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Wang R, Zhang Y, Fan Q, Jiang M, Zou L, Su M. Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma. Ann Hematol 2024; 103:885-892. [PMID: 38030892 DOI: 10.1007/s00277-023-05562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Interim 18F-FDG PET/CT (I-PET) has a role in response evaluation and treatment guidance in patients with nasal-type extranodal natural killer/T cell lymphoma (ENKTL). However, there was no agreement on the timing of I-PET performed, after chemotherapy or after chemoradiotherapy. We aimed to find the appropriate timing for I-PET by assessing the prognostic value of I-PET in response evaluation in ENKTL patients. Two hundred and twenty-seven ENKTL patients who had undergone I-PET were retrospectively included. All patients were grouped based on their therapeutic strategy received, chemotherapy or chemoradiotherapy. The Deauville 5-point score (DS) was used to interpret the I-PET images. The hazard ratio (HR) and C-index were used to measure the discriminatory and prognostic capacities of I-PET performed at different times. One hundred and six patients underwent the I-PET after chemotherapy (chemotherapy group), while I-PET was performed after chemoradiotherapy in 121 patients (chemoradiotherapy group). Eighty-seven patients were classified as metabolic remission (DS score of 1-3), while the other 140 were classified as non-metabolic remission (DS score of 4-5) according to the Deauville criteria. There were no significant survival differences between patients in metabolic remission and in non-metabolic remission in either progression-free survival (PFS, p = 0.406) or overall survival (OS, p = 0.350). In the chemotherapy group, patients in metabolic remission had significantly superior PFS than patients in non-metabolic remission (p = 0.012). For OS, a discriminative trend was also found on the survival curve between patients in metabolic remission and in non-metabolic remission (p = 0.082). In the chemoradiotherapy group, there was no significant difference in PFS (P = 0.185) or OS (P = 0.627) between patients in metabolic remission and in non-metabolic remission. I-PET after chemotherapy yields higher discriminative power and has the ability for prognostic prediction in nasal-type ENKTL patients. I-PET after radiochemotherapy has no prognostic value. Thus, the appropriate timing for I-PET is after chemotherapy but before radiotherapy for response evaluation in nasal-type ENKTL patients.
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Affiliation(s)
- Rang Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Qiuping Fan
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ming Jiang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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van der Zijden CJ, van der Sluis PC, Mostert B, Nuyttens JJME, Spaander MCW, Toxopeus ELA, Valkema R, Beerepoot LV, van Halteren HK, Lagarde SM, Wijnhoven BPL. Induction chemotherapy followed by response evaluation and esophagectomy for advanced esophageal cancer. Eur J Surg Oncol 2024; 50:107968. [PMID: 38241878 DOI: 10.1016/j.ejso.2024.107968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Patients with limited metastatic/advanced esophageal cancer not amenable for neoadjuvant therapy plus surgery have a poor prognosis and often receive palliative care. Alternatively, induction chemotherapy with response evaluation can be considered and in some patients surgery with curative intent may become feasible. The aim of this study was to evaluate the outcomes of patients treated with induction chemotherapy and to identify patient and/or tumor characteristics associated with survival. MATERIAL AND METHODS Patients with esophageal or junctional cancer who underwent induction chemotherapy between 2005 and 2021 were identified from an institutional database of a tertiary referral center. Response to therapy was assessed by (18F-FDG PET)/CT. Response to therapy and treatment options, including surgery or palliation, were discussed in the multidisciplinary tumor board. Overall survival (OS) was calculated using the Kaplan Meier method. Uni- and multivariable analyses were performed to identify prognostic factors for survival. RESULTS 238 patients were identified. The majority had esophageal adenocarcinoma (68.9 %) and were treated with a taxane/platinum-based chemotherapy (79.4 %). Response evaluation was performed in 233 patients and 154 of 238 patients (64.7 %) underwent surgical exploration. Resection was performed in 127 patients (53.4 %) resulting in a median and 5-year OS of 26.3 months (95 % CI 18.8-33.8) and 29.6 %, respectively. Presence of T4b (HR = 2.01, 95 % CI 1.02-3.92) and poorly differentiated tumor (HR = 1.45, 95 % CI 1.02-2.10) was associated with worse survival (p = 0.04). CONCLUSION In carefully selected patients with advanced disease not amenable for standard curative treatment, induction chemotherapy followed by esophagectomy may result in a 5-year overall survival of approximately 30 %.
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Affiliation(s)
| | | | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Joost J M E Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eelke L A Toxopeus
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Laurens V Beerepoot
- Department of Medical Oncology, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | - Henk K van Halteren
- Department of Medical Oncology, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Dave S, Choudhury A, Alurkar SS, Shah AM. Is Ki-67 Really Useful as a Predictor for Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer? Indian J Surg Oncol 2024; 15:44-52. [PMID: 38511030 PMCID: PMC10948718 DOI: 10.1007/s13193-023-01822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 03/22/2024] Open
Abstract
Neoadjuvant chemotherapy (NACT) is routinely offered to operable locally advanced breast cancer (LABC) patients desirous of breast conservation surgery and inoperable LABC patients. Pathological complete response (pCR) following chemotherapy is recognized as a surrogate for survival outcomes in high grade tumour subtypes. Many biological and tumor characters have been shown to predict pCR. The current study was performed with the aim of investigating the ability of Ki-67 in predicting pCR with NACT in breast cancer patients. A total of 105 patients with locally advanced breast cancer who completed NACT followed by surgery were included in this study from January 2020 till December 2022. Patients with advanced metastatic breast carcinoma, who did not give consent for NACT, who did not complete NACT and who did not undergo surgery were excluded. All patients were assessed for Ki-67 score on core-needle biopsy samples and response rate was assessed clinically and by histopathological examination of resected specimen. Quantitative variables were compared using unpaired t-test or Mann-Whitney 'U' test and for categorical variables Chi-square or Fisher's exact test were used. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive potential of Ki-67 expression levels in predicting pCR. To identify the predictive factors associated with pCR, univariate analysis was performed. The P value < 0.05 was considered as statistically significant. Mean age was 51.57 ± 10.8 years. 51 patients achieved clinical complete response (cCR) and 33 achieved pCR after NACT. Mean Ki-67 index in overall study population, in pCR group and no pCR group was 46.44 ± 22.92%, 51.60 ± 22.3% and 44.06 ± 22.7%, respectively. On univariate analysis, ER negativity, PR negativity and Her 2neu positivity were found predictive of pCR. On subgroup analysis, TNBC and Her 2neu positive sub groups were associated with higher cCR and pCR rate. We found no significant association between Ki-67 and pCR. This result may be confounded by the fact that a significant duration of the study was in the COVID-19 pandemic. Validation of this data is required in a large prospective study.
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Affiliation(s)
- Sukruti Dave
- Department of Medical Oncology, Apollo Hospitals International Limited: Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat India
| | - Arpan Choudhury
- Department of Surgical Oncology, Apollo Hospitals International Limited: Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat India
| | - Shirish S. Alurkar
- Department of Medical Oncology, Apollo Hospitals International Limited: Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat India
| | - Akash M. Shah
- Department of Medical Oncology, Apollo Hospitals International Limited: Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat India
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Reddy Bursapalle M, Valakkadaa J, Ayappan A. Role of intravoxel incoherent motion (IVIM) imaging in response assessment of hepatocellular carcinoma after transarterial chemoembolization (TACE) - A prospective study. Radiologia (Engl Ed) 2024; 66:23-31. [PMID: 38365352 DOI: 10.1016/j.rxeng.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/13/2022] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Response evaluation of hepatocellular carcinoma (HCC) currently is based on arterial phase enhancement which doesn't take into microstructural changes in the tumor after trans-arterial chemoembolization (TACE). AIM This prospective study was conducted to assess the feasibility and efficacy of intravascular incoherent motion imaging (IVIM) in response evaluation of HCC after TACE. 39 cirrhotic patients with 48 HCC underwent MR imaging 1 week within and 6weeks after TACE. IVIM parameters like Dslow (true diffusion), Dfast (pseudodiffusion), perfusion fraction and ADC were measured prior to and postTACE. The pre and post TACE values in LR-TR (LIRADS - treatment response) nonviable and viable lesions were compared using paired t-tests. ROC curve analysis was done to calculate sensitivity and specificity and propose cut-off values. RESULT Non-viable lesions showed a significant increase in Dslow (1.208 ± 0.581 vs 1.560 ± 0.494, P-value -.0207) and ADC (1.37 ± 0.53 vs 1.65 ± 0.4287, P value .016) after TACE. There was also significant decrease in Dfast (33.7 ± 10.4 vs 23.75 ± 12.13, P value .0005) and f (19.92 ± 10.54 vs 12.9 ± 10.41, P value .012) values after TACE in non-viable lesions compared to viable lesions. The change in true diffusion had the highest AUC (0.741) among IVIM parameters with greater than 0.075 increase between preTACE and postTACE values having a sensitivity and specificity of 81.8% and 60% respectively for complete response. CONCLUSION IVIM imaging is feasible to assess the response in HCC after TACE. True diffusion is more sensitive and specific than apparent diffusion in evaluating the response.
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Affiliation(s)
- M Reddy Bursapalle
- Departamento de Ciencias de la Imagen y Radiología Intervencionista, Instituto Sreechitra de Ciencias Médicas y Tecnología, Trivandrum, India
| | - J Valakkadaa
- Departamento de Ciencias de la Imagen y Radiología Intervencionista, Instituto Sreechitra de Ciencias Médicas y Tecnología, Trivandrum, India.
| | - A Ayappan
- Departamento de Ciencias de la Imagen y Radiología Intervencionista, Instituto Sreechitra de Ciencias Médicas y Tecnología, Trivandrum, India
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Han S, Oh JS, Seo SY, Lee JJ. Performance of deep learning models for response evaluation on whole-body bone scans in prostate cancer. Ann Nucl Med 2023; 37:685-694. [PMID: 37819584 DOI: 10.1007/s12149-023-01872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE We aimed to develop deep learning classifiers for assessing therapeutic response on bone scans of patients with prostate cancer. METHODS A set of 3791 consecutive bone scans coupled with their last previous scan (1528 patients) was evaluated. Bone scans were labeled as "progression" or "nonprogression" on the basis of clinical reports and image review. A 2D-convolutional neural network architecture was trained with three different preprocessing methods: 1) no preprocessing (Raw), 2) spatial normalization (SN), and 3) spatial and count normalization (SCN). Data were allocated into training, validation, and test sets in the ratio of 72:8:20, with the 20% independent test set rotating all scans over a five-fold testing procedure. A Grad-CAM algorithm was employed to generate class activation maps to visualize the lesions contributing to the decision. Diagnostic performance was compared using area under the receiver operating characteristics curves (AUCs). RESULTS The data consisted of 791 scans labeled as "progression" and 3000 scans labeled as "nonprogression." The AUCs of the classifiers were 0.632-0.710 on the Raw dataset, were significantly higher with the use of SN at 0.784-0.854 (p < 0.001 for Raw versus SN), and higher still with SCN at 0.954-0.979 (p < 0.001 for SN versus SCN). Class activation maps of the SCN model visualized lesions contributing to the model's decision of progression. CONCLUSION With preprocessing of spatial and count normalization, our deep learning model achieved excellent performance in classifying the therapeutic response of bone scans in patients with prostate cancer.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung Yeon Seo
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Li X, Li H, Yan Y, Xu H, Wang Y, Liu Y, Gao R. Metastatic differentiated thyroid cancer with negative serum stimulated Tg but positive post-therapeutic 131I-SPECT/CT scintigraphy: a single-center retrospective study. Endocrine 2023; 82:117-125. [PMID: 37209260 DOI: 10.1007/s12020-023-03397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE This study aimed to describe the characteristics of patients with metastatic differentiated thyroid carcinoma (DTC) who had positive 131I-scintigraphy but negative stimulated thyroglobulin (sTg), and to evaluate their short-term response to radioiodine therapy (RAI). METHODS A total of 2250 consecutive postoperative DTC patients, who underwent RAI treatment from July 2019 to June 2022, were analyzed retrospectively. The target group was defined as stimulated Tg < 2 ng/mL with TgAb < 100 IU/mL but with post-therapeutic 131I-SPECT/CT metastases. The characteristics of these patients were analyzed and the metastatic profiles were compared with TgAb positive or sTg positive ones. A cross-sectional efficacy was evaluated 6-12 months after the RAI therapy and the treatment course until the end of the study was recorded. RESULTS 105 (4.67%) DTC patients were post-therapeutic 131I-SPECT/CT positive and sTg negative (target group). Metastatic profiles were found significant differences between sTg negative and sTg positive ones (P < 0.001). Excellent response (ER) was achieved in 72.4% of the target group between 6-12 months of cross-sectional efficacy assessment, compared with only 12.8% in sTg positive ones (P < 0.001). The majority of the target group didn't require aggressive treatment in short-term follow-up compared with sTg positive group (P < 0.001). CONCLUSION The percentage of DTCs with negative sTg but positive post-therapeutic 131I-SPECT/CT was relatively low, but still significant. Moreover, the majority of these patients showed an ER to RAI and may not require the next course of therapy. Long-term follow-up is still necessary to assess recurrence and adapt surveillance in these patients.
