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Chan TG, Wicks J, Sethi I, Becker J, Brandon D, Schmitt NC, Kaka A, Boyce B, Baddour HM, El-Deiry MW, Patel MR, Gross JH. Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy. Head Neck 2024. [PMID: 39092682 DOI: 10.1002/hed.27889] [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: 02/18/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology. METHODS A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features. RESULTS Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1. CONCLUSIONS On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jaime Wicks
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Ila Sethi
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Jennifer Becker
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - David Brandon
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Azeem Kaka
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Brian Boyce
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mark W El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Sharma A, Quereshy H, Cabrera CI, Fowler N, Li S, Dorth J, Thuener JE, Rezaee RP, Tamaki A. Role of 18F-FDG PET/CT in the management of head and neck cancer patients with persistent cervical lymphadenopathy following chemoradiation. Head Neck 2024. [PMID: 39011903 DOI: 10.1002/hed.27872] [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: 02/16/2024] [Revised: 06/10/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We aim to describe the management and outcomes of patients with persistent lymphadenopathy (LAD) after primary chemoradiation for head and neck squamous cell carcinoma (HNSCC) based on post-treatment PET/CT results. METHODS Retrospective chart review was conducted of all patients who underwent primary concurrent chemoradiation for HNSCC at a tertiary care center from 2010 to 2022 and had persistent post-treatment LAD. RESULTS Nearly 62% of patients were managed conservatively, and 27.0% underwent neck dissection. PET-positive patients were more likely to undergo neck dissection than PET-negative patients (p = 0.042). Positive predictive value (PPV) and negative predictive values (NPV) of PET/CT in detecting residual disease in the neck were 48.0% and 73.7%, respectively. CONCLUSIONS PPV and NPV of PET/CT for detecting residual neck disease in patients with post-treatment LAD was lower than those of HNSCC patients with and without persistent LAD reported in other studies.
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Affiliation(s)
- Anu Sharma
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Humzah Quereshy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Claudia I Cabrera
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicole Fowler
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shawn Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jennifer Dorth
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason E Thuener
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rod P Rezaee
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Akina Tamaki
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Schöder H. Beyond the AJR: Follow-Up Imaging With FDG PET/CT in Head and Neck Cancer Improves Patient Outcome. AJR Am J Roentgenol 2024; 222:e2330240. [PMID: 37729552 DOI: 10.2214/ajr.23.30240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Zhou S, Chan C, Lau YC, Rulach R, Dyab H, Hendry F, Wilson C, Schipani S, Lamb C, Grose D, James A, Maxfield C, Dempsey MF, Paterson C. The Effects of Human Papillomavirus Status and Treatment on the Positive Predictive Value of Post-radiotherapy 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Advanced Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2023; 35:e699-e707. [PMID: 37798198 DOI: 10.1016/j.clon.2023.09.006] [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: 04/03/2023] [Revised: 07/03/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
AIMS The high negative predictive value of post-chemoradiation (CRT) positron emission tomography-computed tomography (PET-CT) is well established in head and neck squamous cell cancers (HNSCC). The positive predictive value (PPV) remains under scrutiny, with increasing evidence that it is affected by several factors. The aim of this study was to assess the PPV of post-treatment PET-CT for residual nodal disease when stratified by treatment modality and tumour human papillomavirus (HPV) status. MATERIALS AND METHODS This was a retrospective cohort study in a tertiary oncology centre carried out between January 2013 and December 2019. Patients were radically treated with radiotherapy only/CRT for node-positive HNSCC. PET-CT nodal responses were categorised as complete, equivocal (EQR) or incomplete (ICR), and outcomes extracted from electronic records. RESULTS In total, 480 patients were evaluated, all had a minimum potential follow-up of 2 years, with a median of 39.2 months. The PPV of 12-week PET-CT was significantly different between HPV-positive (22.5%) and HPV-unrelated (52.7%) disease, P < 0.001. It was also significantly different between the CRT (24.8%) and radiotherapy-only (51.1%) groups, P = 0.001. The PPV of an EQR was significantly less than an ICR, irrespective of HPV status and primary treatment modality. In HPV-positive disease, the PPV of an EQR was 9.0% for the CRT group compared with 21.4% for radiotherapy only, P = 0.278. The PPV in those who achieved an ICR was 34.2% in the CRT group, significantly lower than 70.0% in the radiotherapy-only group, P = 0.03. CONCLUSION The PPV of 12-week PET-CT is significantly lower for HPV-positive compared with HPV-unrelated HNSCC. It is poorer in patients with HPV-positive disease treated with CRT compared with radiotherapy alone.
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Affiliation(s)
- S Zhou
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Chan
- University Hospital Ayr, Ayr, UK
| | - Y C Lau
- Royal Alexandra Hospital, Glasgow, UK
| | - R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Dyab
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - F Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Grose
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Maxfield
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - M-F Dempsey
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Paterson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Michaan N, Wenkert A, Even-Sapir E, Kerzhner K, Rabin T, Safra T, Peleg-Hasson S, Baruch Y, Raz Y, Grisaru D, Laskov I. Prognostic significance of delayed complete metabolic response on PET/CT after primary chemoradiation treatment of cervical cancer. Int J Gynecol Cancer 2023; 33:1695-1701. [PMID: 37657818 DOI: 10.1136/ijgc-2023-004703] [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: 09/03/2023] Open
Abstract
OBJECTIVE To investigate the prognostic significance of near-complete metabolic response on initial follow-up PET/CT after primary chemoradiation treatment of cervical cancer. METHODS Survival data were retrospectively compared between patients who had complete metabolic response on first follow-up PET/CT, 3 months after chemoradiation (group 1) with those who had near-complete metabolic response on first PET/CT and later showed complete metabolic response at subsequent PET/CT, 6 months or more after treatment (group 2). RESULTS Of the 108 patients included in the final analysis, 74 (68.5%) showed complete metabolic response on initial PET/CT, 3 months after treatment, and 34 patients (31.5%) showed complete metabolic response on subsequent PET/CT, 6 months after treatment. Tumor characteristics were comparable between groups. Group 1 had higher percent of stage 1 (12% vs 0%) and lower percent of stage 4 disease (3% vs 14%) than those of group 2. Group 2 patients had significantly fewer cases of recurrences and deaths than group 1 patients (6% vs 26%, p=0.018; 0% vs 20%, p=0.003, respectively), with comparable 3-year survival rates (group 1, 90% vs group 2, 100%, p=0.31). Twelve patients had progressive disease on first follow-up PET/CT; these patients had significantly worse overall survival compared with all other patients (log-rank test, p<0.001). Younger age and delayed complete metabolic response were associated with lower chance of recurrence and death on univariate analysis. On multivariate analysis, delayed complete metabolic response remained significantly associated with no recurrence HR=0.14 (95% CI 0.25 to 0.84), p=0.031. CONCLUSIONS Survival outcome of patients with cervical cancer who show residual 18F-fluorodeoxyglucose uptake on initial PET/CT after treatment, but reach complete metabolic response on follow-up PET/CT, is not inferior compared with survival of patients who show complete metabolic response on initial PET/CT 3 months after treatment. Watchful waiting with follow-up PET/CT seems a safe option for these patients.
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Affiliation(s)
- Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Atalia Wenkert
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kosta Kerzhner
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tatiana Rabin
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Safra
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira Peleg-Hasson
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Baruch
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Raz
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Tsuda T, Fukusumi T, Saito M, Kuki A, Inohara H. Microscopic Residual Disease After Nasal Squamous Cell Carcinoma Not Visualized on FDG PET-CT: A Case Report. Cureus 2023; 15:e47451. [PMID: 38022262 PMCID: PMC10660082 DOI: 10.7759/cureus.47451] [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: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Nasal squamous cell carcinoma (SCC) is rare and aggressive. It often requires combination treatment. Precise post-treatment disease assessment is vital for determining the subsequent management and prognosis. We present the intriguing case of a 52-year-old man with T4bN0M0 stage IVB SCC. Post-treatment fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) findings indicated a complete response; however, microscopic remnants of the cancer were detected during endoscopic sinus surgery. This report underscores the limitations of post-treatment assessment using FDG PET-CT and outpatient endoscopy alone due to these modalities' potential inability to detect microscopic residual disease. Endoscopic sinus surgery should be incorporated into routine post-treatment assessments of nasal SCC to improve disease detection and guide further treatment. Further large-scale studies are required to confirm these findings.
