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Tourneau CL, Takacsi-Nagy Z, Finzi L, Liem X, Calugaru V, Moreno V, Calvo E, Salas S, Doger B, Dubray-Vautrin A, Mirabel X, Badois N, Chilles A, Fakhry N, Kam SWH, Houdas L, Debard A, Vivar OI, Farber LA, Lesnik M. Novel Radioenhancer NBTXR3 Activated by Radiotherapy in Cisplatin-Ineligible Locally Advanced HNSCC Patients: Final Results of a Phase I Trial. Int J Radiat Oncol Biol Phys 2023; 117:S99. [PMID: 37784620 DOI: 10.1016/j.ijrobp.2023.06.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) New approaches are needed for frail or elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) who are unfit to receive cisplatin with concurrent radiotherapy (RT). NBTXR3 is a first-in-class radioenhancer, composed of functionalized hafnium oxide nanoparticles, administered by a single intratumoral (IT) injection and activated by RT. NBTXR3 locally amplifies the anti-tumoral response of RT without adding toxicity to surrounding healthy tissue as shown in a randomized trial in soft tissue sarcoma. This two-part study: dose-escalation followed by the dose-expansion part reported here, evaluated the safety and preliminary efficacy for NBTXR3 activated by RT in elderly or frail patients ineligible to cisplatin. MATERIALS/METHODS This trial enrolled patients who had previously untreated AJCC 8th Stage III-IVA or T3, T4 SCC of the oral cavity or oropharynx (OPC) ineligible to cisplatin. Eligible patients received a single IT injection of NBTXR3 at the recommended dose (22% of the baseline tumor volume) followed by RT (IMRT 70 Gy in 35 fractions). The primary objectives of the dose expansion part were to test the recommended dose, to confirm its safety, and obtain preliminary evidence of efficacy. The secondary objectives included the evaluation of progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-sixpatients in the dose expansion part were treated from April 2019-January 2022; 44 patients were evaluable for objective tumor response. In the all-treated population, median age was 71.9 years. 64.3% had age-adjusted Charlson Comorbidity Index scores ≥4, 55.4% had OPC (45.2% HPV+) and 80% had T3-4. Median injected volume of NBTXR3 was 13.6 [0.5-57.1] mL. Grade ≥ 3 adverse events reported as potentially related to NBTXR3 or to injection procedure were 1.2% and 0.4% of all AEs reported, respectively. In the evaluable population, the best objective response rate of the NBTXR3 injected lesion was 81.8% with a complete response rate of 63.6%. The best overall response rate (injected and non-injected lesions) was 79.5%. Final analyses on PFS and OS with long-term follow-up will be presented. CONCLUSION NBTXR3 IT injection followed by activation with RT was confirmed to be feasible and well tolerated in elderly or frail patients with LA HNSSC and significant comorbidities. The high rate of best overall response suggests that NBTXR3+RT is effective in this elderly population ineligible to cisplatin with a high unmet medical need. These results support our ongoing phase III study comparing NBTXR3/RT ± cetuximab vs. RT ± cetuximab in platinum-based chemotherapy ineligible elderly patients with LA-HNSCC: NANORAY 312 (NCIT04892173).
