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Noble DJ, Ramaesh R, Brothwell M, Elumalai T, Barrett T, Stillie A, Paterson C, Ajithkumar T. The Evolving Role of Novel Imaging Techniques for Radiotherapy Planning. Clin Oncol (R Coll Radiol) 2024; 36:514-526. [PMID: 38937188 DOI: 10.1016/j.clon.2024.05.018] [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: 03/24/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024]
Abstract
The ability to visualise cancer with imaging has been crucial to the evolution of modern radiotherapy (RT) planning and delivery. And as evolving RT technologies deliver increasingly precise treatment, the importance of accurate identification and delineation of disease assumes ever greater significance. However, innovation in imaging technology has matched that seen with RT delivery platforms, and novel imaging techniques are a focus of much research activity. How these imaging modalities may alter and improve the diagnosis and staging of cancer is an important question, but already well served by the literature. What is less clear is how novel imaging techniques may influence and improve practical and technical aspects of RT planning and delivery. In this review, current gold standard approaches to integration of imaging, and potential future applications of bleeding-edge imaging technology into RT planning pathways are explored.
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Affiliation(s)
- D J Noble
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK; Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK.
| | - R Ramaesh
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | - M Brothwell
- Department of Clinical Oncology, University College London Hospitals, London, UK
| | - T Elumalai
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - T Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - A Stillie
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Great Western Road, Glasgow G12 0YN, UK
| | - T Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
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Nath K, Gupta PK, Basappa J, Wang S, Sen N, Lobello C, Tomar JS, Shestov AA, Orlovskiy S, Arias-Mendoza F, Rauert-Wunderlich H, Nelson DS, Glickson JD, Wasik MA. Impact of therapeutic inhibition of oncogenic cell signaling tyrosine kinase on cell metabolism: in vivo-detectable metabolic biomarkers of inhibition. J Transl Med 2024; 22:622. [PMID: 38965536 PMCID: PMC11225145 DOI: 10.1186/s12967-024-05371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/02/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Inhibition of kinases is the ever-expanding therapeutic approach to various types of cancer. Typically, assessment of the treatment response is accomplished by standard, volumetric imaging procedures, performed weeks to months after the onset of treatment, given the predominantly cytostatic nature of the kinase inhibitors, at least when used as single agents. Therefore, there is a great clinical need to develop new monitoring approaches to detect the response to kinase inhibition much more promptly. Noninvasive 1H magnetic resonance spectroscopy (MRS) can measure in vitro and in vivo concentration of key metabolites which may potentially serve as biomarkers of response to kinase inhibition. METHODS We employed mantle cell lymphoma (MCL) cell lines demonstrating markedly diverse sensitivity of inhibition of Bruton's tyrosine kinase (BTK) regarding their growth and studied in-depth effects of the inhibition on various aspects of cell metabolism including metabolite synthesis using metabolomics, glucose and oxidative metabolism by Seahorse XF technology, and concentration of index metabolites lactate, alanine, total choline and taurine by 1H MRS. RESULTS Effective BTK inhibition profoundly suppressed key cell metabolic pathways, foremost pyrimidine and purine synthesis, the citrate (TCA) cycle, glycolysis, and pyruvate and glutamine/alanine metabolism. It also inhibited glycolysis and amino acid-related oxidative metabolism. Finally, it profoundly and quickly decreased concentration of lactate (a product of mainly glycolysis) and alanine (an indicator of amino acid metabolism) and, less universally total choline both in vitro and in vivo, in the MCL xenotransplant model. The decrease correlated directly with the degree of inhibition of lymphoma cell expansion and tumor growth. CONCLUSIONS Our results indicate that BTK inhibition exerts a broad and profound suppressive effect on cell metabolism and that the affected index metabolites such as lactate, alanine may serve as early, sensitive, and reliable biomarkers of inhibition in lymphoma patients detectable by noninvasive MRS-based imaging method. This kind of imaging-based detection may also be applicable to other kinase inhibitors, as well as diverse lymphoid and non-lymphoid malignancies.
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Affiliation(s)
- Kavindra Nath
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA.
| | - Pradeep K Gupta
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Johnvesly Basappa
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111-2497, USA
| | - Shengchun Wang
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111-2497, USA
| | - Neil Sen
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111-2497, USA
| | - Cosimo Lobello
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111-2497, USA
| | - Jyoti S Tomar
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Alexander A Shestov
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Stepan Orlovskiy
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Fernando Arias-Mendoza
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
- Advanced Imaging Research, Inc., Cleveland, OH, USA
| | | | - David S Nelson
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Jerry D Glickson
- Department of Radiology, University of Pennsylvania, 423 Curie Blvd, Philadelphia, PA, 19104-6069, USA
| | - Mariusz A Wasik
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111-2497, USA.