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Affiliation(s)
- Takeshi Tsuda
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Osaka, JPN
| | - Takahito Fukusumi
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Osaka, JPN
| | - Miyu Saito
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Osaka, JPN
| | - Atsuto Kuki
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Osaka, JPN
| | - Hidenori Inohara
- Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Osaka, JPN
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Paul S, Gupta T, Purandare N, Joshi K, Ghosh-Laskar S, Budrukkar A, Swain M, Sinha S, Kumar A, Joshi A, Prabhash K, Nair S, Rangarajan V, Agarwal JP. Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS. Otolaryngol Head Neck Surg 2023; 169:938-947. [PMID: 36856038 DOI: 10.1002/ohn.305] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of response assessment 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG-PET/CECT) following definitive radio(chemo)therapy in head and neck squamous cell carcinoma (HNSCC) using Neck Imaging Reporting and Data System (NI-RADS). STUDY DESIGN A retrospective analysis from a prospectively maintained dataset. SETTING Tertiary-care comprehensive cancer center in a low-middle-income country. METHODS Adults with newly diagnosed, biopsy-proven, nonmetastatic HNSCC treated with definitive radio(chemo)therapy were included. Posttreatment response assessment FDG-PET/CECT scans were retrospectively assigned NI-RADS categories (1-3) for the primary site, neck, and both sites combined. Locoregional recurrence occurring within 2-years was defined as the event of interest. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Locoregional control stratified by NI-RADS categories was computed with the Kaplan-Meier method and compared using the log-rank test. RESULTS Posttreatment FDG-PET/CECT scans were available in 190 patients constituting the present study cohort. Sensitivity, specificity, PPV, NPV, and overall accuracy of the NI-RADS template for the primary site was 73.5%, 81.4%, 46.3%, 93.4%, and 80.0%, respectively. Similar metrics for the neck were 72.7%, 87.5%, 43.2%, 96.1%, and 85.8%, respectively. Combining primary site and neck, the corresponding metrics of diagnostic accuracy were 84.4%, 69.7%, 46.3%, 93.5%, and 73.2%, respectively. At a median follow-up of 40 months, Kaplan-Meier estimates of 2-year locoregional control were significantly higher for NI-RADS category 1 (94.2%) compared to NI-RADS category 2 (69.4%) and category 3 (20.4%), respectively (stratified log-rank p < .0001). CONCLUSION FDG-PET/CECT using the NI-RADS template is associated with good diagnostic performance and prognostic utility in HNSCC treated with definitive radio(chemo)therapy.
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Affiliation(s)
- Sonz Paul
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kishore Joshi
- Department of Medical Physics, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Ottenhof SR, de Vries HM, Doodeman B, Vrijenhoek GL, van der Noort V, Donswijk ML, de Feijter JM, Schaake EE, Horenblas S, Brouwer OR, van der Heijden MS, Pos FJ. A Prospective Study of Chemoradiotherapy as Primary Treatment in Patients With Locoregionally Advanced Penile Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:139-147. [PMID: 37030606 DOI: 10.1016/j.ijrobp.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy followed by surgery for locoregionally advanced penile carcinoma (LAPSCC) is associated with severe toxicity and a 1-year survival probability of ∼50%. We aimed to evaluate the safety and efficacy of chemoradiotherapy (CRT) as the primary treatment for LAPSCC and the association of high-risk human papillomavirus (hrHPV) with the outcome. METHODS AND MATERIALS This was a prospective, single-center, single-arm study of CRT in LAPSCC, defined as a large/inoperable primary tumor, large palpable nodes, suspicion of extranodal extension or pelvic nodal involvement, and no distant metastases. CRT consisted of 49.5 Gy (33 × 1.5 Gy) on affected inguinal and pelvic areas combined with intravenous mitomycin C on day 1 and capecitabine on radiation days. Primary tumors and positron emission tomography/computed tomography-positive deposits received a boost of 59.4 Gy (33 × 1.8 Gy). The response was evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. If feasible, patients with residual/recurrent disease underwent salvage surgery. The primary endpoint was 1-year progression-free survival (PFS), reached when 1-year PFS was ≥50%. Other endpoints were 2-year PFS, overall survival, and toxicity rates. Kaplan-Meier survival curves were compared using the log-rank test. RESULTS Thirty-three patients were included: 29 (88%) with stage IV disease (T4 any-N M0 and/or any-T N3 M0) and 8 (24%) with hrHPV-positive disease. Median follow-up was 41 months. Thirty-two completed CRT. Eleven (33%) experienced ≥1 grade 3 treatment-related adverse event. There were no grade 4 or 5 treatment-related events. Twenty-four patients (73%) responded, including 13 (39%) complete responses. Nine patients (27%) underwent salvage surgery, and an additional 8 patients underwent later surgery (together 52%). One- and 2-year PFS were 34% and 31%, respectively. One- and 2-year overall survival were 73% and 46%, respectively. No significant difference between patients with hrHPV-positive and -negative tumors was observed. CONCLUSIONS CRT is a viable treatment option for LAPSCC with acceptable toxicity. CRT can result in an enduring response. If patients have residual tumor, salvage surgery is feasible. HrHPV status was not associated with outcomes.
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Affiliation(s)
| | | | - Barry Doodeman
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Maarten Lucas Donswijk
- Departments of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Eva Eline Schaake
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Departments of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Floris Jop Pos
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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Glogauer J, Kohanzadeh A, Feit A, Fournier JE, Zians A, Somogyi DZ. The Use of Radiomic Features to Predict Human Papillomavirus (HPV) Status in Head and Neck Tumors: A Review. Cureus 2023; 15:e44476. [PMID: 37664330 PMCID: PMC10472720 DOI: 10.7759/cureus.44476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
Head and neck cancers represent a significant source of morbidity and mortality across the world. The individual genetic makeup of each tumor can help to determine the course of treatment and can help clinicians predict prognosis. Non-invasive tools to determine the genetic status of these tumors, particularly p16 (human papillomavirus (HPV)) status could prove extremely valuable to treating clinicians and surgeons. The field of radiomics is a burgeoning area of radiology practice that aims to provide quantitative biomarkers that can be derived from radiological images and could prove useful in determining p16 status non-invasively. In this review, we summarize the current evidence for the use of radiomics to determine the HPV status of head and neck tumors. .
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Affiliation(s)
- Judah Glogauer
- Department of Pathology and Molecular Medicine, McMaster University, Waterloo, CAN
| | | | - Avery Feit
- Medical School, Albert Einstein College of Medicine, Bronx, USA
| | - Jeffrey E Fournier
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, CAN
| | - Avraham Zians
- Department of Diagnostic and Interventional Radiology, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Dafna Z Somogyi
- Department of Internal Medicine, Westchester Medical Center, Valhalla, USA
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10
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Rosen BS, Vaishampayan N, Cao Y, Mierzwa ML. The Utility of Interim Positron Emission Tomography Imaging to Inform Adaptive Radiotherapy for Head and Neck Squamous Cell Carcinoma. Cancer J 2023; 29:243-247. [PMID: 37471616 DOI: 10.1097/ppo.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT In this article, as part of this special issue on biomarkers of early response, we review the current evidence to support the use of positron emission tomography (PET) imaging during chemoradiation therapy to inform biologically adaptive radiotherapy for head and neck squamous cell carcinoma. We review literature covering this topic spanning nearly 3 decades, including the use of various radiotracers and discoveries of novel predictive PET biomarkers. Through understanding how observational trials have informed current interventional clinical trials, we hope that this review will encourage researchers and clinicians to incorporate PET response criteria in new trial designs to advance biologically optimized radiotherapy.
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Affiliation(s)
- Benjamin S Rosen
- From the Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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11
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Vathiotis IA, Johnson JM, Luginbuhl A, Cognetti D, Curry J, Argiris A. Programmed cell death protein 1 axis blockade in locally advanced squamous cell carcinoma of the head and neck: Neoadjuvant and adjuvant approaches. Cancer Treat Rev 2022; 109:102437. [PMID: 35868194 DOI: 10.1016/j.ctrv.2022.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/25/2022]
Abstract
Immunotherapy and in particular programmed cell death protein 1 (PD-1) inhibitors have been applied not only in the management of recurrent or metastatic disease but also as component of potentially curative treatment for many solid tumors. The incorporation of immunotherapy as neoadjuvant and /or adjuvant therapy in the treatment paradigm of locally advanced squamous cell carcinoma of the head and neck (SCCHN) is appealing with the goals of enhancing antitumor efficacy and, at the same time, reduce toxicity. This review analyzes the rationale for employing immunotherapy in the neoadjuvant and adjuvant settings, reviews the results of relevant clinical trials, and examines the potential benefits and caveats of neoadjuvant and/or adjuvant approaches in patients with SCCHN.
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Affiliation(s)
- Ioannis A Vathiotis
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Section of Medical Oncology, Third Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jennifer M Johnson
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Adam Luginbuhl
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - David Cognetti
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Joseph Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Athanassios Argiris
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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12
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Dmytriw AA, Ortega C, Anconina R, Metser U, Liu ZA, Liu Z, Li X, Sananmuang T, Yu E, Joshi S, Waldron J, Huang SH, Bratman S, Hope A, Veit-Haibach P. Nasopharyngeal Carcinoma Radiomic Evaluation with Serial PET/CT: Exploring Features Predictive of Survival in Patients with Long-Term Follow-Up. Cancers (Basel) 2022; 14:3105. [PMID: 35804877 PMCID: PMC9264840 DOI: 10.3390/cancers14133105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE We aim determine the value of PET and CT radiomic parameters on survival with serial follow-up PET/CT in patients with nasopharyngeal carcinoma (NPC) for which curative intent therapy is undertaken. METHODS Patients with NPC and available pre-treatment as well as follow up PET/CT were included from 2005 to 2006 and were followed to 2021. Baseline demographic, radiological and outcome data were collected. Univariable Cox proportional hazard models were used to evaluate features from baseline and follow-up time points, and landmark analyses were performed for each time point. RESULTS Sixty patients were enrolled, and two-hundred and seventy-eight (278) PET/CT were at baseline and during follow-up. Thirty-eight percent (38%) were female, and sixty-two patients were male. All patients underwent curative radiation or chemoradiation therapy. The median follow-up was 11.72 years (1.26-14.86). Five-year and ten-year overall survivals (OSs) were 80.0% and 66.2%, and progression-free survival (PFS) was 90.0% and 74.4%. Time-dependent modelling suggested that, among others, PET gray-level zone length matrix (GLZLM) gray-level non-uniformity (GLNU) (HR 2.74 95% CI 1.06, 7.05) was significantly associated with OS. Landmark analyses suggested that CT parameters were most predictive at 15 month, whereas PET parameters were most predictive at time points 3, 6, 9 and 15 month. CONCLUSIONS This study with long-term follow up data on NPC suggests that mainly PET-derived radiomic features are predictive for OS but not PFS in a time-dependent evaluation. Furthermore, CT radiomic measures may predict OS and PFS best at initial and long-term follow-up time points and PET measures may be more predictive in the interval. These modalities are commonly used in NPC surveillance, and prospective validation should be considered.
