Positron emission tomography with computed tomography imaging (PET/CT) for the radiotherapy planning definition of the biological target volume: PART 2

Fiorentino, Alba; Laudicella, Riccardo; Ciurlia, E.; Annunziata, Salvatore; Lancellotta, Valentina; Mapelli, Paola; Tuscano, Carmelo; Caobelli, Federico; Evangelista, Laura; Marino, Lorenza; Quartuccio, Natale; Fiore, Michele; Borghetti, Paolo; Chiaravalloti, Agostino; Ricci, Marcos Desídérío; Desideri, Isacco; Alongi, Pierpaolo

doi:10.1016/j.critrevonc.2019.03.008

Cited by 29 publications

(15 citation statements)

References 114 publications

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“…It has also been hypothesized that 18 Ffluorodeoxyglucose ( 18 F-FDG) may be a clinically useful surrogate hypoxia tracer [24]. If this hypothesis proves to be valid, 18 F-FDG PET/CT may turn out be a powerful imaging modality for LACC, since 18 F-FDG PET/CT already is used successfully to detect pathological lymph nodes and high-risk radiation therapy targets [25,26]. The potential of DCE-MRI as an imaging modality for providing hypoxia-associated biomarkers of the outcome of LACC was investigated in the study reported in this communication.…”

Section: Discussionmentioning

confidence: 99%

DCE-MRI of locally-advanced carcinoma of the uterine cervix: Tofts analysis versus non-model-based analyses

et al. 2020

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Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may provide biomarkers of the outcome of locally-advanced cervical carcinoma (LACC). There is, however, no agreement on how DCE-MR recordings should be analyzed. Previously, we have analyzed DCE-MRI data of LACC using non-model-based strategies. In the current study, we analyzed DCE-MRI data of LACC using the Tofts pharmacokinetic model, and the biomarkers derived from this analysis were compared with those derived from the non-model-based analyses. Methods: Eighty LACC patients given cisplatin-based chemoradiotherapy with curative intent were included in the study. Treatment outcome was recorded as disease-free survival (DFS) and overall survival (OS). DCE-MRI series were analyzed voxelwise to produce K trans and v e frequency distributions, and ROC analysis was used to identify the parameters of the frequency distributions having the greatest potential as biomarkers. The prognostic power of these parameters was compared with that of the non-model-based parameters LETV (low-enhancing tumor volume) and TVIS (tumor volume with increasing signal). Results: Poor DFS and OS were associated with low values of K trans , whereas there was no association between treatment outcome and v e . The K trans parameters having the greatest prognostic value were p35-K trans (the K trans value at the 35 percentile of a frequency distribution) and RV-K trans (the tumor subvolume with K trans values below 0.13 min − 1 ). Multivariate analysis including clinical parameters and p35-K trans or RV-K trans revealed that RV-K trans was the only independent prognostic factor of DFS and OS. There were significant correlations between RV-K trans and LETV and between RV-K trans and TVIS, and the prognostic power of RV-K trans was similar to that of LETV and TVIS. Conclusions: Biomarkers of the outcome of LACC can be provided by analyzing DCE-MRI series using the Tofts pharmacokinetic model. However, these biomarkers do not appear to have greater prognostic value than biomarkers determined by non-model-based analyses.

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Section: Discussionmentioning

confidence: 99%

DCE-MRI of locally-advanced carcinoma of the uterine cervix: Tofts analysis versus non-model-based analyses

et al. 2020

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“…Diagnostic accuracy of T staging with CT, however, is limited as measurements of wall thickness can be difficult. FDG-PET/CT imaging has been shown to play an important role in the primary staging of many cancers and has had a major impact on radiotherapy target volume definition [1]. On the other hand, while FDG PET/CT is reliable for remote nodal and distant metastases, it is less reliable for regional lymph node status [2,3].…”

