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Mallum A, Mkhize T, Akudugu JM, Ngwa W, Vorster M. The Role of Positron Emission Tomography and Computed Tomographic (PET/CT) Imaging for Radiation Therapy Planning: A Literature Review. Diagnostics (Basel) 2022; 13:diagnostics13010053. [PMID: 36611345 PMCID: PMC9818506 DOI: 10.3390/diagnostics13010053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
PET/CT is revolutionising radiotherapy treatment planning in many cancer sites. While its utility has been confirmed in some cancer sites, and is used in routine clinical practice, it is still at an experimental stage in many other cancer sites. This review discusses the utility of PET/CT in cancer sites where the role of PET/CT has been established in cases such as head and neck, cervix, brain, and lung cancers, as well as cancer sites where the role of PET/CT is still under investigation such as uterine, ovarian, and prostate cancers. Finally, the review touches on PET/CT utilisation in Africa.
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Affiliation(s)
- Abba Mallum
- Department of Radiotherapy and Oncology, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Department of Radiotherapy and Oncology, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa
- University of Maiduguri Teaching Hospital, Maiduguri 600104, Nigeria
- Correspondence: or
| | - Thokozani Mkhize
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Department of Nuclear Medicine, Inkosi Albert Central Hospital, Durban 4091, South Africa
| | - John M. Akudugu
- Division of Radiobiology, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
| | - Wilfred Ngwa
- School of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Brigham and Women’s Hospital, Dana-Farmer Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Mariza Vorster
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Department of Nuclear Medicine, Inkosi Albert Central Hospital, Durban 4091, South Africa
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Suzumura EA, Gama LM, Jahn B, Campolina AG, Carvalho HDA, de Soárez PC. Effects of 3D image-guided brachytherapy compared to 2D conventional brachytherapy on clinical outcomes in patients with cervical cancer: A systematic review and meta-analyses. Brachytherapy 2021; 20:710-737. [PMID: 33867297 DOI: 10.1016/j.brachy.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the effects of three-dimensional image-guided brachytherapy (3D BT) compared to bi-dimensional BT (2D BT) on clinical outcomes in patients with cervical cancer. METHODS AND MATERIALS We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, Web of Science, and LILACS for studies assessing the effects of 3D BT versus 2D BT on clinical outcomes. Two reviewers independently screened retrieved citations, extracted data and assessed risk of bias from eligible studies. Hazard ratios (HR) were calculated from Kaplan-Meier curves considering the number of events, their timing and the followup of censored patients. We conducted meta-analyses of HR using the inverse-variance random-effects method. Risk Difference (RD) for toxicities were pooled using the Mantel-Haenszel random-effects method. We used the GRADE system to rate the certainty of evidence. RESULTS Twenty observational studies involving 4287 patients were included. The meta-analyses assessing the effect of 3D BT versus 2D BT on overall survival resulted in a HR of 0.78 (95%CI 0.62-0.98), HR of 0.75 (95%CI 0.62-0.90) for pelvic disease-free survival, HR of 0.93 (95%CI 0.81-1.06) for metastatic disease-free survival, and HR of 0.77 (95%CI 0.59-0.99) for local control. Grade 3-4 global and gastrointestinal toxicities were, respectively, 9% lower (95%CI 6% to 11%) and 5% lower (95%CI 2% to 8%) in patients receiving 3D BT versus 2D BT. Certainty of evidence was very low for all assessed outcomes. CONCLUSIONS Our study may suggest a benefit of 3D BT over conventional 2D BT on important clinical outcomes.