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Affiliation(s)
- Adam A. Dmytriw
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (A.A.D.); (R.A.)
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Claudia Ortega
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Reut Anconina
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (A.A.D.); (R.A.)
| | - Ur Metser
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Zhihui A. Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Zijin Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Thiparom Sananmuang
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University,270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Eugene Yu
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Sayali Joshi
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
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13
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Guzmán Pérez-Carrillo GJ, Ivanidze J. PET/CT and PET/MR Imaging of the Post-treatment Head and Neck: Traps and Tips. Neuroimaging Clin N Am 2021; 32:111-132. [PMID: 34809833 DOI: 10.1016/j.nic.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PET/computed tomography and PET/MR imaging are used to evaluate the post-treatment neck. Although 18F-FDG is helpful in the staging and treatment response assessment of head and neck cancer, recently developed PET radiotracers targeting specific surface markers are promising for applications of diagnostic problem solving and improved extent delineation. Diffusion-weighted MR imaging is helpful in the differential diagnosis of head and neck neoplasms, and improves the sensitivity and specificity for the detection of certain pathologies. Following standardized imaging parameters for PET/computed tomography and diffusion-weighted imaging in PET/MR imaging improves diagnostic accuracy and allows for future research data mining.
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Affiliation(s)
- Gloria J Guzmán Pérez-Carrillo
- Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, Campus Box 8131, St Louis, MO 63110, USA.
| | - Jana Ivanidze
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA; Division of Neuroradiology, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA
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14
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Mayne GC, Woods CM, Dharmawardana N, Wang T, Krishnan S, Hodge JC, Foreman A, Boase S, Carney AS, Sigston EAW, Watson DI, Ooi EH, Hussey DJ. Cross validated serum small extracellular vesicle microRNAs for the detection of oropharyngeal squamous cell carcinoma. J Transl Med 2020; 18:280. [PMID: 32650803 PMCID: PMC7350687 DOI: 10.1186/s12967-020-02446-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) is often diagnosed at an advanced stage because the disease often causes minimal symptoms other than metastasis to neck lymph nodes. Better tools are required to assist with the early detection of OPSCC. MicroRNAs (miRNAs, miRs) are potential biomarkers for early head and neck squamous cell cancer diagnosis, prognosis, recurrence, and presence of metastatic disease. However, there is no widespread agreement on a panel of miRNAs with clinically meaningful utility for head and neck squamous cell cancers. This could be due to variations in the collection, storage, pre-processing, and isolation of RNA, but several reports have indicated that the selection and reproducibility of biomarkers has been widely affected by the methods used for data analysis. The primary analysis issues appear to be model overfitting and the incorrect application of statistical techniques. The purpose of this study was to develop a robust statistical approach to identify a miRNA signature that can distinguish controls and patients with inflammatory disease from patients with human papilloma virus positive (HPV +) OPSCC. METHODS Small extracellular vesicles were harvested from the serum of 20 control patients, 20 patients with gastroesophageal reflux disease (GORD), and 40 patients with locally advanced HPV + OPSCC. MicroRNAs were purified, and expression profiled on OpenArray™. A novel cross validation method, using lasso regression, was developed to stabilise selection of miRNAs for inclusion in a prediction model. The method, named StaVarSel (for Stable Variable Selection), was used to derive a diagnostic biomarker signature. RESULTS A standard cross validation approach was unable to produce a biomarker signature with good cross validated predictive capacity. In contrast, StaVarSel produced a regression model containing 11 miRNA ratios with potential clinical utility. Sample permutations indicated that the estimated cross validated prediction accuracy of the 11-miR-ratio model was not due to chance alone. CONCLUSIONS We developed a novel method, StaVarSel, that was able to identify a panel of miRNAs, present in small extracellular vesicles derived from blood serum, that robustly cross validated as a biomarker for the detection of HPV + OPSCC. This approach could be used to derive diagnostic biomarkers of other head and neck cancers.
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Affiliation(s)
- G C Mayne
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - C M Woods
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - N Dharmawardana
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - T Wang
- Flinders Health and Medical Research Institute, Flinders University , Bedford Park, South Australia, 5042, Australia
| | - S Krishnan
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - J C Hodge
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - A Foreman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - S Boase
- Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, 5000, Australia
- Flinders University, South Australia, South Australia, 5042, Australia
| | - A S Carney
- Flinders Health and Medical Research Institute, Flinders University , Bedford Park, South Australia, 5042, Australia
| | - E A W Sigston
- Department of Otorhinolaryngology Head & Neck, Monash Health and Department of Surgery, Monash University, Clayton, Victoria, 3168, Australia
| | - D I Watson
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - E H Ooi
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - D J Hussey
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.
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15
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Gogineni E, Bloom B, Diaz Molina F, Villella J, Goenka A. Radiotherapy dose escalation on pelvic lymph node control in patients with cervical cancer. Int J Gynecol Cancer 2020; 31:524-529. [PMID: 32606098 DOI: 10.1136/ijgc-2020-001342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Data supporting dose escalation for node-positive cervical cancer are currently limited to small retrospective studies. The goal of this study was to assess whether radiation dose was associated with lymph node control or gastrointestinal toxicity in patients with node-positive cervical cancer. METHODS A total of 390 patients with carcinoma of the uterine cervix were treated between October 1997 and October 2017. Patients included in our analysis were those with squamous cell carcinoma or adenocarcinoma who were node-positive, treated definitively, and with at least one follow-up visit and post-treatment imaging scan. We excluded those without follow-up and those treated with palliative intent. All patients were treated with external beam radiation to pelvic±para-aortic fields with concurrent weekly cisplatin. All lymph nodes present at the time of treatment were stratified by size as <2 cm or ≥2 cm. Acute and late gastrointestinal toxicity were recorded for all patients. RESULTS A total of 77 patients with 206 lymph nodes were identified. Median stage at presentation was FIGO IIB. Thirteen patients underwent definitive surgical resection followed by adjuvant radiation, of which 12 were treated to doses ≤5040 (range 2700-5940) cGy. Sixty-four patients were treated with definitive chemoradiation, of which 42 (66%) received ≤5040 (range 4500-5040) cGy and 22 (34%) received >5040 (range 5300-6640) cGy. Patients with pre-chemoradiation lymph nodes ≥2 cm had inferior lymph node control compared with patients with pre-chemoradiation lymph node <2 cm at 12 months (77% vs 100%, p=0.002). Radiation dose >5040 cGy was not significantly associated with improved lymph node control compared with ≤5040 cGy when analyzing all patients (12 months, 100% vs 89%, p=0.112). In patients with pre-chemoradiation lymph nodes ≥2 cm, radiation dose >5040 cGy was associated with improved lymph node control (12 months, 100% vs 60%, p=0.020). Acute grade ≥2 gastrointestinal toxicity was not associated with radiation dose >5040 cGy (20% vs 13%, p=0.424). Two patients developed grade ≥2 late gastrointestinal toxicity, both of whom were treated to ≤5040 cGy. CONCLUSIONS This series supports the role of dose escalation for patients with lymph nodes ≥2 cm. Dose escalation is associated with improved control in patients with larger lymph nodes, and is not associated with greater gastrointestinal toxicity.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Beatrice Bloom
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Ferney Diaz Molina
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Jeannine Villella
- Gynecologic Oncology, Northwell Health, New York, New York, USA.,Gynecologic Oncology, Northwell Health, New York, New York, USA
| | - Anuj Goenka
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
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16
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Shukla M, Forghani R, Agarwal M. Patient-Centric Head and Neck Cancer Radiation Therapy: Role of Advanced Imaging. Neuroimaging Clin N Am 2020; 30:341-357. [PMID: 32600635 DOI: 10.1016/j.nic.2020.04.005] [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: 12/24/2022]
Abstract
The traditional 'one-size-fits-all' approach to H&N cancer therapy is archaic. Advanced imaging can identify radioresistant areas by using biomarkers that detect tumor hypoxia, hypercellularity etc. Highly conformal radiotherapy can target resistant areas with precision. The critical information that can be gleaned about tumor biology from these advanced imaging modalities facilitates individualized radiotherapy. The tumor imaging world is pushing its boundaries. Molecular imaging can now detect protein expression and genotypic variations across tumors that can be exploited for tailoring treatment. The exploding field of radiomics and radiogenomics extracts quantitative, biologic and genetic information and further expands the scope of personalized therapy.
