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Combet-Curt V, Buchalet C, Le Malicot K, Lemanski C, Deshayes E, Bonichon-Lamichhane N, Lièvre A, Huguet F, Tlili G, Vendrely V. Prognostic Value of 18F-FDG PET/CT Assessment After Radiotherapy of Squamous Cell Carcinoma of the Anus in Patients from the National Multicentric Cohort FFCD-ANABASE. J Nucl Med 2024; 65:1194-1201. [PMID: 38936973 DOI: 10.2967/jnumed.124.267626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
This study aimed to evaluate the prognostic value of 18F-FDG PET/CT qualitative assessment in terms of recurrence-free survival (RFS), colostomy-free survival (CFS), and overall survival (OS) after radiation therapy (RT) of squamous cell carcinoma of the anus (SCCA). Secondary objectives were to evaluate the prognostic value of baseline and posttherapeutic quantitative 18F-FDG PET/CT parameters in terms of RFS, CFS, and OS. Methods: We included all consecutive patients from the French multicentric cohort FFCD-ANABASE who had undergone 18F-FDG PET/CT at baseline and 4-6 mo after RT or chemoradiotherapy for a localized SCCA. Qualitative assessments separated patients with complete metabolic response (CMR) and non-CMR. Quantitative parameters were measured on baseline and posttreatment 18F-FDG PET/CT. RFS, CFS, and OS were analyzed using the Kaplan-Meier method. Associations among qualitative assessments, quantitative parameters, and RFS, CFS, and OS were analyzed using univariate and multivariate Cox regression. Results: Among 1,015 patients treated between January 2015 and April 2020, 388 patients (300 women and 88 men) from 36 centers had undergone 18F-FDG PET/CT at diagnosis and after treatment. The median age was 65 y (range, 32-90 y); 147 patients (37.9%) had an early-stage tumor and 241 patients (62.1%) had a locally advanced-stage tumor; 59 patients (15.2%) received RT, and 329 (84.8%) received chemoradiotherapy. The median follow-up was 35.5 mo (95% CI, 32.8-36.6 mo). Patients with CMR had better 3-y RFS, CFS, and OS, at 84.2% (95% CI, 77.8%-88.9%), 84.7% (95% CI, 77.2%-89.3%), and 88.6% (95% CI, 82.5%-92.7%), respectively, than did non-CMR patients, at 42.1% (95% CI, 33.4%-50.6%), 47.9% (95% CI, 38.1%-56.8%), and 63.5 (95% CI, 53.2%-72.1%), respectively (P < 0.0001). Quantitative parameters were available for 154 patients from 3 centers. The following parameters were statistically significantly associated with 3-y RFS: baseline SUVmax (primitive tumor [T]) (hazard ratio [HR], 1.05 [95% CI, 1.01-1.1; P = 0.018]), SUVpeak (T) (HR, 1.09 [95% CI, 1.02-1.15; P = 0.007]), MTV 41% (T) (HR, 1.02 [95% CI, 1-1.03; P = 0.023]), MTV 41% (lymph node [N]) (HR, 1.06 [95% CI, 1.03-1.1; P < 0.001]), MTV 41% (T + N) (HR, 1.02 [95% CI, 1-1.03; P = 0.005]), and posttreatment SUVmax (HR, 1.21 [95% CI, 1.09-1.34; P < 0.001]). Conclusion: Treatment response assessed by 18F-FDG PET/CT after RT for SCCA has a significant prognostic value.18F-FDG PET/CT could be useful for adapting follow-up, especially for patients with locally advanced-stage tumors. Quantitative parameters could permit identification of patients with a worse prognosis but should be evaluated in further trials.
