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Zhong X, Wang Y, He X, He X, Hu Z, Huang H, Chen J, Chen K, Wei P, Zhao S, Wang Y, Zhang H, Feng B, Li D. HIF1A-AS2 promotes the metabolic reprogramming and progression of colorectal cancer via miR-141-3p/FOXC1 axis. Cell Death Dis 2024; 15:645. [PMID: 39227375 PMCID: PMC11372083 DOI: 10.1038/s41419-024-06958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 06/30/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024]
Abstract
lncRNA can regulate tumorigenesis development and distant metastasis of colorectal cancer (CRC). However, the detailed molecular mechanisms are still largely unknown. Using RNA-sequencing data, RT-qPCR, and FISH assay, we found that HIF1A-AS2 was upregulated in CRC tissues and associated with poor prognosis. Functional experiments were performed to determine the roles of HIF1A-AS2 in tumor progression and we found that HIF1A-AS2 can promote the proliferation, metastasis, and aerobic glycolysis of CRC cells. Mechanistically, HIF1A-AS2 can promote FOXC1 expression by sponging miR-141-3p. SP1 can transcriptionally activate HIF1A-AS2. Further, HIF1A-AS2 can be packaged into exosomes and promote the malignant phenotype of recipient tumor cells. Taken together, we discovered that SP1-induced HIF1A-AS2 can promote the metabolic reprogramming and progression of CRC via miR-141-3p/FOXC1 axis. HIF1A-AS2 is a promising diagnostic marker and treatment target in CRC.
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Affiliation(s)
- Xinyang Zhong
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Yaxian Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Xuefeng He
- Cancer Institute, ZJU-UCLA Joint Center for Medical Education and Research, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinxin He
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Zijuan Hu
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Huixia Huang
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Jiayu Chen
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Keji Chen
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Ping Wei
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Senlin Zhao
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China
| | - Yilin Wang
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China.
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Hong Zhang
- Colorectal Tumor Surgery Ward, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dawei Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China.
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Mihailović J, Roganović J, Starčević I, Nikolić I, Prvulović Bunović N, Nikin Z. Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities. J Clin Med 2024; 13:3602. [PMID: 38930131 PMCID: PMC11204678 DOI: 10.3390/jcm13123602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution's Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824-0.946; p < 0.001), 0.844 (95% CI: 0.772-0.916; p < 0.001), 0.753 (95% CI: 0.612-0.844; p < 0.001), and 0.547 (95% CI: 0.442-0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers.
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Affiliation(s)
- Jasna Mihailović
- Department of Nuclear Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Division of Nuclear Medicine, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia; (J.R.); (I.S.)
| | - Jelena Roganović
- Division of Nuclear Medicine, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia; (J.R.); (I.S.)
| | - Ivana Starčević
- Division of Nuclear Medicine, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia; (J.R.); (I.S.)
| | - Ivan Nikolić
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Clinic for Medical Oncology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Nataša Prvulović Bunović
- Department of Nuclear Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Centre for Diagnostic Imaging, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Zoran Nikin
- Department for Pathoanatomical Diagnostics, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia;
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Liz-Pimenta J, Ferreira C, Araújo A, Sousa M. Comprehensive look at rectal squamous cell carcinoma. BMJ Case Rep 2024; 17:e255284. [PMID: 38272508 PMCID: PMC10826491 DOI: 10.1136/bcr-2023-255284] [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] [Indexed: 01/27/2024] Open
Abstract
Rectal squamous cell carcinoma (rSCC) is a rare cancer (0.5% of all rectal cancers). It typically presents at an advanced stage and has a poor prognosis. Recently, chemoradiotherapy with organ preservation has become an option for complete response (CR). Surveillance is essential to prompt recognition of recurrence due to its high risk. We present a case of an elderly woman with rSCC stage cT4N1aM0 who underwent a combination of chemotherapy (mitomycin and fluoropyrimidine) and radiotherapy with CR and organ preservation. The patient has been in follow-up for 2 years with digital rectal examination, tumour markers, pelvic MRI, thoracic and upper abdominal CT, proctoscopy and positron emission tomography, with no disease recurrence. This highlights the success of chemoradiotherapy for rSCC treatment, allowing organ preservation.
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Affiliation(s)
- Joana Liz-Pimenta
- Medical Oncology, Centro Hospitalar de Tras-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Cátia Ferreira
- Surgery, Centro Hospitalar de Tras-os-montes e Alto Douro EPE, Vila Real, Portugal
| | - Alexandra Araújo
- Medical Oncology, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Marta Sousa
- Medical Oncology, Centro Hospitalar de Tras-os-montes e Alto Douro EPE, Vila Real, Portugal
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Al-Ibraheem A, Ruzzeh S, Badarneh M, Al-Adhami D, Telfah A. Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases. Cureus 2023; 15:e51393. [PMID: 38292976 PMCID: PMC10826454 DOI: 10.7759/cureus.51393] [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] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Colorectal cancer is a common malignancy, with the liver being the most frequent site of metastases. [18F] Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a valuable tool in detecting and evaluating liver metastases and extrahepatic disease. Herein, we present a case of a 76-year-old male with colorectal cancer associated with lung and liver metastases. The patient received 12 chemoimmunotherapy cycles and was then put on maintenance cetuximab; serial [18F]FDG PET/CT scans were utilized to evaluate treatment response. The patient exhibited a positive response to chemoimmunotherapy, with regression of rectal disease and resolution of pulmonary metastatic nodules. Serial [18F]FDG PET/CT scans unveiled three distinct necrotic patterns. The case report advocates that [18F]FDG PET/CT plays an important role in evaluating colorectal liver metastases (CRLM) response to treatment, identifying transient necrosis, early recurrence, and emphasizing the limitations of post-treatment CT scans in identifying early CRLM recurrence. Integrating functional imaging, particularly [18F]FDG PET/CT, promises for management monitoring and surveillance of CRLM patients.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
- School of Medicine, University of Jordan, Amman, JOR
| | - Saad Ruzzeh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Mohannad Badarneh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Dhuha Al-Adhami
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Ahmad Telfah
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman, JOR
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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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Al-Ibraheem A, Hammoudeh R, Kasasbeh N, Abdlkadir AS, Juweid ME. Synchronous Colorectal and Prostate Cancer: Dual PET/CT Approach for Detecting and Distinguishing Metastatic Patterns. Nucl Med Mol Imaging 2023; 57:291-294. [PMID: 37982103 PMCID: PMC10654322 DOI: 10.1007/s13139-023-00812-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 11/21/2023] Open
Abstract
