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Chen AM, Harris JP, Gan M, Nabar R, Tjoa T, Haidar YM, Truong A, Chow DS, Armstrong WB. Posttreatment Surveillance Imaging After Radiation for Head and Neck Cancer. JAMA Netw Open 2023; 6:e2342825. [PMID: 37948074 PMCID: PMC10638654 DOI: 10.1001/jamanetworkopen.2023.42825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023] Open
Abstract
Importance The role of surveillance imaging after treatment for head and neck cancer is controversial and evidence to support decision-making is limited. Objective To determine the use of surveillance imaging in asymptomatic patients with head and neck cancer in remission after completion of chemoradiation. Design, Setting, and Participants This was a retrospective, comparative effectiveness research review of adult patients who had achieved a complete metabolic response to initial treatment for head and neck cancer as defined by having an unequivocally negative positron emission tomography (PET) scan using the PET response criteria in solid tumors (PERCIST) scale within the first 6 months of completing therapy. The medical records of 501 consecutive patients who completed definitive radiation therapy (with or without chemotherapy) for newly diagnosed squamous cell carcinoma of the head and neck between January 2014 and June 2022 were reviewed. Exposure Surveillance imaging was defined as the acquisition of a PET with computed tomography (CT), magnetic resonance imaging (MRI), or CT of the head and neck region in the absence of any clinically suspicious symptoms and/or examination findings. For remaining patients, subsequent surveillance after the achievement of a complete metabolic response to initial therapy was performed on an observational basis in the setting of routine follow-up using history-taking and physical examination, including endoscopy. This expectant approach led to imaging only in the presence of clinically suspicious symptoms and/or physical examination findings. Main Outcome and Measures Local-regional control, overall survival, and progression-free survival based on assignment to either the surveillance imaging or expectant management cohort. Results This study included 340 patients (mean [SD] age, 59 [10] years; 201 males [59%]; 88 Latino patients [26%]; 145 White patients [43%]) who achieved a complete metabolic response during this period. There was no difference in 3-year local-regional control, overall survival, progression-free survival, or freedom from distant metastasis between patients treated with surveillance imaging vs those treated expectantly. Conclusions and Relevance In this comparative effectiveness research, imaging-based surveillance failed to improve outcomes compared with expectant management for patients who were seemingly in remission after completion of primary radiation therapy for head and neck cancer.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Jeremy P. Harris
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Meng Gan
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Rupali Nabar
- Department of Internal Medicine, Division of Hematology-Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Tjoson Tjoa
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Yarah M. Haidar
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Annie Truong
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Daniel S. Chow
- Department of Diagnostic Radiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - William B. Armstrong
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
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Patel R, Marano G, Joseph J, Chung J, Plata A, Vos JA. 18 F-fludeoxyglucose positron emission computed tomography ( 18 F-FDG-PET/CT) versus 68 Ga-DOTATATE-PET/CT in patients with head and neck cancer: Comparisons and implications for treatment. Head Neck 2023; 45:347-354. [PMID: 36591637 DOI: 10.1002/hed.27243] [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: 05/19/2022] [Revised: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tumor-specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68 Ga-DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC. METHODS Patients with HNSCC received pretreatment imaging with 18 F-FDG-PET/CT and 68 Ga-DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression. RESULTS Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred. CONCLUSIONS 68 Ga-DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV-mediated tumors. Targeted therapies to SSTR should be explored.
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Affiliation(s)
- Rusha Patel
- Department of Otolaryngology, Oklahoma University, Oklahoma City, Oklahoma, United States
| | - Gary Marano
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Joe Joseph
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Andrew Plata
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
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Tzror-Azankot C, Betzer O, Sadan T, Motiei M, Rahimipour S, Atkins A, Popovtzer A, Popovtzer R. Glucose-Functionalized Liposomes for Reducing False Positives in Cancer Diagnosis. ACS NANO 2021; 15:1301-1309. [PMID: 33356143 DOI: 10.1021/acsnano.0c08530] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) is a powerful tool for cancer detection, staging, and follow-up. However, 18F-FDG-PET imaging has high rates of false positives, as it cannot distinguish between tumor and inflammation regions that both feature increased glucose metabolic activity. In the present study, we engineered liposomes coated with glucose and the chelator dodecane tetraacetic acid (DOTA) complexed with copper, to serve as a diagnostic technology for differentiating between cancer and inflammation. This liposome technology is based on FDA-approved materials and enables complexation with metal cations and radionuclides. We found that these liposomes were preferentially uptaken by cancer cell lines with high metabolic activity, mediated via glucose transporter-1. In vivo, these liposomes were avidly uptaken by tumors, as compared to liposomes without glucose coating. Moreover, in a combined tumor-inflammation mouse model, these liposomes accumulated in the tumor tissue and not in the inflammation region. Thus, this technology shows high specificity for tumors while evading inflammation and has potential for rapid translation to the clinic and integration with existing PET imaging systems, for effective reduction of false positives in cancer diagnosis.