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Affiliation(s)
| | | | | | - X Liem
- Univesrite Montreal, Montreal, QC, Canada
| | - V Calugaru
- Department of Radiation Oncology-Institut Curie, Paris, France
| | - V Moreno
- Hospital Fundación Jimenez Diaz, Madrid, Spain
| | | | - S Salas
- Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, France
| | | | | | | | | | - A Chilles
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - N Fakhry
- Hôpital Timone, Marseille, France
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Perles LA, Niedzielski J, Sawakuchi G, Martin R, Schueler E, Taniguchi CM, Ludmir EB, Vivar OI, Das P, Koong AC, Farber LA, Koay EJ, Beddar S. Assessment of the Spatial Bio-Distribution of NBTXR3 for Locally Advanced or Borderline-Resectable Pancreatic Ductal Adenocarcinoma (LAPC or BRPC) Patients Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e332-e333. [PMID: 37785172 DOI: 10.1016/j.ijrobp.2023.06.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) NBTXR3 is a novel radioenhancer composed of functionalized hafnium oxide nanoparticles that are injected directly into the tumor. An ongoing phase I trial is assessing the application of NBTXR3 in the treatment of locally-advanced or borderline-resectable pancreatic ductal adenocarcinoma, with the primary goal of determining the recommended NBTXR3 dose for a subsequent phase II trial. Using patients from the ongoing phase I trial, we evaluated the spatial bio-distribution of NBTXR3 in the pancreas as function of time and assessed if there is migration of the compound during radiation therapy. MATERIALS/METHODS Adult patients with LAPC or BRPC were enrolled. Analysis of 8 patients who underwent CT simulation at least 24 hours after receiving the NBTXR3 intratumoral injection in the pancreatic lesion under general anesthesia guided by an endoscopic ultrasound was conducted. Patients were simulated with and without iodinated intravenous contrast under breath hold, with 3mm CT slice thickness and 50-60cm FoV. A contrast-enhanced CT series was chosen for RT planning purposes. All patients were planned for a 15-fraction IMRT course using 6-MV beam energy, with 45Gy and 37.5Gy dose levels (using a simultaneous integrated boost technique) to gross primary tumor and microscopic disease/regional nodes, respectively. Daily image guidance included either cone-beam CT (CBCT, n = 1) or CT-on-Rails (CTOR, n = 7) and were fused to the planning CT images using Velocity, ver. 3.0.1. The NBTXR3 volume was determined by thresholding the images to 165 HU and 300 HU for CTOR and CBCT images, respectively. Bones, stents, and artifacts were manually removed from the NBTXR3 volume. The volumes for the NBTXR3 and the NBTXR3 overlapping with the GTV for each patient were individually fit to a linear model in R, ver. 4.1.3. RESULTS One patient from the CTOR cohort was excluded from analysis due to the small volume of NBTXR3 (0.02 cm3) compared to the rest of the cohort (0.716 - 6.917 cm3). The total volume of NBTXR3 in the CBCT images could not be analyzed due the substantial image artifacts, only the volume overlapping the GTV was calculated. There were no statistically significant changes (p > 0.1 Adj-R2 = 0.99) in the raw volume of NBTXR3 for the duration of the treatment in all CTOR patients. For the NBTXR3 volume overlapping with the GTV, five cases did not present with a volume change during the treatment (p > 0.1 Adj-R2 = 0.99), while one CTOR case had a reduction in volume of about 1.5%/day (p = 0.7), and the CBCT case had a reduction of 3%/day (p < 0.001). CONCLUSION The raw volume of NBTXR3 injected in the pancreas did not significantly change over the duration of the three weeks of treatment. We also did not observe significant changes in the NBTXR3 volume overlapping the GTV in most cases. The stability of NBTXR3 was demonstrated during RT.
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Affiliation(s)
- L A Perles
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Niedzielski
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Sawakuchi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Martin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Schueler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C M Taniguchi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - P Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A C Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L A Farber
- The Farber Center for Radiation Oncology, New York, NY
| | - E J Koay
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Beddar
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ginat DT, Juloori A, Vivar OI, Farber LA, Gooi Z, Rosenberg AJ. Imaging Features of Intratumoral Injection of NBTXR3 for Head and Neck Squamous Cell Carcinoma Lymph Node Metastases. Diagnostics (Basel) 2022; 12:diagnostics12092156. [PMID: 36140557 PMCID: PMC9498208 DOI: 10.3390/diagnostics12092156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
NBTXR3 nanoparticle injection is a relatively novel radioenhancer for treatment of various cancers. CT scans following NBTXR3 injection of metastatic lymph nodes from head and neck squamous cell carcinoma were reviewed in a small series of patients. The radioenhancing appears as hyperattenuating, with a mean attenuation of the injected material of 1516 HU. The material was found to leak beyond the margins of the tumor in some cases.