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Affiliation(s)
- Monica Shukla
- Department of Radiation Oncology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory, Department of Radiology, Research Institute of McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Froedtert and Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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17
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Hanemaaijer SH, Fazzi M, Steenbakkers RJHM, Dorgelo B, van der Vegt B, Witjes MJH, van der Laan BFAM, Oosting SF, Stormezand GN, Plaat BEC. 18 F-FDG PET/CT for response evaluation of regional lymph nodes in 97 head and neck squamous cell carcinoma patients: Differences in the predictive value of residual disease after radiotherapy and chemoradiotherapy. Clin Otolaryngol 2020; 45:805-810. [PMID: 32378342 PMCID: PMC7496510 DOI: 10.1111/coa.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/05/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Saskia H Hanemaaijer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maran Fazzi
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Dorgelo
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Section of Oncology, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gilles N Stormezand
- Department of Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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18
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Demétrio de Souza França P, Roberts S, Kossatz S, Guru N, Mason C, Zanoni DK, Abrahão M, Schöder H, Ganly I, Patel SG, Reiner T. Fluorine-18 labeled poly (ADP-ribose) polymerase1 inhibitor as a potential alternative to 2-deoxy-2-[ 18F]fluoro-d-glucose positron emission tomography in oral cancer imaging. Nucl Med Biol 2020; 84-85:80-87. [PMID: 32135475 PMCID: PMC7253343 DOI: 10.1016/j.nucmedbio.2020.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The evaluation of disease extent and post-therapy surveillance of head and neck cancer using 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) PET is often complicated by physiological uptake in normal tissues of the head and neck region, especially after surgery or radiotherapy. However, irrespective of low positive predictive values, [18F]FDG PET remains the standard of care to stage the disease and monitor recurrences. Here, we report the preclinical use of a targeted poly (ADP-ribose) polymerase1 (PARP1) binding PET tracer, fluorine-18 labeled poly (ADP-ribose) polymerase1 inhibitor ([18F]PARPi), as a potential alternative with greater specificity. METHODS Using an orthotopic xenograft mouse model injected with either FaDu or Cal 27 (human squamous cell carcinoma cell lines) we performed PET/CT scans with the 2 tracers and compared the results. Gamma counts and autoradiography were also assessed and correlated with histology. RESULTS The average retained activity of [18F]PARPi across cell lines in tumor-bearing tongues was 0.9 ± 0.3%ID/g, 4.1 times higher than in control (0.2 ± 0.04%ID/g). Autoradiography and histology confirmed that the activity arose almost exclusively from the tumor areas, with a signal/normal tissue around a ratio of 42.9 ± 21.4. In vivo, [18F]PARPi-PET allowed delineation of tumor from healthy tissue (p < .005), whereas [18F]FDG failed to do so (p = .209). CONCLUSIONS AND IMPLICATIONS FOR PATIENT CARE We demonstrate that [18F]PARPi is more specific to tongue tumor tissue than [18F]FDG. [18F]PARPi PET allows for the straightforward delineation of oral cancer in mouse models, suggesting that clinical translation could result in improved imaging of head and neck cancer when compared to [18F]FDG.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil.
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Christian Mason
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA; Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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19
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Pfaehler E, Burggraaff C, Kramer G, Zijlstra J, Hoekstra OS, Jalving M, Noordzij W, Brouwers AH, Stevenson MG, de Jong J, Boellaard R. PET segmentation of bulky tumors: Strategies and workflows to improve inter-observer variability. PLoS One 2020; 15:e0230901. [PMID: 32226030 PMCID: PMC7105134 DOI: 10.1371/journal.pone.0230901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background PET-based tumor delineation is an error prone and labor intensive part of image analysis. Especially for patients with advanced disease showing bulky tumor FDG load, segmentations are challenging. Reducing the amount of user-interaction in the segmentation might help to facilitate segmentation tasks especially when labeling bulky and complex tumors. Therefore, this study reports on segmentation workflows/strategies that may reduce the inter-observer variability for large tumors with complex shapes with different levels of user-interaction. Methods Twenty PET images of bulky tumors were delineated independently by six observers using four strategies: (I) manual, (II) interactive threshold-based, (III) interactive threshold-based segmentation with the additional presentation of the PET-gradient image and (IV) the selection of the most reasonable result out of four established semi-automatic segmentation algorithms (Select-the-best approach). The segmentations were compared using Jaccard coefficients (JC) and percentage volume differences. To obtain a reference standard, a majority vote (MV) segmentation was calculated including all segmentations of experienced observers. Performed and MV segmentations were compared regarding positive predictive value (PPV), sensitivity (SE), and percentage volume differences. Results The results show that with decreasing user-interaction the inter-observer variability decreases. JC values and percentage volume differences of Select-the-best and a workflow including gradient information were significantly better than the measurements of the other segmentation strategies (p-value<0.01). Interactive threshold-based and manual segmentations also result in significant lower and more variable PPV/SE values when compared with the MV segmentation. Conclusions FDG PET segmentations of bulky tumors using strategies with lower user-interaction showed less inter-observer variability. None of the methods led to good results in all cases, but use of either the gradient or the Select-the-best workflow did outperform the other strategies tested and may be a good candidate for fast and reliable labeling of bulky and heterogeneous tumors.
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Affiliation(s)
- Elisabeth Pfaehler
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Coreline Burggraaff
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gem Kramer
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Josée Zijlstra
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Otto S. Hoekstra
- Department of Oncology Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathilde Jalving
- Department of Oncology Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrienne H. Brouwers
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc G. Stevenson
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan de Jong
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald Boellaard
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
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20
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Galiza Barbosa F, Riesterer O, Tanadini‐Lang S, Stieb S, Studer G, Pruschy M, Huber GF, Huellner MW, Stolzmann P, Veit‐Haibach P. Evaluation of 18F‐FDG PET/CT as an early imaging biomarker for response monitoring after radiochemotherapy using cetuximab in head and heck squamous cell carcinoma. Head Neck 2019; 42:163-170. [DOI: 10.1002/hed.25975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/17/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Oliver Riesterer
- Department of Radiation OncologyUniversity Hospital Zurich Zurich Switzerland
| | | | - Sonja Stieb
- Department of Radiation OncologyUniversity Hospital Zurich Zurich Switzerland
| | - Gabriela Studer
- Department of Radiation OncologyUniversity Hospital Zurich Zurich Switzerland
| | - Martin Pruschy
- Department of Radiation OncologyUniversity Hospital Zurich Zurich Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Martin W. Huellner
- Department Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
- Department of NeuroradiologyUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Paul Stolzmann
- Department Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
- Department of NeuroradiologyUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Patrick Veit‐Haibach
- Department Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
- Department of Diagnostic and Interventional RadiologyUniversity Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
- Joint Department Medical Imaging, Toronto General Hospital, University Health NetworkUniversity of Toronto Toronto Ontario Canada
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21
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Wan DQ. Advances in Functional Imaging in the Assessment of Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2019; 31:627-635. [PMID: 31473063 DOI: 10.1016/j.coms.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article discusses the application of fludeoxyglucose PET/computed tomography (CT) technology in head and neck cancer diagnosis and management, as well as advantages and disadvantages relative to traditional imaging modalities. A successful scan relies on precise patient preparation, and compliance to specific protocols before and during the scan. Finally, this article briefly introduces a PET/CT scan recently approved by the Food and Drug Administration for neuroendocrine tumors.
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Affiliation(s)
- David Q Wan
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, Health Science Center in Houston, University of Texas, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030, USA.
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22
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Ha SC, Roh JL, Kim JS, Lee JH, Choi SH, Nam SY, Kim SY. Clinical utility of 18F-FDG PET/CT for patients with recurrent head and neck squamous cell carcinoma. Acta Otolaryngol 2019; 139:810-815. [PMID: 31274365 DOI: 10.1080/00016489.2019.1632483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: The accurate detection of distant metastases can facilitate appropriate treatment planning for patients with recurrent head and neck squamous cell carcinoma (HNSCC). Objectives: We evaluated the role of 18F-FDG PET/CT for distant metastasis diagnosis and survival prediction in patients with recurrent HNSCC. Materials and methods: This study included 95 consecutive patients with recurrent HNSCC and salvage treatments. McNemar's test was used to compare the detection of distant metastasis at recurrence using 18F-FDG PET/CT and contrast-enhanced chest and neck CT, and bone scintigraphy. Results: Thirty-two patients (34%) had distant metastases at recurrence. The sensitivity, specificity, accuracy, and positive and negative predictive values of 18F-FDG PET/CT for detecting chest and bone metastases were comparable to those of conventional imaging (p > .1). However, 18F-FDG PET/CT detected two additional distant metastatic lesions. After controlling for clinicopathological factors, a recurrent lesion with maximum standardized uptake value (SUVmax) >8.7 was identified as an independent predictor of poor overall survival (p = .001). Conclusions and significance: 18F-FDG PET/CT or conventional imaging is comparable with regard to detecting distant metastases of recurrent HNSCC. However, 18F-FDG PET/CT may detect additional metastatic lesions in unusual distant sites and the recurrent lesion SUVmax may predict patient survival after salvage treatments.