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Affiliation(s)
| | | | | | | | | | | | - Astrid Lièvre
- Hepatogastroenterology Department, CHU Rennes, Rennes, France
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Mirshahvalad SA, Mesci A, Murad V, Kohan A, Ortega C, Veit-Haibach P, Metser U. [ 18F]-FDG PET in anal canal cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2023; 51:258-277. [PMID: 37592085 DOI: 10.1007/s00259-023-06393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To provide comprehensive data on the diagnostic and prognostic value of [18F]-FDG PET (PET) in anal canal cancer patients. METHODS This study was designed following the PRISMA-DTA guidelines. For the meta-analysis, published original articles (until December 2022) that met the following criteria were included: Evaluated PET for locoregional and/or distant disease detection in patients with histopathology-proven anal canal cancer; Compared PET with a valid reference standard; Provided crude data to calculate meta-analytic estimates. Diagnostic measurements from subgroups were calculated in evaluating primary tumour detection, T stage, lymph node and distant metastases. Articles providing prognostic information on PET were also reported as a systematic review. For pooled meta-analytic calculations, the hierarchical method was used. The bivariate model was conducted to find the summary estimates. Analyses were performed using STATA 16. RESULTS After the screening, 28 studies were eligible to enter the meta-analytic calculations, and data from 15 were reported descriptively. For distinguishing T3/T4 from other T-stages, PET had pooled sensitivity and specificity of 91%(95%CI:72%-97%) and 96%(95%CI:88%-98%), respectively. The sensitivity and specificity for detecting metastatic (regional and/or distant) disease were 100% (95%CI:82%-100%) and 95% (95%CI:90%-98%), respectively. For therapy response assessment, the sensitivity and specificity of PET were 96%(95%CI:78%-99%) and 86%(95%CI:75%-93%), respectively. Higher pre-treatment total metabolic tumour volume was predictive of poorer survival. Conversely, for those achieving complete metabolic response, the 2-year PFS was 94%(95%CI:91%-97%) versus 51%(95%CI:42%-59%) for others (p-value < 0.001). CONCLUSION PET may be a useful tool for anal canal cancer therapy planning and provides valuable prognostic information.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Aruz Mesci
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, ON, M5T 1P5, Canada
| | - Vanessa Murad
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Andres Kohan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada.
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada.
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Janczewski LM, Faski J, Nelson H, Gollub MJ, Eng C, Brierley JD, Palefsky JM, Goldberg RM, Washington MK, Asare EA, Goodman KA. Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer. CA Cancer J Clin 2023; 73:516-523. [PMID: 37114458 DOI: 10.3322/caac.21780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long-term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1-T2N1M0 disease, (2) redefined stage IIIA as T3N0-N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.
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Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
- American College of Surgeons Cancer Programs, Chicago, Illinois, USA
| | - Joseph Faski
- American College of Surgeons Cancer Programs, Chicago, Illinois, USA
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cathy Eng
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - James D Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Richard M Goldberg
- West Virginia University Cancer Institute, Morgantown, West Virginia, USA
| | - M Kay Washington
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Elliot A Asare
- Department of Surgery, University of Utah Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Golia Pernicka JS, Rauch GM, Gangai N, Bates DDB, Ernst R, Hope TA, Horvat N, Sheedy SP, Gollub MJ. Imaging of Anal Squamous Cell Carcinoma: Survey Results and Expert Opinion from the Rectal and Anal Cancer Disease-Focused Panel of the Society of Abdominal Radiology. Abdom Radiol (NY) 2023; 48:3022-3032. [PMID: 36932225 PMCID: PMC10929685 DOI: 10.1007/s00261-023-03863-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
The role and method of image-based staging of anal cancer has evolved with the rapid development of newer imaging modalities and the need to address the rising incidence of this rare cancer. In 2014, the European Society of Medical Oncology mandated pelvic magnetic resonance imaging (MRI) for anal cancer and subsequently other societies such as the National Comprehensive Cancer Network followed suit with similar recommendations. Nevertheless, great variability exists from center to center and even within individual centers. Notably, this is in stark contrast to the imaging of the anatomically nearby rectal cancer. As participating team members for this malignancy, we embarked on a comprehensive literature review of anal cancer imaging to understand the relative merits of these new technologies which developed after computed tomography (CT), e.g., MRI and positron emission tomography/computed tomography (PET/CT). The results of this literature review helped to inform our next stage: questionnaire development regarding the imaging of anal cancer. Next, we distributed the questionnaire to members of the Society of Abdominal Radiology (SAR) Rectal and Anal Disease-Focused Panel, a group of abdominal radiologists with special interest, experience, and expertise in rectal and anal cancer, to provide expert radiologist opinion on the appropriate anal cancer imaging strategy. In our expert opinion survey, experts advocated the use of MRI in general (65% overall and 91-100% for primary staging clinical scenarios) and acknowledged the superiority of PET/CT for nodal assessment (52-56% agreement for using PET/CT in primary staging clinical scenarios compared to 30% for using MRI). We therefore support the use of MRI and PET and suggest further exploration of PET/MRI as an optimal combined evaluation. Our questionnaire responses emphasized the heterogeneity in imaging practice as performed at numerous academic cancer centers across the United States and underscore the need for further reconciliation and establishment of best imaging practice guidelines for optimized patient care in anal cancer.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- , 530 E 74th St, Room 07118, New York, NY, 10021, USA.