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Affiliation(s)
- Daniel Thomas Ginat
- Department of Radiology, University of Chicago Medical Center, Chicago, IL 60637, USA
- Correspondence: ; Tel.: +1-(773)-702-6039
| | - Aditya Juloori
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Omar I. Vivar
- Department of Global Medical Affairs, Nanobiotix, 75012 Paris, France
| | - Leonard A. Farber
- Department of Global Medical Affairs, Nanobiotix, 75012 Paris, France
| | - Zhen Gooi
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Ari J. Rosenberg
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
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Le Tourneau C, Hoffmann C, Takacsi-Nagy Z, Liem X, Salas S, Debard A, Finzi L, Farber LA, Gogishvili M, Kristesashvili G, Makharadze T, Yom SS. NANORAY-312: A phase III pivotal study of NBTXR3 activated by investigator’s choice of radiotherapy alone or radiotherapy in combination with cetuximab for platinum-based chemotherapy-ineligible elderly patients with locally advanced head and neck squamous cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps6110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS6110 Background: Elderly patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are largely underrepresented in clinical trials (CT). Broad access to CTs in this population is challenging due to an increased prevalence of comorbidities and ageing-related conditions. However, as population-age increases, more and more elderly patients are diagnosed with LA-HNSCC although many are not eligible to receive standard cisplatin-based concurrent chemoradiation (CRT). CRT-related toxicities, treatment burden and compliance are a concern. NBTXR3, a first-in-class radioenhancer, composed of functionalized hafnium oxide nanoparticles, is administered by one-time intratumoral injection and activated by radiotherapy (RT). NBTXR3 is designed to locally amplify the tumor-killing effect of radiotherapy without additional toxicity to surrounding healthy tissue. NBTXR3 has been shown to prime the adaptive immune response in cancer models. NBTXR3 obtained EU marketing approval in preoperative treatment of locally advanced soft tissue sarcomas. In a Phase I trial of NBTXR3 + RT alone in elderly LA-HNSCC patients, the combination was shown to be safe and an Objective Response Rate (ORR) of 85.4% and CRR of 51.2% was reported at ASTRO 2021. A pivotal randomized phase III study was initiated and is now recruiting. Methods: NANORAY-312 [NCT04892173] is a global, open-label, randomized (1:1), 2-arm, Investigator's choice Phase III (Pivotal Stage) study to investigate the efficacy and safety of NBTXR3/RT±cetuximab versus RT±cetuximab in treatment-naïve, platinum-ineligible, elderly patients with LA-HNSCC. 500 patients will be enrolled. Eligible patients are ≥65 years with at least one measurable (RECIST 1.1) biopsy-confirmed T3-4 (AJCC v8) SCC of the oral cavity, oropharynx, hypopharynx, or supraglottic larynx which is amenable for intratumoral injection. For patients with oropharyngeal cancer, human papilloma virus (HPV) status must be known. In addition to the primary tumor, a single accessible LN in the neck is eligible for intranodal injection. The primary objective is PFS. The key secondary endpoint is OS. Other secondary endpoints include ORR, safety and tolerability and quality of life. Enrollment began in January 2022 and is ongoing. Clinical trial information: NCT04892173.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Miranda Gogishvili
- High Technology Medical Centre, University Clinic Ltd., Tbilisi, Georgia
| | | | - Tamta Makharadze
- Ltd Medulla Chemotherapy and Immunotherapy Clinic, Tbilisi, Georgia
| | - Sue S. Yom
- University of California-San Francisco, San Francisco, CA
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Farber LA, Bortecen K, Rotgans A, Hollingsworth C, Tonis A, Greuner DA. Maximizing Patient Satisfaction and Positive Outcomes in the Diagnosis and Treatment of Pelvic Congestion Syndrome in the Outpatient Surgical Setting: A Cohort of 102 Patients. J Vasc Surg Venous Lymphat Disord 2018. [DOI: 10.1016/j.jvsv.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jhaveri JD, Rush SC, Kostroff K, Derisi D, Farber LA, Maurer VE, Bosworth JL. Clinical Outcomes of Postmastectomy Radiation Therapy After Immediate Breast Reconstruction. Int J Radiat Oncol Biol Phys 2008; 72:859-65. [PMID: 18472362 DOI: 10.1016/j.ijrobp.2008.01.055] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/28/2008] [Accepted: 01/30/2008] [Indexed: 11/24/2022]
