FDG PET/CT study. Quant Imaging Med Surg 2019; 9:440-452. [PMID: 31032191 DOI: 10.21037/qims.2019.02.09] [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] [Indexed: 12/20/2022]
Abstract
Background Positron emission tomography (PET) parameters for a combination of the primary tumor and suspicious metastatic lymph nodes (SMLNs) appear to be more potential than those for the primary tumor alone for evaluating tumor recurrence in locally advanced cervical carcinoma (LACC), while the optimal threshold has not been determined. This study investigated the optimal PET parameters and percentage of SUVmax (%SUVmax) thresholds for tumor recurrence evaluation, and the relationship with hematological parameters in patients with LACC treated with concurrent chemoradiotherapy (CCRT). Methods Eighty-nine patients with advanced squamous cell cervical carcinoma (SCCC) scheduled for CCRT underwent pretreatment whole body PET/CT scans. We analyzed PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor (SUVmax-P, MTV-P, TLG-P) and the combination of the primary tumor and SMLNs (SUVmax-C, MTV-C, TLG-C). The association between PET parameters with different %SUVmax threshold and recurrence-free survival (RFS), and the correlations between PET parameters and hematological parameters including squamous cell carcinoma antigen (SCC-ag), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (Hb) were evaluated. Results The optimal threshold for evaluating tumor recurrence was 50%SUVmax, and the optimal PET parameter was MTV-C with the 50%SUVmax threshold (MTV-C50%) (c-index =0.752). Multivariate analysis indicated that MTV-C50% [hazard ratio (HR), 1.065; P<0.001], NLR (HR, 1.195; P=0.045) and SMLNs (HR, 2.225; P=0.003) were independent risk factors for RFS. MTV and TLG with most of %SUVmax thresholds had slight-to-moderate correlations with SCC-ag, NLR and PLR. For SCC-ag, MTV-C55% (r=0.500; P<0.001) had the highest correlation coefficient among all parameters. For NLR and PLR, MTV-C50% (r=0.637 and r=0.515, respectively; P<0.001 for both correlations) received the highest correlation coefficient. Conclusions The MTV-C estimated by using a 50%SUVmax threshold, which is related to systemic inflammatory response biomarker (NLR and PLR), can be used as an optimal PET parameter associated with tumor recurrence of LACC.
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Affiliation(s)
- Siyao Du
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Hongzan Sun
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Si Gao
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jun Xin
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zaiming Lu
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Oldan JD, Khandani AH, Fielding JR, Jones EL, Gehrig PA, Sills TM, Roy P, Lin W. Quantitative accuracy of positron emission tomography/magnetic resonance and positron emission tomography/computed tomography for cervical cancer. World J Nucl Med 2018; 17:213-218. [PMID: 30505216 PMCID: PMC6216731 DOI: 10.4103/wjnm.wjnm_56_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With the spread of positron emission tomography/magnetic resonance (PET/MR), the question of comparability of studies becomes important. We aim to determine whether PET/MR and PET/computed tomography (PET/CT) are comparable for the case of cervical cancer. Fifteen cervical cancer patients identified by either a radiation oncologist or an oncologic surgeon had both PET/MR and PET/CT performed for initial staging within 3 weeks. We then compared the results both quantitatively (measuring standardized uptake values [SUVs] on visible lesions) as well as qualitatively (having radiologists and nuclear medicine physicians interprets the results). While interpretations between PET/MR and PET/CT varied in many cases, SUVs of primary lesions were similar to within 25% in all but one case, and correlation coefficient was 0.92. Maximum SUV ranged between 4.9 and 25.2 for PET-MR and between 5.8 and 30.4 for PET-CT for primary tumors and between 1.5 and 18.8 for PET-MR and between 1.8 and 20.8 for PET-CT for nodes. However, clinical reads often varied significantly between PET/MR and PET/CT. This suggests that SUV is similar on PET/MR and PET/CT although the differing anatomic modalities available for correlation may make the difference in terms of qualitative interpretation.