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Affiliation(s)
- Xinru Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China
| | - Huijie Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China
| | - Yan Yan
- Xi'an Jiaotong University Health Science Center, Xi'an, 710061, P.R. China
| | - Hui Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China
| | - Yuanbo Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China
| | - Yan Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China
| | - Rui Gao
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P.R. China.
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Reijers SJM, Davies E, Grünhagen DJ, Fiore M, Honore C, Rastrelli M, Vassos N, Podleska LE, Niethard M, Jakob J, Perhavec A, Duarte C, González F, Deroose JP, Stas M, Boecxstaens V, Schrage Y, Snow H, Algarra SM, Said HM, Ortega DYG, Martin K, Mattsson J, Djafarrian R, Di Lorenzo G, Colombo C, Gronchi A, Matter M, Verhoef C, Bagge RO, Hohenberger P, Hayes AJ, van Houdt WJ. Variation in response rates to isolated limb perfusion in different soft-tissue tumour subtypes: an international multi-centre study. Eur J Cancer 2023; 190:112949. [PMID: 37453241 DOI: 10.1016/j.ejca.2023.112949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the response rates of different extremity soft-tissue sarcoma subtypes (eSTS) after isolated limb perfusion (ILP), based on an international multi-centre study. MATERIALS AND METHODS The retrospective cohort comprised eSTS patients from 17 specialised ILP centres that underwent melphalan-based ILP, with or without recombinant human tumour necrosis factor (rhTNFα) (TM-ILP and M-ILP, respectively). Response was measured on imaging (magnetic resonance imaging) and/or clinical response, for which M-ILPs were excluded. RESULTS A total of 1109 eSTS patients were included. The three most common histological subtypes were undifferentiated pleomorphic sarcoma (17%, n = 184), synovial sarcoma (16%, n = 175) and myxofibrosarcoma (8%, n = 87). rhTNFα was used in 93% (TM-ILP) and resulted in a significantly better overall response rate (ORR, p = 0.031) and complete responses (CR, p < 0.001) in comparison to M-ILP, without significant differences among histological subgroups. The ORR of TM-ILP was 68%, including 17% CR. Also, 80% showed progressive disease. Significantly higher response rates were shown for Kaposi sarcoma (KS) with 42% CR and 96% ORR (both p < 0.001), and significantly higher CR rates for angiosarcoma (AS, 45%, p < 0.001) and clear cell sarcoma (CCS, 31%, p = 0.049). ILP was followed by resection ≤ 6 months in 80% of the patients. The overall limb salvage rate was 88%, without significant differences among histological subgroups, but was significantly higher for ILP responders compared to non-responders (93% versus 76%, p < 0.001). CONCLUSION ILP resulted in high response and LRS among all eSTS subtypes, however, with significant differences between subtypes with most promising results for KS, AS and CCS.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Emma Davies
- Department of Surgical Oncology, Royal Marsden Hospital, 203 Fulham Rd., SW3 6JJ London, UK.
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Charles Honore
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
| | - Marco Rastrelli
- Department of Surgery Oncology and Gastroenterology, University of Padova, Via VIII Febbraio, 2, 35122 Padua, Italy; Department of Surgical Oncology, Istituto Oncologico Veneto (IOV), Via Gattamelata, 64, 35128 Padua, Italy.
| | - Nikolaos Vassos
- Division of Surgical Oncology, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Lars E Podleska
- Department of Orthopaedic Oncology and Soft Tissue Sarcoma, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany.
| | - Maya Niethard
- Department of Surgical Oncology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125 Berlin, Germany; Department of Orthopedic Surgery, University Medicine Greifswald, Fleischmannstraße 6, 17489 Greifswald, Germany.
| | - Jens Jakob
- Department of Orthopaedic Oncology and Soft Tissue Sarcoma, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany.
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
| | - Carlos Duarte
- Department of Surgical Oncology, Instituto Nacional de Cancerología, Cl. 1 #9-85, Bogota, Colombia.
| | - Felipe González
- Department of Surgical Oncology, Instituto Nacional de Cancerología, Cl. 1 #9-85, Bogota, Colombia.
| | - Jan P Deroose
- Department of Surgical Oncology, Martini Ziekenhuis, Van Swietenplein 1, 9728 NT Groningen, the Netherlands.
| | - Marguerite Stas
- Department of Surgical Oncology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Veerle Boecxstaens
- Department of Surgical Oncology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Hayden Snow
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000. Australia.
| | - Salvador Martín Algarra
- Department of Medical Oncology, Clínica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain.
| | - Hector Martinez Said
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Dorian Yarih Garcia Ortega
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Karla Martin
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Jan Mattsson
- Department of Surgery, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Medicinaregatan 3, 413 90 Gothenburg, Sweden.
| | - Reza Djafarrian
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Giorgia Di Lorenzo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Maurice Matter
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Medicinaregatan 3, 413 90 Gothenburg, Sweden.
| | - Peter Hohenberger
- Division of Surgical Oncology, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Andrew J Hayes
- Department of Surgical Oncology, Royal Marsden Hospital, 203 Fulham Rd., SW3 6JJ London, UK.
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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Fitoussi O, Roche JB, Riviere J, Wallerand H, Poulain JE, Gordien P, Galland S, Henriques B, Dupin C, Vincent M, Kuratle T, Saffarini M, Ramos-Pascual S. Accuracy of FDG-PET/CT for Response Evaluation of Muscle-Invasive Bladder Cancer following Neoadjuvant or Induction Chemotherapy. Urol Int 2023; 107:239-245. [PMID: 36657430 DOI: 10.1159/000528524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of the study was to confirm the diagnostic accuracy of a second FDG-PET/CT following neoadjuvant or induction chemotherapy (NAIC) prior to radical cystectomy for patients with localized muscle-invasive bladder cancer (MIBC). METHODS Retrospective review of 62 consecutive patients with MIBC, that had a first FDG-PET/CT between April 2016 and September 2021. Patients then underwent NAIC, followed by a second FDG-PET/CT and radical cystectomy. Patients with no hypermetabolism in the bladder and lymph nodes on the second FDG-PET/CT were considered metabolic complete responders, while patients with no evidence of residual disease on histopathology were considered pathologic complete responders. The accuracy of the second FDG-PET/CT to distinguish complete responders from patients with residual disease was calculated, with histopathology as gold standard. RESULTS Of 62 patients, 1 was lost to follow-up, 5 died before radical cystectomy, 5 had delay >2 months between the second FDG-PET/CT and radical cystectomy, and 6 did not undergo radical cystectomy and instead underwent alternative treatment. The study cohort comprised 45 patients, 39 males and 6 females, with an age of 66 ± 6 years. In comparison to histopathology, FDG-PET/CT provided (i) sensitivity of 95% and specificity of 42%, for the overall disease; (ii) sensitivity of 100% and specificity of 36%, for the primary tumor only; and (iii) sensitivity of 97% and specificity of 30%, for the lymph nodes only. CONCLUSION FDG-PET/CT has over 95% sensitivity for distinguishing complete responders from patients with residual disease. Thus, FDG-PET/CT can be used for early response evaluation following NAIC to identify patients that did not completely respond to chemotherapy and may require alternative treatment pathways.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Camille Dupin
- Laboratoire de Cytologie et d'anatomie pathologique CAP, Le Bouscat, France
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肾癌免疫治疗疗效评估突变预测模型的建立. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54. [PMID: 35950389 DOI: 10.19723/j.issn.1671-167X.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To establish a mutation prediction model for efficacy assessment, the genomic sequencing data of renal cancer patients from the MSKCC (Memorial Sloan Kettering Cancer Center) pan-cancer immunotherapy cohort was used. METHODS The genomic sequencing data of 121 clear cell renal cell carcinoma patients treated with immune checkpoint inhibitors (ICI) in the MSKCC pan-cancer immunotherapy cohort were obtained from cBioPortal database (<a href="http://www.cbioportal.org/" target="_blank">http://www.cbioportal.org/</a>) and they were analyzed by univariate and multivariate Cox regression analysis to identify mutated genes associated with ICI treatment efficacy, and we constructed a comprehensive prediction model for drug efficacy of ICI based on mutated genes using nomogram. Survival analysis and time-dependent receiver operator characteristic curves were performed to assess the prognostic value of the model. Transcriptome and genomic sequencing data of 538 renal cell carcinoma patients were obtained from the TCGA database (<a href="https://portal.gdc.cancer.gov/" target="_blank">https://portal.gdc.cancer.gov/</a>). Gene set enrichment analysis was used to identify the potential functions of the mutated genes enrolled in the nomogram. RESULTS We used multivariate Cox regression analysis and identified mutations in PBRM1 and ARID1A were associated with treatment outcomes in the patients with renal cancer in the MSKCC pan-cancer immunotherapy cohort. Based on this, we established an efficacy prediction model including age, gender, treatment type, tumor mutational burden (TMB), PBRM1 and ARID1A mutation status (HR=4.33, 95%CI: 1.42-13.23, P=0.01, 1-year survival AUC=0.700, 2-year survival AUC=0.825, 3-year survival AUC=0.776). The validation (HR=2.72, 95%CI: 1.12-6.64, P=0.027, 1-year survival AUC=0.694, 2-year survival AUC=0.709, 3-year survival AUC=0.609) and combination (HR=2.20, 95%CI: 1.14-4.26, P=0.019, 1-year survival AUC=0.613, 2-year survival AUC=0.687, 3-year survival AUC=0.526) sets confirmed these results. Gene set enrichment analysis indicated that PBRM1 was involved in positive regulation of epithelial cell differentiation, regulation of the T cell differentiation and regulation of humoral immune response. In addition, ARID1A was involved in regulation of the T cell activation, positive regulation of T cell mediated cyto-toxicity and positive regulation of immune effector process. CONCLUSION PBRM1 and ARID1A mutations can be used as potential biomarkers for the evaluation of renal cancer immunotherapy efficacy. The efficacy prediction model established based on the mutation status of the above two genes can be used to screen renal cancer patients who are more suitable for ICI immunotherapy.
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Huang W, Li L, Liu S, Chen Y, Liu C, Han Y, Wang F, Zhan P, Zhao H, Li J, Gao J. Enhanced CT-based radiomics predicts pathological complete response after neoadjuvant chemotherapy for advanced adenocarcinoma of the esophagogastric junction: a two-center study. Insights Imaging 2022; 13:134. [PMID: 35976518 DOI: 10.1186/s13244-022-01273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aimed to develop and validate CT-based models to predict pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for advanced adenocarcinoma of the esophagogastric junction (AEG). Methods Pre-NAC clinical and imaging data of AEG patients who underwent surgical resection after preoperative-NAC at two centers were retrospectively collected from November 2014 to September 2020. The dataset included training (n = 60) and external validation groups (n = 32). Three models, including CT-based radiomics, clinical and radiomics–clinical combined models, were established to differentiate pCR (tumor regression grade (TRG) = grade 0) and nonpCR (TRG = grade 1–3) patients. For the radiomics model, tumor-region-based radiomics features in the arterial and venous phases were extracted and selected. The naïve Bayes classifier was used to establish arterial- and venous-phase radiomics models. The selected candidate clinical factors were used to establish a clinical model, which was further incorporated into the radiomics–clinical combined model. ROC analysis, calibration and decision curves were used to assess the model performance. Results For the radiomics model, the AUC values obtained using the venous data were higher than those obtained using the arterial data (training: 0.751 vs. 0.736; validation: 0.768 vs. 0.750). Borrmann typing, tumor thickness and degree of differentiation were utilized to establish the clinical model (AUC-training: 0.753; AUC-validation: 0.848). The combination of arterial- and venous-phase radiomics and clinical factors further improved the discriminatory performance of the model (AUC-training: 0.838; AUC-validation: 0.902). The decision curve reflects the higher net benefit of the combined model. Conclusion The combination of CT imaging and clinical factors pre-NAC for advanced AEG could help stratify potential responsiveness to NAC. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01273-w.