Prostate cancer (PC) and colorectal cancer (CRC) are two of the leading causes of cancer-related mortality. The incidence of synchronous neoplasms in patients with CRC is increasing, though synchronous PC and CRC remains a rare occurrence in clinical practice. Early diagnosis, accurate staging, and characterization of tumors are essential for selecting patient-tailored therapy. The origin of metastatic disease in synchronous cases presents a challenge for conventional imaging modalities, but advances in molecular imaging have addressed this limitation. Positron emission tomography/computed tomography (PET/CT) is now the preferred modality for assessing synchronous cases. The authors present a 72-year-old male patient with the rare occurrence of two coexisting primary cancers. At first, fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT detected the first colorectal primary tumor extension along with evidence of heterogeneous 18F-FDG activity within an enlarged prostate, warranting further evaluation. Subsequently, gallium-68 prostate-specific membrane antigen (68 Ga-PSMA) PET/CT imaging revealed the second prostate primary cancer with evidence of bone metastases. Adoption of a dual PET/CT approach in cases where biopsy is impractical can achieve accurate staging results during the initial diagnostic workup.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman, 11941 Jordan
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University of Jordan, Amman, 11942 Jordan
| | - Rahma Hammoudeh
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University of Jordan, Amman, 11942 Jordan
| | - Nour Kasasbeh
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University of Jordan, Amman, 11942 Jordan
| | - Ahmed Saad Abdlkadir
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman, 11941 Jordan
| | - Malik E. Juweid
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University of Jordan, Amman, 11942 Jordan
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7
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Boanova LG, Altmayer S, Watte G, Raupp AA, Francisco MZ, De Oliveira GS, Hochhegger B, Andrade RGF. Detection of Liver Lesions in Colorectal Cancer Patients Using 18F-FDG PET/CT Dual-Time-Point Scan Imaging. Cancers (Basel) 2023; 15:5403. [PMID: 38001662 PMCID: PMC10670707 DOI: 10.3390/cancers15225403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic performance of dual-time-point fluorine-18-fluorodeoxyglucose positron emission computed tomography/computed tomography (18F-FDG PET/CT) compared to conventional early imaging for detecting colorectal liver metastases (CRLM) in colorectal cancer (CRC) patients. METHODS One hundred twenty-four consecutive CRC patients underwent dual-time-point imaging scans on a retrospective basis. Histopathological confirmation and/or clinical follow-up were accepted as the gold standard. Standard uptake values (SUV), signal-to-noise ratio (SNR), retention index (RI), tumor-to-normal liver ratio (TNR), and lesion sizes were measured for early and delayed PET scans. The diagnostic performance of early and delayed images was calculated on a per-patient basis and compared using McNemar's test. RESULTS Among the 124 patients, 57 (46%) had CRLM, 6 (4.8%) had benign lesions, and 61 (49.2%) had no concerning lesions detected. Smaller CRLM lesions (<5 cm3) showed significantly higher uptake in the delayed scans relative to early imaging (p < 0.001). The SUV and TNR increased significantly in delayed imaging of all metastatic lesions (p < 0.001). The retention index of all CRLM was high (40.8%), especially for small lesions (54.8%). A total of 177 lesions in delayed images and 124 in standard early images were identified. In a per-patient analysis, delayed imaging had significantly higher sensitivity (100% vs. 87.7%) and specificity (91.0% vs. 94.0%) compared to early imaging (p-value = 0.04). CONCLUSIONS The detection of liver lesions using dual-time-point PET/CT scan improves the sensitivity and specificity for the detection of colorectal liver metastasis.
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Affiliation(s)
- Luciane G. Boanova
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Stephan Altmayer
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Guilherme Watte
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Ana Amelia Raupp
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Martina Zaguini Francisco
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Guilherme Strieder De Oliveira
- School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400—Santa Cecília, Porto Alegre 90035-003, Brazil;
| | - Bruno Hochhegger
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Rubens G. F. Andrade
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
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Clinical value of fluorine-18-fluorodeoxyglucose PET/MRI for liver metastasis in colorectal cancer: a prospective study. Nucl Med Commun 2023; 44:150-160. [PMID: 36630219 DOI: 10.1097/mnm.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of liver 18F-FDG PET/MRI in addition to whole-body PET/CT and to compare it with MRI in the detection and clinical management of liver metastasis in patients with colorectal cancer (CRC). MATERIAL AND METHODS Seventy-eight patients with CRC who underwent whole-body 18F-FDG PET/CT followed by liver PET/MRI were prospectively included. Histopathological confirmation and/or at least 3 months of clinical follow-up after PET/MRI were accepted as gold standard. Lesion and patient-based analyses were performed to evaluate the diagnostics performances of PET/CT, PET/MRI and MRI. In addition, changes of clinical management were evaluated. RESULTS On lesion-based analysis, for PET/CT, PET/MRI and MRI; sensitivity (Se): 55.6%, 97.2% and 100%; specificity (Sp): 98.5%, 100% and 80.5%; and accuracy (Acc): 70.7%, 98.2% and 93.1% were calculated, respectively. Se and Acc of PET/MRI and MRI were significantly superior than PET/CT (P < 0.001). Se and Acc of PET/MRI and MRI were comparable; however, Sp of PET/MRI was significantly better than MRI (P < 0.001). On patient-based analysis, Se: 75.6%, 100% and 100%; Sp: 97.3%, 100% and 86.5%; and Acc: 85.9%, 100% and 93.5% were calculated, respectively. Se and Acc of PET/MRI were significantly superior than PET/CT (P < 0.001). Also, Se of MRI was significantly superior than PET/CT (P < 0.001). Se of PET/MRI and MRI were comparable, but Sp and Acc of PET/MRI were significantly better than MRI. The additional information obtained from liver PET/MRI changed treatment strategy in 14/78 (18%) patients compared to PET/CT or alone liver MRI. CONCLUSION Diagnostic performances of PET/MRI and MRI for detection of CRC liver metastasis is superior to PET/CT. PET/MRI especially helps in the accurate detection of liver metastases that are suspicious on MRI and has the potential to change the clinical management of especially oligometastatic patients by identifying uncertain liver lesions.
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Utility of PET Scans in the Diagnosis and Management of Gastrointestinal Tumors. Dig Dis Sci 2022; 67:4633-4653. [PMID: 35908126 DOI: 10.1007/s10620-022-07616-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
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ÇINAR A, ALAGÖZ E, AYAN A, UÇGUN A. Kolorektal kanseri olan hastaların ameliyat sonrası klinik yönetiminde fluorine-18 fluorodeoxyglucose pozitron emisyon tomografisi/bilgisayarlı tomografi’nin tanısal önemi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.969726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Kolorektal kanser, erken tespitinde cerrahi kür sağlanabilen yaygın bir kanser türüdür. Bu kanser tipinde tedaviye yanıtın erken belirlenmesi yaşam süresini olumlu etkilemektedir. Çalışmamızda kolorektal kanseri olan hastaların, ameliyat sonrasındaki klinik yönetimlerinde F-18 FDG PET/BT’nin tanısal önemini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Haziran 2016 ve Ocak 2020 tarihleri arasında 168 hasta kolorektal kanser yönetimi amacıyla bölümümüze yönlendirilmiştir. Bu hastaların hepsi primer kolon tümörleri için ameliyat edilmişlerdi. Sistemik tedavi öncesinde ve sonrasında tedavi yanıtının değerlendirilmesi amacıyla bazal ve ardışık F-18 FDG PET/BT incelemesi yapılmıştır. F-18 FDG PET/BT taramaları sırasıyla analiz edilmiştir.
