[18F]FDG-PET Standard Uptake Value as a Metabolic Predictor of Bone Marrow Response to Radiation: Impact on Acute and Late Hematological Toxicity in Cervical Cancer Patients Treated With Chemoradiation Therapy

Eliçin, Olgun; Callaway, S.; Prior, John O.; Bourhis, Jean; Ozşahin, Mahmut; Herrera, Fernanda G.

doi:10.1016/j.ijrobp.2014.08.017

Cited by 49 publications

(63 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On the whole, our findings indicate that variation in compensatory response after CRT could explain the increased HT seen with more intensive chemotherapy, resulting from impaired recovery of hematopoiesis in unirradiated structures. Many imaging modalities have been used to identify regions of functional (active) BM, including 18 F-FDG-PET, 18 F-FLT-PET, and magnetic resonance imaging (MRI) (16,(19)(20)(21)(22)(23)(24)(25). In 1 study, Elicin et al (19) used 18 F-FDG-PET imaging of pelvic BM to identify hematopoietically ABM and found that relatively low doses of radiation were associated with a reduction in SUV, which was correlated Abbreviations: ABM Z active bone marrow; CI Z confidence interval.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, sparing ABM using intensity modulated RT (IMRT) may be an effective strategy to reduce HT (16,17). Various functional imaging modalities have been used to identify ABM, such as 2-deoxy-2-[fluorine-18]fluoro-D-glucose ( 18 F-FDG) and 3 0 -deoxy-3 0 -[18F] fluorothymidine ( 18 F-FLT) positron emission tomography (PET) (18)(19)(20)(21). These studies suggest that BM-sparing IMRT may improve tolerance to chemotherapy in the concurrent and potentially the adjuvant and salvage settings.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy

Noticewala

Williamson

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

SummaryHematologic toxicity (HT) is a common adverse effect in patients with cervical cancer treated with concurrent chemoradiation therapy. In this study, we used 18 F-fluorodeoxyglucose positron emission tomography to quantify changes in functional bone marrow (BM) in unirradiated (extrapelvic) and irradiated (pelvic) BM in cervical cancer patients treated with concurrent chemotherapy of varying intensities. We found that patients have varying Purpose: To quantify longitudinal changes in active bone marrow (ABM) distributions within unirradiated (extrapelvic) and irradiated (pelvic) bone marrow (BM) in cervical cancer patients treated with concurrent chemoradiation therapy (CRT). Methods and Materials: We sampled 39 cervical cancer patients treated with CRT, of whom 25 were treated with concurrent cisplatin (40 mg/m 2 ) and 14 were treated with cisplatin (40 mg/m 2 ) plus gemcitabine (50-125 mg/m 2 ) (C/G). Patients underwent 18 F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and 1.5 to 6.0 months after treatment. ABM was defined as the subvolume of bone with standardized uptake value (SUV) above the mean SUV of the total bone. The primary aim was to measure the compensatory response, defined as the change in the log of the ratio of extrapelvic versus pelvic ABM percentage from baseline to after treatment. We also quantified the change in the proportion of ABM and mean SUV in pelvic and extrapelvic BM using a 2-sided paired t test. Results: We observed a significant increase in the overall extrapelvic compensatory response after CRT (0.381; 95% confidence interval [CI]: 0.312, 0.449) and separately in patients treated with cisplatin (0.429; 95% CI: 0.340, 0.517) and C/G (0.294; 95% CI: 0.186, 0.402). We observed a trend toward higher compensatory response in patients treated with cisplatin compared with C/G (PZ.057). Pelvic ABM percentage

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy

Noticewala

Williamson

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…Previous studies have suggested that refining IMRT plans to spare hematopoietically ''active" bone marrow (ABM) subregions could be an effective strategy to reduce HT [13][14][15][16][17][18]. Functional imaging using [ Although studies have found that incorporating functional imaging with IMRT planning is likely to be effective [15][16][17][18][19], this approach remains investigational.…”

Section: F-fdg Pet/ct Atlas-based Active Bone Marrow Radiotherapy Plamentioning

confidence: 99%

“…Functional imaging using [ Although studies have found that incorporating functional imaging with IMRT planning is likely to be effective [15][16][17][18][19], this approach remains investigational. Moreover, functional imaging is expensive and not universally available.…”