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Wang GY, Zhu QZ, Zhu HL, Jiang LJ, Zhao N, Liu ZK, Zhang FQ. Clinical performance evaluation of O-Ring Halcyon Linac: A real-world study. World J Clin Cases 2022; 10:7728-7737. [PMID: 36158510 PMCID: PMC9372831 DOI: 10.12998/wjcc.v10.i22.7728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiation therapy, especially the development of linear accelerators, plays a key role in cancer management. The fast-rotating coplanar O-ring Halcyon Linac has demonstrated many advantages. The previous literature has mainly focused on the machine parameters and plan quality of Halcyon, with a lack of relevant research on its clinical application.
AIM To evaluate the clinical performance of the O-ring Halcyon treatment system in a real-world application setting.
METHODS Data from sixty-one patients who were treated with the Halcyon system throughout the entire radiotherapy process in Peking Union Medical College Hospital between August 2019 and September 2020 were retrospectively reviewed. We evaluated the target tumour response to radiotherapy and irradiation toxicity from 1 to 3 mo after treatment. Dosimetric verification of Halcyon plans was performed using a quality assurance procedure, including portal dosimetry, ArcCHECK and point dose measurements for verification of the system delivery accuracy.
RESULTS Of the 61 patients in the five groups, 16, 12, 7 and 26 patients had complete response, partial response, progressive disease and stable disease, respectively. No increase in the irradiated target tumour volume was observed when separately evaluating the local response. Regarding irradiation toxicity, no radiation-induced deaths were observed. Thirty-eight percent (23/61 patients) had no radiation toxicity after radiotherapy, 56% (34/61 patients) experienced radiation toxicity that resolved after treatment, and 6% (4/61 patients) had irreversible adverse reactions. The average gamma passing rates with a 2% dose difference and 2-mm distance to agreement for IMRT/VMAT/SRT plans were ArcCHECK at 96.4% and portal dosimetry at 96.7%, respectively. All of the validated clinical plans were within 3% for point dose measurements, and Halcyon’s ArcCHECK demonstrated a high pass rate of 99.1% ± 1.1% for clinical gamma passing criteria of 3%/3 mm.
CONCLUSION The O-ring Halcyon Linac could achieve a better therapeutic effect on the target volume by providing accurate treatment delivery plans with tolerable irradiation toxicity.
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Affiliation(s)
- Guang-Yu Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi-Zhen Zhu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - He-Ling Zhu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ling-Juan Jiang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Nan Zhao
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Kai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Fu-Quan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Gafita A, Rauscher I, Fendler WP, Murthy V, Hui W, Armstrong WR, Herrmann K, Weber WA, Calais J, Eiber M, Weber M, Benz MR. Measuring response in metastatic castration-resistant prostate cancer using PSMA PET/CT: comparison of RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP 1.0 criteria. Eur J Nucl Med Mol Imaging 2022; 49:4271-4281. [PMID: 35767071 DOI: 10.1007/s00259-022-05882-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the adapted Prostate Cancer Working Group Criteria 3 (aPCWG3), the adapted Positron Emission Tomography Response Criteria in Solid Tumors (aPERCIST), the PSMA PET Progression (PPP), and the Response Evaluation Criteria In PSMA-Imaging (RECIP) 1.0 for response evaluation using prostate-specific membrane antigen (PSMA)-PET/CT in men with metastatic castration-resistant prostate cancer (mCRPC) treated with 177Lu-PSMA radioligand therapy. METHODS A total of 124 patients were included in this multicenter retrospective study. All patients received 177Lu-PSMA and underwent PSMA-PET/CT scans at baseline (bPET) and at 12 weeks (iPET). Imaging responses according to RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP 1.0 were interpreted by consensus among three blinded readers. Changes in total tumor burden were obtained using the semi-automatic qPSMA software. The response according to each criterion was classified to progressive disease (PD) vs no-PD. Primary outcome measure was the prognostic value (by Cox regression analysis) for overall survival (OS). Secondary outcome measure was the inter-reader reliability (by Cohen's κ coefficient). RESULTS A total of 43 (35%) of patients had non-measurable disease according to RECIST 1.1. Sixteen (13%), 66 (52%), 72 (58%), 69 (56%), and 39 (32%) of 124 patients had PD according to RECIST 1.1, aPCWG3, aPERCIST, PPP, and RECIP, respectively. PD vs no-PD had significantly higher risk of death according to aPCWG3 (HR = 2.37; 95%CI, 1.62-3.48; p < 0.001), aPERCIST (HR = 2.48; 95%CI, 1.68-3.66; p < 0.001), PPP (HR = 2.72; 95%CI, 1.85-4.01; p < 0.001), RECIP 1.0 (HR = 4.33; 95%CI, 2.80-6.70; p < 0.001), but not according to RECIST 1.1 (HR = 1.29; 95%CI, 0.73-2.27; p = 0.38). The κ index of RECIST 1.1, aPCWG3, aPERCIST 1.0, PPP, and RECIP 1.0 for identifying PD vs no-PD were 0.50 (95%CI, 0.32-0.76), 0.72 (95%CI, 0.63-0.82), 0.68 (95%CI, 0.63-0.73), 0.73 (95%CI, 0.63-0.83), and 0.83 (95%CI, 0.77-0.88), respectively. CONCLUSION PSMA-PET-specific criteria for early response evaluation in men with mCRPC treated with 177Lu-PSMA achieved higher prognostic values and inter-reader reliabilities in comparison to conventional CT assessment or to criteria adapted to PSMA-PET from other imaging modalities. RECIP 1.0 identified the fewest patients with PD and achieved the highest risk of death for PD vs. no-PD, suggesting that other classification methods tend to overcall progression. Prospective validation of our findings on an independent patient cohort is warranted.
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Affiliation(s)
- Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA. .,Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Vishnu Murthy
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Wang Hui
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Wesley R Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Matthias R Benz
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA.,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Díaz-Silván A, Otón-Sánchez LF, Caresia-Aróztegui AP, Del Puig Cózar-Santiago M, Orcajo-Rincón J, de Arcocha-Torres M, Delgado-Bolton RC, Cabello-García D. Clinical application of [ 18F]FDG PET/CT in follicular lymphoma. Rev Esp Med Nucl Imagen Mol 2022; 41:202-212. [PMID: 35490105 DOI: 10.1016/j.remnie.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
The objective of the present paper was to review the clinical application of [18F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it is characterized as indolent, this type of lymphoma usually shows a high [18F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up.
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Affiliation(s)
- A Díaz-Silván
- Programa de Doctorado en Ciencias de La Salud, Universidad de La Laguna (ULL), Santa Cruz de Tenerife, Islas Canarias, Spain; Servicio de Medicina Nuclear, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain.
| | - L F Otón-Sánchez
- Programa de Doctorado en Ciencias de La Salud, Universidad de La Laguna (ULL), Santa Cruz de Tenerife, Islas Canarias, Spain; Departamento de Medicina Física y Farmacología, Universidad de La Laguna (ULL), Santa Cruz de Tenerife, Islas Canarias, Spain; Servicio de Oncología Radioterápica, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Islas Canarias, Spain
| | - A P Caresia-Aróztegui
- Servicio de Medicina Nuclear, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Barcelona, Spain
| | | | - J Orcajo-Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M de Arcocha-Torres
- Unidad de Radiofarmacia, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - R C Delgado-Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - D Cabello-García
- Servicio de Medicina Nuclear, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain
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Gao J, Meng L, Xu Q, Zhao X, Deng Y, Fu Y, Guo S, He K, Shi J, Wang F, Zhang S, Guo H. 68Ga-PSMA-11 PET/CT Parameter Correlates with Pathological VEGFR-2/PDGFR-β Expression in Renal Cell Carcinoma Patients. Mol Imaging Biol 2022; 24:759-768. [PMID: 35451707 DOI: 10.1007/s11307-022-01725-1] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Response prediction is necessary for renal cell carcinoma (RCC) tumors. We aim to evaluate parameters derived from 68 Ga-PSMA-11 PET/CT images for prediction of pathological VEGFR-2/PDGFR-β expression of primary RCC tumors. METHODS Forty-eight RCC patients were retrospectively enrolled with preoperative 68 Ga-PSMA-11 PET/CT scan and surgical specimen. Radiological parameters including tumor diameter, mean CT value, and maximal standard uptake value (SUVmax) were derived from PET/CT images and pathological VEGFR-2/PDGFR-β/PSMA expression were identified with immunohistochemistry. Mann-Whitney U test was performed for continuous variables and the chi-square test for categorical variables. ROC was used for determining the effectiveness of preoperative parameters in differentiating VEGFR-2/PDGFR-β expression. Univariate and multivariate logistic regression analyses were performed for significant parameters to predict VEGFR-2 & PDGFR-β co-expression. RESULTS Of the 48 tumors, 25 (52.1%) harbored positive VEGFR-2 expression, 28 (58.3%) harbored positive PDGFR-β expression, and 24 (50%) were both VEGFR-2 positive and PDGFR-β positive. SUVmax significantly differed by subgroups of VEGFR-2/PDGFR-β expression (both P < 0.001). SUVmax demonstrated superior performance for differentiating VEGFR-2 & PDGFR-β co-expression (positive vs. negative), with area under the curve 0.87 (95% CI 0.78-0.96, P < 0.001), sensitivity 93% and specificity 78%. Moreover, SUVmax was identified as the significant predictor for VEGFR-2 & PDGFR-β co-expression (odds ratio 4.01, 95% CI 1.99-8.08, P < 0.001). Concordant with radiological findings with 68 Ga-PSMA-11 PET/CT, pathological PSMA staining intensity was significantly higher in both VEGFR-2-positive tumor and PDGFR-β-positive tumor (P = 0.009 and P < 0.001, respectively). CONCLUSION 68 Ga-PSMA-11 PET/CT could effectively identify pathological VEGFR-2/PDGFR-β expression of primary RCC tumors, which may help with selection of mRCC patients suitable for TKIs treatment.
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Affiliation(s)
- Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Longxiyu Meng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Qinfeng Xu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiaozhi Zhao
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Yongming Deng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Yao Fu
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Suhan Guo
- School of Artificial Intelligence, Nanjing University, Jiangsu, China
| | - Kuiqiang He
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
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Kubihal V, Sharma R, Krishna Kumar R, Chandrashekhara S, Garg R. Imaging update in spinal tuberculosis. J Clin Orthop Trauma 2022; 25:101742. [PMID: 34956831 PMCID: PMC8671643 DOI: 10.1016/j.jcot.2021.101742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis is ancient disease known to mankind. Diagnosis and management of spinal tuberculosis has immensely improved in last few decades. Imaging, particularly MRI, plays important role in diagnosis of spinal tuberculosis and its complications. Four common imaging patterns of spinal tuberculosis include paradiscal type, central type, Anterior subligamentous type, and posterior type. Imaging also plays important role in differentiation of spinal tuberculosis from its mimics, particularly pyogenic spondylitis, and metastasis. Radiological interventions, such as CT guided vertebral biopsy, and percutaneous drainage of cold abscess, are commonly used in management of spinal tuberculosis. Monitoring of therapeutic response is often based on clinical evaluation and imaging. MRI is most common imaging modality used. Signs of healing include bony ankylosis, resolution of marrow edema, decrease in contrast enhancement, and fatty change with in bone marrow. PET CT is recently evaluated for response assessment with promising results. This review summarizes pathophysiology, clinical presentation, imaging features, radiological interventions, and response assessment in spinal tuberculosis.
