1
|
Yeh R, Amer A, Johnson JM, Ginat DT. Pearls and Pitfalls of 18FDG-PET Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:287-298. [DOI: 10.1016/j.nic.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
2
|
Flaus A, Nevesny S, Guy JB, Sotton S, Magné N, Prévot N. Positron emission tomography for radiotherapy planning in head and neck cancer: What impact? Nucl Med Commun 2021; 42:234-243. [PMID: 33252513 DOI: 10.1097/mnm.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PET-computed tomography (CT) plays a growing role to guide target volume delineation for head and neck cancer in radiation oncology. Pretherapeutic [18F]FDG PET-CT adds information to morphological imaging. First, as a whole-body imaging modality, it reveals regional or distant metastases that induce major therapeutic changes in more than 10% of the cases. Moreover, it allows better pathological lymph node selection which improves overall regional control and overall survival. Second, locally, it allows us to define the metabolic tumoral volume, which is a reliable prognostic feature for survival outcome. [18F]FDG PET-CT-based gross tumor volume (GTV) is on average significantly smaller than GTV based on CT. Nevertheless, the overlap is incomplete and more evaluation of composite GTV based on PET and GTV based on CT are needed. However, in clinical practice, the study showed that using GTV PET alone for treatment planning was similar to using GTVCT for local control and dose distribution was better as a dose to organs at risk significantly decreased. In addition to FDG, pretherapeutic PET could give access to different biological tumoral volumes - thanks to different tracers - guiding heterogeneous dose delivery (dose painting concept) to resistant subvolumes. During radiotherapy treatment, follow-up [18F]FDG PET-CT revealed an earlier and more important diminution of GTV than other imaging modality. It may be a valuable support for adaptative radiotherapy as a new treatment plan with a significant impact on dose distribution became possible. Finally, additional studies are required to prospectively validate long-term outcomes and lower toxicity resulting from the use of PET-CT in treatment planning.
Collapse
Affiliation(s)
- Anthime Flaus
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
| | - Stéphane Nevesny
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
| | - Jean-Baptiste Guy
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Sandrine Sotton
- Department of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, University Departement of Research and Teaching
| | - Nicolas Magné
- Département de Radiothérapie, Institut de Cancérologie de la Loire-Lucien Neuwirth, St Priest en Jarez
- UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Oullins Cedex
| | - Nathalie Prévot
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France
| |
Collapse
|
3
|
Abgral R, Bourhis D, Calais J, Lucia F, Leclère JC, Salaün PY, Vera P, Schick U. Correlation between fluorodeoxyglucose hotspots on preradiotherapy PET/CT and areas of cancer local relapse: Systematic review of literature. Cancer Radiother 2020; 24:444-452. [DOI: 10.1016/j.canrad.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
|
4
|
Truffault B, Bourhis D, Chaput A, Calais J, Robin P, Le Pennec R, Lucia F, Leclère JC, Gujral DM, Vera P, Salaün PY, Schick U, Abgral R. Correlation Between FDG Hotspots on Pre-radiotherapy PET/CT and Areas of HNSCC Local Relapse: Impact of Treatment Position and Images Registration Method. Front Med (Lausanne) 2020; 7:218. [PMID: 32582727 PMCID: PMC7287148 DOI: 10.3389/fmed.2020.00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023] Open
Abstract
Aim: Several series have already demonstrated that intratumoral subvolumes with high tracer avidity (hotspots) in 18F-flurodesoxyglucose positron-emission tomography (FDG-PET/CT) are preferential sites of local recurrence (LR) in various solid cancers after radiotherapy (RT), becoming potential targets for dose escalation. However, studies conducted on head and neck squamous cell carcinoma (HNSCC) found only a moderate overlap between pre- and post-treatment subvolumes. A limitation of these studies was that scans were not performed in RT treatment position (TP) and were coregistred using a rigid registration (RR) method. We sought to study (i) the influence of FDG-PET/CT acquisition in TP and (ii) the impact of using an elastic registration (ER) method to improve the localization of hotpots in HNSCC. Methods: Consecutive patients with HNSCC treated by RT between March 2015 and September 2017 who underwent FDG-PET/CT in TP at initial staging (PETA) and during follow-up (PETR) were prospectively included. We utilized a control group scanned in non treatment position (NTP) from our previous retrospective study. Scans were registered with both RR and ER methods. Various sub-volumes (AX; x = 30, 40, 50, 60, 70, 80, and 90%SUVmax) within the initial tumor and in the subsequent LR (RX; x = 40 and 70%SUVmax) were overlaid on the initial PET/CT for comparison [Dice, Jaccard, overlap fraction = OF, common volume/baseline volume = AXnRX/AX, common volume/recurrent volume = AXnRX/RX]. Results: Of 199 patients included, 43 (21.6%) had LR (TP = 15; NTP = 28). The overlap between A30, A40, and A50 sub-volumes on PETA and the whole metabolic volume of recurrence R40 and R70 on PETR showed moderate to good agreements (0.41–0.64) with OF and AXnRX/RX index, regardless of registration method or patient position. Comparison of registration method demonstrated OF and AXnRX/RX indices (x = 30% to 50%SUVmax) were significantly higher with ER vs. RR in NTP (p < 0.03), but not in TP. For patient position, the OF and AXnRX/RX indices were higher in TP than in NTP when RR was used with a trend toward significance, particularly for x=40%SUVmax (0.50±0.22 vs. 0.31 ± 0.13, p = 0.094). Conclusion: Our study suggested that PET/CT acquired in TP improves results in the localization of FDG hotspots in HNSCC. If TP is not possible, using an ER method is significantly more accurate than RR for overlap estimation.