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Affiliation(s)
- Seung Cheol Ha
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Graff P, Blanchard P, Thariat J, Racadot S, Lapeyre M. [Post-treatment follow-up of head and neck cancer patients]. Cancer Radiother 2019; 23:576-580. [PMID: 31422000 DOI: 10.1016/j.canrad.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Post-therapeutic follow-up of patients with head and neck cancer involves numerous professionals. The radiation oncologist should play an active role in this process. His oncological knowledge and technical expertise position him as a cornerstone for the detection of recurrences from the treated tumor, the research of second primary cancers and the screening of potential side-effects induced by the different treatments administered. To improve the benefits/costs ratio and allow good patient-compliance, follow-up programs should be built through close collaboration between the different contributors and planned according to a feasible schedule. Paraclinical exams must be arranged to respond to accurate objectives. Patient-education is essential to ensure the patient's full understanding and active participation. Finally, the transfer of the long-term follow-up of cancer survivors from specialists to primary care physicians is relevant but would require a prospective evaluation of its efficiency for this specific population.
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Affiliation(s)
- P Graff
- Département de radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
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24
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Li Y, Awan MJ, Chang T, Lavertu P, Zender C, Rezaee R, Fowler N, Wasman J, Avril NE, Chen N, Machtay M, Yao M. Post-radiotherapy PET/CT for predicting treatment outcomes in head and neck cancer after postoperative radiotherapy. Eur J Nucl Med Mol Imaging 2019; 46:794-800. [PMID: 30680587 DOI: 10.1007/s00259-019-4272-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to retrospectively review the role of post-treatment (post-tx) FDG-PET/CT scans in patients receiving postoperative intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinomas (HNSCC). MATERIALS AND METHODS Eighty-two patients with HNSCC treated with surgery and postoperative IMRT with or without chemotherapy from October 15, 2008 to December 31, 2014 that had post-tx PET/CT within 6 months of completing IMRT were included. PET/CT was considered positive based on multi-disciplinary review integrating clinical information. Survival analysis was performed using the Kaplan-Meier method. Categorical and continuous predictors of positive post-tx PET/CT were evaluated using Fisher's exact test and logistic regression, respectively. Predictors for survival outcomes were evaluated with log-rank testing. A p ≤ 0.05 was considered statistically significant. RESULTS Median follow-up was 3.88 years. For all patients, 3-year overall survival (OS) and recurrence-free survival (RFS) were 71.8% and 61.3%, respectively. Patients with positive post-tx PET/CT had worse OS compared to those with negative post-tx PET/CT (log rank p < 0.001). For patients with positive post-tx PET/CT, 3-year OS was 11.2% compared to 89.9% for patients with negative post-tx PET/CT. The positive predictive value (PPV) of PET/CT was 100% for local recurrence (LR), regional recurrence (RR) and distant metastasis (DM). The negative predictive values (NPV) for LR, RR and DM were 89.0%, 89.2%, and 85.9%, respectively. Perineural invasion (p = 0.009), p16 status (p = 0.009), non-oropharyngeal primary site (p = 0.002), and the use of chemotherapy (p = 0.01) were independent predictors of positive PET/CT. CONCLUSIONS Post-tx PET/CT after postoperative radiation is prognostic for survival outcomes. The PPV of post-tx PET for recurrence was excellent, allowing for early detection of recurrent disease. Post-tx PET/CT should be considered after postoperative radiation.
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Affiliation(s)
- Yan Li
- Department of Radiation Oncology, West China Hospital of Sichuan University, Chengdu, China
| | - Musaddiq J Awan
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Tangel Chang
- Department of Radiation Oncology, University of Toledo, Toledo, OH, USA
| | - Pierre Lavertu
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA
| | - Chad Zender
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA
| | - Rod Rezaee
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA
| | - Nicole Fowler
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA
| | - Jay Wasman
- Department of Pathology, University Hospitals, Cleveland, OH, USA
| | - Norbert E Avril
- Department of Nuclear Medicine and Radiology, University Hospitals, Cleveland, OH, USA
| | - Nianyong Chen
- Department of Radiation Oncology, West China Hospital of Sichuan University, Chengdu, China
| | - Mitchell Machtay
- Department of Radiation Oncology, Case Western Reserve University and University Hospitals, Cleveland, OH, USA
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve University and University Hospitals, Cleveland, OH, USA
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25
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Chest radiography or chest CT plus head and neck CT versus 18F-FDG PET/CT for detection of distant metastasis and synchronous cancer in patients with head and neck cancer. Oral Oncol 2019; 88:109-114. [DOI: 10.1016/j.oraloncology.2018.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/18/2022]
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26
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Pfaehler E, De Jong JR, Dierckx RAJO, van Velden FHP, Boellaard R. SMART (SiMulAtion and ReconsTruction) PET: an efficient PET simulation-reconstruction tool. EJNMMI Phys 2018; 5:16. [PMID: 30225675 PMCID: PMC6141406 DOI: 10.1186/s40658-018-0215-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/25/2018] [Indexed: 01/28/2023] Open
Abstract
Background Positron-emission tomography (PET) simulators are frequently used for development and performance evaluation of segmentation methods or quantitative uptake metrics. To date, most PET simulation tools are based on Monte Carlo simulations, which are computationally demanding. Other analytical simulation tools lack the implementation of time of flight (TOF) or resolution modelling (RM). In this study, a fast and easy-to-use PET simulation-reconstruction package, SiMulAtion and ReconsTruction (SMART)-PET, is developed and validated, which includes both TOF and RM. SMART-PET, its documentation and instructions to calibrate the tool to a specific PET/CT system are available on Zenodo. SMART-PET allows the fast generation of 3D PET images. As input, it requires one image representing the activity distribution and one representing the corresponding CT image/attenuation map. It allows the user to adjust different parameters, such as reconstruction settings (TOF/RM), noise level or scan duration. Furthermore, a random spatial shift can be included, representing patient repositioning. To evaluate the tool, simulated images were compared with real scan data of the NEMA NU 2 image quality phantom. The scan was acquired as a 60-min list-mode scan and reconstructed with and without TOF and/or RM. For every reconstruction setting, ten statistically equivalent images, representing 30, 60, 120 and 300 s scan duration, were generated. Simulated and real-scan data were compared regarding coefficient of variation in the phantom background and activity recovery coefficients (RCs) of the spheres. Furthermore, standard deviation images of each of the ten statistically equivalent images were compared. Results SMART-PET produces images comparable to actual phantom data. The image characteristics of simulated and real PET images varied in similar ways as function of reconstruction protocols and noise levels. The change in image noise with variation of simulated TOF settings followed the theoretically expected behaviour. RC as function of sphere size agreed within 0.3–11% between simulated and actual phantom data. Conclusions SMART-PET allows for rapid and easy simulation of PET data. The user can change various acquisition and reconstruction settings (including RM and TOF) and noise levels. The images obtained show similar image characteristics as those seen in actual phantom data. Electronic supplementary material The online version of this article (10.1186/s40658-018-0215-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth Pfaehler
- Departments of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan R De Jong
- Departments of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Departments of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronald Boellaard
- Departments of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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27
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Lee JR, Almuhaimid TM, Roh JL, Oh JS, Kim SJ, Kim JS, Choi SH, Nam SY, Kim SY. Prognostic value of 18
F-FDG PET/CT parameters in patients who undergo salvage treatments for recurrent squamous cell carcinoma of the larynx and hypopharynx. J Surg Oncol 2018; 118:644-650. [DOI: 10.1002/jso.25185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jae Ryung Lee
- Department of Otolaryngology-Head & Neck Surgery; Keimyung University Dongsan Medical Center; Daegu Korea
| | - Turki M. Almuhaimid
- Department of Surgery; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Soo-Jong Kim
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Seung-Ho Choi
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Sang Yoon Kim
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
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28
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Frequency of Follow-up of Oral Cavity and Oropharynx Patients and Appropriate Use of Imaging and Other Surveillance Methodology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yamamoto M, Inohara H, Nakagawa T. Targeting metabolic pathways for head and neck cancers therapeutics. Cancer Metastasis Rev 2018; 36:503-514. [PMID: 28819926 DOI: 10.1007/s10555-017-9691-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cancer cells have distinctive energy metabolism pathways that support their rapid cell division. The preference for anaerobic glycolysis under the normal oxygen condition is known as the Warburg effect and has been observed in head and neck cancers. These metabolic changes are controlled by cancer-related transcription factors, such as tumor suppressor gene and hypoxia inducible factor 1α. In addition, various metabolic enzymes also actively regulate cancer-specific metabolism including the switch between aerobic and anaerobic glycolysis. For a long time, these metabolic changes in cancer cells have been considered a consequence of transformation required to maintain the high rate of tumor cell replication. However, recent studies indicate that alteration of metabolism is sufficient to initiate tumor transformation. Indeed, oncogenic mutations in the metabolic enzymes, isocitrate dehydrogenase and succinate dehydrogenase, have been increasingly found in various cancers, including head and neck cancers. In the present review, we introduce recent findings regarding the cancer metabolism, including the molecular mechanisms of how they affect cancer pathogenesis and maintenance. We also discuss the current and future perspectives on therapeutics that target metabolic pathways, with an emphasis on head and neck cancer.