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Affiliation(s)
- Chen Tzror-Azankot
- Faculty of Engineering and the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Oshra Betzer
- Faculty of Engineering and the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Tamar Sadan
- Faculty of Engineering and the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Menachem Motiei
- Faculty of Engineering and the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Shai Rahimipour
- Department of Chemistry, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Ayelet Atkins
- Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, 5290002, Israel
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hadassah Hebrew Medical Center, Jerusalem 9112001, Israel
| | - Rachela Popovtzer
- Faculty of Engineering and the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
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Pietrzak AK, Kazmierska J, Marszalek A, Golusinski P, Heydrych A, Wiechec K, Cholewinski W. Dual-time-point PET/CT study protocol can improve the larynx cancer diagnosis. Rep Pract Oncol Radiother 2020; 25:533-538. [PMID: 32477019 DOI: 10.1016/j.rpor.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 01/24/2023] Open
Abstract
Aim To evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx. Background In some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value. Materials and methods 90 patients (mean age: 61 ± 11 years, range: 41-84 years): 23 women (mean age: 63 ± 10 years, range: 51-84 years) and 67 men (mean age: 61 ± 11 years, range: 41-80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values. Results The SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%). Conclusions In this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx.
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Affiliation(s)
- Agata Karolina Pietrzak
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Joanna Kazmierska
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland
| | - Andrzej Marszalek
- Poznan University of Medical Sciences and the Greater Poland Cancer Center, Garbary 15, 61-866 Poznan, Poland
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Poland
| | - Aleksandra Heydrych
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Katarzyna Wiechec
- Department of Clinical Psychology, University of Medical Sciences, Poznan, Poland
| | - Witold Cholewinski
- Poznan University of Medical Sciences, Garbary 15, 61-866 Poznan, Poland.,Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
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Pratas E, Carvalho J, Domingues I, Pinheiro S, Amaral S, Khouri L, Costa M, Eufrásio J, Pires I, Davies M, Garcia R, Teixeira M. Case Report: Sarcoidosis mimicking head and neck cancer progression. F1000Res 2019; 8:215. [PMID: 31608145 PMCID: PMC6777012 DOI: 10.12688/f1000research.17834.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
Several case reports have been published describing the coexistence of sarcoidosis and cancer. In the literature, simultaneous occurrence of head and neck cancer and sarcoidosis is rarely reported. In this paper we present a case of a 42-year-old man with squamous cell carcinoma of the oral cavity, locally advanced, which after surgery and adjuvant radiotherapy developed local persistence and progression in the mediastinal lymph nodes. The patient was submitted to chemotherapy and after a complete response, new suspicious mediastinal and hilar lymph nodes appeared in the thoracic computed tomography (CT) scan and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan. To enroll the patient in a clinical trial, the patient underwent mediastinoscopy with mediastinal lymph node dissection. The histopathological findings were consistent with sarcoidosis and no metastatic disease was found. Since the patient had no symptoms and the levels of serum angiotensin converting enzyme were normal, no further pharmacological intervention was done. After 4 years of follow up the patient remains without evidence of cancer. This case shows that although imagological techniques (CT and FDG-PET scan) are extensively used to assess the tumor response, false-positive cases can occur. Whenever it is possible a biopsy of the suspected metastatic site should always be performed.
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Affiliation(s)
- Edgar Pratas
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - João Carvalho
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Isabel Domingues
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Sara Pinheiro
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Susana Amaral
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Leila Khouri
- Department of Radiation Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Miguel Costa
- Department of Stomatology and Maxilofacial Surgery, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - José Eufrásio
- Department of Stomatology and Maxilofacial Surgery, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Isonda Pires
- Department of Radiology and Medical Imaging, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Michael Davies
- Melanoma Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Rita Garcia
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Margarida Teixeira
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
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