| | - Gaiane M Rauch
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Randy Ernst
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Hope
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Di Carlo C, di Benedetto M, Vicenzi L, Costantini S, Cucciarelli F, Fenu F, Arena E, Mariucci C, Montisci M, Panni V, Patani F, Valenti M, Palucci A, Burroni L, Mantello G. FDG-PET/CT in the Radiotherapy Treatment Planning of Locally Advanced Anal Cancer: A Monoinstitutional Experience. Front Oncol 2021; 11:655322. [PMID: 34277406 PMCID: PMC8281886 DOI: 10.3389/fonc.2021.655322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS Radiotherapy with concurrent 5-fluorouracil/mitomycin-C based chemotherapy has been established as definitive standard therapy approach for anal cancer. Intensity Modulated Radiotherapy (IMRT) leads to a precise treatment of the tumor, allowing dose escalation on Gross Tumor Volume (GTV), with a surrounding healthy tissues sparing. Our study assessed the impact of 18-Fluorodeoxyglucose positron emission tomography (18FDG-PET/CT) on the radiotherapy contouring process and its contribution to lymphatic spread detection, resulting to a personalization of Clinical Target Volume (CTV) and dose prescription. METHODS Thirty-seven patients, with histologically proven squamous cell carcinoma of the anal canal (SCCAC) were analyzed. All patients were evaluated with history and physical examination, trans-anal endoscopic ultrasound, pelvis magnetic resonance imaging (MRI), computed tomography (CT) scans of the chest, abdomen and pelvis and planning 18FDG-PET/CT. The GTV and CTV were drawn on CT, MRI and 18FDG-PET/CT fused images. RESULTS Thirty-four (91%) out of 37 patients presented lymph nodes involvement, in one or more areas, detected on 18FDG-PET/CT and/or MRI. The 18FDG-PET/CT showed positive lymph nodes not detected on MRI imaging (PET+, MRI-) in 14/37 patients (38%). In 14 cases, 18FDG-PET/CT allowed to a dose escalation in the involved nodes. The 18FDG-PET/CT fused images led to change the stage in 5/37(14%) cases: four cases from N0 to N1 (inguinal lymph nodes) and in one case from M0 to M1 (common iliac lymph nodes). CONCLUSIONS The 18FDG-PET/CT has a potentially relevant impact in staging and target volume delineation/definition in patients affected by anal cancer. In our experience, clinical stage variation occurred in 14% of cases. More investigations are needed to define the role of 18FDG-PET/CT in the target volume delineation of anal cancer.
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Affiliation(s)
- Clelia Di Carlo
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Maika di Benedetto
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Lisa Vicenzi
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Sara Costantini
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesca Cucciarelli
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesco Fenu
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Eleonora Arena
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Cristina Mariucci
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Maria Montisci
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Valeria Panni
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Fabiola Patani
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Marco Valenti
- Department of Medical Physics, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Andrea Palucci
- Department of Nuclear Medicine, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Luca Burroni
- Department of Nuclear Medicine, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
| | - Giovanna Mantello
- Department of Radiation Oncology, Ospedali Riuniti Umberto I°, GM Lancisi, G Salesi, Ancona, Italy
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Siegel R, Werner RN, Koswig S, Gaskins M, Rödel C, Aigner F. Clinical Practice Guideline: Anal Cancer—Diagnosis, Treatment and Follow-up. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:217-24. [PMID: 33531112 DOI: 10.3238/arztebl.m2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of anal cancer diagnoses has been rising steadily, so that the incidence has doubled in the past 20 years. Almost all anal cancers are induced by persistent infection with human papillomaviruses. Hitherto the care of patients with anal cancer has been heterogeneous and little experience exists with the primary management of anal cancer. METHODS The guideline was developed in accordance with the requirements of the German Guideline Program in Oncology. In line with the GRADE approach, the certainty of the evidence was assessed on the outcome level following a systematic literature search. Interdisciplinary working groups were set up to compile suggestions for recommendations, which were discussed and agreed upon in a formal consensus conference. RESULTS Ninety-three recommendations and statements were developed. No high-quality evidence was available to support recommendations for or against the treatment of stage I anal cancer with local excision alone as an alternative to chemoradiotherapy. Chemoradiotherapy is the gold standard in the treatment of stages II–III. Among other aspects regarding the timing and extent of response evaluation after chemoradiotherapy, the guideline panel recommended against obtaining a biopsy in the event of complete clinical response. Owing to lack of confidence in the available evidence, only open recommendations were given for treatment of stage IV. CONCLUSION This evidence-based clinical practice guideline provides a sound basis for optimizing the interdisciplinary, cross-sector care of anal cancer patients. Among other areas, gaps in research were identified with respect to the care of patients with early-stage or metastatic anal cancer. Approaches such as chemoradiotherapy combined with regional deep hyperthermia require further investigation. The role for immunotherapy in the management of metastasized anal cancer has also been insufficiently explored to date.
