PET imaging in adaptive radiotherapy of gastrointestinal tumors

Bulens, P.; Thomas, Melissa L.; Deroose, Christophe M.; Haustermans, Karin

doi:10.23736/s1824-4785.18.03081-9

Cited by 11 publications

(6 citation statements)

References 99 publications

(96 reference statements)

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“…They promise a clinical challenge for physicians, because they may have various growth patterns ranging from very slowly progressive to rapidly aggressive tumors. An effective diagnosis of NEN is based on clinical presentation, pathology, cross-sectional imaging (computed tomography (CT) or magnetic resonance imaging (MRI)), and functional nuclear medicine procedures, including 68-Gallium PET and 18FDG PET [4,5,6]. Recently, the involvement of the immune system and the role of tumor micro-environment has also been suggested as important in tumor evolution [7].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

Mazzuca

Rinzivillo

Arrivi

et al. 2019

JCM

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Purpose: Multidisciplinary approach is widely advised for an effective care of patients with neuroendocrine neoplasia (NEN). Since data on efficacy of multidisciplinary management of NENs patients in referral centers are scanty, this study aimed at analyzing the modality of presentation and clinical outcome of patients with NENs managed by a dedicated multidisciplinary team. Methods. In this prospective observational study, we included all consecutive new patients visiting the Sant’Andrea Hospital in Rome (ENETS—Center of Excellence) between January 2014 and June 2018. Results. A total of 195 patients were evaluated. The most frequent sites were pancreas (38.5%), small bowel (22%), and lung (9.7%). Median Ki67 was 3%. After the first visit at the center, additional radiological and/or nuclear medicine procedures were requested in 163 patients (83.6%), whereas histological data revision was advised in 84 patients (43.1%) (revision of histological slides: 27.7%, new bioptic sampling: 15.4%). After that, disease imaging staging and grading was modified in 30.7% and 17.9% of patients, respectively. Overall, a change in therapeutic management was proposed in 98 patients (50.3%). Conclusions. Multidisciplinary approach in a dedicated team may lead to change of disease imaging staging and grading in a significant proportion of patients. Enhancing referral routes to dedicated-NEN center should be promoted, since it may improve patients’ clinical outcome.

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Section: Introductionmentioning

confidence: 99%

Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

Mazzuca

Rinzivillo

Arrivi

et al. 2019

JCM

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“…18 F-FDG-PET/CT, as well as MRI, can be theoretically used for adaptive dose escalated CRT in LARC [29,30]. Moreover, some studies reported a signi cant correlation between early 18 F-FDG-PET/CT and pathological tumor response [31,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…Our combined approach allowed to further improved pCR but without worsening of toxicity. This has important clinical implication based on the emerging data on the possibility to avoid major surgery in LARC patients with complete clinical response after preoperative CRT [30,35].…”

Section: Discussionmentioning

confidence: 99%

Adaptive Individualized high-Dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial

Guido

Cuicchi

Castellucci

et al. 2022

Preprint

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Purpose To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT). Methods The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of 18 F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed 18 F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m2 twice daily orally) was prescribed for the entire treatment duration. Results Eighteen patients (13 Males, 5 Females; median age 55 years [range, 41–77 years]) were enrolled in the trial. Patients underwent surgical resection at 8–9 weeks after the end of neoadjuvant CRT. No patient showed grade > 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1,2,3 (non pCR). Accepting p < 0.05 as the level of significance, at the Kruskal-Wallis test, the medians of baseline-MTV, interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. 18 F-FDG-PET/CT was able to predict the pCR in 77.8% of cases. Conclusions Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate.

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Section: Discussionmentioning

confidence: 99%

Adaptive Individualized high-dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial

Guido

Cuicchi

Castellucci

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT). Methods The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of 18 F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed 18 F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore, a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m2 twice daily orally) was prescribed for the entire treatment duration. Results Eighteen patients (13 males, 5 females; median age 55 years [range, 41–77 years]) were enrolled in the trial. Patients underwent surgical resection at 8–9 weeks after the end of neoadjuvant CRT. No patient showed grade > 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1, 2, 3 (non pCR). Accepting p < 0.05 as the level of significance, at the Kruskal–Wallis test, the medians of baseline-MTV, interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. 18 F-FDG-PET/CT was able to predict the pCR in 77.8% of cases through compared evaluation of both baseline PET/CT and interim PET/CT. Conclusions Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate.

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PET imaging in adaptive radiotherapy of gastrointestinal tumors

Abstract: Overview and main research question of studies in radiation treatment planning of oesophageal cancer (Table 1), pancreas cancer (Table 2), liver cancer (Table 3), rectal cancer (Table 4), anal cancer (Table 5)

Cited by 11 publications

References 99 publications

Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

Adaptive Individualized high-Dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial

Adaptive Individualized high-dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial

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