Bulgular: Hastalar primer tümör lokalizasyonlarına göre gruplandırıldı. Toplam 168 hastanın 55’inde sağ kolonda, 33’ünde sol kolonda, 14’ünde transvers kolonda, 61’inde rektosigmoid kolonda ve 5’inde çekumda primer tümör saptandı. Lokal rekürrens 57 hastada saptanmış olup 33’ü erkek (%57.9) ve 24’ü (%42.1) kadındı. Lokal rekürrense ait ortalama SUVmaks 8.97±3.42 g/ml olarak saptandı. Ek olarak çıkan kolon grubunda 2 hastada (%1.20) yeni tümöral odak gözlendi.
Sonuç: Kolorektal kanserli hastalarda, yapılabiliyorsa kolon rezeksiyonu tedavide ilk aşamadır. Küratif cerrahi sonrası ilk iki yıl içinde, hastaların yaklaşık %40’ında rekürrens görülebilmektedir. Rekürrensin erken tespiti, hastaların yaşam süresini iyileştirmektedir.
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Affiliation(s)
- Alev ÇINAR
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Engin ALAGÖZ
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aslı AYAN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aybüke UÇGUN
- University of Health Sciences, Gulhane Training & Research Hospital
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Kömek H, Can C, Kaplan İ, Gündoğan C, Kepenek F, Karaoglan H, Demirkıran A, Ebinç S, Güzel Y, Gündeş E. Comparison of [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT and [ 18F]FDG PET/CT in colorectal cancer. Eur J Nucl Med Mol Imaging 2022; 49:3898-3909. [PMID: 35578038 DOI: 10.1007/s00259-022-05839-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
AIM In this study, we aimed to evaluate the diagnostic sensitivity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary or recurrent tumor, and nodal, peritoneal, and distant organ metastases in patients with newly diagnosed or relapsed colorectal cancer (CRC) in comparison with [18F]FDG PET/CT. MATERIALS AND METHOD Thirty-nine patients with histopathologically confirmed primary or relapsed CRC were included in our study. All patients underwent both [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT imaging in the same week. Primary lesions, lymph nodes, and metastatic lesions were recorded on both scans. SUVmax and background values were measured from the primary and metastatic lesions; tumor-to-background ratio (TBR) was calculated and compared. The results of the operation were compared with PET findings in patients who underwent surgical treatment without neoadjuvant chemotherapy (NAC). RESULTS The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary tumors were 100%, while the sensitivity of [18F]FDG PET/CT was 100% and its specificity was 85.3%. When evaluated with surgical results in the detection of lymph nodes, [68 Ga]Ga-DOTA-FAPI-04 PET/CT had a sensitivity of 90% and a specificity of 100%, whereas [18F]FDG PET/CT had a sensitivity of 80% and a specificity of 81.8%. The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI PET/CT for peritoneal implants were 100%, and the sensitivity of [18F]FDG PET/CT was 55%. The SUVmax of primary lesions was higher with [18F]FDG (p < 0.001), while TBR was higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p: 0.008). SUVmax and TBR of the lymph nodes were significantly higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p < 0.001 for both). CONCLUSION [68 Ga]Ga-DOTA-FAPI-04 PET/CT achieved much higher sensitivity and specificity in the detection of primary lesions, and especially the lymph nodes and peritoneal metastases, suggesting that it can be employed in the assessment of primary tumor and metastases in patients with CRC in routine clinical practice.
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Affiliation(s)
- Halil Kömek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey.
| | - Canan Can
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - İhsan Kaplan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Cihan Gündoğan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ferat Kepenek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Hüseyin Karaoglan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Aykut Demirkıran
- Division of Medical Oncology, Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Senar Ebinç
- Division of Medical Oncology, Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Yunus Güzel
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ebubekir Gündeş
- Department of Gastroenterological Surgery, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Orel VE, Ashykhmin A, Golovko T, Rykhalskyi O, Orel VB. Texture Analysis of Tumor and Peritumoral Tissues Based on 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Hybrid Imaging in Patients With Rectal Cancer. J Comput Assist Tomogr 2021; 45:820-828. [PMID: 34469907 DOI: 10.1097/rct.0000000000001218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to determine whether texture parameters could be used in differentiation between the tumor and the peritumoral tissues based on hybrid 18F-Fluorodeoxyglucose positron emission tomography/computed tomography imaging for patients with rectal cancer. METHODS Seven parameters, including heterogeneity, entropy, energy, skewness, kurtosis, standard deviation, and average brightness, were extracted from positron emission tomography/computed tomography scans of 22 patients (12 male and 10 female; mean age, 61 ± 2 years). RESULTS The peritumoral tissue had a significantly lower value of the heterogeneity parameter (23%) than the tumor. Tumor size (r = -0.48, P < 0.05) and extramural venous invasion scores (r = 0.64, P < 0.05) correlated with heterogeneity in the peritumoral tissue. There were significant differences (P < 0.05) in the correlation coefficients between men and women. CONCLUSIONS Therefore, we provided additional quantitative information to differentiate the tumor from the peritumoral tissue and indicated possible application for extramural venous invasion evaluation in rectal cancer.