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Additional Value of 2-[ 18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients. J Clin Med 2020; 9:jcm9092715. [PMID: 32842617 PMCID: PMC7563850 DOI: 10.3390/jcm9092715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Accurate staging and treatment planning are imperative for precise management in Anal Cancer (ACa) patients. We aimed to evaluate the additive and prognostic value of pre-treatment 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) in the staging and management of ACa compared to magnetic resonance imaging (MRI). This retrospective study was conducted on 54 patients. Pre-treatment 2-[18F]FDG PET/CT studies and MRI reports were compared considering the primary tumor, pelvic lymph nodes, and metastatic lesions. The impact of 2-[18F]FDG PET/CT in the management and its prognostic value, using maximum standardized uptake value (SUVmax), were assessed. Discordant findings were found in 46.3% of patients (5 in T; 1 in T and N; 18 in N; and 1 in M stage). 2-[18F]FDG PET/CT resulted in up-staging in 9.26% and down-staging in 3.7% of patients. Perirectal lymph nodes were metabolically inactive in 12.9% of patients. Moreover, 2-[18F]FDG PET/CT resulted in management change in 24.1% of patients. Finally, SUVmax provided no prognostic value. 2-[18F]FDG PET/CT altered staging and management in a sizable number of patients in this study, and supports a need for a change in guidelines for it to be used as a routine complementary test in the initial management of ACa.
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De Nardi P, Guarneri G, Canevari C, Tamburini A, Slim N, Passoni P, Rosati R. Prognostic value of fluorodeoxyglucose positron emission tomography/computed tomography and inguinal sentinel lymph node biopsy in patients with anal cancer. Colorectal Dis 2019; 21:1017-1024. [PMID: 31077550 DOI: 10.1111/codi.14691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to assess the value of positron emission tomography (PET)/CT and sentinel lymph node (SLN) biopsy in staging inguinal lymph nodes in anal cancer patients and to determine if the results of the two methods could be of prognostic value. METHOD Sixty-three patients with anal cancer and clinically negative inguinal lymph nodes underwent lymphoscintigraphy and inguinal SLN biopsy and/or fluorodeoxyglucose (FDG) PET/CT scan. All patients were treated with radiotherapy combined with 5-fluorouracil and mitomycin-C. RESULTS Overall (OS) and disease-free survival (DFS) were 43 months (range 5-211) and 43 months (range 4-142) respectively. PET/CT examination showed high FDG uptake in the inguinal lymph nodes in 25% of patients. Thirty-five patients with inguinal uptake at lymphoscintigraphy underwent inguinal SLN biopsy and metastatic nodes were found in 31.4%. There was no statistical difference in OS (55 vs 41 months; P = 0.652) and DFS (48 vs 38 months; P = 0.992) between the group which showed inguinal uptake on PET/CT and the group which did not, while a positive inguinal SLN was associated with a worse OS (28 vs 59 months; P = 0.028) and DFS (56 vs 21 months; P = 0.046). When the two examinations were compared PET/CT showed a sensitivity, specificity, positive predictive value and negative predictive value of 22%, 82%, 33% and 73% respectively. CONCLUSION The technique of SLN biopsy had a better diagnostic accuracy than total body FDG-PET/CT for the staging of inguinal lymph nodes in anal cancer patients; moreover it was a stronger predictor of OS and DFS than PET/CT.