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Metrard G, Cohen C, Bailly M. Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward? Front Med (Lausanne) 2024; 11:1373260. [PMID: 38566921 PMCID: PMC10985176 DOI: 10.3389/fmed.2024.1373260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
The integration of diagnostic CT scans into PET/CT facilitates a comprehensive single examination, presenting potential advantages for patients seeking a thorough one-shot check-up. The introduction of iodinated contrast media during PET scanning raises theoretical concerns about potential interference with uptake quantification, due to the modification of tissue density on CT. Nevertheless, this impact appears generally insignificant for clinical use, compared to the intrinsic variability of standardized uptake values. On the other hand, with the growing indications of PET, especially 18F-FDG PET, contrast enhancement increases the diagnostic performances of the exam, and provides additional information. This improvement in performance achieved through contrast-enhanced PET/CT must be carefully evaluated considering the associated risks and side-effects stemming from the administration of iodinated contrast media. Within this article, we present a comprehensive literature review of contrast enhanced PET/CT, examining the potential impact of iodinated contrast media on quantification, additional side-effects and the pivotal clinically demonstrated benefits of an all-encompassing examination for patients. In conclusion, the clinical benefits of iodinated contrast media are mainly validated by the large diffusion in PET protocols. Contrary to positive oral contrast, which does not appear to offer any major advantage in patient management, intravenous iodine contrast media provides clinical benefits without significant artifact on images or quantification. However, studies on the benefit-risk balance for patients are still lacking.
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Affiliation(s)
- Gilles Metrard
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
| | - Clara Cohen
- Radiology Department, Orléans University Hospital, Orléans, France
| | - Matthieu Bailly
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
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Liu XS, Liu C, Chen YJ, Zeng DB, Wang YL, Pei ZJ. Uterine Burkitt Lymphoma with Rare Extranodal Deposits in the Bone, Breast, and Sacral Canal: A Case Report. Onco Targets Ther 2024; 17:41-44. [PMID: 38298550 PMCID: PMC10827631 DOI: 10.2147/ott.s440228] [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] [Received: 09/14/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
Burkitt lymphoma is a highly invasive non-Hodgkin lymphoma. Sporadic Burkitt's lymphoma is commonly found in the abdomen. However, Burkitt lymphoma infiltrating the uterus is uncommon in occurrence. We report the results of 18F-FDG PET/CT examination of a 36-year-old woman. The report indicates that in addition to the strong uptake of FDG imaging agent in the uterus, bilateral cervical and abdominal lymph nodes also have strong activity. At the same time, it was also found that bilateral small breast nodules, sacral canal and multiple bones in the whole body showed a radiation uptake pattern similar to that of the uterus. 18F-FDG PET/CT imaging can help determine the extent of the disease and the affected body area, which is helpful to guide the treatment decision. This case report shows the application of 18F-FDG PET/CT imaging in the diagnosis, staging and post-treatment evaluation of Burkitt lymphoma of the uterus. It provides very useful information for clinicians and helps to improve the accuracy of diagnosis and treatment effect.
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Affiliation(s)
- Xu-Sheng Liu
- Department of Nuclear Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Chao Liu
- Medical Imaging Center, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Yi-Jia Chen
- Department of Nuclear Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Dao-Bing Zeng
- Department of Nuclear Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Ya-Lan Wang
- Department of Nuclear Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Zhi-Jun Pei
- Department of Nuclear Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
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5
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Choi JW, Dean EA, Lu H, Thompson Z, Qi J, Krivenko G, Jain MD, Locke FL, Balagurunathan Y. Repeatability of metabolic tumor burden and lesion glycolysis between clinical readers. Front Immunol 2023; 14:994520. [PMID: 36875072 PMCID: PMC9975754 DOI: 10.3389/fimmu.2023.994520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
The Metabolic Tumor Volume (MTV) and Tumor Lesion Glycolysis (TLG) has been shown to be independent prognostic predictors for clinical outcome in Diffuse Large B-cell Lymphoma (DLBCL). However, definitions of these measurements have not been standardized, leading to many sources of variation, operator evaluation continues to be one major source. In this study, we propose a reader reproducibility study to evaluate computation of TMV (& TLG) metrics based on differences in lesion delineation. In the first approach, reader manually corrected regional boundaries after automated detection performed across the lesions in a body scan (Reader M using a manual process, or manual). The other reader used a semi-automated method of lesion identification, without any boundary modification (Reader A using a semi- automated process, or auto). Parameters for active lesion were kept the same, derived from standard uptake values (SUVs) over a 41% threshold. We systematically contrasted MTV & TLG differences between expert readers (Reader M & A). We find that MTVs computed by Readers M and A were both concordant between them (concordant correlation coefficient of 0.96) and independently prognostic with a P-value of 0.0001 and 0.0002 respectively for overall survival after treatment. Additionally, we find TLG for these reader approaches showed concordance (CCC of 0.96) and was prognostic for over -all survival (p ≤ 0.0001 for both). In conclusion, the semi-automated approach (Reader A) provides acceptable quantification & prognosis of tumor burden (MTV) and TLG in comparison to expert reader assisted measurement (Reader M) on PET/CT scans.