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Jayaprakasam VS, Paroder V, Schöder H. Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers. Semin Nucl Med 2021; 51:485-501. [PMID: 33965198 PMCID: PMC8338802 DOI: 10.1053/j.semnuclmed.2021.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past two decades, PET/CT has become an essential modality in oncology increasingly used in the management of gastrointestinal (GI) cancers. Most PET/CT tracers used in clinical practice show some degree of GI uptake. This uptake is quite variable and knowledge of common patterns of biodistribution of various radiotracers is helpful in clinical practice. 18F-Fluoro-Deoxy-Glucose (FDG) is the most commonly used radiotracer and has quite a variable uptake within the bowel. 68Ga-Prostate specific membrane antigen (PSMA) shows intense uptake within the proximal small bowel loops. 11C-methyl-L-methionine (MET) shows high accumulation within the bowels, which makes it difficult to assess bowel or pelvic diseases. One must also be aware of technical artifacts causing difficulties in interpretations, such as high attenuation oral contrast material within the bowel lumen or misregistration artifact due to patient movements. It is imperative to know the common variants and benign diseases that can mimic malignant pathologies. Intense FDG uptake within the esophagus and stomach may be a normal variant or may be associated with benign conditions such as esophagitis, reflux disease, or gastritis. Metformin can cause diffuse intense uptake throughout the bowel loops. Intense physiologic uptake can also be seen within the anal canal. Segmental bowel uptake can be seen in inflammatory bowel disease, radiation, or medication induced enteritis/colitis or infection. Diagnosis of appendicitis or diverticular disease requires CT correlation, as normal appendix or diverticulum can show intense uptake. Certain malignant pathologies are known to have only low FDG uptake, such as early-stage esophageal adenocarcinoma, mucinous tumors, indolent lymphomas, and multicystic mesotheliomas. Response assessment, particularly in the neoadjuvant setting, can be limited by post-treatment inflammatory changes. Post-operative complications such as abscess or fistula formation can also show intense uptake and may obscure underlying malignant pathology. In the absence of clinical suspicion or rising tumor marker, the role of FDG PET/CT in routine surveillance of patients with GI malignancy is not clear.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Squamous rectal carcinoma: a rare malignancy, literature review and management recommendations. ESMO Open 2021; 6:100180. [PMID: 34111760 PMCID: PMC8193111 DOI: 10.1016/j.esmoop.2021.100180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
Squamous cell carcinoma of the rectum is a rare malignancy (0.3% of all rectal cancers), with no known risk factor. These tumours are assessed as rectal cancer using immunohistochemical and radiological tests, and certain criteria (localisation, relationship with neighbouring structures) have to be fulfilled to make the diagnosis. Some clinicians used to stage them with the anal cancer TNM (tumour–node–metastasis), whereas others used the rectal cancer TNM. When localised, the tendency nowadays is to treat those tumours like squamous anal cancers with definitive chemoradiotherapy (5-fluorouracil and mitomycin) and to skip surgery. For metastatic disease there is no clearly validated regimen and treatment should be based on recommendations of squamous anal cancers because of their common histology. Concerning follow-up after a curative approach, techniques should follow those for anal cancer as well, evaluating a delayed response. Rectal squamous cell carcinoma (rSCC) is a rare entity for which we have limited knowledge and no clear recommendations. Creation of an international registry and a biological repository could increase our understating of this rare entity. Definitive chemoradiotherapy (CRT) should be the gold standard treatment of local/locally-advanced rSCC. Clarification of clinical and pathologic response rates with CRT or radiotherapy alone and patterns of failure is important. Timing for tumour response assessment is paramount. Data tilt towards waiting until 6 months after definitive treatment.
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Ragheb SR, Sharara SM. Can PET/CT detect recurrence in post-operative colorectal carcinoma patients with elevated CEA level? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PET is considered to be the most sensitive and specific modality for the detection of recurrent colorectal cancer. This study is to assess the role of F18-FDG PET/CT in post-operative assessment in a patient with colorectal cancer with elevated CEA level to rule out local recurrence and/or metastasis and hence guiding the clinician to the proper management strategy.
Results
This study was performed on 45 patients who underwent surgical resection of the colon and/or rectal cancer; they were referred for PET/CT assessment at least 3 months after surgical resection. F18-FDG PET/CT sensitivity and specificity in detecting the recurrence and/or metastasis were 96.9 % and 83.3%, respectively. The positive predictive value was 94.2% while the negative predictive value was 90%.
Conclusion
For post-operative detection of loco-regional recurrence and metastasis in patients with colorectal cancer and elevated CEA level, 18F-FDG PET/CT can be considered as an efficient diagnostic imaging tool due to its high sensitivity and specificity which extensively affect further management.
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Abstract
At the moment, international guidelines for rectal cancer suggest to consider F-FDG PET/CT scan in a few conditions: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma with potentially curable M1 disease; (2) in the recurrence workup for serial carcinoembryonic antigen level elevation; (3) in the recurrence workup with metachronous metastases documented by CT, MRI, or biopsy; (4) in case of strong contraindication to IV contrast agent administration; and (5) to evaluate an equivocal finding on a contrast-enhanced CT or MRI. PET/CT is not indicated in the follow-up or surveillance of rectal cancer. On the other hand, an attentive evaluation of the literature shows that PET/CT may also be used in some circumstances with significant levels of diagnostic accuracy. This review article aims to emphasize differences between current international guidelines and scientific literature in the role of PET/CT in rectal cancer.
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Murchison SC, DeVries KJ, Atrchian S. Patient Outcomes With Dose Escalation Using Modern Radiotherapy Techniques: A Retrospective Review of Anal Cancer Treated at a Large Academic Institution Between 2010 and 2016. Cureus 2020; 12:e10989. [PMID: 33209545 PMCID: PMC7668229 DOI: 10.7759/cureus.10989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The use of modern radiotherapy techniques (MRTs) has contributed to reduced treatment-related toxicities through better avoidance of normal structures and dose tapering, and has enabled the delivery of higher doses continuously. The purpose of this study was to review retrospectively (1) outcomes for anal cancer treated at BC Cancer (Canada) using MRT, and (2) the utilization and effect of dose escalation on cancer-related outcomes. Methods: Patients between 2010 and 2016 with biopsy-proven anal cancer, aged >18 years, and treated with primary curative-intent chemoradiation using intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) were included. Primary end points included overall survival (OS), relapse-free survival (RFS), and colostomy-free survival (CFS). Kaplan-Meier curves were created for prognostic factors, as well as dose escalation (>54 Gy vs. ≤54 Gy). Univariate and multivariate analyses were performed to evaluate predictors of the outcome. Results: A total of 273 patients were assessed. The median age was 61 years with 70% being female, 6% HIV positive, and 68% with locally advanced cancer (T3-4, or node positive). The median follow-up time was 41.3 months. Time from diagnosis to treatment was 60 days, and treatment duration 42 days. Dose escalation was prescribed for 22, of whom 15 were locally advanced cases. A total of 97% completed their radiation, including all who were dose-escalated; 11% required unplanned treatment breaks, with over half of breaks <5 days. More than 90% completed at least half of their chemotherapy; 41% had pre-treatment, and 34% post-treatment positron emission tomography (PET) scans. For primary tumor response, 88% were complete and 10% partial; 23% relapsed, with 15% locoregional, 5% distant, and 3% both, and 12% had salvage surgery. The colostomy rate was 15%, with 4% pre-treatment, 10% relapse related, and only 1% treatment-toxicity related. On univariate analysis, male sex was associated with a higher risk of death (p=0.02) and relapse (p=0.041). Non-squamous histology was consistently a strong predictor of all outcomes (OS, p=0.0089; RFS, p<0.0001; CFS, p<0.0001) as was advanced T stage (OS, p=0.0075; RFS, p=0.0019; CFS, p=0.0099), and node positivity (OS, p=0.0014; RFS, p=0.001; CFS, p=0.0071). Age, HIV status, grade, longer treatment times (>42-day median), and lack of a pre- or post-treatment PET scan were not associated with the outcome. Dose escalation beyond 54 Gy was not significant, even among locally advanced tumors. On multivariate analysis, non-squamous histology (OS, p=0.043; RFS, p<0.001; CFS, p=0.01), T4 (OS, p=0.049; RFS, p=0.026; CFS, p=0.042) and node positivity (OS, p=0.05; RFS, p=0.006) remained significant predictors of the outcome, although node positivity was no longer significant for CFS (p=0.10). Conclusion: BC Cancer outcomes for anal cancer treated with MRTs are comparable to what has been previously reported. Unplanned breaks were notably few, and short. Treatment-related colostomies were rare. Dose-escalated regimens were infrequently prescribed, appeared tolerable, but more often required a break. Prospective trials are needed to clarify efficacy of such regimens.