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Affiliation(s)
- Vijay Kubihal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R.G. Krishna Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S.H. Chandrashekhara
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Corresponding author. Department of Radiodiagnosis, IRCH All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Rakesh Garg
- Department of Onco-anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Gosmann D, Russelli L, Weber WA, Schwaiger M, Krackhardt AM, D'Alessandria C. Promise and challenges of clinical non-invasive T-cell tracking in the era of cancer immunotherapy. EJNMMI Res 2022; 12:5. [PMID: 35099641 PMCID: PMC8804060 DOI: 10.1186/s13550-022-00877-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
In the last decades, our understanding of the role of the immune system in cancer has significantly improved and led to the discovery of new immunotherapeutic targets and tools, which boosted the advances in cancer immunotherapy to fight a growing number of malignancies. Approved immunotherapeutic approaches are currently mainly based on immune checkpoint inhibitors, antibody-derived targeted therapies, or cell-based immunotherapies. In essence, these therapies induce or enhance the infiltration and function of tumor-reactive T cells within the tumors, ideally resulting in complete tumor eradication. While the clinical application of immunotherapies has shown great promise, these therapies are often accompanied either by a variety of side effects as well as partial or complete unresponsiveness of a number of patients. Since different stages of disease progression elicit different local and systemic immune responses, the ability to longitudinally interrogate the migration and expansion of immune cells, especially T cells, throughout the whole body might greatly facilitate disease characterization and understanding. Furthermore, it can serve as a tool to guide development as well as selection of appropriate treatment regiments. This review provides an overview about a variety of immune-imaging tools available to characterize and study T-cell responses induced by anti-cancer immunotherapy. Moreover, challenges are discussed that must be taken into account and overcome to use immune-imaging tools as predictive and surrogate markers to enhance assessment and successful application of immunotherapies.
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Affiliation(s)
- Dario Gosmann
- Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lisa Russelli
- Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Wolfgang A Weber
- Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Angela M Krackhardt
- Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. .,German Cancer Consortium (DKTK), Partner-Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Calogero D'Alessandria
- Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Song Q, Chen P, Chen X, Sun C, Wang J, Tan B, Liu H, Cheng Y. Dynamic Change of Amide Proton Transfer Imaging in Irradiated Nasopharyngeal Carcinoma and Related Histopathological Mechanism. Mol Imaging Biol 2021; 23:846-853. [PMID: 33876335 DOI: 10.1007/s11307-021-01607-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the dynamic change of amide proton transfer (APT) imaging before and after irradiation in nasopharyngeal carcinoma (NPC) and the underlying histopathological mechanism. MATERIALS AND METHODS Tumor-bearing BALB/C nude mouse models were established and randomly divided into three groups: high-dose group (20 Gy/2 fractions), low-dose group (10 Gy/2 fractions), and control group (0 Gy). MRI scanning was performed before irradiation and 3rd, 6th, and 9th day post-irradiation. Scanning sequence included T1 weighted, T2 weighted, and APT. HE staining and TUNEL immunofluorescence detection were performed to detect necrosis and apoptosis. RESULTS After high-dose irradiation, the mean tumor APT values decreased significantly on the 3rd day and 6th day (from 3.83 before radiotherapy to 2.41%, P < 0.001, 3rd day; from 2.41 to 1.80%, P = 0.001, 6th day). For low-dose irradiation, the mean tumor APT values decreased slightly on the 3rd day and 6th day (from 3.52 to 3.13%, P = 0.109, 3rd day; from 3.13 to 3.05%, P = 0.64, 6th day). The mean APT values of nonirradiated tumor changed slightly. In contrast, the average volume of high-dose irradiated tumors did not decrease obviously until the 9th day post-irradiation (from 290 before radiotherapy to 208 mm3 on the 9th day). The low-dose irradiated tumors showed slow growth, and the nonirradiated tumors showed rapid growth. Subsequent HE staining and TUNEL staining showed obvious necrosis characteristics and higher proportion of positive apoptotic cell nucleus in high-dose irradiated tumors, but not nonirradiated tumors. CONCLUSION The APT signal intensity decreased after irradiation, which is earlier than the change of tumor volume. What is more, the decrease of APT signal intensity is more significant in high-dose group. Histological analysis showed obvious apoptosis and necrosis histological characteristic in irradiated tumor, which may explain the decrease of APT signal intensity. These results indicate that APT imaging has the potential to serve as a reliable biomarker for response assessment in NPC.
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Affiliation(s)
- Qingxu Song
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xin Chen
- Department of MR, Shandong Medical Imaging Research Institute, Jinan, Shandong, People's Republic of China
| | - Cong Sun
- Department of MR, Shandong Medical Imaging Research Institute, Jinan, Shandong, People's Republic of China
| | - Jianbo Wang
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Bingxu Tan
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Hong Liu
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Haak HE, Gao X, Maas M, Waktola S, Benson S, Beets-Tan RGH, Beets GL, van Leerdam M, Melenhorst J. The use of deep learning on endoscopic images to assess the response of rectal cancer after chemoradiation. Surg Endosc 2021; 36:3592-3600. [PMID: 34642794 PMCID: PMC9001548 DOI: 10.1007/s00464-021-08685-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/07/2021] [Indexed: 12/30/2022]
Abstract
Background Accurate response evaluation is necessary to select complete responders (CRs) for a watch-and-wait approach. Deep learning may aid in this process, but so far has never been evaluated for this purpose. The aim was to evaluate the accuracy to assess response with deep learning methods based on endoscopic images in rectal cancer patients after neoadjuvant therapy. Methods Rectal cancer patients diagnosed between January 2012 and December 2015 and treated with neoadjuvant (chemo)radiotherapy were retrospectively selected from a single institute. All patients underwent flexible endoscopy for response evaluation. Diagnostic performance (accuracy, area under the receiver operator characteristics curve (AUC), positive- and negative predictive values, sensitivities and specificities) of different open accessible deep learning networks was calculated. Reference standard was histology after surgery, or long-term outcome (>2 years of follow-up) in a watch-and-wait policy. Results 226 patients were included for the study (117(52%) were non-CRs; 109(48%) were CRs). The accuracy, AUC, positive- and negative predictive values, sensitivity and specificity of the different models varied from 0.67–0.75%, 0.76–0.83%, 67–74%, 70–78%, 68–79% to 66–75%, respectively. Overall, EfficientNet-B2 was the most successful model with the highest diagnostic performance. Conclusions This pilot study shows that deep learning has a modest accuracy (AUCs 0.76-0.83). This is not accurate enough for clinical decision making, and lower than what is generally reported by experienced endoscopists. Deep learning models can however be further improved and may become useful to assist endoscopists in evaluating the response. More well-designed prospective studies are required. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08685-7.
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Affiliation(s)
- Hester E Haak
- Department of Surgery, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology-Maastricht University, Maastricht, The Netherlands
| | - Xinpei Gao
- Department of Radiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Selam Waktola
- Department of Radiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Sean Benson
- Department of Radiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology-Maastricht University, Maastricht, The Netherlands.,Department of Radiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology-Maastricht University, Maastricht, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jarno Melenhorst
- GROW School for Oncology and Developmental Biology-Maastricht University, Maastricht, The Netherlands. .,Department of Surgery, Maastricht University Medical Centre, Postbox 5800, 6202 AZ, Maastricht, The Netherlands.
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Sandø AD, Fougner R, Grønbech JE, Bringeland EA. The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study. World J Surg Oncol 2021; 19:212. [PMID: 34256790 PMCID: PMC8278640 DOI: 10.1186/s12957-021-02313-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. Methods Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. Results Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004–0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. Conclusions Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.
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Affiliation(s)
- Alina Desiree Sandø
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway. .,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Reidun Fougner
- Department of Radiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Erik Grønbech
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Audun Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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20
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van de Stadt EA, Yaqub M, Lammertsma AA, Poot AJ, Schuit RC, Remmelzwaal S, Schwarte LA, Smit EF, Hendrikse H, Bahce I. Identifying advanced stage NSCLC patients who benefit from afatinib therapy using 18F-afatinib PET/CT imaging. Lung Cancer 2021. [PMID: 33836373 DOI: 10.1016/j.lungcan.2021.03.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) tumors harboring common (exon19del, L858R) and uncommon (e.g. G719X, L861Q) activating epidermal growth factor receptor (EGFR) mutations are best treated with EGFR tyrosine kinase inhibitors (TKI) such as the first-generation EGFR TKI erlotinib, second-generation afatinib or third-generation osimertinib. However, identifying these patients through biopsy is not always possible. Therefore, our aim was to evaluate whether 18F-afatinib PET/CT could identify patients with common and uncommon EGFR mutations. Furthermore, we evaluated the relation between tumor 18F-afatinib uptake and response to afatinib therapy. MATERIALS AND METHODS 18F-afatinib PET/CT was performed in 12 patients: 6 EGFR wild type (WT), 3 EGFR common and 3 EGFR uncommon mutations. Tumor uptake of 18F-afatinib was quantified using TBR_WB60-90 (tumor-to-whole blood activity ratio 60-90 min post-injection) for each tumor. Response was quantified per lesion using percentage of change (PC): [(response measurement (RM)-baseline measurement (BM))/BM]×100. Statistical analyses were performed using t-tests, correlation plots and sensitivity/specificity analysis. RESULTS Twenty-one tumors were identified. Injected dose was 348 ± 31 MBq. Group differences were significant between WT versus EGFR (common and uncommon) activating mutations (p = 0.03). There was no significant difference between EGFR common versus uncommon mutations (p = 0.94). A TBR_WB60-90 cut-off value of 6 showed the best relationship with response with a sensitivity of 70 %, a specificity of 100 % and a positive predictive value of 100 %. CONCLUSION 18F-afatinib uptake was higher in tumors with EGFR mutations (common and uncommon) compared to WT. Furthermore, a TBR_WB60-90 cut-off of 6 was found to best predict response to therapy. 18F-afatinib PET/CT could provide a means to identify EGFR mutation positive patients who benefit from afatinib therapy.
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Affiliation(s)
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Alex J Poot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Sharon Remmelzwaal
- Department of Epidemiology and Data Science, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Lothar A Schwarte
- Department of Anesthesiology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Egbert F Smit
- Department of Pulmonology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harry Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands; Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
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21
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van de Stadt EA, Yaqub M, Lammertsma AA, Poot AJ, Schuit RC, Remmelzwaal S, Schwarte LA, Smit EF, Hendrikse H, Bahce I. Identifying advanced stage NSCLC patients who benefit from afatinib therapy using 18F-afatinib PET/CT imaging. Lung Cancer 2021; 155:156-162. [PMID: 33836373 DOI: 10.1016/j.lungcan.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) tumors harboring common (exon19del, L858R) and uncommon (e.g. G719X, L861Q) activating epidermal growth factor receptor (EGFR) mutations are best treated with EGFR tyrosine kinase inhibitors (TKI) such as the first-generation EGFR TKI erlotinib, second-generation afatinib or third-generation osimertinib. However, identifying these patients through biopsy is not always possible. Therefore, our aim was to evaluate whether 18F-afatinib PET/CT could identify patients with common and uncommon EGFR mutations. Furthermore, we evaluated the relation between tumor 18F-afatinib uptake and response to afatinib therapy. MATERIALS AND METHODS 18F-afatinib PET/CT was performed in 12 patients: 6 EGFR wild type (WT), 3 EGFR common and 3 EGFR uncommon mutations. Tumor uptake of 18F-afatinib was quantified using TBR_WB60-90 (tumor-to-whole blood activity ratio 60-90 min post-injection) for each tumor. Response was quantified per lesion using percentage of change (PC): [(response measurement (RM)-baseline measurement (BM))/BM]×100. Statistical analyses were performed using t-tests, correlation plots and sensitivity/specificity analysis. RESULTS Twenty-one tumors were identified. Injected dose was 348 ± 31 MBq. Group differences were significant between WT versus EGFR (common and uncommon) activating mutations (p = 0.03). There was no significant difference between EGFR common versus uncommon mutations (p = 0.94). A TBR_WB60-90 cut-off value of 6 showed the best relationship with response with a sensitivity of 70 %, a specificity of 100 % and a positive predictive value of 100 %. CONCLUSION 18F-afatinib uptake was higher in tumors with EGFR mutations (common and uncommon) compared to WT. Furthermore, a TBR_WB60-90 cut-off of 6 was found to best predict response to therapy. 18F-afatinib PET/CT could provide a means to identify EGFR mutation positive patients who benefit from afatinib therapy.