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Affiliation(s)
- Erica Aranha Suzumura
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Layse Martins Gama
- Departamento de Radiologia e Oncologia, Divisao de Radioterapia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Alessandro Gonçalves Campolina
- Centro de Investigação Translacional em Oncologia, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Heloisa de Andrade Carvalho
- Departamento de Radiologia e Oncologia, Divisao de Radioterapia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Khader J, Al-Mousa A, Al Khatib S, Wadi-Ramahi S. Successful Development of a Competency-Based Residency Training Program in Radiation Oncology: Our 15-Year Experience from Within a Developing Country. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1011-1016. [PMID: 31154636 DOI: 10.1007/s13187-019-01557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
One of the main challenges of delivering high quality of care to cancer patients in developing countries is the lack of well-trained radiation oncologists. This is a direct cause for the lack of residency programs coupled with lack of resources. This article describes and details establishments of a successful and sustainable radiation-oncology residency program in our country. The program has been in operation for 14 years and has trained and graduated radiation oncologists who are now working in various countries. The curriculum of the 4-year residency program, fashioned according to American College of Radiologists (ACR) recommendations, includes site-specific clinical rotations and didactic lectures in clinical oncology, radiobiology, medical physics, statistics, and epidemiology. It also includes a component of advanced clinical experience in the form of 3-month externship at one of collaborating centers outside the country. Evaluation of the residents is conducted annually via written exams and 360° feedback. Residents also sit for the formal certification exam in radiation oncology from the national Medical Council. The exam consists of 2 written exams and one oral. As a form of benchmarking residents' knowledge, they are required to sit for the ACR examinations held annually and conducted in Amman in tandem. The program has successfully trained and graduated 28 residents, who now work as consultant radiation oncologists locally and abroad. Each resident has gone through a structured training that includes exposure to a Western-style patient-management culture, enhancing the breadth and width of their clinical experience. The residency program, initiated in a developing country, underwent many challenges, yet it overcome all obstacles and resulted in a successful training of competent radiation oncologists serving the region.
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Affiliation(s)
- Jamal Khader
- Radiation Oncology Department, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
| | - Abdelatif Al-Mousa
- Radiation Oncology Department, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Sondos Al Khatib
- Radiation Oncology Department, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Shada Wadi-Ramahi
- Biomedical Physics Department, MBC#03, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia
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Fiorentino A, Laudicella R, Ciurlia E, Annunziata S, Lancellotta V, Mapelli P, Tuscano C, Caobelli F, Evangelista L, Marino L, Quartuccio N, Fiore M, Borghetti P, Chiaravalloti A, Ricci M, Desideri I, Alongi P. Positron emission tomography with computed tomography imaging (PET/CT) for the radiotherapy planning definition of the biological target volume: PART 2. Crit Rev Oncol Hematol 2019; 139:117-124. [PMID: 30940428 DOI: 10.1016/j.critrevonc.2019.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
AIM Positron Emission Tomography with Computed Tomography (PET/CT) has been proven to be useful in the definition of Radiotherapy (RT) target volume. In this regard, the present expert review summarizes existing data for pancreas, prostate, gynecological and rectum/anal cancer. METHODS A comprehensive search of published original article was made, based on SCOPUS and PubMed database, selecting the paper that evaluated the role of PET/CT in the definition of RT volume. RESULTS FDG-PET has an important and promising role for pancreatic cancer. Choline PET/CT could be useful for identifying high-risk volumes for prostate cancer; while PSMA PET/CT is still under evaluation. FDG PET/CT in gynecological cancers has been shown to impact external-beam RT planning. The role of FDG-PET for Gross Tumor volume identification is crucial, representing a useful and powerful tool for anal and rectal cancer. CONCLUSION Taken together, molecular and functional imaging approaches offer a major step to individualize radiotherapeutic approach.
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Affiliation(s)
- Alba Fiorentino
- Radiotherapy Oncology Department, General Regional Hospital "F. Miulli", Acquaviva delle Fonti-Bari, Italy.
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Elisa Ciurlia
- Radiotherapy Oncology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Salvatore Annunziata
- Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica Sacro Cuore, Roma, Italy
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Paola Mapelli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Tuscano
- Radiotherapy Oncology Department, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Evangelista
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Lorenza Marino
- Radiotherapy Oncology Department, REM, Viagrande, Catania, Italy
| | | | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Paolo Borghetti
- Radiation Oncology Department University and Spedali Civili, Brescia, Italy
| | - Agostino Chiaravalloti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Maria Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Cefalu, Italy
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Abstract
FDG-PET/CT has an established role in the initial staging of locally advanced cervical cancers, particularly in evaluation of nodal disease and distant metastases. It is common practice to perform FDG-PET/CT 3 months postcompletion of chemoradiotherapy as it can predict outcome and be used to tailor management, including adjuvant therapy and follow-up. It is also routinely used prior to pelvic exenterative surgery to ensure there is no disease outside the pelvis. There is growing evidence that FDG-PET-derived parameters are prognostic and could potentially be used to tailor therapy. This review outlines the use of FDG-PET/CT imaging in cervical cancer.
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Affiliation(s)
- Nemi Gandy
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Mubarik A Arshad
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Won-Ho E Park
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Andrea G Rockall
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK; Imperial College London Cancer Imaging Centre, Department of Surgery & Cancer, Hammersmith Hospital, London, UK
| | - Tara D Barwick
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK; Imperial College London Cancer Imaging Centre, Department of Surgery & Cancer, Hammersmith Hospital, London, UK.