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Affiliation(s)
| | - Kimberly J DeVries
- Population Oncology, Cancer Surveillance & Outcomes, BC Cancer - Vancouver, Vancouver, CAN
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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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Sena Y, Matsumoto S, Silman C, Otsuka K, Kiyota T. Physiological 18F-FDG uptake in the normal adult anal canal: evaluation by PET/CT. Ann Nucl Med 2020; 34:538-544. [PMID: 32430619 DOI: 10.1007/s12149-020-01480-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography-computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. METHODS We conducted a retrospective study of-PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn's disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. RESULTS In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00-6.30), and delayed phase: 2.52 (range 1.00-8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24-2.25), and delayed: 0.81 (range 0.23-2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30-1.89), and delayed: 0.90 (range 0.30-1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40-17.73) and 14.23 (range 6.70-22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. CONCLUSIONS PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.
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Affiliation(s)
- Yankel Sena
- Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Sakanaka K, Mizowaki T. A Case Report of a Solitary Pelvic Mass Proven to Be a Lymph Nodal Metastasis from Anal Cancer. Case Rep Oncol 2020; 13:164-169. [PMID: 32231539 DOI: 10.1159/000505969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
A solitary pelvic-wall lymph nodal metastasis can be mistaken as a primary malignancy when a primary tumor has not been diagnosed. We report the case of a 72-year-old woman with a solitary left pelvic-wall mass that was finally proven to be a left internal iliac lymph nodal metastasis from anal cancer. No signs of the primary tumor had been initially found by general screening using computed tomography, colonoscopy, pelvic magnetic resonance imaging, and gynecological/urological examination; however, squamous cell carcinoma was detected by surgical biopsy of the left pelvic-wall mass. Additional <sup>18</sup>F-fluorodeoxyglucose positron emission tomography (<sup>18</sup>F-FDG-PET) showed focal accumulations in the left pelvic mass and the anal canal. A biopsy of the induration in the anal canal led to the diagnosis of anal cancer, clinical T2N2M0, and stage IIIB (UICC-TNM 7th ed.), which was indicated for definitive chemoradiotherapy. Two months after completing a definitive chemoradiotherapy for anal cancer, a fixed induration developed under the surgical wound along with the surgical tract of the biopsy site. Physical examination and <sup>18</sup>F-FDG-PET/computed tomography led to the clinical diagnosis of unresectable surgical tract recurrence of anal cancer. The patient underwent palliative treatment and died 14 months after the diagnosis of the surgical tract recurrence. In conclusion, anal cancer may present as a solitary pelvic mass without any anal symptoms. To evaluate the solitary pelvic mass, <sup>18</sup>F-FDG-PET/computed tomography, along with digital examination, will probably help in establishing an accurate diagnosis. Anal cancer must be considered during the differential diagnosis of a solitary pelvic-wall mass for a correct diagnosis and to avoid unnecessary procedures.
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Affiliation(s)
- Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Aljubran AH, Badran A, Alshaer O, Alhashem H, Omar A, Eldali A. Pattern of use of positron emission tomography/computed tomography (PET/CT) scan in non-colorectal gastrointestinal cancers at KFSHRC, Riyadh, Saudi Arabia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0067-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Positron emission tomography/computed tomography (PET/CT) scan is useful if clinically indicated. It is not for conventional routine use due to its high cost. Moreover, it can be confusing if ordered in non-indicated conditions. We evaluate if the pattern of PET/CT ordered in gastrointestinal cancers (non-colorectal origin) has followed evidence-based guidelines and whether it helped in the improvement of patient’s outcome. This study included non-colorectal gastrointestinal cancer patients from 2007 to 2008 who had one or more PET/CT scans done during their management. In each case, data collected revealed whether PET/CT affected the management or the stage or not. Patients were identified through the hospital tumor registry software CNExT (C/NET Solutions, Berkeley, CA). Tabulation and statistical data analysis were done using JMP-SAS statistical software application (version 9.4: SAS Institute, Cary, NC, USA). The scan report quality and use indications were outlined.
Results
Seventy-seven patients were identified, with 107 PET/CT scans done. Their median age is 59 (21–86) years. Males were 45 (58.5%). Tumor origin was 46.8% esophageal and gastroesophageal junction cancer, 15.6% gastric cancer, 11.7% pancreatic cancer, 11.7% hepatobiliary tumors, 10.4% neuroendocrine tumors, 2.6 % gastrointestinal stromal tumors, and 1.3% small bowel cancer. Indications of the PET/CT were as follows: staging in 59.8%, follow-up after finishing treatment in 14.9%, restaging at relapse in 8.4%, assessing response after/during treatment in 3.7%, follow-up of previous PET/CT in 12.1%, and others in 0.9%. PET/CT changed the stage in 19.6% and affected the management plan in 11.2% only. Fifty-two scans needed pathological pursuit as decided by investigators; of them, PET/CT for the lesions that could have changed the stage reported indeterminate/equivocal results in 32 (29.9%) of all scans. The pathological pursuit for the equivocal lesions on PET/CT scans was done in only 12 of 52 (23.1%) scans.
Conclusions
Local guidelines for ordering PET/CT scan are suggested because overuse was documented, and an evidence-based approach should be respected before its use.
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Abstract
Anal canal cancer is a rare disease and squamous cell carcinoma is the most common histologic subtype. Traditionally, anal cancer is imaged with CT and PET/CT for purposes of TNM staging. With the increased popularity of MRI for rectal cancer evaluation, MRI has become increasingly utilized for local staging of anal cancer. In this review, we focus on the necessary information radiologists need to know to understand this rare and unique disease and to be familiar with staging of anal cancer on MRI.