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Affiliation(s)
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Alex J Poot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Sharon Remmelzwaal
- Department of Epidemiology and Data Science, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Lothar A Schwarte
- Department of Anesthesiology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Egbert F Smit
- Department of Pulmonology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harry Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, the Netherlands; Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
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Shang J, Tan Z, Cheng Y, Tang Y, Guo B, Gong J, Ling X, Wang L, Xu H. A method for evaluation of patient-specific lean body mass from limited-coverage CT images and its application in PERCIST: comparison with predictive equation. EJNMMI Phys 2021; 8:12. [PMID: 33555478 PMCID: PMC7870732 DOI: 10.1186/s40658-021-00358-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 01/28/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is recommended as metric by PERCIST 1.0. The James predictive equation (PE) is a frequently used formula for LBM estimation, but may cause substantial error for an individual. The purpose of this study was to introduce a novel and reliable method for estimating LBM by limited-coverage (LC) CT images from PET/CT examinations and test its validity, then to analyse whether SUV normalised by LC-based LBM could change the PERCIST 1.0 response classifications, based on LBM estimated by the James PE. METHODS First, 199 patients who received whole-body PET/CT examinations were retrospectively retrieved. A patient-specific LBM equation was developed based on the relationship between LC fat volumes (FVLC) and whole-body fat mass (FMWB). This equation was cross-validated with an independent sample of 97 patients who also received whole-body PET/CT examinations. Its results were compared with the measurement of LBM from whole-body CT (reference standard) and the results of the James PE. Then, 241 patients with solid tumours who underwent PET/CT examinations before and after treatment were retrospectively retrieved. The treatment responses were evaluated according to the PE-based and LC-based PERCIST 1.0. Concordance between them was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. The impact of differing LBM algorithms on PERCIST 1.0 classification was evaluated. RESULTS The FVLC were significantly correlated with the FMWB (r=0.977). Furthermore, the results of LBM measurement evaluated with LC images were much closer to the reference standard than those obtained by the James PE. The PE-based and LC-based PERCIST 1.0 classifications were discordant in 27 patients (11.2%; κ = 0.823, P=0.837). These discordant patients' percentage changes of peak SUL (SULpeak) were all in the interval above or below 10% from the threshold (±30%), accounting for 43.5% (27/62) of total patients in this region. The degree of variability is related to changes in LBM before and after treatment. CONCLUSIONS LBM algorithm-dependent variability in PERCIST 1.0 classification is a notable issue. SUV normalised by LC-based LBM could change PERCIST 1.0 response classifications based on LBM estimated by the James PE, especially for patients with a percentage variation of SULpeak close to the threshold.
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Affiliation(s)
- Jingjie Shang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Zhiqiang Tan
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Yong Cheng
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Yongjin Tang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Bin Guo
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Jian Gong
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Xueying Ling
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Lu Wang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Hao Xu
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China.
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Abstract
Positron emission tomography/x-ray computed tomography (PET/CT) has long been discussed as a promising modality for response evaluation in cancer. When designing respective clinical trials, several design issues have to be addressed, especially the number/timing of PET/CT scans, the approach for quantifying metabolic activity, and the final translation of measurements into a rule. It is unclear how well these issues have been tackled in quest of an optimised use of PET/CT in response evaluation. Medline via Ovid and Science Citation Index via Web of Science were systematically searched for articles from 2015 on cancer patients scanned with PET/CT before and during/after treatment. Reports were categorised as being either developmental or evaluative, i.e. focusing on either the establishment or the evaluation of a rule discriminating responders from non-responders. Of 124 included papers, 112 (90 %) were accuracy and/or prognostic studies; the remainder were response-curve studies. No randomised controlled trials were found. Most studies were prospective (62 %) and from single centres (85 %); median number of patients was 38.5 (range 5-354). Most (69 %) of the studies employed only one post-baseline scan. Quantification was mainly based on SUVmax (91 %), while change over time was most frequently used to combine measurements into a rule (79 %). Half of the reports were categorised as developmental, the other half evaluative. Most development studies assessed only one element (35/62, 56 %), most frequently the choice of cut-off points (25/62, 40 %). In summary, the majority of studies did not address the essential open issues in establishing PET/CT for response evaluation. Reasonably sized multicentre studies are needed to systematically compare the many different options when using PET/CT for response evaluation.
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Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Karen Ehlers
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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Zhang K, Dai Z, Liu S, Li D, Yang D, Cui S. [Clinical Value of Cerebrospinal Fluid ctDNA in Patients
with Non-small Cell Lung Cancer Meningeal Metastasis]. Zhongguo Fei Ai Za Zhi 2020; 23:1039-1048. [PMID: 33357310 PMCID: PMC7786234 DOI: 10.3779/j.issn.1009-3419.2020.102.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
背景与目的 肺癌脑膜转移病死率极高。循环肿瘤DNA(circulating tumor DNA, ctDNA)已被证实含有肿瘤的基因组改变信息,并已被用于监测肿瘤的进展和对治疗的响应。对于存在脑膜转移瘤的患者,由于血脑屏障等因素的存在,外周血ctDNA不能反映脑部病灶的信息,此时脑脊液ctDNA作为检测样本能更好地体现颅内肿瘤的基因状态,指导临床对颅内病灶的靶向治疗。本研究旨在探究脑脊液ctNDA用于监测非小细胞肺癌(non-small cell lung cancer, NSCLC)脑膜转移的可行性以及脑脊液ctDNA检测对NSCLC脑膜转移的临床价值。 方法 入组NSCLC脑膜转移患者21例,通过二代基因测序技术对患者的脑脊液及外周血样本进行基因检测,并进行脑脊液细胞学病理学检测和头颅核磁共振增强检查。 结果 入组21例患者脑脊液中均检测到ctDNA。脑脊液ctDNA检测的灵敏性在脑膜转移诊断方面优于细胞学(P < 0.001)。脑脊液的基因突变检出率及基因突变丰度均高于血浆(P < 0.001)。脑脊液具有独特的基因谱。6例动态检测的患者中,脑脊液中ctDNA丰度变化均同时或早于临床疾病变化出现,可及时揭示耐药机制和监测复发趋势。 结论 脑脊液ctDNA检出率高于细胞学及影像学;脑脊液ctDNA检测可展现脑膜转移病灶特有的突变图谱;脑脊液ctDNA动态监测对肺癌患者临床疗效具有提示意义。
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Affiliation(s)
- Kunyu Zhang
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Zhaoxia Dai
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Siya Liu
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Dan Li
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Dafu Yang
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Saiqiong Cui
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
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Rhee H, Park MS. The Role of Imaging in Current Treatment Strategies for Pancreatic Adenocarcinoma. Korean J Radiol 2020; 22:23-40. [PMID: 32901458 PMCID: PMC7772381 DOI: 10.3348/kjr.2019.0862] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
In pancreatic cancer, imaging plays an essential role in surveillance, diagnosis, resectability evaluation, and treatment response evaluation. Pancreatic cancer surveillance in high-risk individuals has been attempted using endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI). Imaging diagnosis and resectability evaluation are the most important factors influencing treatment decisions, where computed tomography (CT) is the preferred modality. EUS, MRI, and positron emission tomography play a complementary role to CT. Treatment response evaluation is of increasing clinical importance, especially in patients undergoing neoadjuvant therapy. This review aimed to comprehensively review the role of imaging in relation to the current treatment strategy for pancreatic cancer, including surveillance, diagnosis, evaluation of resectability and treatment response, and prediction of prognosis.
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Affiliation(s)
- Hyungjin Rhee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Christensen TN, Langer SW, Villumsen KE, Johannesen HH, Löfgren J, Keller SH, Hansen AE, Kjaer A, Fischer BM. 18F-fluorothymidine (FLT)-PET and diffusion-weighted MRI for early response evaluation in patients with small cell lung cancer: a pilot study. Eur J Hybrid Imaging 2020; 4:2. [PMID: 34191195 PMCID: PMC8218141 DOI: 10.1186/s41824-019-0071-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is an aggressive cancer often presenting in an advanced stage and prognosis is poor. Early response evaluation may have impact on the treatment strategy. Aim We evaluated 18F-fluorothymidine-(FLT)-PET/diffusion-weighted-(DW)-MRI early after treatment start to describe biological changes during therapy, the potential of early response evaluation, and the added value of FLT-PET/DW-MRI. Methods Patients with SCLC referred for standard chemotherapy were eligible. FLT-PET/DW-MRI of the chest and brain was acquired within 14 days after treatment start. FLT-PET/DW-MRI was compared with pretreatment FDG-PET/CT. Standardized uptake value (SUV), apparent diffusion coefficient (ADC), and functional tumor volumes were measured. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian; spatial distribution of aggressive areas; and voxel-by-voxel analyses were evaluated to compare the biological information derived from the three functional imaging modalities. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian were also analyzed for ability to predict final treatment response. Results Twelve patients with SCLC completed FLT-PET/MRI 1–9 days after treatment start. In nine patients, pretreatment FDG-PET/CT was available for comparison. A total of 16 T-sites and 12 N-sites were identified. No brain metastases were detected. FDG-SUVpeak was 2.0–22.7 in T-sites and 5.5–17.3 in N-sites. FLT-SUVpeak was 0.6–11.5 in T-sites and 1.2–2.4 in N-sites. ADCmedian was 0.76–1.74 × 10− 3 mm2/s in T-sites and 0.88–2.09 × 10−3 mm2/s in N-sites. FLT-SUVpeak correlated with FDG-SUVpeak, and voxel-by-voxel correlation was positive, though the hottest regions were dissimilarly distributed in FLT-PET compared to FDG-PET. FLT-SUVpeak was not correlated with ADCmedian, and voxel-by-voxel analyses and spatial distribution of aggressive areas varied with no systematic relation. LT-SUVpeak was significantly lower in responding lesions than non-responding lesions (mean FLT-SUVpeak in T-sites: 1.5 vs. 5.7; p = 0.007, mean FLT-SUVpeak in N-sites: 1.6 vs. 2.2; p = 0.013). Conclusions FLT-PET and DW-MRI performed early after treatment start may add biological information in patients with SCLC. Proliferation early after treatment start measured by FLT-PET is a promising predictor for final treatment response that warrants further investigation. Trial registration Clinicaltrials.gov, NCT02995902. Registered 11 December 2014 - Retrospectively registered.
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Affiliation(s)
- Tine Nøhr Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark.
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Engholm Villumsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Sune Høgild Keller
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Adam Espe Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,PET Centre, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
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Abstract
Background iRECIST for the objective monitoring of immunotherapies was published by the official RECIST working group in 2017. Main body Immune-checkpoint inhibitors represent one of the most important therapy advancements in modern oncology. They are currently used for treatment of multiple malignant diseases especially at advanced, metastatic stages which were poorly therapeutically accessible in the past. Promising results of recent studies suggest that their application will further grow in the near future, particularly when used in combination with chemotherapy. A challenging aspect of these immunotherapies is that they may show atypical therapy response patterns such as pseudoprogression and demonstrate a different imaging spectrum of adverse reactions, both of which are crucial for radiologists to understand. In 2017 the RECIST working group published a modified set of response criteria, iRECIST, for immunotherapy, based on RECIST 1.1 which was developed for cytotoxic therapies and adapted for targeted agents. Conclusion This article provides guidance for response assessment of oncologic patients under immunotherapy based on iRECIST criteria.
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Affiliation(s)
- Thorsten Persigehl
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Lawrence H Schwartz
- Department of Radiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Belmouhand M, Löfgren J, Johannesen HH, Baeksgaard L, Gutte H, Tariq K, Achiam MP. Early response evaluation of neoadjuvant therapy with PET/MRI to predict resectability in patients with adenocarcinoma of the esophagogastric junction. Abdom Radiol (NY) 2019; 44:836-44. [PMID: 30467723 DOI: 10.1007/s00261-018-1841-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN AND PURPOSE Positron emission tomography (PET)/magnetic resonance imaging (MRI) is a new modality that has showed promising results for various clinical indications. Currently, evaluation of neoadjuvant therapy (NT) among patients with adenocarcinoma of the esophagogastric junction has primarily been reserved for PET/computed tomography. Our aim was to evaluate if early response evaluation by PET/MRI is a feasible method to predict resectability. METHODS AND MATERIALS Patients with untreated adenocarcinoma of the esophagogastric junction (Siewert types I/II) and fit for NT with no contraindications for PET/MRI were considered eligible. A baseline scan was performed prior to NT induction and an evaluation scan 3 weeks later. For histopathological response evaluation, the Mandard tumor regression grade score was applied. Response on PET/MRI was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and change in ADC and SUVmax values. RESULTS Twenty-eight patients were enrolled, and 22 completed both scans and proceeded to final analyses. Seventeen patients were found resectable versus five who were found unresectable. PET/MRI response evaluation had a sensitivity 94%, specificity 80%, and AUC = 0.95 when predicting resectability in patients with adenocarcinoma of the esophagogastric junction. No association with histopathological response (tumor regression grade) was found nor was RECIST correlated with resectability. CONCLUSION Response evaluation using PET/MRI was a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction in this pilot study. However, larger studies are warranted to justify the use of the modality for this indication.