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Affiliation(s)
- Jorge Daniel Oldan
- Department of Radiology, Division of Nuclear Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Amir Hossein Khandani
- Department of Radiology, Division of Nuclear Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Julia R Fielding
- Department of Radiology, Division of Abdominal Radiology, University of Texas-Southwestern, Dallas, Texas, USA
| | - Ellen Louise Jones
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Paola Alvarez Gehrig
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Pinakpani Roy
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Weili Lin
- Biomedical Research Imaging Center, Chapel Hill, NC, USA
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Press RH, Shu HKG, Shim H, Mountz JM, Kurland BF, Wahl RL, Jones EF, Hylton NM, Gerstner ER, Nordstrom RJ, Henderson L, Kurdziel KA, Vikram B, Jacobs MA, Holdhoff M, Taylor E, Jaffray DA, Schwartz LH, Mankoff DA, Kinahan PE, Linden HM, Lambin P, Dilling TJ, Rubin DL, Hadjiiski L, Buatti JM. The Use of Quantitative Imaging in Radiation Oncology: A Quantitative Imaging Network (QIN) Perspective. Int J Radiat Oncol Biol Phys 2018; 102:1219-1235. [PMID: 29966725 PMCID: PMC6348006 DOI: 10.1016/j.ijrobp.2018.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/25/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
Modern radiation therapy is delivered with great precision, in part by relying on high-resolution multidimensional anatomic imaging to define targets in space and time. The development of quantitative imaging (QI) modalities capable of monitoring biologic parameters could provide deeper insight into tumor biology and facilitate more personalized clinical decision-making. The Quantitative Imaging Network (QIN) was established by the National Cancer Institute to advance and validate these QI modalities in the context of oncology clinical trials. In particular, the QIN has significant interest in the application of QI to widen the therapeutic window of radiation therapy. QI modalities have great promise in radiation oncology and will help address significant clinical needs, including finer prognostication, more specific target delineation, reduction of normal tissue toxicity, identification of radioresistant disease, and clearer interpretation of treatment response. Patient-specific QI is being incorporated into radiation treatment design in ways such as dose escalation and adaptive replanning, with the intent of improving outcomes while lessening treatment morbidities. This review discusses the current vision of the QIN, current areas of investigation, and how the QIN hopes to enhance the integration of QI into the practice of radiation oncology.
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Affiliation(s)
- Robert H. Press
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hui-Kuo G. Shu
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hyunsuk Shim
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - James M. Mountz
- Dept. of Radiology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Ella F. Jones
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Nola M. Hylton
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Elizabeth R. Gerstner
- Dept. of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Lori Henderson
- Cancer Imaging Program, National Cancer Institute, Bethesda, MD
| | | | - Bhadrasain Vikram
- Radiation Research Program/Division of Cancer Treatment & Diagnosis, National Cancer Institute, Bethesda, MD
| | - Michael A. Jacobs
- Dept. of Radiology and Radiological Science, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Matthias Holdhoff
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Edward Taylor
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David A. Jaffray
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - David A. Mankoff
- Dept. of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Philippe Lambin
- Dept. of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas J. Dilling
- Dept. of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - John M. Buatti
- Dept. of Radiation Oncology, University of Iowa, Iowa City, IA
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14