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Vlachavas E, Pilalis E, Papadodima O, Koczan D, Willis S, Klippel S, Cheng C, Pan L, Sachpekidis C, Pintzas A, Gregoriou V, Dimitrakopoulou-Strauss A, Chatziioannou A. Radiogenomic Analysis of F-18-Fluorodeoxyglucose Positron Emission Tomography and Gene Expression Data Elucidates the Epidemiological Complexity of Colorectal Cancer Landscape. Comput Struct Biotechnol J 2019; 17:177-185. [PMID: 30809322 PMCID: PMC6374701 DOI: 10.1016/j.csbj.2019.01.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Transcriptomic profiling has enabled the neater genomic characterization of several cancers, among them colorectal cancer (CRC), through the derivation of genes with enhanced causal role and informative gene sets. However, the identification of small-sized gene signatures, which can serve as potential biomarkers in CRC, remains challenging, mainly due to the great genetic heterogeneity of the disease. METHODS We developed and exploited an analytical framework for the integrative analysis of CRC datasets, encompassing transcriptomic data and positron emission tomography (PET) measurements. Profiling data comprised two microarray datasets, pertaining biopsy specimen from 30 untreated patients with primary CRC, coupled by their F-18-Fluorodeoxyglucose (FDG) PET values, using tracer kinetic analysis measurements. The computational framework incorporates algorithms for semantic processing, multivariate analysis, data mining and dimensionality reduction. RESULTS Transcriptomic and PET data feature sets, were evaluated for their discrimination performance between primary colorectal adenocarcinomas and adjacent normal mucosa. A composite signature was derived, pertaining 12 features: 7 genes and 5 PET variables. This compact signature manifests superior performance in classification accuracy, through the integration of gene expression and PET data. CONCLUSIONS This work represents an effort for the integrative, multilayered, signature-oriented analysis of CRC, in the context of radio-genomics, inferring a composite signature with promising results for patient stratification.
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Key Words
- 18F-FDG PET
- ACADM, Acyl-Coenzyme A Dehydrogenase
- AUC, Area Under the Curve
- CCT7, Chaperonin Containing TCP1 Subunit 7
- CD44, CD44 Molecule (Indian Blood Group)
- CRC, Colorectal cancer
- Colorectal cancer
- DE, Differentially Expressed
- FD, Fractal Dimension
- FDG, F-18-Fluorodeoxyglucose
- GDC, Genomics Data Commons
- GEO, Gene Expression Omnibus
- GSTP1, Glutathione S-Transferase Pi 1
- KIT, Proto-Oncogene Receptor Tyrosine Kinase
- Lasso, least absolute shrinkage and selection operator
- MFA, Multiple Factor Analysis
- Microarray analysis
- PCs, Principal Components
- PET, Positron Emission Tomography
- ROC, Receiver-operator Characteristic curve
- Radiogenomics
- SUV, Standardized Uptake Value
- TCGA
- TCGA-COAD, The Cancer Genome Atlas-Colon Adenocarcinoma
- Translational bioinformatics
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Affiliation(s)
- Efstathios–Iason Vlachavas
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
- Department of Molecular Biology and Genetics, Democritus University of Thrace, 68100 Dragana, Greece
- Enios Applications Private Limited Company, A17671 Athens, Greece
| | - Eleftherios Pilalis
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
- Enios Applications Private Limited Company, A17671 Athens, Greece
| | - Olga Papadodima
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Dirk Koczan
- Core Facility Micro-Array-Technology, Center of Medical Research, University of Rostock, Germany
| | | | - Sven Klippel
- Surgical Clinic A, Klinikum Ludwigshafen, Germany
| | - Caixia Cheng
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Leyun Pan
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Alexandros Pintzas
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Vasilis Gregoriou
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | | | - Aristotelis Chatziioannou
- Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
- Enios Applications Private Limited Company, A17671 Athens, Greece
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Hamidizadeh R, Eftekhari A, Wiley EA, Wilson D, Alden T, Bénard F. Metformin Discontinuation prior to FDG PET/CT: A Randomized Controlled Study to Compare 24- and 48-hour Bowel Activity. Radiology 2018; 289:418-425. [PMID: 30106348 DOI: 10.1148/radiol.2018180078] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the relationship of 24- and 48-hour metformin discontinuation to bowel uptake of fluorine 18 fluorodeoxyglucose (FDG) on PET/CT scans. Materials and Methods Patients with diabetes who were treated with metformin and referred for FDG PET/CT were randomized to three equal groups based on duration of metformin discontinuation: 24 hours, 48 hours, and no discontinuation (control group). Two interpreters blinded to the study groups assessed FDG uptake in multiple segments of small and large bowel qualitatively and semiquantitatively by using maximum standardized uptake values (SUVsmax). Differences in age, sex, weight, dose of metformin, duration of metformin treatment, blood glucose levels, and FDG dose injected were assessed. Data were analyzed with analysis of variance when passing normality, and by nonparametric testing when not. Results Ninety study participants (62 male, 28 female; median age, 70 years) were enrolled from July 2010 through March 2012. There were no differences between study groups in weight, blood glucose levels 3 days prior to scanning, or normal organ uptake. Large bowel SUVmax was lower after 24 hours (4.10 ± 2.00 vs 5.42 ± 2.36; P = .020) and 48 hours (2.63 ± 0.88 vs 5.42 ± 2.36; P ˂ .001) of metformin discontinuation than for no discontinuation (control), and for 48 hours versus 24 hours of discontinuation (P = .0015). Small bowel SUVmax was lower after 24 hours (2.86 ± 0.67 vs 3.73 ± 1.08 [control]; P ˂ .001) and 48 hours (2.78 ± 0.73 vs 3.73 ± 1.08 [control]; P ˂ .001) of metformin discontinuation versus no metformin discontinuation, but not for 48 hours versus 24 hours of discontinuation (P = .57). Examination-day blood glucose levels increased after 48-hour withdrawal of metformin (8.41 mmol/L ± 2.86 vs 6.83 mmol/L ± 2.13 [control]; P = .002). Conclusion Metformin discontinuation for 48 hours prior to PET/CT was associated with lower accumulation of fluorodeoxyglucose in the bowel, compared to when there was no discontinuation (control group) or 24-hour discontinuation of metformin. © RSNA, 2018.
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Affiliation(s)
- Ramin Hamidizadeh
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Arash Eftekhari
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - E Ashley Wiley
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Don Wilson
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - Tina Alden
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
| | - François Bénard
- From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.)