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Eyck BM, van der Wilk BJ, Lagarde SM, Wijnhoven BPL, Valkema R, Spaander MCW, Nuyttens JJME, van der Gaast A, van Lanschot JJB. Neoadjuvant chemoradiotherapy for resectable oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:37-44. [PMID: 30551855 DOI: 10.1016/j.bpg.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
At present, treatment of potentially curable oesophageal cancer includes neoadjuvant chemoradiotherapy followed by oesophagectomy. Alternatively, neoadjuvant chemotherapy is used. To date, strong evidence on the superiority of one modality over the other has not been provided. Currently, up to one-third of patients show a pathologically complete response after neoadjuvant chemoradiotherapy. To optimise the efficacy of neoadjuvant treatment for individual patients, prediction of response to neoadjuvant treatment is highly desired. Therefore, several clinical diagnostic modalities have been investigated for early response evaluation, of which positron emission tomography (PET) has been studied most extensively. To identify patients who might benefit from postponing or even omitting surgery, recent advances have been made in evaluating response after completion of neoadjuvant chemoradiotherapy. This review provides an overview of current evidence and recent advances in neoadjuvant chemoradiotherapy for oesophageal cancer and discusses the use of neoadjuvant chemotherapy compared to chemoradiotherapy. Moreover, clinical response evaluation to neoadjuvant chemoradiotherapy is reviewed.
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Affiliation(s)
- B M Eyck
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands.
| | - B J van der Wilk
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - R Valkema
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - M C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - J J M E Nuyttens
- Department of Radiotherapy, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - A van der Gaast
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Dr. Molenwaterplein 40, 3000 CA, Rotterdam, the Netherlands
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Kim HJ, Lee R, Choi H, Paeng JC, Cheon GJ, Lee DS, Chung JK, Kang KW. Application of Quantitative Indexes of FDG PET to Treatment Response Evaluation in Indolent Lymphoma. Nucl Med Mol Imaging 2018; 52:342-349. [PMID: 30344782 DOI: 10.1007/s13139-018-0543-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose Although 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a standard imaging modality for response evaluation in FDG-avid lymphoma, there is a controversy using FDG PET in indolent lymphoma. The purpose of this study was to investigate the effectiveness of quantitative indexes on FDG PET in response evaluation of the indolent lymphoma. Methods Fifty-seven indolent lymphoma patients who completed chemotherapy were retrospectively enrolled. FDG PET/computed tomography (CT) scans were performed at baseline, interim, and end of treatment (EOT). Response was determined by Lugano classification, and progression-free survival (PFS) by follow-up data. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured in the single hottest lesion (target A) or five hottest lesions (target B). Their efficacies regarding response evaluation and PFS prediction were evaluated. Results On EOT PET, SUVmax, and MTV of both targets were well associated with visual analysis. Changes between initial and EOT PET were not significantly different between CR and non-CR groups. On interim PET, SUVmax, and %ΔSUVmax in both targets were significantly different between CR and non-CR groups. For prediction of PFS, most tested indexes were significant on EOT and interim PET, with SUVmax being the most significant prognostic factor. Conclusion Quantitative indexes of FDG PET are well associated with Lugano classification in indolent lymphoma. SUVmax measured in the single hottest lesion can be effective in response evaluation and prognosis prediction on interim and EOT PET.
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Affiliation(s)
- Hyun Joo Kim
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Reeree Lee
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
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Tang L, Li J, Li ZY, Li XT, Gong JF, Ji JF, Sun YS, Shen L. MRI in predicting the response of gastrointestinal stromal tumor to targeted therapy: a patient-based multi-parameter study. BMC Cancer 2018; 18:811. [PMID: 30103713 PMCID: PMC6088415 DOI: 10.1186/s12885-018-4606-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background To investigate the performance of quantitative indicators of MRI in early prediction of the response of gastrointestinal stromal tumor (GIST) to targeted therapy in a patient-based study. Methods MRI examinations were performed on 62 patients with GIST using 1.5 T scanners before and at two and 12 weeks after treatment with targeted agents. The longest diameter (LD) and contrast-to-noise ratio (CNR) of the tumors were measured by T2-weighted imaging (T2WI), and the apparent diffusion coefficient (ADC) was determined using diffusion-weighted imaging (DWI). The pre-therapy and early percentage changes (%Δ) of the three parameters were compared with regard to their abilities to differentiate responder and non- responder patients, using ROC curves. Results There were 42 patients in responder and 20 in non-responder group. After two weeks of therapy, the percentage changes in the ADC and LD were significantly different between the two groups (ADC: responder 30% vs. non- responder 1%, Z = − 4.819, P < 0.001; LD: responder − 7% vs. non- responder − 2%, Z = − 3.238, P = 0.001), but not in T2WI-CNR (responder − 3% vs. non-responder 9%, Z = − 0.663, P = 0.508). The AUCs on ROC for %ΔLD, %ΔT2WI-CNR and %ΔADC after two weeks of therapy were 0.756, 0.552 and 0.881, respectively, for response differentiation. When %ΔADC ≥15% was used to predict responder, the PPV was 93.3%. Conclusions The percentage change of the ADC after two weeks of therapy outperformed T2WI-CNR and longest diameter in predicting the early response of GIST to targeted therapy.
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Affiliation(s)
- Lei Tang
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No. 52Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Jian Li
- Department of Gastroenterology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No.52 Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No.52Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No. 52Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Ji-Fang Gong
- Department of Gastroenterology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No.52 Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No.52Fu Cheng Road, HaiDian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No. 52Fu Cheng Road, HaiDian District, Beijing, 100142, China.
| | - Lin Shen
- Department of Gastroenterology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), No.52 Fu Cheng Road, HaiDian District, Beijing, 100142, China.
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van Egdom LSE, Lagendijk M, Heijkoop EHM, Koning AHJ, van Deurzen CHM, Jager A, van Lankeren W, Koppert LB. Three-dimensional ultrasonography of the breast; An adequate replacement for MRI in neoadjuvant chemotherapy tumour response evaluation? - RESPONDER trial. Eur J Radiol 2018; 104:94-100. [PMID: 29857873 DOI: 10.1016/j.ejrad.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Accurate measurement of tumour response during and after neoadjuvant chemotherapy (NAC) is important and may influence treatment decisions in invasive breast cancer patients. Breast MRI forms the gold standard but is more burdensome, time consuming and costly. In this study response measurement was done with 3-D ultrasound by Automated Breast Volume Scanner (ABVS) and compared to breast MRI. Moreover, patient satisfaction with both techniques was compared. METHODS AND MATERIALS A single-institution, prospective observational pilot study evaluating tumour response by ABVS in addition to breast MRI (standard care) was performed in 25 invasive breast cancer patients receiving NAC. Tumour response was evaluated comparing longest tumour diameters as well as tumour volumes at predefined time points using Bland-Altman analysis. Volume measurements for breast MRI were obtained using a fully immersive virtual reality system (a Barco I-Space) and V-Scope software. Same software was used to obtain ABVS volume measurements using an in-house developed desktop VR system. Inter- and intra-observer agreement was evaluated by Intraclass Correlation Coefficient (ICC). RESULTS Twenty-five patients were eligible for baseline measurement, 20 for a mid-NAC response evaluation, and five for a post-NAC response evaluation. MRI and ABVS showed absolute concordance in 73% of patients for the mid-NAC evaluation, with a 'good' correlation for the difference in longest diameter measurement (ICC 0.73, p < 0.01) as compared to baseline assessment. Concerning difference in volume measurement in the mid-NAC response evaluation showed a 'fair' correlation (ICC 0.52, p < 0.01) and in the post-NAC response evaluation an 'excellent' correlation (ICC 0.98, p < 0.01). 'Excellent' inter- and intra-observer agreement was found (ICC 0.88, p < 0.01) with comparable limits of agreement (LOA) for observer 1 and 2 in both diameter and volume measurement. Patient satisfaction was higher for ABVS compared to breast MRI, 93% versus 12% respectively. CONCLUSION ABVS showed 'good' correlation with MRI tumour response evaluation in breast cancer patients during NAC with 'excellent' inter- and intra-observer agreement. ABVS has patients' preference over breast MRI and could be considered as alternative to breast MRI, in case results on an on-going prospective trial confirm these results (NTR6799).
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Affiliation(s)
- L S E van Egdom
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - M Lagendijk
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - E H M Heijkoop
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - A H J Koning
- Department of Bio-informatics, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - C H M van Deurzen
- Department of Pathology, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - A Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - W van Lankeren
- Department of Radiology, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
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Abstract
The objective, accurate, and standardized evaluation of tumor response to treatment is an indispensable procedure in clinical oncology. Compared to manual measurement, computer-assisted linear measurement can significantly improve the accuracy and reproducibility of tumor burden quantification. For irregular-shaped and infiltrating or diffuse tumors, which are difficult to quantify by linear measurement, computer-assisted volumetric measurement may provide a more objective and sensitive quantification to evaluate tumor response to treatment than linear measurement does. In the evaluation of tumor response to novel oncologic treatments such as targeted therapy, changes in overall tumor size do not necessarily reflect tumor response to therapy due to the presence of internal necrosis or hemorrhages. This leads to a new generation of imaging biomarkers to evaluate tumor response by using texture analysis methods, also called radiomics. Computer-assisted texture analysis technology offers a more comprehensive and in-depth imaging biomarker to evaluate tumor response. The application of computer-assisted quantitative imaging analysis techniques not only reduces the inaccuracy and improves the reliability in tumor burden quantification, but facilitates the development of more comprehensive and intelligent approaches to evaluate treatment response, and hence promotes precision imaging in the evaluation of tumor response in clinical oncology. This article summarizes the state-of-the-art technical developments and clinical applications of quantitative imaging analysis in evaluation of tumor response in clinical oncology.
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Affiliation(s)
- Wen-Li Cai
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Guo-Bin Hong
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, China
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Franke V, van der Hiel B, van de Wiel BA, Klop WMC, Ter Meulen S, van Akkooi ACJ. Positron emission tomography/computed tomography evaluation of oncolytic virus therapy efficacy in melanoma. Eur J Cancer 2018; 90:149-152. [PMID: 29224902 DOI: 10.1016/j.ejca.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Viola Franke
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
| | - Bernies van der Hiel
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
| | - Willem M C Klop
- Department of Head & Neck Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
| | - Sylvia Ter Meulen
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands.
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Greuter MJ, Schouten CS, Castelijns JA, de Graaf P, Comans EF, Hoekstra OS, de Bree R, Coupé VM. Cost-effectiveness of response evaluation after chemoradiation in patients with advanced oropharyngeal cancer using 18F-FDG-PET-CT and/or diffusion-weighted MRI. BMC Cancer 2017; 17:256. [PMID: 28399836 PMCID: PMC5387392 DOI: 10.1186/s12885-017-3254-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 04/01/2017] [Indexed: 12/24/2022] Open
Abstract
Background Considerable variation exists in diagnostic tests used for local response evaluation after chemoradiation in patients with advanced oropharyngeal cancer. The yield of invasive examination under general anesthesia (EUA) with biopsies in all patients is low and it may induce substantial morbidity. We explored four response evaluation strategies to detect local residual disease in terms of diagnostic accuracy and cost-effectiveness. Methods We built a decision-analytic model using trial data of forty-six patients and scientific literature. We estimated for four strategies the proportion of correct diagnoses, costs concerning diagnostic instruments and the proportion of unnecessary EUA indications. Besides a reference strategy, i.e. EUA for all patients, we considered three imaging strategies consisting of 18FDG-PET-CT, diffusion-weighted MRI (DW-MRI), or both 18FDG-PET-CT and DW-MRI followed by EUA after a positive test. The impact of uncertainty was assessed in sensitivity analyses. Results The EUA strategy led to 96% correct diagnoses. Expected costs were €468 per patient whereas 89% of EUA indications were unnecessary. The DW-MRI strategy was the least costly strategy, but also led to the lowest proportion of correct diagnoses, i.e. 93%. The PET-CT strategy and combined imaging strategy were dominated by the EUA strategy due to respectively a smaller or equal proportion of correct diagnoses, at higher costs. However, the combination of PET-CT and DW-MRI had the highest sensitivity. All imaging strategies considerably reduced (unnecessary) EUA indications and its associated burden compared to the EUA strategy. Conclusions Because the combined PET-CT and DW-MRI strategy costs only an additional €927 per patient, it is preferred over immediate EUA since it reaches the same diagnostic accuracy in detecting local residual disease while leading to substantially less unnecessary EUA indications. However, if healthcare resources are limited, DW-MRI is the strategy of choice because of lower costs while still providing a large reduction in unnecessary EUA indications.