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Affiliation(s)
- Masashi Yamamoto
- Department of Metabolism and Nutrition, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Takashi Nakagawa
- Department of Metabolism and Nutrition, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan. .,Institute of Natural Medicine, University of Toyama, Toyama, 930-0194, Japan.
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30
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Alves WEFM, Pitella FA, da Rocha ET, Wichert-Ana L. The Role of PET/CT with 18F-FDG in the Assessment of Therapeutic Response of Head and Neck Cancer. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Zhao X, Rao S. Surveillance imaging following treatment of head and neck cancer. Semin Oncol 2017; 44:323-329. [DOI: 10.1053/j.seminoncol.2018.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 11/11/2022]
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Kim KR, Shim HJ, Hwang JE, Cho SH, Chung IJ, Park KS, Kang SR, Kwon SY, Chung WK, Bae WK. The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer. Eur J Nucl Med Mol Imaging 2017; 45:170-178. [PMID: 28940101 PMCID: PMC5745569 DOI: 10.1007/s00259-017-3836-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/14/2017] [Indexed: 02/06/2023]
Abstract
Purpose Induction chemotherapy (ICT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CCRT) has the advantages of organ preservation and systemic control in head and neck cancer (HNC). Early prediction of CCRT efficacy may help identify patients who will benefit more from surgery than from CCRT. We investigated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) after ICT to predict the efficacy of CCRT and clinical outcomes. Methods Tumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDG PET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response (percentage decrease in the maximum standardized uptake value [SUVmax] and total metabolic tumor volume [MTV]) after ICT and complete response (CR) to CCRT, progression-free survival (PFS), and overall survival (OS). Results We studied 43 HNC patients with a median follow-up of 32.7 months. Lymph node (LN) SUVmax and total MTV decreases from baseline after ICT were greater in patients with a CR to CCRT than in non-CR patients (LN SUVmax, 88.8% vs. 62.5%, respectively; total MTV, 99.7% vs. 89.9%, respectively). Decreases in total MTV ≥ 78% and LN SUVmax ≥73% after ICT predicted CR to CCRT and longer OS and PFS. Conclusions Using interim FDG PET-CT to measure SUVmax and total MTV after three cycles of ICT may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes. Electronic supplementary material The online version of this article (10.1007/s00259-017-3836-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ka-Rham Kim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jun-Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sang-Hee Cho
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ik-Joo Chung
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki Seong Park
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea. .,Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea.
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Haylock AK, Nilvebrant J, Mortensen A, Velikyan I, Nestor M, Falk R. Generation and evaluation of antibody agents for molecular imaging of CD44v6-expressing cancers. Oncotarget 2017; 8:65152-65170. [PMID: 29029420 PMCID: PMC5630320 DOI: 10.18632/oncotarget.17996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/26/2017] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of this study was to generate and characterize scFv antibodies directed to human CD44v6, as well as to radiolabel and evaluate top candidates in vitro and in vivo for their potential use in CD44v6-targeted molecular imaging in cancer patients. MATERIALS AND METHODS Phage display selections were used to isolate CD44v6-specific scFvs. A chain shuffling strategy was employed for affinity maturation based on a set of CD44v6-specific first-generation clones. Two second-generation scFv clones were then chosen for labeling with 111In or 125I and assessed for CD44v6-specific binding on cultured tumor cells. In vivo uptake and distribution was evaluated in tumor-bearing mice using a dual tumor model. Finally, a proof-of-concept small animal PET-CT study was performed on one of the candidates labeled with 124I. RESULTS Two affinity-matured clones, CD44v6-scFv-A11 and CD44v6-scFv-H12, displayed promising binding kinetics. Seven out of eight radiolabeled conjugates demonstrated CD44v6-specific binding. In vivo studies on selected candidates demonstrated very advantageous tumor-to-organ ratios, in particular for iodinated conjugates, where 125I-labeled scFvs exhibited favorable kinetics and tumor-to-blood ratios above five already at 24 hours p.i.. The small animal PET-CT study using 124I-labeled CD44v6-scFv-H12 was in line with the biodistribution data, clearly visualizing the high CD44v6-expressing tumor. CONCLUSION The single chain fragments, CD44v6-scFv-A11 and CD44v6-scFv-H12 specifically bind to CD44v6, and the radiolabeled counterparts provide high tumor-to-blood ratios and fast clearance from organs and blood. We conclude that radioiodinated CD44v6-scFv-A11 and CD44v6-scFv-H12 possess features highly suitable for stringent molecular imaging.
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Affiliation(s)
- Anna-Karin Haylock
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Johan Nilvebrant
- Division of Protein Technology, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Anja Mortensen
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Marika Nestor
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ronny Falk
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Folkert MR, Setton J, Apte AP, Grkovski M, Young RJ, Schöder H, Thorstad WL, Lee NY, Deasy JO, Hun Oh J. Predictive modeling of outcomes following definitive chemoradiotherapy for oropharyngeal cancer based on FDG-PET image characteristics. Phys Med Biol 2017; 62:5327-5343. [PMID: 28604368 PMCID: PMC5729737 DOI: 10.1088/1361-6560/aa73cc] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this study, we investigate the use of imaging feature-based outcomes research ('radiomics') combined with machine learning techniques to develop robust predictive models for the risk of all-cause mortality (ACM), local failure (LF), and distant metastasis (DM) following definitive chemoradiation therapy (CRT). One hundred seventy four patients with stage III-IV oropharyngeal cancer (OC) treated at our institution with CRT with retrievable pre- and post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans were identified. From pre-treatment PET scans, 24 representative imaging features of FDG-avid disease regions were extracted. Using machine learning-based feature selection methods, multiparameter logistic regression models were built incorporating clinical factors and imaging features. All model building methods were tested by cross validation to avoid overfitting, and final outcome models were validated on an independent dataset from a collaborating institution. Multiparameter models were statistically significant on 5 fold cross validation with the area under the receiver operating characteristic curve (AUC) = 0.65 (p = 0.004), 0.73 (p = 0.026), and 0.66 (p = 0.015) for ACM, LF, and DM, respectively. The model for LF retained significance on the independent validation cohort with AUC = 0.68 (p = 0.029) whereas the models for ACM and DM did not reach statistical significance, but resulted in comparable predictive power to the 5 fold cross validation with AUC = 0.60 (p = 0.092) and 0.65 (p = 0.062), respectively. In the largest study of its kind to date, predictive features including increasing metabolic tumor volume, increasing image heterogeneity, and increasing tumor surface irregularity significantly correlated to mortality, LF, and DM on 5 fold cross validation in a relatively uniform single-institution cohort. The LF model also retained significance in an independent population.
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Affiliation(s)
- Michael R. Folkert
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jeremy Setton
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aditya P. Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Robert J. Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wade L. Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Garibaldi C, Ronchi S, Cremonesi M, Gilardi L, Travaini L, Ferrari M, Alterio D, Kaanders JH, Ciardo D, Orecchia R, Jereczek-Fossa BA, Grana CM. Interim 18 F-FDG PET/CT During Chemoradiation Therapy in the Management of Head and Neck Cancer Patients: A Systematic Review. Int J Radiat Oncol Biol Phys 2017; 98:555-573. [DOI: 10.1016/j.ijrobp.2017.02.217] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 01/27/2023]
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Kale H, Rath TJ. Chapter 3 The Role of PET/CT in Squamous Cell Carcinoma of the Head and Neck. Semin Ultrasound CT MR 2017; 38:479-494. [PMID: 29031365 DOI: 10.1053/j.sult.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Head and neck squamous cell carcinoma is an important cause of cancer morbidity worldwide and has been stratified into human papillomavirus-related and human papillomavirus-unrelated subgroups that affect prognosis and now staging. Conventional anatomical imaging methods are suboptimal for the detection of regional and distant metastases that are important prognosticators associated with poor outcomes. Functional imaging with (F18)-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) is a useful tool in the management of head and neck squamous cell carcinoma, providing complementary physiological and anatomical information. In this article, optimal PET/CT technique will be reviewed and the pretreatment and posttreatment applications of PET/CT will be described. A simplified approach to imaging interpretation, including review of pearls and pitfalls will be discussed. An initial framework for follow-up evaluation will be provided.
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Affiliation(s)
- Hrishikesh Kale
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Tanya J Rath
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Grkovski M, Lee NY, Schöder H, Carlin SD, Beattie BJ, Riaz N, Leeman JE, O'Donoghue JA, Humm JL. Monitoring early response to chemoradiotherapy with 18F-FMISO dynamic PET in head and neck cancer. Eur J Nucl Med Mol Imaging 2017; 44:1682-1691. [PMID: 28540417 DOI: 10.1007/s00259-017-3720-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/03/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of 18F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC. EXPERIMENTAL DESIGN Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0-30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∼95 min and ∼160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k 3 and Tumor-to-Blood Ratio (TBR)), perfusion (K 1 ) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia. RESULTS One hundred and thirty-five lesions in total were analyzed. TBR, k 3 and DV decreased on early response scans, while no significant change was observed for K 1 . The k 3 -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k 3 and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k 3 indicated the presence of hypoxia. CONCLUSION Pharmacokinetic modeling of FMISO dynamic PET reveals a more detailed characterization of the tumor microenvironment and assessment of response to chemoradiotherapy in HNC patients than a single static image does. In a clinical trial where absence of hypoxia in primary tumor and lymph nodes would lead to de-escalation of therapy, the observed disagreement between visual analysis and pharmacokinetic modeling results would have affected patient management in <20% cases. While simple static PET imaging is easily implemented for clinical trials, the clinical applicability of pharmacokinetic modeling remains to be investigated.