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Affiliation(s)
- Jung W Choi
- Department of Diagnostic Imaging and Interventional Radiology, H Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Erin A Dean
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States.,Division of Hematology and Oncology, University of Florida, Gainesville, FL, , United States
| | - Hong Lu
- Cancer Physiology, H. Lee. Moffitt Cancer Center, Tampa, FL, United States.,Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zachary Thompson
- Biostatistics & Bioinformatics, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Jin Qi
- Cancer Physiology, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Gabe Krivenko
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Michael D Jain
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Frederick L Locke
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
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Triumbari EKA, Morland D, Cuccaro A, Maiolo E, Hohaus S, Annunziata S. Classical Hodgkin Lymphoma: A Joint Clinical and PET Model to Predict Poor Responders at Interim Assessment. Diagnostics (Basel) 2022; 12:diagnostics12102325. [PMID: 36292014 PMCID: PMC9600607 DOI: 10.3390/diagnostics12102325] [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] [Received: 06/20/2022] [Revised: 08/24/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
(1) This study aimed to investigate whether baseline clinical and Positron Emission Tomography/Computed Tomography (bPET)-derived parameters could help predicting early response to the first two cycles of chemotherapy (Deauville Score at interim PET, DS at iPET) in patients with classical Hodgkin lymphoma (cHL) to identify poor responders (DS ≥ 4) who could benefit from first-line treatment intensification at an earlier time point. (2) cHL patients with a bPET and an iPET imaging study in our Centre’s records (2013−2019), no synchronous/metachronous tumors, no major surgical resection of disease prior to bPET, and treated with two cycles of ABVD chemotherapy before iPET were retrospectively included. Baseline International Prognostic Score for HL (IPS) parameters were collected. Each patient’s bPET total metabolic tumor volume (TMTV) and highest tumoral SUVmax were collected. ROC curves and Youden’s index were used to derive the optimal thresholds of TMTV and SUVmax with regard to the DS (≥4). Chi-square or Fisher’s exact test were used for the univariate analysis. A multivariate analysis was then performed using logistic regression. The type I error rate in the hypothesis testing was set to 5%. (3) A total of 146 patients were included. The optimal threshold to predict a DS ≥ 4 was >177 mL for TMTV and >14.7 for SUVmax (AUC of 0.65 and 0.58, respectively). The univariate analysis showed that only TMTV, SUVmax, advanced disease stage, and age were significantly associated with a DS ≥ 4. A multivariate model was finally derived from TMTV, SUVmax, and age, with an AUC of 0.77. (4) A multivariate model with bPET parameters and age at diagnosis was satisfactorily predictive of poor response at iPET after ABVD induction chemotherapy in cHL patients. More studies are needed to validate these results and further implement DS-predictive factors at baseline in order to prevent poor response and intensify therapeutic strategies a-priori when needed.