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Farber LA, Ames JW, Rush S, Gal D. Laparoscopic ovarian transposition to preserve ovarian function before pelvic radiation and chemotherapy in a young patient with rectal cancer. MedGenMed 2005; 7:66. [PMID: 16369371 PMCID: PMC1681369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Ovarian transposition is a surgical maneuver used to protect ovarian function before delivery of gonadocidal doses of radiation therapy. Ovarian transposition has been performed in patients whose treatment includes pelvic radiotherapy as a part of management for Hodgkin's disease and other gynecologic malignancies. CASE Laparoscopic ovarian transposition was performed on a 28-year-old female with rectal cancer. At 13-month follow-up from completion of chemoradiation treatments, normal menstrual cycles at regular monthly intervals are reported. FSH, LH, and progesterone levels obtained during the second half of menstrual cycles were within normal ranges. CONCLUSION Ovarian transposition is an effective surgical procedure for preserving ovarian function in patients at risk of radiotherapy-induced ovarian failure. Laparoscopic techniques can be used to move the ovaries outside of the radiation portal. Consideration should be given for ovarian transposition for other abdominal and pelvic malignancies before onset of radiation treatments in patients who desire preservation of ovarian function.
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Affiliation(s)
- Leonard A Farber
- Radiation Oncology, Long Island Radiation Therapy/Nassau Radiologic Group, New York, NY, USA
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Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, Alavi A. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med 1999; 26:1345-8. [PMID: 10541835 DOI: 10.1007/s002590050593] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) studies imaging FDG PET imaging is used to detect and stage head and neck cancers. However, the variable physiologic uptake of FDG in different normal structures as well as at inflammatory sites may either obscure a tumor focus or be falsely interpreted to represent tumor activity. Twenty-one patients (9 men, 12 women, median age 59) were scanned serially at two time points, one at 70 min (range 47-112) and the second at 98 min (77-142) after the intravenous injection of 4.3 MBq/kg of FDG. The mean interval between emission scans was 28 min (13-49). Transmission scans were performed and regions of interest (ROIs) were overlayed on the fully corrected images. Standardiued uptake values (SUVs) were generated for the cerebellum, tongue, larynx, every lesion, and a matched contralateral site. Follow-up and pathologic studies revealed 18 squamous cell carcinomas and nine inflammatory or infectious lesions. Tumor SUVs were 4.0+/-1.6 (mean +/- SD) for the first scan and 4. 5+/-2.2 for the second scan. Contralateral SUVs were 1.2+/-0.5 and 1. 1+/-0.5 for the two scans. Tumor SUVs increased by 12%+/-12% as compared with a 5%+/-17% decrease for contralateral sites (P<0.05). SUVs for inflammatory sites (2.0+/-0.7 and 2.0+/-0.9), cerebellum (4. 2+/-1.3 and 4.3+/-1.4), tongue (1.8+/-0.4 and 1.9+/-0.5) and larynx (1.5+/-0.6 and 1.5+/-0.6) remained constant over time (+0.6%, +2.8%, +1.4%, and -2.4%; P<0.05 when compared with tumor SUV changes). The ratio tumor/contralateral SUV increased by 23%+/-29% over time while this ratio for inflamed sites increased by only 5%+/-15% (P=0.07). The time interval between scans correlated with increase in SUV for tumors (r=0.55, P<0.05) but not for any of the other ROIs. Separation was superior when studies were performed more than 30 min apart (P<0.05). These preliminary data suggest that dual time point imaging compatible with a clinical study protocol is helpful in differentiating malignant lesions from inflammation and normal tissues, especially when separated by a sufficient time interval.