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Positron emission tomography and computed tomographic (PET/CT) imaging for radiation therapy planning in anal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 126:6-12. [PMID: 29759568 DOI: 10.1016/j.critrevonc.2018.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
To improve the accuracy of chemoradiation therapy in anal cancer patients PET/CT is frequently used in the planning of radiation therapy. A systematic review was performed to assess impact on survival, quality of life, symptom score, change in target definition and treatment intention. Systematic literature searches were conducted in Medline, EMBASE, the Cochrane Library, and Centre for Reviews and Dissemination. Ten cross-sectional studies were identified. No data were available on survival or quality of life. The summary estimate of the proportion of patients in which PET/CT had an impact on the target definition, was 23% (95% CI 16;33). The corresponding summary estimate of a change in treatment intent from curative to palliative was 3% (95% CI 2;6). Almost one in four patients had a change in target definition, which supports the use of PET/CT in radiation therapy planning, but the consequence regarding survival and quality of life is still uncertain.
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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MRI and FDG-PET/CT based assessment of axillary lymph node metastasis in early breast cancer: a meta-analysis. Clin Radiol 2017; 72:295-301. [DOI: 10.1016/j.crad.2016.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/13/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022]
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Koo PJ, Kim SJ, Chang S, Kwak JJ. Interim Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict Pathologic Response to Preoperative Chemoradiotherapy and Prognosis in Patients With Locally Advanced Rectal Cancer. Clin Colorectal Cancer 2016; 15:e213-e219. [DOI: 10.1016/j.clcc.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/03/2016] [Accepted: 04/27/2016] [Indexed: 01/03/2023]
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Positron Emission Tomography: Basic Principles, New Applications, and Studies Under Anesthesia. Int Anesthesiol Clin 2016; 54:109-28. [PMID: 26655512 DOI: 10.1097/aia.0000000000000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Matalon SA, Mamon HJ, Fuchs CS, Doyle LA, Tirumani SH, Ramaiya NH, Rosenthal MH. Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy. Radiographics 2016; 35:2090-107. [PMID: 26562239 DOI: 10.1148/rg.2015150037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although rectal and anal cancers are anatomically close, they are distinct entities with different histologic features, risk factors, staging systems, and treatment pathways. Imaging is at the core of initial clinical staging of these cancers and most commonly includes magnetic resonance imaging for local-regional staging and computed tomography for evaluation of metastatic disease. The details of the primary tumor and involvement of regional lymph nodes are crucial in determining if and how radiation therapy should be used in treatment of these cancers. Unfortunately, available imaging modalities have been shown to have imperfect accuracy for identification of nodal metastases and imaging features other than size. Staging of nonmetastatic rectal cancers is dependent on the depth of invasion (T stage) and the number of involved regional lymph nodes (N stage). Staging of nonmetastatic anal cancers is determined according to the size of the primary mass and the combination of regional nodal sites involved; the number of positive nodes at each site is not a consideration for staging. Patients with T3 rectal tumors and/or involvement of perirectal, mesenteric, and internal iliac lymph nodes receive radiation therapy. Almost all anal cancers warrant use of radiation therapy, but the extent and dose of the radiation fields is altered on the basis of both the size of the primary lesion and the presence and extent of nodal involvement. The radiologist must recognize and report these critical anatomic and staging distinctions, which affect use of radiation therapy in patients with anal and rectal cancers.
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Affiliation(s)
- Shanna A Matalon
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Harvey J Mamon
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Charles S Fuchs
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Leona A Doyle
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Sree Harsha Tirumani
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Nikhil H Ramaiya
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Michael H Rosenthal
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
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García-Figueiras R, Baleato-González S, Padhani AR, Marhuenda A, Luna A, Alcalá L, Carballo-Castro A, Álvarez-Castro A. Advanced imaging of colorectal cancer: From anatomy to molecular imaging. Insights Imaging 2016; 7:285-309. [PMID: 27136925 PMCID: PMC4877344 DOI: 10.1007/s13244-016-0465-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Imaging techniques play a key role in the management of patients with colorectal cancer. The introduction of new advanced anatomical, functional, and molecular imaging techniques may improve the assessment of diagnosis, prognosis, planning therapy, and assessment of response to treatment of these patients. Functional and molecular imaging techniques in clinical practice may allow the assessment of tumour-specific characteristics and tumour heterogeneity. This paper will review recent developments in imaging technologies and the evolving roles for these techniques in colorectal cancer. TEACHING POINTS • Imaging techniques play a key role in the management of patients with colorectal cancer. • Advanced imaging techniques improve the evaluation of these patients. • Functional and molecular imaging allows assessment of tumour hallmarks and tumour heterogeneity.
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Affiliation(s)
- Roberto García-Figueiras
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Sandra Baleato-González
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anwar R. Padhani
- />Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN UK
| | - Ana Marhuenda
- />Department of Radiology, IVO (Instituto Valenciano de Oncología), C/ Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Antonio Luna
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
- />Case Western Reserve University, Cleveland, OH USA
| | - Lidia Alcalá
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
| | - Ana Carballo-Castro
- />Department of Radiotherapy, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Ana Álvarez-Castro
- />Department of Gastroenterology, Colorectal Cancer Group, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, Santiago de Compostela, 15706 Spain
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18F-FDG positron emission tomography in oncology: main indications. RADIOLOGIA 2016; 58:303-19. [PMID: 27184919 DOI: 10.1016/j.rx.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/28/2016] [Indexed: 12/31/2022]
Abstract
The development of molecular and functional imaging with new imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography (PET) among others, has greatly improved the detection of tumors, tumor staging, and the detection of possible recurrences. Furthermore, the combination of these different imaging modalities and the continual development of radiotracers for PET have advanced our understanding and knowledge of the different pathophysiological processes in cancer, thereby helping to make treatment more efficacious, improving patients' quality of life, and increasing survival. PET is one of the imaging techniques that has attracted the most interest in recent years for its diagnostic capabilities. Its ability to anatomically locate pathologic foci of metabolic activity has revolutionized the detection and staging of many tumors, exponentially broadening its potential indications not only in oncology but also in other fields such as cardiology, neurology, and inflammatory and infectious diseases.
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Abstract
PURPOSE To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. METHODS A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. RESULTS Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. CONCLUSIONS Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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Guerra GR, Kong CH, Warrier SK, Lynch AC, Heriot AG, Ngan SY. Primary squamous cell carcinoma of the rectum: An update and implications for treatment. World J Gastrointest Surg 2016; 8:252-265. [PMID: 27022453 PMCID: PMC4807327 DOI: 10.4240/wjgs.v8.i3.252] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma (SCC).
METHODS: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference list of selected articles reviewed to ensure all relevant publications were captured. The search strategy was limited to the English language, spanning from 1946 to 2015. A qualitative analysis was undertaken examining patient demographics, clinical presentation, diagnosis, staging, treatment and outcome. The quantitaive analysis was limited to data extracted on treatment and outcomes including radiological, clinical and pathological complete response where available. The narrative and quantitative review were synthesised in concert.