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Affiliation(s)
- Marjolein Je Greuter
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007, MB, Amsterdam, the Netherlands.
| | - Charlotte S Schouten
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center Nijmegen, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear medicine, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear medicine, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Emile Fi Comans
- Department of Radiology and Nuclear medicine, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear medicine, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, the Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Cancer Utrecht, PO Box 85500, 3508, GA, Utrecht, the Netherlands
| | - Veerle Mh Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007, MB, Amsterdam, the Netherlands
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Hellbach K, Sterzik A, Sommer W, Karpitschka M, Hummel N, Casuscelli J, Ingrisch M, Schlemmer M, Graser A, Staehler M. Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 2016; 27:2532-2537. [PMID: 27678131 DOI: 10.1007/s00330-016-4597-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the potential role of dual energy CT (DECT) to visualize antiangiogenic treatment effects in patients with metastatic renal cell cancer (mRCC) while treated with tyrosine-kinase inhibitors (TKI). METHODS 26 patients with mRCC underwent baseline and follow-up single-phase abdominal contrast enhanced DECT scans. Scans were performed immediately before and 10 weeks after start of treatment with TKI. Virtual non-enhanced (VNE) and colour coded iodine images were generated. 44 metastases were measured at the two time points. Hounsfield unit (HU) values for VNE and iodine density (ID) as well as iodine content (IC) in mg/ml of tissue were derived. These values were compared to the venous phase DECT density (CTD) of the lesions. Values before and after treatment were compared using a paired Student's t test. RESULTS Between baseline and follow up, mean CTD and DECT-derived ID both showed a significant reduction (p < 0.005). The relative reduction measured in percent was significantly greater for ID than for CTD (49.8 ± 36,3 % vs. 29.5 ± 20.8 %, p < 0.005). IC was also significantly reduced under antiangiogenic treatment (p < 0.0001). CONCLUSIONS Dual energy CT-based quantification of iodine content of mRCC metastases allows for significantly more sensitive and reproducible detection of antiangiogenic treatment effects. KEY POINTS • A sign of tumour response to antiangiogenic treatment is reduced tumour perfusion. • DECT allows visualizing iodine uptake, which serves as a marker for vascularization. • More sensitive detection of antiangiogenic treatment effects in mRCC is possible.
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Affiliation(s)
- K Hellbach
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - A Sterzik
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - W Sommer
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Karpitschka
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - N Hummel
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - J Casuscelli
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Ingrisch
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Schlemmer
- Department of Palliative Care, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Germany
| | - A Graser
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
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Fledelius J, Khalil A, Hjorthaug K, Frøkiær J. Inter-observer agreement improves with PERCIST 1.0 as opposed to qualitative evaluation in non-small cell lung cancer patients evaluated with F-18-FDG PET/CT early in the course of chemo-radiotherapy. EJNMMI Res 2016; 6:71. [PMID: 27655428 PMCID: PMC5031580 DOI: 10.1186/s13550-016-0223-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study is to determine whether a qualitative approach or a semi-quantitative approach provides the most robust method for early response evaluation with 2′-deoxy-2′-[18F]fluoro-d-glucose (F-18-FDG) positron emission tomography combined with whole body computed tomography (PET/CT) in non-small cell lung cancer (NSCLC). In this study eight Nuclear Medicine consultants analyzed F-18-FDG PET/CT scans from 35 patients with locally advanced NSCLC. Scans were performed at baseline and after 2 cycles of chemotherapy. Each observer used two different methods for evaluation: (1) PET response criteria in solid tumors (PERCIST) 1.0 and (2) a qualitative approach. Both methods allocate patients into one of four response categories (complete and partial metabolic response (CMR and PMR) and stable and progressive metabolic disease (SMD and PMD)). The inter-observer agreement was evaluated using Fleiss’ kappa for multiple raters, Cohens kappa for comparison of the two methods, and intraclass correlation coefficients (ICC) for comparison of lean body mass corrected standardized uptake value (SUL) peak measurements. Results The agreement between observers when determining the percentage change in SULpeak was “almost perfect”, with ICC = 0.959. There was a strong agreement among observers allocating patients to the different response categories with a Fleiss kappa of 0.76 (0.71–0.81). In 22 of the 35 patients, complete agreement was observed with PERCIST 1.0. The agreement was lower when using the qualitative method, moderate, having a Fleiss kappa of 0.60 (0.55–0.64). Complete agreement was achieved in only 10 of the 35 patients. The difference between the two methods was statistically significant (p < 0.005) (chi-squared). Comparing the two methods for each individual observer showed Cohen’s kappa values ranging from 0.64 to 0.79, translating into a strong agreement between the two methods. Conclusions PERCIST 1.0 provides a higher overall agreement between observers than the qualitative approach in categorizing early treatment response in NSCLC patients. The inter-observer agreement is in fact strong when using PERCIST 1.0 even when the level of instruction is purposely kept to a minimum in order to mimic the everyday situation. The variability is largely owing to the subjective elements of the method. Electronic supplementary material The online version of this article (doi:10.1186/s13550-016-0223-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joan Fledelius
- Department of Nuclear Medicine, Herning Regional Hospital, 7400, Herning, Denmark.
| | - Azza Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Karin Hjorthaug
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
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Shang J, Ling X, Zhang L, Tang Y, Xiao Z, Cheng Y, Guo B, Gong J, Huang L, Xu H. Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 2016; 43:1945-53. [PMID: 27236466 DOI: 10.1007/s00259-016-3420-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/10/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy. METHODS A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent (18)F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test. RESULTS RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0). CONCLUSION EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and PERCIST 1.0 showed similar results, PERCIST 1.0 is preferred because detailed and unambiguous definitions are given. We also found that response evaluations with PERCIST 1.0 using a single lesion and multiple lesions gave similar response classifications.
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Affiliation(s)
- Jingjie Shang
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Xueying Ling
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Linyue Zhang
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Zeyu Xiao
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Yong Cheng
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Bin Guo
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Jian Gong
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Li Huang
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine and PET/CT-MRI Centre, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
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Blank S, Knebel P, Haag GM, Bruckner T, Klaiber U, Burian M, Schaible A, Sisic L, Schmidt T, Diener MK, Ott K. Immediate tumor resection in patients with locally advanced gastroesophageal adenocarcinoma with nonresponse to chemotherapy after 4 weeks of treatment versus resection after completion of chemotherapy (OPTITREAT trial, DRKS00004668): study protocol for a randomized controlled pilot trial. Pilot Feasibility Stud 2016; 2:18. [PMID: 27965838 PMCID: PMC5153833 DOI: 10.1186/s40814-016-0059-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 03/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background Neoadjuvant chemotherapy is a standard of care for patients with adenocarcinoma of the esophagus and stomach in Europe, but still only 20–40 % respond to therapy and the critical issue; how to treat nonresponding patients is still unclear. So far, there is no randomized trial evaluating the impact of early termination of neoadjuvant chemotherapy and immediate tumor resection in nonresponding patients with locally advanced gastroesophageal cancer on postoperative outcome. With this exploratory pilot trial, we want to get first estimates about the effect of discontinuation of chemotherapy with the aim to plan and conduct a further definitive trial. Methods/design OPTITREAT is designed as a single-center, randomized controlled pilot trial with two parallel study groups. Four weeks after starting neoadjuvant chemotherapy in all patients, clinical response will be assessed by endoscopy and endosonographic ultrasound. Then, nonresponding patients (n = 84) will be randomized in a 1:1 ratio to intervention group with stopping chemotherapy and immediate tumor resection or control group with completion of chemotherapy before surgery. Outcome measures are overall survival, R0 resection rate, perioperative morbidity and mortality, histopathological response, and quality of life. Statistical analysis will be based on the intention-to-treat population. Due to the study design as an explorative pilot trial, no formal sample size calculation was performed. The planned total sample size of 120 patients is considered ethical and large enough to show the feasibility and safety of the concept. First data on differences between the study groups in the defined endpoints will also be generated. Discussion Individualized therapy is of utmost interest in the treatment of locally advanced gastroesophageal adenocarcinoma as less than half of the patients show objective response to current chemotherapy regimens. The findings of the OPTITREAT trial will help to get first data about clinical response evaluation followed by immediate tumor resection in nonresponding patients after 4 weeks of neoadjuvant chemotherapy. Based on the results of this pilot study, a future confirmatory trial will be planned to prove efficacy and evaluate significance. Trial registration German Clinical Trial Register number: DRKS00004668
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Affiliation(s)
- Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Georg-Martin Haag
- Department of Medical Oncology, National Center of Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120 Germany
| | - Thomas Bruckner
- Institute of Medical Statistics and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg, 69120 Germany
| | - Ulla Klaiber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Maria Burian
- Department of General Visceral and Transplantation Surgery, Endoscopic Center, University of Gießen, Rudolf-Buchheimstr. 7, Gießen, 35392 Germany
| | - Anja Schaible
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Interdisciplinary Endoscopic Center, University of Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120 Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum, Pettenkoferstr. 10, Rosenheim, 83022 Germany
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Hassan A, Khalid M, Riaz S, Nawaz MK, Bashir H. Follicular Thyroid Carcinoma: Disease Response Evaluation Using American Thyroid Association Risk Assessment Guidelines. Eur Thyroid J 2015; 4:260-5. [PMID: 26835430 PMCID: PMC4716413 DOI: 10.1159/000442237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the overall and progression-free survival for follicular thyroid carcinoma (FTC) based on the American Thyroid Association (ATA) staging system for recurrence risk assessment and the TNM staging system. METHODS A clinical review of FTC patients between 1995 and 2014 was conducted at a single center. The data was classified using the TNM staging system into low, intermediate, and high risk of recurrence as per the ATA risk assessment. RESULTS Over the course of 19 years, 114 (11.9%) of all of the thyroid cancer patients presenting to our hospital had FTC (i.e. 78 females and 36 males). The age range was 15-80 years. Ninety-four tumors were resectable and 18 were unresectable. Sixteen patients were excluded due to insufficient information on their recurrence risk. Based on the ATA categorization, 36 patients had a low recurrence risk. All patients were alive at the time of categorization, and 1 showed progressive disease. Thirty-eight patients had an intermediate recurrence risk. One patient died and 2 showed progression. Twenty-four had a high recurrence risk. Seven patients died and 6 showed progression. In terms of TNM stages, 2 (3.2%) stage I, 3 (17.6%) stage II, 1 (14%) stage III, and 2 (12.5%) stage IV patients died during follow-up. Both ATA risk classification and TNM staging were significant predictors of disease-free survival. On bivariate analysis, the ATA classification (HR 4.67; 95% CI 1.74-12.5, p = 0.002) was a better predictor of survival compared to the TNM classification (HR 1.26; 95% CI 0.98-1.62, p = 0.063). CONCLUSION ATA risk stratification predicts the disease recurrence rate and survival better than TNM staging. Age does not have an association; the risk category with dynamic reassessment effectively better predicts the course of disease in FTC.