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Affiliation(s)
- R Hustinx
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Donner Building Room 110, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Farber LA, Shlofmitz RA, Haag ES, Speck T, Berke A. Application of intravascular brachytherapy: utilization of beta-irradiation source delivery systems within a community-based cardiac center. Cardiovasc Radiat Med 1999; 1:323-6. [PMID: 10828561 DOI: 10.1016/s1522-1865(00)00028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE There are numerous clinical studies ongoing to assess the outcome, physics, and radiobiology of intravascular brachytherapy and its effect on the reduction of the rate of restenosis after balloon angioplasty procedures. The present study reports on the experience of two different delivery systems as utilized in the community hospital setting. METHODS AND MATERIALS Patients were enrolled into one of four ongoing trials at our institution: the Novoste Beta-Cath trial, the Novoste Stents and Radiation Therapy trial (START), the Novoste START 40/20 trial, and the Guidant Intimal Hyperplasia Inhibition with Beta In-stent Trial (INHIBIT). The Novoste studies utilized the Novoste Beta-Cath System with 90Sr/Y, and the Guidant INHIBIT trial used 32P. Enrollments into the various trials were determined by inclusion and exclusion criteria specified by each protocol. Randomization was conducted per criteria as determined by the participating study protocol. RESULTS Forty-two patients were enrolled in total. Thirty-four were included in the Novoste trials and eight in the Guidant study, according to availability of the trial. Assessment of practicality of treatment was dependent primarily on treatment duration and extension of time of catheterization procedures by the addition of intravascular radiation. Average dwell time within the Novoste trials was 3 min 40 s, and 7 min 46 s for patients in the Guidant study. No acute complications were observed in any of the trials. CONCLUSIONS Intravascular brachytherapy can be performed in the community hospital setting without compromising the efficiency of balloon angioplasty procedures. Pending long-term outcome data and FDA approval for specific delivery systems, endovascular brachytherapy in community hospital cardiac catheterization laboratories can be realized in an efficient and timely manner.
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Affiliation(s)
- L A Farber
- Long Island Radiation Therapy/Nassau Radiologic Group, Manhasset, New York 11030, USA.
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Farber LA, Benard F, Machtay M, Smith RJ, Weber RS, Weinstein GS, Chalian AA, Alavi A, Rosenthal DI. Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography. Laryngoscope 1999; 109:970-5. [PMID: 10369292 DOI: 10.1097/00005537-199906000-00024] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Fluorodeoxyglucose positron emission tomography (FDG-PET) has been proposed as a sensitive method to diagnose and stage various malignancies. We assessed the efficacy of FDG-PET imaging in distinguishing tumor persistence/recurrence from posttreatment changes following radiation therapy for squamous carcinomas of the head and neck STUDY DESIGN Retrospective analysis of FDG-PET results compared with biopsy results or outcome, or both. METHODS Twenty-eight patients who had undergone radiation therapy with or without surgery for treatment of squamous cell carcinoma were studied with FDG-PET imaging. There was clinical suspicion for recurrence in each patient, but no obvious mass or lesion to biopsy was found on physical examination or anatomic imaging. The results of FDG-PET imaging were compared with those of biopsy or clinical follow-up of at least 6 months, or both. RESULTS FDG-PET imaging was positive in 13 patients, and the presence of active disease was confirmed in 12. Two thirds of the 12 received further cancer treatment. There were 15 negative FDG-PET images. Thirteen of these were confirmed true-negative images, but two studies were false-negative images. The sensitivity and specificity of FDG-PET were 86% and 93%, respectively, with positive and negative predictive values of 92% and 87%, respectively. The overall accuracy was 89%. CONCLUSION FDG-PET imaging is a useful modality to distinguish tumor persistence/recurrence from radiation-induced tissue changes in the neck following treatment for head and neck cancer. FDG-PET can identify patients who may benefit from further treatment, and may lead to improved outcome for individual patients.
