FDG-PET/CT in the Radiotherapy Treatment Planning of Locally Advanced Anal Cancer: A Monoinstitutional Experience

Carlo, C. Di; Benedetto, Maika di; Vicenzi, L.; Costantini, Sara; Cucciarelli, F.; Fenu, F.; Arena, E.; Mariucci, C.; Montisci, M.; Panni, V.; Patani, F.; Valenti, Marco; Palucci, Andrea; Burroni, Luca; Mantello, G.

doi:10.3389/fonc.2021.655322

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…The European Organization for Research and Treatment of Cancer (EORTC) 22931 10 and Radiation Therapy Oncology Group (RTOG) 95-01 randomized clinical trial 6 demonstrated the survival benefit of concurrent chemoradiotherapy in high-risk head and neck cancer patients. This paved the way for chemoradiotherapy to become the standard treatment protocol 22 , 23 for locally advanced OPSCC patients, regardless of HPV status. However, clinical characteristics and treatment response differ between various head and neck cancer subsites 24 (e.g., oropharyngeal, laryngeal and oral cavity).…”

Section: Discussionmentioning

confidence: 99%

CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma

et al. 2023

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Chemoradiation is a common therapeutic regimen for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). However, not all patients benefit from chemotherapy, especially patients with low-risk characteristics. We aim to develop and validate a prognostic and predictive radiomic image signature (pRiS) to inform survival and chemotherapy benefit using computed tomography (CT) scans from 491 stage I and II HPV-associated OPSCC, which were divided into three cohorts D1–D3. The prognostic performance of pRiS was evaluated on two test sets (D2, n = 162; D3, n = 269) using concordance index. Patients from D2 and D3 who received either radiotherapy alone or chemoradiation were used to validate pRiS as predictive of added benefit of chemotherapy. Seven features were selected to construct pRiS, which was found to be prognostic of overall survival (OS) on univariate analysis in D2 (hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.1–4.16, p = 0.02) and D3 (HR = 2.74, 95% CI, 1.34–5.62, p = 0.006). Chemotherapy was associated with improved OS for high-pRiS patients in D2 (radiation vs chemoradiation, HR = 4.47, 95% CI, 1.73–11.6, p = 0.002) and D3 (radiation vs chemoradiation, HR = 2.99, 95% CI, 1.04–8.63, p = 0.04). In contrast, chemotherapy did not improve OS for low-pRiS patients, which indicates these patients did not derive additional benefit from chemotherapy and could be considered for treatment de-escalation. The proposed radiomic signature was prognostic of patient survival and informed benefit from chemotherapy for stage I and II HPV-associated OPSCC patients.

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Section: Discussionmentioning

confidence: 99%

CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma

et al. 2023

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“…Another finding was a nonsignificant trend towards a lower RT boost volume (≤ 241.1 cm 3 vs. > 241.1 cm 3 ; P = 0.197) in patients with PET-CT planning. PET-CT may serve as a further diagnostic tool to precisely confirm the location of the PT and detect affected/unaffected lymph nodes, thus influencing staging and target volume delineation [48][49][50][51][52][53][54]. In a study by Zimmermann et al [51], upstaging and downstaging by PET-CT were reported in 13% of cases each for nodal disease, with a consequent change in treatment planning for 17% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma

et al. 2023

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Purpose Primary radiochemotherapy (RCT) constitutes the standard of care for early- and advanced-stage anal carcinoma. This retrospective study investigates the impact of dose escalation on colostomy-free survival (CFS), overall survival (OS), locoregional control (LRC), progression-free survival (PFS), and acute and late toxicities in patients with squamous cell anal cancer. Methods Considered were the outcomes of 87 patients with anal cancer treated with radiation/RCT between May 2004 and January 2020 at our institution. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE version 5.0). Results The 87 patients received treatment with a median boost of 63 Gy to the primary tumor. With a median follow-up of 32 months, the 3‑year CFS, OS, LRC, and PFS were 79.5%, 71.4%, 83.9%, and 78.5%, respectively. Tumor relapse occurred in 13 patients (14.9%). Dose escalation to > 63 Gy (maximum 66.6 Gy) to the primary tumor in 38/87 patients revealed a nonsignificant trend for improved 3‑year CFS (82.4% vs. 97%, P = 0.092), a significantly improved CFS for T2/T3 tumors (72.6% vs. 100%, P = 0.008), and a significantly improved 3‑year PFS for T1/T2 tumors (76.7% vs. 100%, P = 0.035). While acute toxicities did not differ, dose escalation > 63 Gy led to a higher rate of chronic skin toxicities (43.8% vs. 69%, P = 0.042). Treatment with intensity-modulated radiotherapy (IMRT) showed a significant improvement in 3‑year OS (75.4% vs. 53.8%, P = 0.048). In multivariate analysis, significant improvements for T1/T2 tumors (CFS, OS, LRC, PFS), G1/2 tumors (PFS), and IMRT (OS) were shown. The nonsignificant trend for CFS improvement with dose escalation > 63 Gy was also apparent in multivariate analysis (P = 0.067). Conclusion Dose escalation > 63 Gy (maximum 66.6 Gy) may improve CFS and PFS for certain subgroups, with a concomitant increase in chronic skin toxicities. Modern IMRT seems to be associated with an improvement in OS.

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“…In these 14 cases, dose escalation was performed on the FDG-PET/CT-positive nodes. According to this study, FDG-PET/CT is particularly important for the detection of inguinal LNMs [21]. We can assume due to the moderate specificity and high sensitivity and due to the major changes in treatment planning when FDG-PET/CT is used that it is indispensable for detecting and contouring LNMs in AC in the context of curative radiotherapy for dose escalation.…”

Section: Anal Canal Cancermentioning

confidence: 93%

The Role of MRI and PET/CT in Radiotherapy Target Volume Determination in Gastrointestinal Cancers—Review of the Literature

Ermenc

Šegedin

2023

Cancers

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Positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (MRI) could improve accuracy in target volume determination for gastrointestinal cancers. A systematic search of the PubMed database was performed, focusing on studies published within the last 20 years. Articles were considered eligible for the review if they included patients with anal canal, esophageal, rectal or pancreatic cancer, as well as PET/CT or MRI for radiotherapy treatment planning, and if they reported interobserver variability or changes in treatment planning volume due to different imaging modalities or correlation between the imaging modality and histopathologic specimen. The search of the literature retrieved 1396 articles. We retrieved six articles from an additional search of the reference lists of related articles. Forty-one studies were included in the final review. PET/CT seems indispensable for target volume determination of pathological lymph nodes in esophageal and anal canal cancer. MRI seems appropriate for the delineation of primary tumors in the pelvis as rectal and anal canal cancer. Delineation of the target volumes for radiotherapy of pancreatic cancer remains challenging, and additional studies are needed.

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FDG-PET/CT in the Radiotherapy Treatment Planning of Locally Advanced Anal Cancer: A Monoinstitutional Experience

Cited by 5 publications

References 24 publications

CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma

CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma

Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma

The Role of MRI and PET/CT in Radiotherapy Target Volume Determination in Gastrointestinal Cancers—Review of the Literature

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