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Affiliation(s)
- P De Nardi
- Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - G Guarneri
- Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - C Canevari
- Nuclear Medicine Department, San Raffaele Scientific Institute, Milan, Italy
| | - A Tamburini
- Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - N Slim
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | - P Passoni
- Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | - R Rosati
- Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
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Duimering A, Riauka T, Nijjar Y, Ghosh S, MacEwan R, Warkentin H, Schiller D, Tankel K, Usmani N, Severin D, Nijjar T, Fairchild A, Mulder K, Doll C, Wong C, Joseph K. Prognostic utility of pre- and post-treatment FDG-PET parameters in anal squamous cell carcinoma. Radiother Oncol 2019; 136:21-28. [PMID: 31015125 DOI: 10.1016/j.radonc.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE We prospectively assessed the contributions of PET to initial staging, early detection of treatment failures, and prognostication in patients with anal squamous cell carcinoma (ASCC). MATERIALS AND METHODS Consecutive patients with ASCC referred for radical chemoradiotherapy (CRT) consented to undergo FDG-PET imaging pre-treatment and at 3 and 6 months post-treatment. Clinicopathologic data were collected and CT and PET imaging reviewed for contribution to staging and recurrence detection. Maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were assessed for association with progression-free survival (PFS), cause-specific survival (CSS), and overall survival (OS) using the Kaplan-Meier and Cox regression models. RESULTS Between 2009 and 2016, 73 patients with clinical stages I-IIIB ASCC completed curative-intent CRT. Median follow-up was 48 months. 14 patients died and 18 patients experienced disease progression. 4-year PFS, CSS, and OS were 73%, 87%, and 84%, respectively. A pre-treatment MTV >35 cm3 predicted for worse PFS (p = 0.011) and CSS (p = 0.024) on univariate and multivariate analyses, employing an MTV definition of voxels ≥25% of SUVmax. Higher 6-month post-treatment SUVmax and SUVpeak predicted for worse PFS and OS (p ≤ 0.011). Pre-treatment SUVmax, SUVpeak, and TLG, and 3-month post-treatment SUVmax and SUVpeak did not significantly correlate with survival outcomes. CONCLUSIONS Our findings support that pre-treatment MTV provides meaningful prognostic information, with suggestion that an MTV delineation threshold of voxels ≥25% of SUVmax is appropriate in the anal region. Post treatment, the combination of clinical examination and PET effectively detected all treatment failures. Higher 6-month post-treatment SUVmax and SUVpeak predicted worse PFS and OS; however, the optimal timing of post-treatment PET imaging remains unclear.
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Affiliation(s)
- Adele Duimering
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Terence Riauka
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Canada
| | - Yugmel Nijjar
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Sunita Ghosh
- Divison of Medical Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Robert MacEwan
- Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Canada
| | - Heather Warkentin
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Canada
| | - Dan Schiller
- Department of Surgical Oncology, University of Alberta, Edmonton, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Diane Severin
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Karen Mulder
- Divison of Medical Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Corinne Doll
- Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Clarence Wong
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
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12
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Comparative accuracy of qualitative and quantitative 18F-FDG PET/CT analysis in detection of lymph node metastasis from anal cancer. Abdom Radiol (NY) 2019; 44:828-835. [PMID: 30694369 DOI: 10.1007/s00261-019-01907-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the diagnostic performance of qualitative and quantitative 18F-FDG PET/CT in detection of regional and distant lymph node metastasis in patients with anal cancer. METHODS Between 2004 and 2017, 28 patients with anal cancer who had staging PET/CT and pathological assessment of suspicious lymph nodes were included. For qualitative analysis, positive lymph nodes were defined as uptake visually higher than the liver reference uptake. For quantitative study, lymph nodes were contoured to determine maximum standard uptake value (SUVmax) and metabolic tumor volume (MTV). Receiver operating characteristic (ROC) curves were plotted to extract the optimal cut-offs and area under the curve (AUC) of SUVmax, lesion to background (L/B) ratio, short axis diameter (SAD), and MTV of lymph nodes. Histopathologic analysis was a reference standard. RESULTS A total of 28 lymph nodes (24 inguinal, 2 external iliac, 1 internal iliac, and 1 paraaortic nodes) in 28 patients on PET/CT were included. With the qualitative visual analysis, 19 patients were categorized as positive for nodal metastasis with sensitivity, specificity, and accuracy of 85%, 75%, and 82%. The optimal SUVmax and L/B ratio cut-offs were 2.6 and 1.0 with both sensitivity and specificity of 95% and 75% (AUC of SUVmax = 0.893, AUC of L/B ratio = 0.912). Using the best cut-off of 1.6 cm for SAD and 3.65 cm3 for MTV, both sensitivity and specificity were 80% and 100% (AUC of SAD = 0.950, AUC of MTV = 0.931). CONCLUSIONS SUVmax optimization may be helpful in enhancing the diagnostic accuracy of 18F-FDG PET/CT in nodal staging patients with anal cancer.