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Affiliation(s)
- L A Farber
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Farber LA, Bloch P, Yorke ED, Stevens CW, Herrmann H, Ruffer JE. A dosimetric comparison of conventional vs conformal external beam irradiation of a stented coronary artery utilizing a new fluoroscopic imaging detector system. Cardiovasc Radiat Med 1999; 1:80-5. [PMID: 11272361 DOI: 10.1016/s1522-1865(98)00008-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Purpose. To determine whether conformal external photon beam irradiation may prevent or reduce the rate of restenosis of a stented coronary artery following percutaneous transluminal coronary angioplasty (PTCA). Optimal conformal external beam irradiation with limited cardiac dose requires adequate visualization of the stented vascular segment. With existing image intensifiers, identification of a coronary stent is poorly localized. We propose using an amorphous silicon panel detector to observe the movement of the stent during the cardiac cycle. BACKGROUND Long-term radiation-induced coronary complications can be minimized by: (a) reducing the radiation field sizes, (b) fractionating the total dose over several days, and (c) applying multiple treatment beams. Localization of the movement of the stent during the cardiac cycle may allow for the design of radiation fields that conform to the stented vessel segment. This scheme may permit gating the radiation beam on or off relative to movement of the stent within or outside the radiation fields, respectively. METHODS Using a new solid-state amorphous silicon planar detector, with a dynamic range of 12 bits, fluoroscopic images of a Palmaz-Schatz coronary stent were obtained. The stent was centered in a polystyrene phantom 20 cm thick and imaged using a 90-kVp, 3.5-ma, source-detector and source stent distances of 114 and 100 cm, respectively. With the solid-state silicon detector, the stent was identified in a single video frame (1/30 s). This fast image acquisition should allow for mapping the motion of the stent during the cardiac cycle. The stent movement during the cardiac cycle may then be correlated with the QRS complex in the electrocardiogram. CONCLUSIONS The localization of a coronary stent during the cardiac cycle under fluoroscopy permits delivery of small conformal external radiation fields to treat stented coronary arteries, while minimizing radiation dose to surrounding normal cardiac tissue and vasculature. The best selection of treatment beam angles will be provided by high resolution fluoroscopic images of the stented region obtained from different beam directions. The three-dimensional movement of the stent, indexed in time with the QRS complex, will provide an important measure for gating radiation beams for conformal treatment delivery.
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Affiliation(s)
- L A Farber
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA.
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Bruckner HW, Farber LA, Fier CM. Definitive surgery for duct cell carcinomas of the pancreas. J Am Coll Surg 1996; 183:292-4. [PMID: 8784327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
Using radioimmunoassay methods, the blood of patients with pancreatic tumors was screened for circulating polypeptide hormones. This screening discovered pancreatic polypeptide in abnormally high concentration in the serum of six of seven patients with adenocarcinomas of the bile duct. The assay appears to be very sensitive finding excessive residual pancreatic polypeptide production after palliative resections. Serum pancreatic polypeptide assays warrant evaluation as an aid in the diagnosis and management of patients with bile duct tumors.
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Affiliation(s)
- H W Bruckner
- Department of Neoplastic Diseases, Mount Sinai Medical Center, New York, NY 10029
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Vasil'eva VM, Slavutskaia MV, Farber LA. [Characteristics of conditioned reactions in different phases of natural sleep in humans]. Zh Vyssh Nerv Deiat Im I P Pavlova 1974; 24:1122-9. [PMID: 4375910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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