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Al-Ibraheem A, AlSharif A, Abu-Hijlih R, Jaradat I, Mansour A. Clinical Impact of 18F-FDG PET/CT on the Management of Gynecologic Cancers: One Center Experience. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2019; 7:7-12. [PMID: 30705906 PMCID: PMC6352047 DOI: 10.22038/aojnmb.2018.11208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective(s): We aim to investigate the clinical impact of 18F-FDG PET/CT in managing patients with gynecological malignancies and pelvic or extrapelvic lymph nodes that are of equivocal significance on conventional imaging. Methods: We retrospectively evaluated 18F-FDG PET/CT scans of patients with gynecologic tumors who were referred to King Hussein Cancer Center from January 2010 to August 2014. PET/CT results were compared with MRI and CT findings. We evaluated sensitivity and specificity of 18F-FDG PET/CT, its role in changing treatment plan and its positive predictive value (PPV) and negative predictive value (NPV). Results: Ninety seven patients (mean age: 49 years) underwent 18F-FDG/PET in the study period (40 cervical, 37 endometrial and 20 ovarian cancers). PET/CT scan provided additional information in 23 patients; upstaging 4.1% (4 patients; 3 true positive) and down staging in 19.5% (19 patients; 15 true negative). As a result, treatment strategy was changed from curative to palliative in three patients, and modification of radiation field or additional curative therapy was implemented following exclusion of distant metastasis in 11 patients. Mean follow up time for the whole cohort was 35 months (range 6 - 60 months). NPV of 18F-FDG PET/CT in detecting extrapelvic lymphadenopathy was 83.3%. Conclusion: 18F-FDG PET/CT has high clinical impact in management of gynaecological cancers as it alters the treatment plan in a substantial number of patients who had equivocal findings on conventional imaging, as well as it offers excellent validity in lymph nodes staging.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abedallatif AlSharif
- Department of Radiology & Nuclear Medicine, Jordan University hospital, Amman, Jordan
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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Lima GM, Matti A, Vara G, Dondi G, Naselli N, De Crescenzo EM, Morganti AG, Perrone AM, De Iaco P, Nanni C, Fanti S. Prognostic value of posttreatment 18F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters. Eur J Nucl Med Mol Imaging 2018; 45:2139-2146. [PMID: 30069578 PMCID: PMC6182406 DOI: 10.1007/s00259-018-4077-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the prognostic value of posttreatment 18F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment. METHODS This retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent 18F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student's t test, Pearson's chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy. RESULTS Kaplan-Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002-1.028, Nagelkerke R2 = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000-1.002, Nagelkerke R2 = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879-6.343, Nagelkerke R2 = 0.051). CONCLUSION 18F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio = 1.015).
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Affiliation(s)
- Giacomo Maria Lima
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Antonella Matti
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Dondi
- Oncologic Gynecology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicoletta Naselli
- Radiology Unit, Department of Diagnostic and Preventive Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Alessio Giuseppe Morganti
- Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Oncologic Gynecology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Oncologic Gynecology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Waldenström AC, Bergmark K, Michanek A, Hashimi F, Norrlund RR, Olsson CE, Gjertsson P, Leonhardt H. A comparison of two imaging modalities for detecting lymphatic nodal spread in radiochemotherapy of locally advanced cervical cancer. Phys Imaging Radiat Oncol 2018; 8:33-37. [PMID: 33458414 PMCID: PMC7807631 DOI: 10.1016/j.phro.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/01/2022] Open
Abstract
Background and purpose Material and methods Results Conclusions
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Abstract
Combined PET/computed tomography is used for oncological indications. PET/computed tomography benefits from the metabolic information of PET and the anatomic localization of computed tomography. The integrated scanner provides data with accurate registration of anatomy and molecular information. Many physiologic conditions, normal variants, and benign lesions within the pelvis and the body can cause confusion and uncertainty. False-negative results owing to low 18F-fluorodeoxyglucose uptake from the tumor can produce diagnostic challenges and inaccurate conclusions. This article reviews normal variants and potential pitfalls encountered in PET assessment of gynecologic malignancies to provide useful information for the referring and reporting physicians.