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Prognostic Significance of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in Anal Squamous Cell Carcinoma: A Systematic Review and a Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9760492. [PMID: 30627062 PMCID: PMC6305045 DOI: 10.1155/2018/9760492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/04/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022]
Abstract
Purpose Prognostic significance of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in anal squamous cell carcinoma (SCC) has been evaluated in several studies; however, the results seem to be controversial and no consensus exists about its predictive capability. The current meta-analysis was carried out to comprehensively investigate the prognostic significance of 18F-FDG-PET parameters in patients with anal SCC. Methods A comprehensive literature search of PubMed/MEDLINE and Scopus databases was performed to retrieve pertinent articles published until August 5th 2018, concerning the prognostic significance of 18F-FDG-PET in patients with anal SCC. No language restriction was used. Several prognostic factors were reported for progression-free survival (PFS) and overall survival (OS) including pretreatment maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), inguinal nodal uptake, and metabolic response to therapy. Results Eleven studies (741 patients) were included. The pooled hazard ratio (HR) for the probability of PFS was 5.36 (95% confidence interval (95% CI): 3.12–9.21, p < 0.001) for metabolic response to therapy and 1.98 (95% CI: 1.26–3.12, p=0.003) for SUVmax. The pooled HR for the probability of OS was 5.87 (3.02–11.39, p < 0.0001) for metabolic response to therapy. On the other hand, the study revealed that the pooled HRs of MTV and inguinal nodal uptake for PFS were 1.56 (95% CI: 0.96–2.53, p=0.072) and 1.79 (95% CI: 1–3.21, p=0.051), respectively. Conclusions Our findings propose that some 18F-FDG-PET parameters could serve as prognostic indicators in anal SCC, but further larger studies are needed in this setting.
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14
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Abstract
Anal cancer is a rare condition, although its incidence has been increasing over the past several decades, particularly in women. The majority of anal cancers are squamous cell cancers and are linked with human papilloma virus (HPV) infection. Recent work in HPV basic science has delineated the mechanism by which the virus leads to the development of anal cancer. With widespread availability of an HPV vaccine since 2006, vaccination has become an important strategy for anal cancer prevention. However, in the US, there remain no guidelines for anal cancer screening. Treatment of anal cancer is dictated largely by accurate staging, which is generally accomplished with a combination of physical exam, magnetic resonance imaging, computed tomography, and positron emission tomography. Chemoradiation remains the mainstay of treatment for most patients, with surgery reserved for salvage therapy. Recent trials have identified the optimal use of available chemotherapeutics. Exciting developments in immune therapies targeting HPV oncoproteins as well as therapeutic vaccines may soon dramatically change the way patients with anal cancer are managed.
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Affiliation(s)
- Matthew M. Symer
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, 525 East 68th Street, New York, NY 10065, USA
| | - Heather L. Yeo
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, 525 East 68th Street, New York, NY 10065, USA
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15
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Mahmud A, Poon R, Jonker D. PET imaging in anal canal cancer: a systematic review and meta-analysis. Br J Radiol 2017; 90:20170370. [PMID: 28972796 PMCID: PMC6047643 DOI: 10.1259/bjr.20170370] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to synthesize and summarize the evidence surrounding the clinical utility of positron emission tomography (PET) imaging in patients with anal canal cancer. METHODS The literature was searched using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews databases. Studies comparing PET or PET/CT with conventional imaging in the staging, response evaluation and follow-up of anal canal cancer were deemed eligible for inclusion. RESULTS 17 studies met the inclusion criteria. For the detection of primary tumour in situ, the pooled sensitivity was 99% for PET or PET/CT and 67% for CT. For the detection of inguinal lymph nodes, PET/CT had an overall sensitivity of 93% and specificity of 76%. PET or PET/CT upstaged 5.1 to 37.5% of patients and downstaged 8.2 to 26.7% of patients. Treatment plans were modified in 12.5 to 59.3% of patients, which consisted mainly of radiotherapy dose or field changes. Complete response on PET or PET/CT is a good prognostic factor for overall and progression-free survival. CONCLUSIONS PET/CT seems to add value to conventional imaging in the initial staging of patients with T2-4 disease but further high-quality research is required to validate this. There is insufficient evidence at this time to recommend a routine use of PET/CT in the assessment of treatment response or follow-up. Advances in knowledge: PET/CT appears to alter the disease stage and management in a meaningful number of patients to justify its use as part of staging investigations in locally advanced cases.
