Detection of Recurrent Nasopharyngeal Carcinomas with Technetium-99m Methoxyisobutylisonitrile Single Photon Emission Computed Tomography in Patients with Indeterminate Magnetic Resonance Imaging Findings after Radiotherapy

Tsai, Ming Hsui; Shiau, Yu‐Chien; Tai, Chih‐Jaan; Lin, Cheng Chieh; Lee, Cheng C.; Kao, Albert

doi:10.1177/000348940311200505

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…A study of patients with advanced NPC found that a combination of EBV DNA clearance and a reduction in maximum standardized uptake value of less than 50% at 4 weeks after initiation of chemotherapy was prognostic and predicted improvements in PFS and OS compared with either modality alone, which provided an opportunity for modification of treatment decisions at an early stage [64]. The functional aspect of PET allows tissue metabolic changes to be detected that may not be apparent on cross-sectional imaging and has also been found to be more accurate than MRI in the assessment of early treatment response [65]. These studies support a potential opportunity to identify low-risk groups who could potentially be spared from concurrent chemotherapy throughout the treatment course.…”

Section: Imaging As Biomarkermentioning

confidence: 99%

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Liu

Du²,

Song

et al. 2023

Holist Integ Oncol

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Purpose A “one-size-fits-all” treatment recommendation is not advisable for nasopharyngeal carcinoma (NPC). This article aims to review the risk-stratified strategies and propose future directions in NPC. Results For low-risk NPC patients, a review of literature shows that de-escalation approaches can be generally categorized into de-escalating systemic therapy and de-escalating radiotherapy. Studies have explored the exemption of concurrent chemotherapy in stage II and T3N0M0 NPC patients, as well as sparing concurrent chemotherapy after induction chemotherapy in selected low-risk patients, changing the cisplatin-based chemotherapy schedules, and doses. De-escalation of radiotherapy involves a reduction in dose and clinical treatment volume (CTV). For high-risk patients, increasing treatment intensity is commonly used, including selecting appropriate patients to receive induction or adjuvant chemotherapy or adding targeted therapy to standard chemo-radiotherapy to improve survival. In many instances, these risk-stratified approaches are guided by the measurement of Epstein-Barr virus DNA levels and various image-based modalities. Immunotherapy has shown initial efficacy in recurrent or metastatic NPC patients. The treatment advances of ICIs monotherapy in Locoregionally advanced NPC have remained scarce, and several phase II and III anti-PD-1/PD-L1 monoclonal antibody clinical trials are currently underway. Conclusions Various strategies for the risk-stratified treatment of NPC have been investigated and remain highly effective in most approaches. Optimization of patient selection is still critical, and both long-term oncological outcomes and late complications remain to be determined. More prospective, multi-institutional researches are needed to elucidate how best to individualize the treatment of NPC.

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Section: Imaging As Biomarkermentioning

confidence: 99%

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Liu

Du²,

Song

et al. 2023

Holist Integ Oncol

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“…A noninvasive approach to predicting early response to treatment and thus offering an opportunity for deescalation in NPC is with fluorodeoxyglucose positron emission tomography (PET). The functional aspect of PET allows tissue metabolic changes to be detected that may not be apparent on cross-sectional imaging and has been found to be more accurate than magnetic resonance imaging (MRI) in the assessment of early treatment response . One longitudinal study of serial PET computed tomography imaging of NPC found significant reductions in the maximum standardized uptake value by 71% at the primary site and 77% in nodal disease by the middle to late treatment period (50 Gy of radiation).…”

Section: Introductionmentioning

confidence: 99%

Treatment Deescalation Strategies for Nasopharyngeal Cancer

2021

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asopharyngeal carcinoma (NPC) accounts for 0.6% of all cancers diagnosed worldwide and is an endemic disease in Southeast Asia. 1 Nasopharyngeal carcinoma is highly sensitive to radiotherapy and chemotherapy and is typically treated with definitive radiotherapy alone for stage I, chemoradiotherapy for stage II, and chemoradiotherapy with induction or adjuvant chemotherapy for stage III to IVA. With modern radiotherapy techniques and effective systemic chemotherapy, prognosis of NPC has improved remarkably in the past 2 decades. Since the wide adoption of intensity-modulated radiotherapy (IMRT) following results of the Radiation Therapy Oncology Group 0225 trial, 2 there has been improvement in target conformity and short-term and long-term toxic effects compared with conventional techniques. However, late sequelae of treatment still occur because of the significant dose delivered to the surrounding healthy tissues. Furthermore, the use of cisplatin in extended cycles also increases the risk of cumulative platinum toxic effects. Recently, studies 3-6 have attempted to individualize treatments in NPC to limit toxicity without compromising efficacy. Alternative dosing, schedules, and substitutes for cisplatin have been proposed. Radiation doses, elective nodal irradiation vol-umes, and postinduction radiation target delineation have also evolved. This article aims to review strategies and propose future directions for deescalating systemic or radiotherapy in NPC.