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Affiliation(s)
- Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean D Carlin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bradley J Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph A O'Donoghue
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - John L Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Ginat DT, Westiin C, Brisson RJ, Chin CT, Pu Y, Zhang H, De Souza JA. Pilot Study of 99mTc-labeled Ethylene Dicysteine Deoxyglucose SPECT-CT Imaging in Treatment Response Evaluation in Patients with Locally Advanced Head and Neck Cancer. Cureus 2017; 9:e1152. [PMID: 28503388 PMCID: PMC5426824 DOI: 10.7759/cureus.1152] [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: 11/22/2022] Open
Abstract
Background The purpose of this study is to describe the preliminary findings of 99mTc-labeled ethylene dicysteine deoxyglucose (99mTc-EC-DG) performed four weeks after chemoradiotherapy in patients with locally advanced head and neck squamous cell carcinoma. Methods Review of nine patients with locally advanced head and neck squamous cell carcinomas imaged with 99mTc-EC-DG single photon emission computed tomography-computed tomography (SPECT-CT) at baseline before treatment and at four weeks after treatment completion was performed. Results At four weeks post-treatment, five patients had either decreased activity or no significant activity on 99mTc-EC-DG SPECT-CT and were considered to have responded to treatment, whereas four patients did not have significantly decreased uptake on 99mTc-EC-DG SPECT-CT and were considered to have not adequately responded to treatment. Among the five patients considered to have treatment response at four weeks, all were free of disease (true-negative). Among the four patients considered to have stable activity on 99mTc-EC-DG SPECT-CT at four weeks, two were designated as having no response or incomplete response (true-positive), and two were designated as having complete response (false-positive) on subsequent composite assessment. Conclusions The pilot data is promising but warrants further investigation of 99mTc-EC-DG SPECT-CT for the assessment of locoregional treatment response at four weeks in patients with locally advanced head and neck squamous cell carcinomas.
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Affiliation(s)
| | | | - Ryan J Brisson
- Hematology and Oncology, The University of Chicago Medicine
| | | | - Yonglin Pu
- Radiology, The University of Chicago Medicine
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Kim SA, Roh JL, Kim JS, Lee JH, Lee SH, Choi SH, Nam SY, Kim SY. 18F-FDG PET/CT surveillance for the detection of recurrence in patients with head and neck cancer. Eur J Cancer 2017; 72:62-70. [DOI: 10.1016/j.ejca.2016.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 12/01/2022]
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Aramburu Núñez D, Lopez Medina A, Mera Iglesias M, Salvador Gomez F, Dave A, Hatzoglou V, Paudyal R, Calzado A, Deasy JO, Shukla-Dave A, Muñoz VM. Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience. World J Radiol 2017; 9:17-26. [PMID: 28144403 PMCID: PMC5241537 DOI: 10.4329/wjr.v9.i1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/29/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To noninvasively investigate tumor cellularity measured using diffusion-weighted magnetic resonance imaging (DW-MRI) and glucose metabolism measured by 18F-labeled fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during radiation therapy (RT) for human papillomavirus negative (HPV-) head and neck squamous cell carcinoma (HNSCC).
METHODS In this prospective study, 6 HPV- HNSCC patients underwent a total of 34 multimodality imaging examinations (DW-MRI at 1.5 T Philips MRI scanner [(n = 24) pre-, during- (2-3 wk), and post-treatment (Tx), and 18F-FDG PET/CT pre- and post-Tx (n = 10)]. All patients received RT. Monoexponential modeling of the DW-MRI data yielded the imaging metric apparent diffusion coefficient (ADC) and the mean of standardized uptake value (SUV) was measured from 18F-FDG PET uptake. All patients had a clinical follow-up as the standard of care and survival status was documented at 1 year.
RESULTS There was a strong negative correlation between the mean of pretreatment ADC (ρ = -0.67, P = 0.01) and the pretreatment 18F-FDG PET SUV. The percentage (%) change in delta (∆) ADC for primary tumors and neck nodal metastases between pre- and Wk2-3 Tx were as follows: 75.4% and 61.6%, respectively, for the patient with no evidence of disease, 27.5% and 32.7%, respectively, for those patients who were alive with disease, and 26.9% and 7.31%, respectively, for those who were dead with disease.
CONCLUSION These results are preliminary in nature and are indicative, and not definitive, trends rendered by the imaging metrics due to the small sample size of HPV- HNSCC patients in a Meixoeiro Hospital of Vigo Experience.
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Post-treatment 18F-FDG-PET/CT versus contrast-enhanced CT in patients with oropharyngeal squamous cell carcinoma: comparative effectiveness study. Nucl Med Commun 2017; 38:250-258. [PMID: 28099264 DOI: 10.1097/mnm.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the accuracy of same-day therapy-assessment PET/computed tomography (PET/CT) and conventional contrast-enhanced computed tomography (CECT) in patients with oropharyngeal squamous cell carcinoma (OPSCC). METHODS A total of 110 (95 men and 15 women; mean age 59 years) patients with biopsy-proven OPSCC were evaluated with same-day PET/CT and CECT pair scans as part of follow-up therapy assessment. Scans were performed within 6 months after the completion of primary treatment (median time: 3.1 months; range: 0.5-6 months). PET/CT and CECT scans were reviewed retrospectively for residual primary site disease, and right and left cervical lymph node involvement. Histopathology or 6 month clinical/imaging follow-up were used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the primary site and cervical nodal disease. RESULTS Of 110 OPSCC patients, 90.9% were human papilloma virus positive, 80.8% were stage 4, and 76.4% received chemoradiation as the primary treatment. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT were similar in the evaluation of the primary cancer site (PET/CT: 75.0, 91.5, 25.0, 99.0, and 90.9, respectively, versus CECT: 75.0, 90.6, 23.1, 99.0, and 90.0, respectively). In evaluating cervical lymph node involvement, PET/CT appeared to have higher accuracy (96.8 vs. 81.7%), specificity (97.7 vs. 81.7%), and PPV (45.8 vs. 16.5%), comparable NPV (99.4% for both), and lower sensitivity (65 vs. 75%) compared with same-day CECT. CONCLUSION Same-day PET/CT and CECT scans had comparable accuracy in the evaluation of primary tumor sites after completion of therapy in patients with OPSCC. PET/CT showed higher accuracy in the evaluation of cervical lymph node involvement.
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Matoba M, Tuji H, Shimode Y, Kondo T, Oota K, Tonami H. The role of changes in maximum standardized uptake value of FDG PET-CT for post-treatment surveillance in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy: preliminary findings. Br J Radiol 2017; 90:20150404. [PMID: 28055245 DOI: 10.1259/bjr.20150404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE No clear consensus exists regarding the optimal interval and frequency of follow-up positron emission tomography (PET)-CT in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy (CRT). Here, we sought to clarify whether the changes in the maximum standardized uptake value (ΔSUVmax) may be a valid parameter to help decision-making for surveillance management after CRT. METHODS 40 patients underwent PET-CT at pre-treatment and 3 months after CRT. Patients were followed by sequential PET-CT for 2 years after CRT. The ΔSUVmax of the primary tumour and the metastatic nodes were calculated between pre-treatment and 3 months after the CRT, and we evaluated the associations between ΔSUVmax and the manifestation of recurrence, time to recurrence and the patient survival. RESULTS The ΔSUVmax of the primary tumour was significantly lower for the lesions with recurrence than that for those with non-recurrence for both the primary site and the nodal site (p = 0.007, 0.02). A significant correlation was found between the time to recurrence and the ΔSUVmax of the primary tumour (r = 0.63, p < 0.05). The threshold ΔSUVmax of the primary tumour of 1.04 revealed 76.9% sensitivity and 86.4% specificity for distinguishing recurrence from non-recurrence. The progression-free survival and overall survival of the two patient groups divided by the ΔSUVmax of the primary tumour at 1.04 showed a significant difference (p = 0.003, 0.02). The ΔSUVmax of the metastatic nodes did not show a significant association with recurrence or patient survival. CONCLUSION The ΔSUVmax of the primary tumour showed a significant association with recurrence and patient survival. Advances in knowledge: The ΔSUVmax of the primary tumour may be a valid clinical parameter to help decision-making for the surveillance management of patients with HNSCC after CRT.
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Affiliation(s)
- Munetaka Matoba
- 1 Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroyuki Tuji
- 2 Department of Head and Neck Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Yuzo Shimode
- 2 Department of Head and Neck Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Tamaki Kondo
- 1 Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Kiyotaka Oota
- 1 Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Hisao Tonami
- 1 Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
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Quartuccio N, Caobelli F, Di Mauro F, Cammaroto G. Non-18F-FDG PET/CT in the management of patients affected by HNC: state-of-the-art. Nucl Med Commun 2016; 37:891-8. [PMID: 27139114 DOI: 10.1097/mnm.0000000000000530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PET/computed tomography with F-fluorodeoxyglucose is considered a powerful molecular imaging technique that can provide useful information in the management of patients affected by head and neck cancer. However, misleading findings have been reported because of nonspecific uptake caused by peritumoural inflammation and physiologic changes in nonmalignant tissues in the head and neck region. More specific β-emitting tracers have been introduced that can track other pathological processes. We aimed to review the existing literature performing the search until June 2015 on non-F-fluorodeoxyglucose PET tracers in head and neck cancer to highlight their role in clinical practice.