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Affiliation(s)
- Aamer Mahmud
- Department of Oncology, School of Medicine, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ONT, Canada
| | - Raymond Poon
- Program in Evidence-Based Care, Cancer Care Ontario, Juravinski Hospital and Cancer Centre, Hamilton, ONT, Canada
| | - Derek Jonker
- Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, General Campus, Ottawa, ONT, Canada
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16
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Sekhar H, Zwahlen M, Trelle S, Malcomson L, Kochhar R, Saunders MP, Sperrin M, van Herk M, Sebag-Montefiore D, Egger M, Renehan AG. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study. Lancet Oncol 2017; 18:1348-1359. [PMID: 28802802 DOI: 10.1016/s1470-2045(17)30456-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients with squamous cell carcinoma of the anus (SCCA), lymph node positivity (LNP) indicates poor prognosis for survival and is central to radiotherapy planning. Over the past three decades, LNP proportion has increased, mainly reflecting enhanced detection with newer imaging modalities; a process known as nodal stage migration. If accompanied by constant T stage distributions, prognosis for both lymph node-positive and lymph node-negative groups may improve without any increase in overall survival for individual patients; a paradox termed the Will Rogers phenomenon. Here, we aim to systematically evaluate the impact of nodal stage migration on survival in SCCA and address a novel hypothesis that this phenomenon results in reduced prognostic discrimination. METHODS We did a systematic review and meta-regression to quantify changes in LNP over time and the impact of this change on survival and prognostic discrimination. We searched MEDLINE, Embase, and the Cochrane Library to identify randomised trials and observational studies in patients with SCCA published between Jan 1, 1970, and Oct 11, 2016. Studies were eligible if patients received chemoradiotherapy or radiotherapy as the main treatment, reported LNP proportions (all studies), and reported overall survival (not necessarily present in all studies). We excluded studies with fewer than 50 patients. We extracted study-level data with a standardised, piloted form. The primary outcome measure was 5-year overall survival. To investigate scenarios in which reduced prognostic discrimination might occur, we simulated varying true LNP proportions and true overall survival, and compared these with expected observed outcomes for varying levels of misclassification of true nodal state. FINDINGS We identified 62 studies reporting LNP proportions, which included 10 569 patients. From these, we included 45 studies (6302 patients) with whole cohort 5-year overall survival, 11 studies with 5-year survival stratified by nodal status, and 20 studies with hazard ratios in our analyses of temporal changes. In 62 studies, the LNP proportions increased from a mean estimate of 15·3% (95% CI 10·5-20·1) in 1980 to 37·1% (34·0-41·3) in 2012 (p<0·0001). In 11 studies with prognostic data, increasing LNP was associated with improved overall survival in both lymph node-positive and lymph node-negative categories, whereas the proportions with combined tumour stage T3 and T4 remained constant. In 20 studies, across a range of LNP proportions from 15% to 40%, the hazard ratios for overall survival of lymph node-positive versus lymph node-negative patients decreased significantly from 2·5 (95% CI 1·8-3·3) at 15% LNP to 1·3 (1·2-1·9; p=0·014) at 40% LNP. The simulated scenarios reproduced this effect if the true LNP proportions were 20% or 25%, but not if the true LNP proportions were 30% or greater. INTERPRETATION We describe a consequence of staging misclassification in anal cancer that we have termed reduced prognostic discrimination. We used this new observation to infer that the LNP proportions of more than 30% seen in modern clinical series (11 out of 15 studies with a median year since 2007) are higher than the true LNP proportion. The introduction of new staging technologies in oncology might misclassify true disease stage, spuriously informing disease management and ultimately increasing the risk of overtreatment. FUNDING Bowel Disease Research Foundation.