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Khan SR, Arshad M, Wallitt K, Stewart V, Bharwani N, Barwick TD. What’s New in Imaging for Gynecologic Cancer? Curr Oncol Rep 2017; 19:85. [DOI: 10.1007/s11912-017-0640-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gabriele P, Maggio A, Garibaldi E, Bracco C, Delmastro E, Gabriele D, Rosi A, Munoz F, Di Muzio N, Corvò R, Stasi M. Quality indicators in the intensity modulated/image-guided radiotherapy era. Crit Rev Oncol Hematol 2016; 108:52-61. [DOI: 10.1016/j.critrevonc.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/24/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
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Chung YL, Horng CF, Lee PI, Chen FL. Patterns of failure after use of (18)F-FDG PET/CT in integration of extended-field chemo-IMRT and 3D-brachytherapy plannings for advanced cervical cancers with extensive lymph node metastases. BMC Cancer 2016; 16:179. [PMID: 26940959 PMCID: PMC4778334 DOI: 10.1186/s12885-016-2226-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/28/2016] [Indexed: 02/02/2023] Open
Abstract
Background The study is to evaluate the patterns of failure, toxicities and long-term outcomes of aggressive treatment using 18F-FDG PET/CT-guided chemoradiation plannings for advanced cervical cancer with extensive nodal extent that has been regarded as a systemic disease. Methods We retrospectively reviewed 72 consecutive patients with 18F-FDG PET/CT-detected widespread pelvic, para-aortic and/or supraclavicular lymph nodes treated with curative-intent PET-guided cisplatin-based extended-field dose-escalating intensity-modulated radiotherapy (IMRT) and adaptive high-dose-rate intracavitary 3D-brachytherapy between 2002 and 2010. The failure sites were specifically localized by comparing recurrences on fusion of post-therapy recurrent 18F-FDG PET/CT scans to the initial PET-guided radiation plannings for IMRT and brachytherapy. Results The median follow-up time for the 72 patients was 66 months (range, 3–142 months). The 5-year disease-free survival rate calculated by the Kaplan-Meier method for the patients with extensive N1 disease with the uppermost PET-positive pelvic-only nodes (26 patients), and the patients with M1 disease with the uppermost PET-positive para-aortic (31 patients) or supraclavicular (15 patients) nodes was 78.5 %, and 41.8–50 %, respectively (N1 vs. M1, p = 0.0465). Eight (11.1 %), 18 (25.0 %), and 3 (4.2 %) of the patients developed in-field recurrence, out-of-field and/or distant metastasis, and combined failure, respectively. The 6 (8.3 %) local failures around the uterine cervix were all at the junction between IMRT and brachytherapy in the parametrium. The rate of late grade 3/4 bladder and bowel toxicities was 4.2 and 9.7 %, respectively. When compared to conventional pelvic chemoradiation/2D-brachytherapy during 1990–2001, the adoption of 18F-FDG PET-guided extended-field dose-escalating chemoradiation plannings in IMRT and 3D-brachytherapy after 2002 appeared to provide higher disease-free and overall survival rates with acceptable toxicities in advanced cervical cancer patients. Conclusions For AJCC stage M1 cervical cancer with supraclavicular lymph node metastases, curability can be achieved in the era of PET and chemo-IMRT. However, the main pattern of failure is still out-of-field and/or distant metastasis. In addition to improving systemic treatment, how to optimize and integrate the junctional doses between IMRT and 3D-brachytherapy in PET-guided plannings to further decrease local recurrence warrants investigation. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2226-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yih-Lin Chung
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, No.125 Lih-Der Road, Pei-Tou district, Taipei, 112, Taiwan.
