Additional Value of 2-[18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients

Manafi‐Farid, Reyhaneh; Kupferthaler, Alexander; Wundsam, Helwig; Gruber, Georg B.; Vali, Reza; Venhoda, C.; Track, C.; Beheshti, Ali; Langsteger, Werner; Geinitz, Hans; Beheshti, Mohsen

doi:10.3390/jcm9092715

Cited by 9 publications

(4 citation statements)

References 42 publications

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“…Endoanal ultrasounds may therefore be useful for the detection of superficial anal cancers compared to MRIs, but it should be noted that an additional CT or MRI of the pelvis is required for nodal assessment due to the lack of visualization of these regions by endoanal ultrasound [6]. The consideration of a baseline positron emission tomography (PET)/CT scan can be used to further characterize/investigate/assess regional or distal nodal involvement, tumor size and radiation planning [7,8]. Accurate staging in anal cancer is vital as disease burden is correlated with survival outcomes and guides treatment approaches.…”

Section: Locoregional Anal Cancermentioning

confidence: 99%

Recent Advances in the Management of Anal Cancer

Upadhyay,

Hartzell,

Parikh

et al. 2023

Healthcare

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The incidence and mortality of squamous cell carcinoma of the anus (SCCA) is on the rise, which highlights the unmet need for advances in treatment options. The landscape of treatment for this cancer is rapidly evolving with novel combination strategies including immunotherapy, radiation therapy and biomarker-guided therapy. This review article features an overview of recent advancements in both locoregional and metastatic SCCA. The recent focus on locoregional SCCA management is to tailor treatment according to tumor burden and minimize treatment-related toxicities. Mitomycin plus either infusional 5-fluorouracil (5-FU) or capecitabine is used for first-line chemoradiotherapy (CRT), and intensity-modulated radiotherapy (IMRT) is the preferred modality for radiation for locoregional anal cancer. Locally recurrent disease is managed with surgical resection. Systemic treatment is first-line for metastatic SCCA and immunotherapy with nivolumab and pembrolizumab being included as second-line agents. Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

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Section: Locoregional Anal Cancermentioning

confidence: 99%

Recent Advances in the Management of Anal Cancer

Upadhyay,

Hartzell,

Parikh

et al. 2023

Healthcare

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“…Results of previous studies are discordant about the utility of PET for detection of LN involvement or recurrent disease. Although some authors have reported that PET is superior to conventional imaging for the detection of LN involvement or suspected recurrence and can result in a change of the treatment plan [ 39 , 40 ], others have not been able to reproduce these advantages [ 41 ]. Part of the limitations for the use of PET/CT is the difficulty in differentiating post-radiation inflammatory change and the lack of sensitivity for small lesions which results in false-negative reassurance.…”

Section: Diagnosis Of Recurrent/persistent Anal Cancermentioning

confidence: 99%

Survival and Operative Outcomes After Salvage Surgery for Recurrent or Persistent Anal Cancer

Park

Chang

2020

Ann Coloproctol

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Anal squamous cell carcinoma (SCC) is a relatively rare cancer comprising less than 2.5% of all gastrointestinal malignancies. The standard treatment for anal SCC is primary chemoradiation therapy which can result in complete regression. After successful treatment, the 5-year survival is approximately 80%. However, up to 30% of patients experience recurrent persistent or recurrent disease. The role of surgery in the treatment of anal cancer, therefore, is limited to the management of recurrent or persistent disease with abdominoperineal resection and/or <i>en bloc</i> adjacent organ excision. Salvage surgery after irradiated anal cancer can be technically demanding in terms of acquisition of oncologically safe surgical margins and minimization of postoperative morbidity. In addition, 5-year survival outcomes after salvage resection have been reported to vary from 23% to 69%. Positive resection margins are generally regarded as the important risk factor associated with poor survival outcome. Perineal wound complications are the most common major postoperative morbidity. Because of the challenges of primary wound closure after salvage abdominoperineal resection, myocutaneous flap reconstruction has been performed to reduce the severity of perianal would complications. We, therefore, descriptively reviewed contemporary published evidence describing the treatment and outcomes after salvage surgery for persistent or recurrent anal SCC.

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“…Advanced imaging may contribute to nodal migration, potentially leading to N-stage misclassification. In ASCC, there is a discrepancy in LNM detection on PET-CT versus MRI [ 15 – 17 ]. This emphasizes the need for a deeper understanding of the morphological characteristics of LNs in ASCC patients treated primarily non-surgically, especially in relation to metabolic activity on PET-CT. We hypothesized that combined information from MRI and PET-CT could further improve nodal staging and support decision-making.…”

Section: Introductionmentioning

confidence: 99%

MRI morphological characteristics of lymph nodes in anal squamous cell carcinoma

Gulevski,

Frennered,

Trägårdh

et al. 2024

Abdom Radiol

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Objectives Pre-treatment staging of anal squamous cell carcinoma (ASCC) includes pelvic MRI and [18F]-fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT). MRI criteria to define lymph node metastases (LNMs) in ASCC are currently lacking. The aim of this study was to describe the morphological characteristics of lymph nodes (LNs) on MRI in ASCC patients with PET-CT-positive LNs. Methods ASCC patients treated at Skåne University Hospital between 2009 and 2017 were eligible for inclusion if at least one positive LN according to PET-CT and a pre-treatment MRI were present. All PET-CT-positive LNs and PET-CT-negative LNs were retrospectively identified on baseline MRI. Each LN was independently classified according to pre-determined morphological characteristics by two radiologists blinded to clinical patient information. Results Sixty-seven ASCC patients were included, with a total of 181 PET-CT-positive LNs identified on baseline MRI with a median short-axis diameter of 9.0 mm (range 7.5–12 mm). MRI morphological characteristics of PET-CT-positive LNs included regular contour (87%), round shape (89%), and homogeneous signal intensity on T2-weighed images (67%). An additional 78 PET-CT-negative LNs were identified on MRI. These 78 LNs had a median size of 6.8 mm (range 5.5–8.0 mm). The majority of PET-CT-negative LNs had a regular contour, round shape, and a homogeneous signal that was congruent to the primary tumor. Conclusions There are MRI-specific morphological characteristics for pelvic LNs in ASCC. PET-CT-positive and negative LNs share similar morphological features apart from size, with PET-CT-positive LNs being significantly larger. Further studies are needed to determine discrimination criteria for LNM in ASCC.

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Additional Value of 2-[18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients

Cited by 9 publications

References 42 publications

Recent Advances in the Management of Anal Cancer

Recent Advances in the Management of Anal Cancer

Survival and Operative Outcomes After Salvage Surgery for Recurrent or Persistent Anal Cancer

MRI morphological characteristics of lymph nodes in anal squamous cell carcinoma

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