RESULTS: The search identified 487 articles in total with 79 included in the qualitative review. The quantitative analysis involved 63 articles, consisting of 43 case reports and 20 case series with a total of 142 individual cases. The underlying pathogenesis of rectal SCC while unclear, continues to be defined, with increasing evidence of a metaplasia-dysplasia-carcinoma sequence and a possible role for human papilloma virus in this progression. The presentation is similar to rectal adenocarcinoma, with a diagnosis confirmed by endoscopic biopsy. Many presumed rectal SCC’s are in fact an extension of an anal SCC, and cytokeratin markers are a useful adjunct in this distinction. Staging is most accurately reflected by the tumour-node-metastasis classification for rectal adenocarcinoma. It involves examining locoregional disease by way of magnetic resonance imaging and/or endorectal ultrasound, with systemic spread excluded by way of computed tomography. Positron emission tomography is integral in the workup to exclude an external site of primary SCC with metastasis to the rectum. While the optimal treatment remains as yet undefined, recent studies have demonstrated a global shift away from surgery towards definitive chemoradiotherapy as primary treatment. Pooled overall survival was calculated to be 86% in patients managed with chemoradiation compared with 48% for those treated traditionally with surgery. Furthermore, local recurrence and metastatic rates were 25% vs 10% and 30% vs 13% for the chemoradiation vs conventional treatment cohorts.
CONCLUSION: The changing paradigm in the treatment of rectal SCC holds great promise for improved outcomes in this rare disease.
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Impact of point spread function reconstruction on quantitative 18F-FDG-PET/CT imaging parameters and inter-reader reproducibility in solid tumors. Nucl Med Commun 2016; 37:288-96. [DOI: 10.1097/mnm.0000000000000445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Barral M, Dohan A, Allez M, Boudiaf M, Camus M, Laurent V, Hoeffel C, Soyer P. Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings. Crit Rev Oncol Hematol 2016; 97:30-46. [DOI: 10.1016/j.critrevonc.2015.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 06/15/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022] Open
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Liver metabolic activity changes over time with neoadjuvant therapy in locally advanced rectal cancer. Nucl Med Commun 2015; 37:116-21. [PMID: 26440564 DOI: 10.1097/mnm.0000000000000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate, using PET/computed tomography (CT), changes in liver metabolic activity in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT). PATIENTS AND METHODS A total of 29 biopsy-proven LARC patients between 2009 and 2012 were studied. Liver standardized uptake values (SUVs) and SUVs adjusted for lean body mass (SULs) were obtained from PET/CT images obtained at 1 h (early) and 2 h (late) after (18)F-fluorodeoxyglucose ((18)F-FDG) administration both before and after neoadjuvant CRT. Age, sex, BMI, lean body mass, blood glucose level, and (18)F-FDG dose, which can influence liver SUVs and SULs, were also analyzed. RESULTS Fourteen (48%) men and 15 (52%) women with a mean age of 62±11 years (range 34-80 years) were included in the study. The mean SUVs and SULs were significantly decreased in the late scans. Sex was significantly correlated with the mean liver SUV in early and late scans. The mean SUV differed significantly between male and female patients in early and late images (P<0.05). In a multivariate stepwise regression analysis, only liver SUVs (maximum and mean) were significantly associated with BMI before and after therapy. SUVs were significantly higher in the high (≥25) BMI group after but not before therapy. Mean SUL was not influenced by BMI. CONCLUSION Liver (18)F-FDG uptake is consistent before and after neoadjuvant CRT therapy in patients with LARC. When assessing response to therapy and using liver metabolic activity to indicate background activity, BMI should be considered as it can influence liver metabolic activity.
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Wu HB, Wang Z, Wang QS, Han YJ, Wang M, Zhou WL, Li HS. Use of Labelled tLyP-1 as a Novel Ligand Targeting the NRP Receptor to Image Glioma. PLoS One 2015; 10:e0137676. [PMID: 26398657 PMCID: PMC4580457 DOI: 10.1371/journal.pone.0137676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Neuropilin (NRP) receptors are overexpressed in glioma tumor tissue, and therefore may be a potential target for imaging markers. We investigated whether labelled tLyP-1, an NRP targeting peptide, could be used as the targeting ligand for developing reagents for imaging glioma tumors. Methods The tLyP-1 peptide (CGNKRTR) was labeled with 5-carboxyfluorescein (FAM) or 18F-fluoride. A control peptide (MAQKTSH) was also labeled with FAM. The in vitro binding between FAM-tLyP-1 and U87MG cells and in vivo biodistribution of FAM-tLyP-1 in a U87MG glioblastoma xenograft model (nude mouse) were determined. The in vivo biodistribution of 18F-tLyP-1 was also determined by microPET/CT. Results In vitro, FAM-tLyP-1 was strongly taken up by U87MG cells at very low concentrations (1μM). In vivo, FAM-tLyP-1 accumulated in glioma (U87MG) tumors, but uptake was minimal in the normal brain tissue 1 h after administration. The distribution of FAM-tLyP-1 in the tumor tissue was consistent with expression of NRP1. The tumor/brain fluorescence intensity ratio in mice treated with FAM-tLyP-1 was significantly higher than the control FAM-labeled peptide 1 h after administration (3.44 ± 0.83 vs. 1.32 ± 0.15; t = 5.547, P = 0.001). Uptake of FAM-tLyP-1 in glioma tumors could be blocked by administering an excess of non-conjugated tLyP-1 peptide. [Lys4] tLyP-1 was labeled with 18F to synthesis a PET (18F-tLyP-1). MicroPET/CT imaging showed the tumor was visualized clearly with a high tumor/brain radiolabel ratio at 60 min (2.69 ± 0.52) and 120 min (3.11±0.25). Conclusion Taken together, our results suggest that tLyP-1 could be developed as a novel fluorescent or radio labelled tracer for imaging glioma.
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Affiliation(s)
- Hu-bing Wu
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail:
| | - Zhen Wang
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Quan-shi Wang
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan-jian Han
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Meng Wang
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-lan Zhou
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong-sheng Li
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Peiffert D. [Recommendations for the management of cancers of the anal canal]. Cancer Radiother 2015; 19:416-20. [PMID: 26337477 DOI: 10.1016/j.canrad.2015.06.005] [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: 05/20/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022]
Abstract
Anal canal carcinomas remain rare, but their management has improved recently. The PET-CT is now used as a standard at the first diagnosis and after relapses. The introduction of intensity-modulated irradiation techniques makes it possible to better conform the pelviperineal and inguinal volumes, improving the homogeneity of the irradiation while sparing some pelvic structures, thus reducing acute and late effects. Nevertheless, the conversion from 3D to intensity-modulated radiotherapy needs a specific and careful approach, mainly for the management of the perineal region, where relapses and complications occur. Last but not least, new chemotherapy associations are studied for metastatic disease.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, CS 30519, 54500 Vandœuvre-lès-Nancy, France.
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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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