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Prognostic Value of Volume-Based Metabolic Parameters of 18F-FDG PET/CT in Uterine Cervical Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:1112-1121. [DOI: 10.2214/ajr.18.19734] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Prognostic Value of Volume-Based Metabolic Parameters Obtained by 18F-FDG-PET/CT in Patients With Locally Advanced Squamous Cell Cervical Carcinoma. J Comput Assist Tomogr 2018; 42:429-434. [PMID: 29369948 DOI: 10.1097/rct.0000000000000708] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the study was to assess the prognostic impact of volume-based metabolic F-fluorodeoxyglucose-positron emission tomography/ computed tomography (F-FDG-PET/CT) parameters in patients with stage IB-IVA squamous cell cervical carcinoma (SCCC). MATERIALS AND METHODS We reviewed the pretreatment F-FDG-PET/CT records of 67 patients with stage IB-IVA SCCC. The maximum standardized uptake value (SUVmax) of the primary tumor (PSUVmax), highest SUVmax of the whole malignant lesions (WSUVmax), metabolic tumor volume (MTV) of the primary tumor (PMTV), MTV of the whole malignant lesion (WMTV), total lesion glycolysis (TLG) of primary tumor (PTLG), and TLG of the whole malignant lesion (WTLG) were obtained. Univariate and multivariate analyses were performed to assess the predictive values of metabolic parameters. RESULTS Twenty-nine patients showed disease progression and 21 patients died during follow-up. In univariate analysis, positive lymph node, WSUVmax of greater than 11, WMTV of greater than 63 cm, and WTLG of greater than 373 adversely affected the progression-free survival (P = 0.004, 0.045, 0.023, and 0.005, respectively). A positive lymph node, WSUVmax of greater than 12, WMTV of greater than 68 cm, and WTLG of greater than 373 significantly adversely affected overall survival (P = 0.002, 0.032, 0.015, and 0.006, respectively). In multivariate analysis, independent prognostic factor for progression-free survival was WTLG (relative risk = 2.384, 95% confidence interval = 1.095-5.187, P = 0.029). Independent prognostic factors for overall survival was WTLG (relative risk = 2.763; 95% confidence interval = 1.107-6.896, P = 0.029). CONCLUSIONS Preliminary results indicated that pretreatment WTLG measured by F-FDG-PET/CT could independently predict survival in patients with locally advanced SCCC.
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Guler OC, Torun N, Yildirim BA, Onal C. Pretreatment metabolic tumour volume and total lesion glycolysis are not independent prognosticators for locally advanced cervical cancer patients treated with chemoradiotherapy. Br J Radiol 2018; 91:20170552. [PMID: 29293366 DOI: 10.1259/bjr.20170552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the prognostic significance of metabolic parameters derived from fludeoxyglucose (FDG) positron emission tomography (PET)/CT, in cervical cancer patients treated with concurrent chemoradiotherapy. METHODS We retrospectively reviewed medical records from 129 biopsy-proven non-metastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at our department. Correlation between metabolic parameters and tumour characteristics was evaluated. Prognostic factors for survival, local control and distant metastasis were analysed. RESULTS The median follow up for all patients and surviving patients was 30.0 months (range, 3.7-94.7 months) and 50.5 months (range, 14.5-94.7 months), respectively. The 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 68 42, 54 and 38%, respectively. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis were significantly higher in patients with larger tumours (>4 cm) and partial regression or progressive disease after definitive treatment compared to patients with smaller tumour (≤4 cm) and post-treatment complete response. On univariate analysis, stage, lymph node metastasis, tumour size >4 cm, SUVmax, MTV, SUVmean and total lesion glycolysis were prognostic factors for OS and DFS. On multivariate analysis, only larger tumour and presence of lymph node metastasis were significant prognostic factors for both OS and DFS. Additionally, extensive stage was a significant prognosticator for DFS. CONCLUSION Although, metabolic parameters derived from FDG-PET/CT had a prognostic significance in univariate analysis, the significance was lost in multivariate analysis where tumour stage, size and lymph node status were the only independent parameters. Advances in knowledge: The clinical benefit of using FDG-PET/CT metabolic parameters to evaluate the high-risk patients among cervical cancer patients and to eventually change patient management still needs further clarification.
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Affiliation(s)
- Ozan Cem Guler
- 1 Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey
| | - Nese Torun
- 2 Department of Nuclear Medicine, Baskent University Faculty of Medicine , Adana , Turkey
| | - Berna Akkus Yildirim
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
| | - Cem Onal
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
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17
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Ferrari M, Travaini LL, Ciardo D, Garibaldi C, Gilardi L, Glynne-Jones R, Grana CM, Jereczek-Fossa BA, Marvaso G, Ronchi S, Leonardi MC, Orecchia R, Cremonesi M. Interim 18 FDG PET/CT during radiochemotherapy in the management of pelvic malignancies: A systematic review. Crit Rev Oncol Hematol 2017; 113:28-42. [DOI: 10.1016/j.critrevonc.2017.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/22/2016] [Accepted: 02/15/2017] [Indexed: 12/14/2022] Open
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