Section: F-fdg Pet/ct Atlas-based Active Bone Marrow Radiotherapy Plamentioning

confidence: 99%

Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer

Noticewala

Williamson

et al. 2017

Radiotherapy and Oncology

View full text Add to dashboard Cite

F-FDG PET/CT Atlas-based Active bone marrow Radiotherapy planning a b s t r a c tBackground: To test the hypothesis that atlas-based active bone marrow (ABM)-sparing intensity modulated radiation therapy (IMRT) yields similar dosimetric results compared to custom ABM-sparing IMRT for cervical cancer patients. Methods: We sampled 62 cervical cancer patients with pre-treatment FDG-PET/CT in training (n = 32) or test (n = 30) sets. ABM was defined as the subvolume of the pelvic bone marrow (PBM) with standardized uptake value (SUV) above the mean on the average FDG-PET image (ABM Atlas ) vs. the individual's PET (ABM Custom ). Both were deformed to the planning CT. Overlap between the two subvolumes was measured using the Dice coefficient. Three IMRT plans designed to spare PBM, ABM Atlas , or ABM Custom were compared for 30 test patients. Dosimetric parameters were used to evaluate plan quality. Results: ABM Atlas and ABM Custom volumes were not significantly different (p = 0.90), with a mean Dice coefficient of 0.75, indicating good agreement. Compared to IMRT plans designed to spare PBM and ABM Custom , ABM Atlas -sparing IMRT plans achieved excellent target coverage and normal tissue sparing, without reducing dose to ABM Custom (mean ABM Custom dose 29.4 Gy vs. 27.1 Gy vs. 26.9 Gy, respectively; p = 0.10); however, PTV coverage and bowel sparing were slightly reduced. Conclusions: Atlas-based ABM sparing IMRT is clinically feasible and may obviate the need for customized ABM-sparing as a strategy to reduce hematologic toxicity.Ó 2017 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 123 (2017) 325-330Concurrent chemoradiotherapy (CRT) is standard treatment for women with locoregionally advanced cervical cancer [1][2][3][4][5]. However, hematologic toxicity (HT) is a significant clinical problem that limits the intensity of CRT, which can lead to chemotherapy dose reductions and/or treatment breaks, potentially compromising patient outcomes [6][7][8]. Clinical studies have shown that increased radiation dose and volume of irradiated pelvic bone marrow (PBM) are associated with increased risk of HT, suggesting that techniques designed to limit PBM irradiation could reduce toxicity [9,10]. Intensity modulated radiation therapy (IMRT) is a technology that can reduce toxicity by decreasing dose to normal tissues, without compromising tumor control. However, current IMRT plans are constrained by the large PBM volume to avoid, as defined by computed tomography (CT) [11,12].Previous studies have suggested that refining IMRT plans to spare hematopoietically ''active" bone marrow (ABM) subregions could be an effective strategy to reduce HT [13][14][15][16][17][18]. Functional imaging using [ Although studies have found that incorporating functional imaging with IMRT planning is likely to be effective [15][16][17][18][19], this approach remains investigational. Moreover, functional imaging is expensive and not universally available.To address this problem, McGuire et al. [20] proposed a method to identify ABM ...

show abstract

“…Generally, bone marrow activity can be measured by several imaging modalities, such as CT, MRI, and PET. Imaging with 18 F-FDG PET or 18 F-FLT PET has been shown to help differentiate active from nonactive bone marrow in cervical cancer patients who have undergone chemoradiotherapy (144,145).…”

Section: Normal-tissue Response Evaluationmentioning

confidence: 99%

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

2015

View full text Add to dashboard Cite

Learning Objectives: On successful completion of this activity, participants should be able to describe (1) how to acquire high-quality molecular images for use in radiation therapy; (2) how molecular imaging can be used to plan radiotherapy and evaluate treatment efficacy; and (3) the limitations and challenges to widespread use of molecular imaging in radiation oncology.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through November 2018.Molecular imaging plays a central role in the management of radiation oncology patients. Specific uses of imaging, particularly to plan radiotherapy and assess its efficacy, require an additional level of reproducibility and image quality beyond what is required for diagnostic imaging. Specific requirements include proper patient preparation, adequate technologist training, careful imaging protocol design, reliable scanner technology, reproducible software algorithms, and reliable data analysis methods. As uncertainty in target definition is arguably the greatest challenge facing radiation oncology, the greatest impact that molecular imaging can have may be in the reduction of interobserver variability in target volume delineation and in providing greater conformity between target volume boundaries and true tumor boundaries. Several automatic and semiautomatic contouring methods based on molecular imaging are available but still need sufficient validation to be widely adopted. Biologically conformal radiotherapy (dose painting) based on molecular imaging-assessed tumor heterogeneity is being investigated, but many challenges remain to fully exploring its potential. Molecular imaging also plays increasingly important roles in both early (during treatment) and late (after treatment) response assessment as both a predictive and a prognostic tool. Because of potentially confounding effects of radiation-induced inflammation, treatment response assessment requires careful interpretation. Although molecular imaging is already strongly embedded in radiotherapy, the path to widespread and all-inclusive use is still long. The lack of solid clinical evidence is the main impediment to broader use. Recommendations for practicing physicians are still rather scarce. 18 F-FDG PET/CT remains the main molecular imaging modality in radiation oncology applications. Although other molecular imaging options (e.g., proliferation imaging) are becoming more common, their widespread use is limited ...

show abstract

[18F]FDG-PET Standard Uptake Value as a Metabolic Predictor of Bone Marrow Response to Radiation: Impact on Acute and Late Hematological Toxicity in Cervical Cancer Patients Treated With Chemoradiation Therapy

Cited by 49 publications

References 31 publications

Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy

Longitudinal Changes in Active Bone Marrow for Cervical Cancer Patients Treated With Concurrent Chemoradiation Therapy

Feasibility of atlas-based active bone marrow sparing intensity modulated radiation therapy for cervical cancer

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

Contact Info

Product

Resources

About