Section: Introductionmentioning

confidence: 99%

Impact of Primary Staging with Fibroblast Activation Protein Specific Enzyme Inhibitor (FAPI)-PET/CT on Radio-Oncologic Treatment Planning of Patients with Esophageal Cancer

et al. 2020

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Purpose Quinoline-based ligands targeting cancer-associated fibroblasts have emerged as promising radiopharmaceuticals in different tumor entities. The aim of this retrospective study was to explore the potential of FAPI-PET/CT in the initial staging of esophageal cancer patients and its usefulness in radiotherapy planning as a first clinical analysis. Methods Seven patients with treatment-naive esophageal cancer underwent FAPI-PET/CT. Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean. Six patients received definitive and one neoadjuvant (chemo)radiation therapy. Endo-esophageal clipping, the gold standard to define tumor margins not delineable per CT, was performed in three patients. Results Primary tumors demonstrated high FAPI uptake with a median SUVmax of 17.2. Excellent tumor-to-background ratios resulted in accurate target volume delineation and were found in perfect match with clipping. Detection of regional lymph node metastases facilitated the use of simultaneous integrated boost radiotherapy plans for these patients. Conclusion FAPI-PET/CT may be beneficial for the management of esophageal cancer particularly in planning radiotherapy, but further research is necessary to increase patient number and statistical reliability.

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“…Therefore, it is particularly important to give sufficient doses to the distal parametrium. If possible, PET-CT should be used to accurately delineate the target volume for distal parametrium due to the major capability to identify high-risk RT areas ( 18 ). For similar patients, even more efforts to devise satisfactory individualized treatment plans will be necessary to address the difficult challenge of simultaneously increasing the dose for HR-CTV yet limiting the dose to OARs.…”

Section: Discussionmentioning

confidence: 99%

Intracavitary/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric Study

Han

Zhang

et al. 2021

Front. Oncol.

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PurposeTo explore the dosimetric advantage of combining intracavitary/interstitial applicator with distal parametrial free needle interstitial brachytherapy (IC/IS+ISBT DP) based on MRI for locally advanced cervical cancer.Methods and Materials77 IC/IS+ISBT DP treatment plans were developed for 34 patients with locally advanced cervical cancer from June 2016 to January 2020 in this study. We removed the free needles and devised a new IC/ISBT treatment plan based on the same principle. We then compared the dosimetric differences of D90, D98, V100, V150, V200 for HR-CTV (high-risk clinical target volume), D90 for IR-CTV (Intermediate risk-CTV) and D2cc for OARs (organs at risk) between the two groups of treatment plans for the same patient, and the paired T test was performed in parallel. Further, the dosage differences between the two group plans under different parametrial extension widths (the maximum distance of HR-CTV from the vertical direction of the uterine tandem at coronal position) were compared. The survival rate was calculated using the Kaplan-Meier method. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were determined by Cox regression method. RTOG/EORTC criteria were used to grade toxicities.ResultsA total of 297 free needles were used, with a weight ratio of 15.8% ± 0.11, and a mean insertion depth of 6.52cm ± 2.8cm. D90, D98, V100 for HR-CTV, and D90 for IR-CTV for IC/IS+ISBT DP were significantly higher than IC/ISBT for which free needles were removed (p<0.05). And the V200 for HR-CTV and D2cc for bladder, rectum and sigmoid were decreased (p<0.05). When the parametrial extension widths were greater than 3cm, the HR-CTV D90 and the D2CC for rectum, bladder and sigmoid colon for IC/IS-ISBT DP were advantageous compared to IC/ISBT (p<0.05). The 2-yr OS, PFS and local control rate (LC) were 82.3, 66.8, and 93.1%, respectively. Parametrial extension widths was the only statistically prognostic factors for PFS (p = 0.002) on univariate analysis. No grade 3 or 4 Treatment-related toxicities were observed.ConclusionOur institutional experiences showed that IC/IS+ISBT DP is an effective treatment for cervical cancer patients with distal parametrial extension. IC/IS-ISBT DP had dosage advantage and clinical feasibility in locally advanced cervical cancer with distal parametrial extension when the parametrial extension widths were greater than 3cm.

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Positron emission tomography with computed tomography imaging (PET/CT) for the radiotherapy planning definition of the biological target volume: PART 2

Cited by 29 publications

References 114 publications

DCE-MRI of locally-advanced carcinoma of the uterine cervix: Tofts analysis versus non-model-based analyses

DCE-MRI of locally-advanced carcinoma of the uterine cervix: Tofts analysis versus non-model-based analyses

Impact of Primary Staging with Fibroblast Activation Protein Specific Enzyme Inhibitor (FAPI)-PET/CT on Radio-Oncologic Treatment Planning of Patients with Esophageal Cancer

Intracavitary/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric Study

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