Collapse
Affiliation(s)
- Blandine Truffault
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - David Bourhis
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, Brest, France
| | - Anne Chaput
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - Jeremie Calais
- Department of Medical and Molecular Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Philippe Robin
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, Brest, France
| | - Romain Le Pennec
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - François Lucia
- Department of Radiotherapy, Brest University Hospital, Brest, France
| | | | - Dorothy M Gujral
- Clinical Oncology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Hammersmith, London, United Kingdom.,Department of Cancer and Surgery, Imperial College London, London, United Kingdom
| | - Pierre Vera
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, Brest, France
| | - Ulrike Schick
- Department of Radiotherapy, Brest University Hospital, Brest, France
| | - Ronan Abgral
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, Brest, France
| |
Collapse
|
5
|
Lucia F, Miranda O, Abgral R, Bourbonne V, Dissaux G, Pradier O, Hatt M, Schick U. Use of Baseline 18 F-FDG PET/CT to Identify Initial Sub-Volumes Associated With Local Failure After Concomitant Chemoradiotherapy in Locally Advanced Cervical Cancer. Front Oncol 2020; 10:678. [PMID: 32457839 PMCID: PMC7221149 DOI: 10.3389/fonc.2020.00678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/09/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction: Locally advanced cervical cancer (CC) patients treated by chemoradiotherapy (CRT) have a significant local recurrence rate. The objective of this work was to assess the overlap between the initial high-uptake sub-volume (V1) on baseline 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans and the metabolic relapse (V2) sites after CRT in locally advanced CC. Methods: PET/CT performed before treatment and at relapse in 21 patients diagnosed with LACC and treated with CRT were retrospectively analyzed. CT images at the time of recurrence were registered to baseline CT using the 3D Slicer TM Expert Automated Registration module. The corresponding PET images were then registered using the corresponding transform. The fuzzy locally adaptive Bayesian (FLAB) algorithm was implemented using 3 classes (one for the background and the other two for tumor) in PET1 to simultaneously define an overall tumor volume and the sub-volume V1. In PET2, FLAB was implemented using 2 classes (one for background, one for tumor), in order to define V2. Four indices were used to determine the overlap between V1 and V2 (Dice coefficients, overlap fraction, X = (V1nV2)/V1 and Y = (V1nV2)/V2). Results: The mean (±standard deviation) follow-up was 26 ± 11 months. The measured overlaps between V1 and V2 were moderate to good according to the four metrics, with 0.62-0.81 (0.72 ± 0.05), 0.72-1.00 (0.85 ± 0.10), 0.55-1.00 (0.73 ± 0.16) and 0.50-1.00 (0.76 ± 0.12) for Dice, overlap fraction, X and Y, respectively. Conclusion: In our study, the overlaps between the initial high-uptake sub-volume and the recurrent metabolic volume showed moderate to good concordance. These results now need to be confirmed in a larger cohort using a more standardized patient repositioning procedure for sequential PET/CT imaging, as there is potential for RT dose escalation exploiting the pre-treatment PET high-uptake sub-volume.