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Affiliation(s)
- Hema Sekhar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sven Trelle
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Farr Institute, MRC Health eResearch Centre (HeRC), Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
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Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Anal Cancer. Colorectal Dis 2017; 19 Suppl 1:82-97. [PMID: 28632308 DOI: 10.1111/codi.13709] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew Renehan
- University of Manchester and Christie Hospital, Manchester, UK
| | - John Scholefield
- University of Nottingham and Queens Medical Centre, Nottingham, UK
| | - Vicky Goh
- King's College and Guy's & St Thomas' Hospital, London, UK
| | | | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Mark Bower
- Imperial College and Chelsea & Westminster Hospital, London, UK
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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18
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Teagle AR, Gilbert DC, Jones JR, Burkill GJ, McKinna F, Dizdarevic S. Negative 18F-FDG-PET-CT may exclude residual or recurrent disease in anal cancer. Nucl Med Commun 2017; 37:1038-45. [PMID: 27341410 DOI: 10.1097/mnm.0000000000000560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The incidence of anal cancer is increasing in Western countries. Fluorine-18 fluorodeoxyglucose (F-FDG) PET-computed tomography (CT) is used in the assessment of anal cancer, but its routine use is not established. The aim of this study was to assess the value of F-FDG-PET-CT in staging and post-treatment assessment in anal cancer and to determine its impact on management. METHODS This was a retrospective analysis of patients with anal cancer treated at the Sussex Cancer Centre who underwent PET-CT between November 2004 and September 2014. Information was retrieved from patient notes and the local cancer register, and verified by referring consultants in all cases. RESULTS A total of 75 PET-CT scans in 52 patients were identified, representing 38.5% of patients diagnosed with anal cancer during this period. There were 24 staging scans and 51 post-treatment scans. Management was altered following 45.8% of staging scans and 56.0% of all scans, mostly changing treatment type or radiotherapy volume. Out of 28 positive post-treatment scans, 71.4% were true positives, 7.1% were false positives and 21.4% showed nonspecific uptake. Of the 23 negative post-treatment scans, all remained disease free at clinical/radiological follow-up (median follow-up 25 months). The sensitivity and specificity of post-treatment PET-CT were 100 and 74%, respectively. Negative predictive and positive predictive values were 100 and 71%, respectively. CONCLUSION Evidence is evolving for the use of PET-CT in anal cancer. Because of a high negative predictive value, our series shows that PET-CT can be used in the assessment of treatment response to exclude residual/recurrent disease.
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Affiliation(s)
- Alexandra R Teagle
- Department of Imaging and Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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19
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Abstract
Anal canal cancer is an uncommon malignancy but one that is often curable with optimal therapy. Owing to its unique location, histology, risk factors, and usual presentation, a careful diagnostic approach is warranted. This approach includes an excellent history and physical examination, including digital rectal examination, laboratory data, and comprehensive imaging. Anal cancer staging and formulation of a treatment plan depends on accurate imaging data. Modern radiographic techniques have improved staging quality and accuracy, and a thorough knowledge of anal anatomy is paramount to the optimal multidisciplinary treatment of this disease.
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20
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Meillan N, Huguet F, Peiffert D. [Follow-up after radiotherapy of anal canal carcinoma]. Cancer Radiother 2015; 19:610-5. [PMID: 26323891 DOI: 10.1016/j.canrad.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 01/11/2023]
Abstract
Anal canal carcinoma is a rare and curable disease for which the standard of care is radiation therapy with concurrent 5-fluoro-uracil and mitomycine-based chemotherapy. Post-treatment follow-up however is rather poorly defined. This article offers a review of the various post-treatment surveillance options both for early diagnosis of relapse and care for late treatment effects. While follow-up remains mostly clinical, we will discuss morphologic (endorectal echoendoscopy, pelvic magnetic resonance imaging, tomodensitometry and positron emission tomography) and biologic (squamous cell carcinoma antigen and pathology) follow-up so as to determine their diagnostic and prognostic value.
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Affiliation(s)
- N Meillan
- Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - D Peiffert
- Institut de cancérologie de Lorraine (Alexis-Vautrin), 6, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France
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21
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Surgical Options in the Treatment of Lower Gastrointestinal Tract Cancers. Curr Treat Options Oncol 2015; 16:46. [DOI: 10.1007/s11864-015-0363-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Abstract
PET imaging has contributed substantially in oncology by allowing improved clinical staging and guiding appropriate cancer management. Integration with radiotherapy planning via PET/computed tomography (CT) simulation enables improved target delineation, which is paramount for conformal radiotherapy techniques. This article reviews the present literature regarding implications of PET/CT for radiotherapy planning and management.
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Affiliation(s)
- Beant S Gill
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Sarah S Pai
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stacey McKenzie
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA.
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