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“…Among the radionuclide studies for pharyngeal carcinoma considerable experience has been accrued with Tc 99m methoxyisobutylisonitrile (MIBI), thallium (Tl‐201), and fluorodeoxyglucose (FDG‐18) positron emission tomography (PET) studies of nasopharyngeal carcinoma pre‐ and post‐therapeutically, 5–12 but no studies have been carried out in a Pakistani population. To our knowledge, only one or two studies have been conducted regarding oropharyngeal and hypopharyngeal carcinoma pretherapeutically 1 but no study has explored the role of Tc 99m MIBI in the assessment of treatment response.…”

Section: Introductionmentioning

confidence: 99%

Role of Tc^99m MIBI SPECT in the Assessment of Treatment Response in Pharyngeal Carcinoma

Khawar

Rafique

Jafri

et al. 2008

Annals of the New York Academy of Sciences

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The purpose of this study was to compare Tc(99m) MIBI SPECT imaging with computed tomography (CT) for assessment of post-radiotherapy treatment response in pharyngeal carcinoma. Twenty-two subjects took part in this study, which included six patients with nasopharyngeal carcinoma (Group I), three patients with oropharyngeal carcinoma and eight patients with hypopharyngeal carcinoma (Group II), and five control patients (Group III). All scans were analyzed qualitatively and quantitatively and correlated with findings on local examination and biopsy. Various indices such as ratios of nasopharynx, oropharynx, and hypopharynx to scalp (NSR, OSR, HSR), to nuchal muscles (NNR, ONR, HNR), and parotid glands (NPR, OPR, HPR) were calculated. The mean values of these above mentioned ratios calculated in the control group (Group III) were used as cutoff values to determine the presence or absence of tumor tissue in the patient groups (Groups I and II). The cutoff values calculated were 2.89 (NSR), 1.39 (NNR), 0.57(NPR), 3.83 (OSR), 1.81 (ONR), 0.83 (OPR), 2.86 (HSR), 1.73 (HNR), and 0.59 (HPR). The results revealed 100% sensitivity for primary nasopharyngeal tumors but less sensitivity for primary oropharyngeal and hypopharyngeal tumors (63.6%). Based on a relative decrease in tracer uptake, Tc(99m) MIBI SPECT scan was able to predict partial remission, complete remission, and no response on post-therapy scans. There were three false-negative results of disease progression in addition to evidence of disease eradication on CT scan. Thus Tc(99m) MIBI SPECT imaging has shown promising results in the detection of primary tumors and evaluation of treatment response much earlier than CT scan, which needs further exploration and large-scale studies.

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Detection of Recurrent Nasopharyngeal Carcinomas with Technetium-99m Methoxyisobutylisonitrile Single Photon Emission Computed Tomography in Patients with Indeterminate Magnetic Resonance Imaging Findings after Radiotherapy

Cited by 7 publications

References 12 publications

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Treatment Deescalation Strategies for Nasopharyngeal Cancer

Role of Tc^99m MIBI SPECT in the Assessment of Treatment Response in Pharyngeal Carcinoma

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Detection of Recurrent Nasopharyngeal Carcinomas with Technetium-99m Methoxyisobutylisonitrile Single Photon Emission Computed Tomography in Patients with Indeterminate Magnetic Resonance Imaging Findings after Radiotherapy

Cited by 7 publications

References 12 publications

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Progress in the comprehensive treatment of nasopharyngeal carcinoma: a review for risk-stratified management strategies

Treatment Deescalation Strategies for Nasopharyngeal Cancer

Role of Tc99m MIBI SPECT in the Assessment of Treatment Response in Pharyngeal Carcinoma

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Role of Tc^99m MIBI SPECT in the Assessment of Treatment Response in Pharyngeal Carcinoma