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Affiliation(s)
- Aamna Hassan
- *Dr. Aamna Hassan, Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7-A, R 3 Johar Town, Lahore (Pakistan), E-Mail
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Djuric-Stefanovic A, Micev M, Stojanovic-Rundic S, Pesko P, Saranovic D. Absolute CT perfusion parameter values after the neoadjuvant chemoradiotherapy of the squamous cell esophageal carcinoma correlate with the histopathologic tumor regression grade. Eur J Radiol 2015; 84:2477-84. [PMID: 26467704 DOI: 10.1016/j.ejrad.2015.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To analyze value of the computed tomography (CT) perfusion imaging in response evaluation of the esophageal carcinoma to neoadjuvant chemoradiotherapy (nCRT) using the histopathology as reference standard. METHODS Forty patients with the squamous cell esophageal carcinoma were re-evaluated after the nCRT by CT examination, which included low-dose CT perfusion study that was analyzed using the deconvolution-based CT perfusion software (Perfusion 3.0, GE). Histopathologic assessment of tumor regression grade (TRG) according to Mandard's criteria served as reference standard of response evaluation. Statistical analysis was performed using Spearman's rank correlation coefficient (r(S)) and Kruskal-Wallis's test. RESULTS The perfusion CT parameter values, measured after the nCRT in the segment of the esophagus that had been affected by neoplasm prior to therapy, significantly correlated with the TRG: blood flow (BF) (r(S)=0.851; p<0.001), blood volume (BV) (r(S)=0.732; p<0.001) and mean transit time (MTT) (r(S)=-0.386; p=0.014). Median values of BF and BV significantly differed among TRG 1-4 groups (p<0.001), while maximal esophageal wall thickness did not (p=0.102). Median BF and BV were gradually rose and MTT decreased as TRG increased, from 21.4 ml/min/100 g (BF), 1.6 ml/100 g (BV) and 8.6 s (MTT) in TRG 1 group, to 37.3 ml/min/100 g, 3.5 ml/100 g and 7.5 s in TRG 2 group, 81.4 ml/min/100 g, 4.1 ml/100 g and 3.8 s in TRG 3 group, and 121.1 ml/min/100 g, 4.9 ml/100 g and 3.7 s in TRG 4 group. In all 15 patients who achieved complete histopathologic regression (TRG 1), BF was <30.0 ml/min/100 g. CONCLUSIONS CT perfusion could improve the accuracy in response evaluation of the esophageal carcinoma to nCRT.
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Affiliation(s)
- A Djuric-Stefanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade, Serbia.
| | - M Micev
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Pathology, First Surgery University Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Stojanovic-Rundic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - P Pesko
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; First Surgery University Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Dj Saranovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade, Serbia
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Yoon RG, Kim HS, Kim DY, Hong GS, Kim SJ. Apparent diffusion coefficient parametric response mapping MRI for follow-up of glioblastoma. Eur Radiol 2015; 26:1037-47. [PMID: 26159871 DOI: 10.1007/s00330-015-3896-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/31/2015] [Accepted: 06/16/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To determine the diagnostic superiority of parametric response mapping of apparent diffusion coefficient (ADCPR) for predicting glioblastoma treatment response, compared to single time point measurement. METHODS Fifty post-treatment glioblastoma patients were enrolled. ADCPR was calculated from serial apparent diffusion coefficient (ADC) maps acquired before and at the time of first detection of an enlarged contrast-enhancing lesion on voxel-by-voxel basis. The percentage-decrease in ADCPR and tenth percentile histogram cutoff value of ADC (ADC10) were compared at subsequent 3-month and 1-year follow-ups. RESULTS The percentage-decrease in ADCPR was significantly higher in the progression group (mean = 33.2-38.3 %) than in the stable-response group (mean = 9.7 %) at 3 months follow-up (corrected p < 0.001 for both readers). ADCPR significantly improved area under the receiver operating characteristic curve from 0.67 to 0.88 (corrected p = 0.037) and from 0.70 to 0.92 (corrected p = 0.020) for both readers, respectively, compared to ADC10 at 3-month follow-up, but did not significantly improve at 1-year follow-up. The inter-reader agreement was higher for ADCPR than ADC10 (intraclass correlation coefficient, 0.93 versus 0.86). CONCLUSION Voxel-based ADCPR appears to be a superior imaging biomarker than ADC, particularly for predicting early tumour progression in patients with glioblastoma. KEY POINTS • Treatment response pattern of glioblastoma was evaluated using voxel-based ADCPR and ADC10. • Voxel-based ADCPR was more accurate in predicting treatment response pattern than ADC10. • Inter-reader agreement was higher in ADCPR calculation than in ADC10 calculation. • Voxel-based ADCPR can be a predictor of early treatment response pattern for glioblastoma.
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Affiliation(s)
- Ra Gyoung Yoon
- Department of Radiology, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 beon-gil, Seo-gu, Incheon, 404-834, Republic of Korea.
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Dae Yoon Kim
- Department of Radiology, Bundang Jesaeng Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-774, Republic of Korea
| | - Gil Sun Hong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
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Colagrande S, Regini F, Taliani GG, Nardi C, Inghilesi AL. Advanced hepatocellular carcinoma and sorafenib: Diagnosis, indications, clinical and radiological follow-up. World J Hepatol 2015; 7:1041-1053. [PMID: 26052393 PMCID: PMC4450181 DOI: 10.4254/wjh.v7.i8.1041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Advanced stage hepatocellular carcinoma (HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenib treatment, a multi-kinase inhibitor with anti-proliferative and anti-angiogenic effect. Trans-arterial Radio Embolization also represents a promising new approach to intermediate/advanced HCC. Post-marketing clinical studies showed that only a portion of patients actually benefits from sorafenib treatment, and an even smaller percentage of patients treated shows partial/complete response on follow-up examinations, up against relevant costs and an incidence of drug related adverse effects. Although the treatment with sorafenib has shown a significant increase in mean overall survival in different studies, only a part of patients actually shows real benefits, while the incidence of drug related significant adverse effects and the economic costs are relatively high. Moreover, only a small percentage of patients also shows a response in terms of lesion dimensions reduction. Being able to properly differentiate patients who are responding to the therapy from non-responders as early as possible is then still difficult and could be a pivotal challenge for the future; in fact it could spare several patients a therapy often difficult to bear, directing them to other second line treatments (many of which are at the moment still under investigation). For this reason, some supplemental criteria to be added to the standard modified Response Evaluation Criteria in Solid Tumors evaluation are being searched for. In particular, finding some parameters (cellular density, perfusion grade and enhancement rate) able to predict the sensitivity of the lesions to anti-angiogenic agents could help in stratifying patients in terms of treatment responsiveness before the beginning of the therapy itself, or in the first weeks of sorafenib treatment. This would bring a strongly desirable help in clinical managements of these patients.
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Ciftci E, Demirsoy U, Anik Y, Gorur G, Corapcioglu F, Demir H. Staging and evaluation of neoadjuvant chemotherapy response with ¹⁸F-FDG PET/CT in NUT-midline carcinoma in a child: a case report and review of the literature. Rev Esp Med Nucl Imagen Mol 2014; 34:53-5. [PMID: 25304847 DOI: 10.1016/j.remn.2014.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/28/2014] [Accepted: 08/30/2014] [Indexed: 12/20/2022]
Abstract
NUT midline carcinoma (NMC) is a newly defined and lethal cancer with aggressive course. It mostly affects children and young adults. Diagnosis is confirmed with the evidence of BRD4-NUT mutation on the chromosome 15q14 by fluorescence in situ hybridization. Use of (18)F-FDG PET/CT in NMC patients is very limited in the literature. In this report, we describe a 7-year-old boy with the diagnosis of NMC who was scanned with (18)F-FDG PET/CT for staging and treatment response evaluation after the chemotherapy. It was disseminated and had moderate FDG avidity in the initial scan and showed progression after 4 cycles of chemotherapy. We also reviewed the literature related to (18)F-FDG PET/CT in staging and assessment of chemotherapy response of NMC.
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Affiliation(s)
- E Ciftci
- Department of Nuclear Medicine, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - U Demirsoy
- Department of Pediatric Oncology, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - Y Anik
- Department of Radiology, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - G Gorur
- Department of Nuclear Medicine, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - F Corapcioglu
- Department of Pediatric Oncology, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - H Demir
- Department of Nuclear Medicine, Faculty of Medicine, University of Kocaeli, Kocaeli, Turkey.
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Dhull VS, Mukherjee A, Karunanithi S, Durgapal P, Bal C, Kumar R. Bilateral primary renal lymphoma in a pediatric patient: staging and response evaluation with ¹⁸F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 34:49-52. [PMID: 25065972 DOI: 10.1016/j.remn.2014.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 05/18/2014] [Indexed: 11/19/2022]
Abstract
Primary renal lymphoma (PRL) is a rare disease. We here present the case of an 8-year-old child who presented with bilateral renal masses. On biopsy, it was confirmed to be B-cell non-Hodgkin's lymphoma. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET/CT) for staging demonstrated (18)F-FDG avid bilateral renal masses, with no other abnormal focus. Follow up (18)F-FDG PET/CT showed complete resolution of the disease after six cycles of chemotherapy. Here we have highlighted the potential role of (18)F-FDG PET/CT in staging and response evaluation of a patient with PRL and presented a brief review.
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Affiliation(s)
- V S Dhull
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P Durgapal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - C Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Janoray G, Barillot I, Calais G. [Evaluation of the therapeutic response after stereotactic body radiation therapy for liver tumors]. Cancer Radiother 2014; 18:320-4. [PMID: 24811896 DOI: 10.1016/j.canrad.2014.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/23/2014] [Accepted: 02/13/2014] [Indexed: 01/20/2023]
Abstract
Stereotactic body radiation therapy takes more and more an important place in the therapeutic arsenal of primitive and secondary liver tumours. The administration of ablative radiation doses can result in specific changes to both the tumour and the healthy hepatic parenchyma, relative to conventional radiation therapy, making the assessment of local changes after stereotactic body radiation therapy, in terms of local control and reaction of healthy tissue, often difficult. It is mandatory to standardize and simplify our evaluation criteria to benefit from a better understanding of the effectiveness of this new treatment modality and allow better reproducibility of available imaging exams. This article presents a literature review of the various radiological changes observed after stereotactic body radiation therapy for liver tumours according to the multiple assessment methods used to determine local control. From the data available, we recommend using modified RECIST criteria proposed by the American Association for the Study of Liver Diseases (AASLD), as objective and relevant criteria of local control after stereotactic body radiation therapy for liver tumours.
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Smith AD, Shah SN, Rini BI, Lieber ML, Remer EM. Utilizing pre-therapy clinical schema and initial CT changes to predict progression-free survival in patients with metastatic renal cell carcinoma on VEGF-targeted therapy: a preliminary analysis. Urol Oncol 2011; 31:1283-91. [PMID: 21956044 DOI: 10.1016/j.urolonc.2011.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/17/2011] [Accepted: 08/18/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Because of varying treatment effectiveness with vascular endothelial growth factor (VEGF)-targeted therapy in patients with metastatic renal cell carcinoma (RCC), the association of prognostic pre-therapy clinical schema, initial post-therapy computed tomography (CT) findings, and combination thereof in predicting progression-free survival (PFS) was investigated. A predictive biomarker that combines clinical risk factors and CT imaging features associated with initial response to therapy would be useful in stratifying patients into risk groups to guide therapy, in designing and interpreting results of clinical trials, in planning risk-directed therapy, and in patient counseling. Early identification of poor responders using an imaging biomarker may reduce drug-related toxicity and cost and allow for a therapeutic intervention before disease burden significantly advances. MATERIALS AND METHODS For this institutional review board-approved HIPAA-compliant retrospective study, baseline data for 82 patients with metastatic RCC treated with sunitinib or sorafenib was obtained for risk stratification by Memorial Sloan Kettering Cancer Center (MSKCC) criteria and criteria by Heng et al. (J Clin Oncol 2009;27:5794-9), (described here as "VEGF prognostic factors criteria"). The initial post-therapy CT was evaluated by Response Assessment Criteria in Solid Tumors (RECIST), Choi criteria, and Morphology, Attenuation, Size, and Structure (MASS) criteria. Kaplan-Meier estimates of PFS (the reference standard) for each patient group and overall accuracy of each method and combined criteria were calculated. RESULTS The MSKCC model, VEGF prognostic factors criteria, RECIST, MASS criteria, MSKCC + MASS criteria, and VEGF prognostic factors + MASS criteria each demonstrated significant differences in PFS among patient groups (P < 0.005 for each, Log-rank test). Stratification of patient groups by Choi criteria was not statistically significant with respect to PFS (P = 0.101). MSKCC + MASS criteria yielded the highest overall accuracy for identifying PFS ≥ 1 year (77%) and for identifying PFS < 1 year (77%). CONCLUSIONS A combination of pre-therapy clinical risk factors and CT imaging response by MASS criteria more effectively predicted PFS in patients with metastatic RCC on VEGF-targeted therapy than any single method.
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Affiliation(s)
- Andrew D Smith
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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