Collapse
Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Omar Miranda
- Radiation Oncology Department, University Hospital, Brest, France
| | - Ronan Abgral
- Nuclear Medicine Department, University Hospital, Brest, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Gurvan Dissaux
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| |
Collapse
|
6
|
Hatt M, Tixier F, Desseroit MC, Badic B, Laurent B, Visvikis D, Rest CCL. Revisiting the identification of tumor sub-volumes predictive of residual uptake after (chemo)radiotherapy: influence of segmentation methods on 18F-FDG PET/CT images. Sci Rep 2019; 9:14925. [PMID: 31624321 PMCID: PMC6797734 DOI: 10.1038/s41598-019-51096-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
Our aim was to evaluate the impact of the accuracy of image segmentation techniques on establishing an overlap between pre-treatment and post-treatment functional tumour volumes in 18FDG-PET/CT imaging. Simulated images and a clinical cohort were considered. Three different configurations (large, small or non-existent overlap) of a single simulated example was used to elucidate the behaviour of each approach. Fifty-four oesophageal and head and neck (H&N) cancer patients treated with radiochemotherapy with both pre- and post-treatment PET/CT scans were retrospectively analysed. Images were registered and volumes were determined using combinations of thresholds and the fuzzy locally adaptive Bayesian (FLAB) algorithm. Four overlap metrics were calculated. The simulations showed that thresholds lead to biased overlap estimation and that accurate metrics are obtained despite spatially inaccurate volumes. In the clinical dataset, only 17 patients exhibited residual uptake smaller than the pre-treatment volume. Overlaps obtained with FLAB were consistently moderate for esophageal and low for H&N cases across all metrics. Overlaps obtained using threshold combinations varied greatly depending on thresholds and metrics. In both cases overlaps were variable across patients. Our findings do not support optimisation of radiotherapy planning based on pre-treatment 18FDG-PET/CT image definition of high-uptake sub-volumes. Combinations of thresholds may have led to overestimation of overlaps in previous studies.
Collapse
Affiliation(s)
- Mathieu Hatt
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France.
| | - Florent Tixier
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Nuclear Medicine department, CHU Milétrie, Poitiers, France
| | - Marie-Charlotte Desseroit
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Nuclear Medicine department, CHU Milétrie, Poitiers, France
| | - Bogdan Badic
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | | | | | - Catherine Cheze Le Rest
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Nuclear Medicine department, CHU Milétrie, Poitiers, France
| |
Collapse
|
7
|
Beaumont J, Acosta O, Devillers A, Palard-Novello X, Chajon E, de Crevoisier R, Castelli J. Voxel-based identification of local recurrence sub-regions from pre-treatment PET/CT for locally advanced head and neck cancers. EJNMMI Res 2019; 9:90. [PMID: 31535233 PMCID: PMC6751236 DOI: 10.1186/s13550-019-0556-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Overall, 40% of patients with a locally advanced head and neck cancer (LAHNC) treated by chemoradiotherapy (CRT) present local recurrence within 2 years after the treatment. The aims of this study were to characterize voxel-wise the sub-regions where tumor recurrence appear and to predict their location from pre-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Materials and methods Twenty-six patients with local failure after treatment were included in this study. Local recurrence volume was identified by co-registering pre-treatment and recurrent PET/CT images using a customized rigid registration algorithm. A large set of voxel-wise features were extracted from pre-treatment PET to train a random forest model allowing to predict local recurrence at the voxel level. Results Out of 26 expert-assessed registrations, 15 provided enough accuracy to identify recurrence volumes and were included for further analysis. Recurrence volume represented on average 23% of the initial tumor volume. The MTV with a threshold of 50% of SUVmax plus a 3D margin of 10 mm covered on average 89.8% of the recurrence and 96.9% of the initial tumor. SUV and MTV alone were not sufficient to identify the area of recurrence. Using a random forest model, 15 parameters, combining radiomics and spatial location, were identified, allowing to predict the recurrence sub-regions with a median area under the receiver operating curve of 0.71 (range 0.14–0.91). Conclusion As opposed to regional comparisons which do not bring enough evidence for accurate prediction of recurrence volume, a voxel-wise analysis of FDG-uptake features suggested a potential to predict recurrence with enough accuracy to consider tailoring CRT by dose escalation within likely radioresistant regions.
Collapse
Affiliation(s)
- J Beaumont
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - O Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - A Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - X Palard-Novello
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - E Chajon
- Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - R de Crevoisier
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - J Castelli
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France. .,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France.
| |
Collapse
|