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Affiliation(s)
- Natale Quartuccio
- aWolfson Molecular Imaging Centre, University of Manchester, Manchester, UK bDepartment of Nuclear Medicine, Hannover Medical School, Hanover, Germany cDepartment of Nuclear Medicine, Universitätsspital Basel, Basel, Switzerland dNuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images eDepartment of Otorhinolaryngology, University of Messina, Messina fYoung Executive Committee of the Italian Association of Nuclear Medicine (AIMN), Milan, Italy
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Cammaroto G, Quartuccio N, Sindoni A, Di Mauro F, Caobelli F. The role of PET/CT in the management of patients affected by head and neck tumors: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:1961-73. [PMID: 25971995 DOI: 10.1007/s00405-015-3651-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
The management of head and neck tumor (HNSCC) has been changing over the years, especially due to the aid of imaging techniques that help physicians to attain a correct diagnosis. These techniques represent a valuable tool to help tailor treatment and during follow-up of patients affected by malignancies. The aim of this review is to summarize the results of the most recent and relevant studies about the use of PET imaging in HNSCCs. This review is divided into six chapters: (1) The role of PET/CT in the pre-treatment phase; (2) PET/CT and radiotherapy planning; (3) PET/CT in the post-treatment setting; (4) PET/CT and SUVmax for prediction of prognosis; (5) miscellanea on the utility of PET in specific HNSCCs; (6) non-FDG PET tracers used in HNSCC. Promising results have been obtained so far. Despite the encouraging outcomes, more investigations are needed to warrant the value of this technique, especially in the pre-treatment setting.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Sindoni
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Francesca Di Mauro
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
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Wright CL, Pan Q, Knopp MV, Tweedle MF. Advancing theranostics with tumor-targeting peptides for precision otolaryngology. World J Otorhinolaryngol Head Neck Surg 2016; 2:98-108. [PMID: 29204554 PMCID: PMC5698525 DOI: 10.1016/j.wjorl.2016.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023] Open
Abstract
Worldwide, about 600,000 head and neck squamous cell carcinoma (HNSCC) are detected annually, many of which involve high risk human papilloma virus (HPV). Surgery is the primary and desired first treatment option. Following surgery, the existence of cancer cells at the surgical margin is strongly associated with eventual recurrence of cancer and a poor outcome. Despite improved surgical methods (robotics, microsurgery, endoscopic/laparoscopic, and external imaging), surgeons rely only on their vision and touch to locate tumors during surgery. Diagnostic imaging systems like computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and positron-emission tomography (PET) are too large, slow and costly to use efficiently during most surgeries and, ultrasound imaging, while fast and portable, is not cancer specific. This purpose of this article is to review the fundamental technologies that will radically advance Precision Otolaryngology practices to the benefit of patients with HNSCC. In particular, this article will address the potential for tumor-targeting peptides to enable more precise diagnostic imaging while simultaneously advancing new therapeutic paradigms for next generation image-guided surgery, tumor-specific chemotherapeutic delivery and tumor-selective targeted radiotherapy (i.e., theranostic).
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Affiliation(s)
- Chadwick L Wright
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Quintin Pan
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Michael F Tweedle
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Pretreatment tumor SUVmax predicts disease-specific and overall survival in patients with head and neck soft tissue sarcoma. Eur J Nucl Med Mol Imaging 2016; 44:33-40. [DOI: 10.1007/s00259-016-3456-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/01/2016] [Indexed: 12/16/2022]
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Serkova NJ, Eckhardt SG. Metabolic Imaging to Assess Treatment Response to Cytotoxic and Cytostatic Agents. Front Oncol 2016; 6:152. [PMID: 27471678 PMCID: PMC4946377 DOI: 10.3389/fonc.2016.00152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 12/24/2022] Open
Abstract
For several decades, cytotoxic chemotherapeutic agents were considered the basis of anticancer treatment for patients with metastatic tumors. A decrease in tumor burden, assessed by volumetric computed tomography and magnetic resonance imaging, according to the response evaluation criteria in solid tumors (RECIST), was considered as a radiological response to cytotoxic chemotherapies. In addition to RECIST-based dimensional measurements, a metabolic response to cytotoxic drugs can be assessed by positron emission tomography (PET) using (18)F-fluoro-thymidine (FLT) as a radioactive tracer for drug-disrupted DNA synthesis. The decreased (18)FLT-PET uptake is often seen concurrently with increased apparent diffusion coefficients by diffusion-weighted imaging due to chemotherapy-induced changes in tumor cellularity. Recently, the discovery of molecular origins of tumorogenesis led to the introduction of novel signal transduction inhibitors (STIs). STIs are targeted cytostatic agents; their effect is based on a specific biological inhibition with no immediate cell death. As such, tumor size is not anymore a sensitive end point for a treatment response to STIs; novel physiological imaging end points are desirable. For receptor tyrosine kinase inhibitors as well as modulators of the downstream signaling pathways, an almost immediate inhibition in glycolytic activity (the Warburg effect) and phospholipid turnover (the Kennedy pathway) has been seen by metabolic imaging in the first 24 h of treatment. The quantitative imaging end points by magnetic resonance spectroscopy and metabolic PET (including 18F-fluoro-deoxy-glucose, FDG, and total choline) provide an early treatment response to targeted STIs, before a reduction in tumor burden can be seen.
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Affiliation(s)
- Natalie J. Serkova
- Department of Anesthesiology, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
- Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - S. Gail Eckhardt
- Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
- Division of Medical Oncology, Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
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FDG PET/CT in Patients With Head and Neck Squamous Cell Carcinoma After Primary Surgical Resection With or Without Chemoradiation Therapy. AJR Am J Roentgenol 2016; 206:1093-100. [PMID: 26999264 DOI: 10.2214/ajr.15.15604] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the value of posttreatment FDG PET/CT in patients with squamous cell carcinoma of the head and neck (HNSCC) treated with primary surgical resection with or without adjuvant concurrent chemoradiotherapy. MATERIALS AND METHODS A total of 98 HNSCC patients were treated with primary surgical resection and had undergone PET/CT within 6 months of treatment completion. The accuracy of the scans and the added value to clinical assessment and impact on management were established based on the clinical information before and after each scan. Overall survival of patients was estimated with Kaplan-Meier curves. RESULTS Of the total 98 scans, 25 (25.5%) were interpreted as positive and 73 (74.5%) as negative. The sensitivity of posttreatment PET/CT was 80.0%; specificity, 89.5%; positive predictive value, 66.7%; negative predictive value, 94.4%; and accuracy, 87.5%. These scans were helpful in excluding tumor in 31.8% of patients with clinical suspicion of residual disease and identifying suspected residual disease in 13.2% of patients with no prior clinical suspicion. Multivariate regression analysis showed that tumor size, grade (p = 0.041), scan type (p = 0.002), and scan result (p = 0.005) were independent covariates associated with overall survival. Kaplan-Meier analysis showed a significant difference and association in overall survival between patients with a positive versus a negative posttherapy PET/CT scan result (hazard ratio, 5.65; 95% CI, 2.48-12.83; log rank Mantel-Cox p < 0.001). CONCLUSION Posttreatment FDG PET/CT results had a high negative predictive value, added value to clinical assessment of 35% of patients, influenced subsequent management, and were associated with survival outcome of HNSCC patients treated with primary surgical resection.
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Kim R, Ock CY, Keam B, Kim TM, Kim JH, Paeng JC, Kwon SK, Hah JH, Kwon TK, Kim DW, Wu HG, Sung MW, Heo DS. Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study. BMC Cancer 2016; 16:116. [PMID: 26884055 PMCID: PMC4756525 DOI: 10.1186/s12885-016-2147-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The accuracy of 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery. Methods Medical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3 months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6 months after CRT. Results Maximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0 %, 83.8 %, 98.3 %, and 45.0 %, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6 %), with postSUVmax <4.4 in 58 (74.4 %). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7 %; P = 0.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1 %; P < 0.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6 %; Log-rank P = 0.913). Conclusion Post CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2147-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryul Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - J Hun Hah
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol 2016; 205:W519-31. [PMID: 26496574 DOI: 10.2214/ajr.14.12828] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This image-based article illustrates the anatomic regions of squamous cell carcinomas of the head and neck and describes the metastatic pathways in and TNM staging for each region. Both the role and limitations of FDG PET/CT in imaging such cancers are discussed, and cases exemplifying these issues are reported. Also included is a discussion of the use of FDG PET/CT to monitor the response of squamous cell carcinomas of the head and neck to therapy, in addition to a brief comparison of PET/CT with such traditional imaging modalities as CT, MRI, and ultrasound. CONCLUSION Understanding the characteristics of squamous cell carcinoma of the head and neck, as imaged by FDG PET/CT, is crucial for determining treatment strategy, because it helps to avoid incorrect staging and also provides an accurate assessment of treatment response.
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