| | - Cheng-Fang Horng
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Pei-Ing Lee
- Department of Nuclear Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Fong-Lin Chen
- Department of Medical Physics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
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Al Feghali KA, Elshaikh MA. Why brachytherapy boost is the treatment of choice for most women with locally advanced cervical carcinoma? Brachytherapy 2016; 15:191-9. [DOI: 10.1016/j.brachy.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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15
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Hildebrandt MG, Kodahl AR, Teilmann-Jørgensen D, Mogensen O, Jensen PT. [18F]Fluorodeoxyglucose PET/Computed Tomography in Breast Cancer and Gynecologic Cancers. PET Clin 2015; 10:89-104. [DOI: 10.1016/j.cpet.2014.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Fleming S, Cooper RA, Swift SE, Thygesen HH, Chowdhury FU, Scarsbrook AF, Patel CN. Clinical impact of FDG PET-CT on the management of patients with locally advanced cervical carcinoma. Clin Radiol 2014; 69:1235-43. [PMID: 25439186 DOI: 10.1016/j.crad.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/18/2014] [Accepted: 07/04/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the impact of staging FDG PET-CT on the initial management of patients with locally advanced cervical carcinoma (LACC) and any prognostic variables predicting survival. MATERIALS AND METHODS Retrospective analysis of consecutive patients undergoing FDG PET-CT for staging of LACC in a single tertiary referral centre, between April 2008 and August 2011. Comparison was made between MRI and PET-CT findings and any subsequent impact on treatment intent or radiotherapy planning was evaluated. RESULTS Sixty-three patients underwent FDG PET-CT for initial staging of LACC. Major impact on management was found in 20 patients (32%), a minor impact in five (8%), and no impact in 38 (60%). In those patients where PET-CT had a major impact, 12 had more extensive local nodal involvement, five had occult metastatic disease, two had synchronous tumours, and one patient had equivocal lymph nodes on MRI characterized as negative. PET-positive nodal status at diagnosis was found to be a statistically significant predictor of relapse-free survival (p < 0.05). CONCLUSION Staging FDG PET-CT has a major impact on the initial management of approximately one-third of patients with LACC by altering treatment intent and/or radiotherapy planning. PET-defined nodal status is a poor prognostic indicator.
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Affiliation(s)
- S Fleming
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK
| | - R A Cooper
- Department of Clinical Oncology, St James's University Hospital, Leeds, UK
| | - S E Swift
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK
| | - H H Thygesen
- Leeds Cancer Research UK Centre, St James's University Hospital, Leeds, UK
| | - F U Chowdhury
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK
| | - A F Scarsbrook
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK
| | - C N Patel
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK.
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Barwick TD, Taylor A, Rockall A. Functional Imaging to Predict Tumor Response in Locally Advanced Cervical Cancer. Curr Oncol Rep 2013; 15:549-58. [DOI: 10.1007/s11912-013-0344-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Niyazi M, Landrock S, Elsner A, Manapov F, Hacker M, Belka C, Ganswindt U. Automated biological target volume delineation for radiotherapy treatment planning using FDG-PET/CT. Radiat Oncol 2013; 8:180. [PMID: 23848981 PMCID: PMC3722117 DOI: 10.1186/1748-717x-8-180] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study compared manually delineated gross tumour volume (GTV) and automatically generated biological tumour volume (BTV) based on fluoro-deoxy-glucose (FDG) positron emission tomography (PET)/CT to assess the robustness of predefined PET algorithms for radiotherapy (RT) planning in routine clinical practice. METHODS RT-planning data from 20 consecutive patients (lung- (40%), oesophageal- (25%), gynaecological- (25%) and colorectal (10%) cancer) who had undergone FDG-PET/CT planning between 08/2010 and 09/2011 were retrospectively analysed, five of them underwent neoadjuvant chemotherapy before radiotherapy. In addition to manual GTV contouring, automated segmentation algorithms were applied-among these 38%, 42%, 47% and 50% SUVmax as well as the PERCIST total lesion glycolysis (TLG) algorithm. Different ratios were calculated to assess the overlap of GTV and BTV including the conformity index and the ratio GTV included within the BTV. RESULTS Median age of the patients was 66 years and median tumour SUVmax 9.2. Median size of the GTVs defined by the radiation oncologist was 43.7 ml. Median conformity indices were between 30.0-37.8%. The highest amount of BTV within GTV was seen with the 38% SUVmax algorithm (49.0%), the lowest with 50% SUVmax (36.0%). Best agreement was obtained for oesophageal cancer patients with a conformity index of 56.4% and BTV within GTV ratio of 71.1%. CONCLUSIONS At present there is only low concordance between manually derived GTVs and automatically segmented FDG-PET/CT based BTVs indicating the need for further research in order to achieve higher volumetric conformity and therefore to get access to the full potential of FDG-PET/CT for optimization of radiotherapy planning.
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Delikgoz Soykut E, Ozsahin EM, Yukselen Guney Y, Aytac Arslan S, Derinalp Or O, Altundag MB, Ugurluer G, Tsoutsou PG. The use of PET/CT in radiotherapy planning: contribution of deformable registration. Front Oncol 2013; 3:33. [PMID: 23630662 PMCID: PMC3624079 DOI: 10.3389/fonc.2013.00033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ela Delikgoz Soykut
- Radiation Oncology, Dr. Abdurrahman Yurtarslan Ankara Oncology Education and Research Hospital Ankara, Turkey
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