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Affiliation(s)
- Elizabeth Katherine Anna Triumbari
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630-154-777; Fax: +39-0630-137-45
| | - David Morland
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France
- Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, 51100 Reims, France
- CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, 51100 Reims, France
| | - Annarosa Cuccaro
- Hematology Unit, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, 55100 Livorno, Italy
| | - Elena Maiolo
- Hematology Unit, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Stefan Hohaus
- Hematology Unit, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Hematology Section, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Salvatore Annunziata
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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He W, Xia C, Chen X, Yu J, Liu J, Pu H, Li X, Liu S, Chen X, Peng L. Computed Tomography-Based Radiomics for Differentiation of Thymic Epithelial Tumors and Lymphomas in Anterior Mediastinum. Front Oncol 2022; 12:869982. [PMID: 35646676 PMCID: PMC9136168 DOI: 10.3389/fonc.2022.869982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the differential diagnostic performance of computed tomography (CT)-based radiomics in thymic epithelial tumors (TETs) and lymphomas in anterior mediastinum. Methods There were 149 patients with TETs and 93 patients with lymphomas enrolled. These patients were assigned to a training set (n = 171) and an external validation set (n = 71). Dedicated radiomics prototype software was used to segment lesions on preoperative chest enhanced CT images and extract features. The multivariable logistic regression algorithm was used to construct three models according to clinico-radiologic features, radiomics features, and combined features, respectively. Performance of the three models was compared by using the area under the receiver operating characteristic curves (AUCs). Decision curve analysis was used to evaluate clinical utility of the three models. Results For clinico-radiologic model, radiomics signature model, and combined model, the AUCs were 0.860, 0.965, 0.975 and 0.843, 0.961, 0.955 in the training cohort and the test cohort, respectively (all P<0.05). The accuracies of each model were 0.836, 0.895, 0.918 and 0.845, 0.901, 0.859 in the two cohorts, respectively (all P<0.05). Compared with the clinico-radiologic model, better diagnostic performances were found in the radiomics signature model and the combined model. Conclusions Radiomics signature model and combined model exhibit outstanding and comparable differential diagnostic performances between TETs and lymphomas. The CT-based radiomics analysis might serve as an effective tool for accurately differentiating TETs from lymphomas before treatment.
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Affiliation(s)
- Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huaxia Pu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyue Chen
- Computed Tomography (CT) Collaboration, Siemens Healthineers, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Yoo KH. Staging and response assessment of lymphoma: a brief review of the Lugano classification and the role of FDG-PET/CT. Blood Res 2022; 57:75-78. [PMID: 35483930 PMCID: PMC9057662 DOI: 10.5045/br.2022.2022055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/06/2023] Open
Abstract
The accurate assessment of initial disease status and therapeutic responses is critical to the optimal management of patients with lymphoma. Currently, staging and treatment response evaluation for lymphoma has been standardized into the Lugano classification. Lugano classification incorporates positron emission tomography (PET) into the existing response criteria, and response assessment using FDG-PET/CT has been proven to predict the prognosis in various lymphoma subtypes effectively. We will briefly review the current staging and response evaluation system and explore the role of functional imaging in the field of lymphoma.
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Affiliation(s)
- Kwai Han Yoo
- Division of Hematology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Aznar M, Ntentas G, Enmark M, Flampouri S, Meidhal Petersen P, Ricardi U, Levis M. The role of motion management and position verification in lymphoma radiotherapy. Br J Radiol 2021; 94:20210618. [PMID: 34677090 PMCID: PMC8553184 DOI: 10.1259/bjr.20210618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
In the last decades, the substantial technical progress in radiation oncology offered the opportunity for more accurate planning and delivery of treatment. At the same time, the evolution of systemic treatment and the advent of modern diagnostic tools allowed for more accurate staging and consequently a safe reduction of radiotherapy (RT) target volumes and RT doses in the treatment of lymphomas. As a result, incidental irradiation of organs at risk was reduced, with a consequent reduction of severe late toxicity in long-term lymphoma survivors. Nevertheless, these innovations warrant that professionals pay attention to concurrently ensure precise planning and dose delivery to the target volume and safe sparing of the organs at risk. In particular, target and organ motion should be carefully managed in order to prevent any compromise of treatment efficacy. Several aspects should be taken into account during the treatment pathway to minimise uncertainties and to apply a valuable motion management strategy, when needed. These include: reliable image registration between diagnostic and planning radiologic exams to facilitate the contouring process, image guidance to limit positioning uncertainties and to ensure the accuracy of dose delivery and management of lung motion through procedures of respiratory gating and breath control. In this review, we will cover the current clinical approaches to minimise these uncertainties in patients treated with modern RT techniques, with a particular focus on mediastinal lymphoma. In addition, since uncertainties have a different impact on the dose deposition of protons compared to conventional x-rays, the role of motion management and position verification in proton beam therapy (PBT) will be discussed in a separate section.
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Affiliation(s)
| | | | | | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | | | - Mario Levis
- Department of Oncology, University of Torino, Turin, Italy
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Illidge T, Mikhaeel NG, Specht L, Yahalom J. Lymphoma: advances in imaging and radiotherapy - introductory editorial. Br J Radiol 2021; 94:20219005. [PMID: 34677091 DOI: 10.1259/bjr.20219005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tim Illidge
- Manchester NIHR Biomedical Research Centre, University of Manchester, Christie Hospital, Manchester, United Kingdom
| | - N George Mikhaeel
- Guy's & St Thomas' NHS Foundation Trust and King's College University, London, United Kingdom
| | - Lena Specht
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Yahalom
- Memorial Sloan Kettering Cancer Center, New York, United States
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