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1.
Akram Al‐Ibraheem MD Andreas K. Buck MD Matthias R. Benz MD Maximilian Rudert MD Ambros J. Beer MD Asem Mansour MD Kelsey L. Pomykala BSc Bernhard Haller PhD Hendrik Juenger MD Klemens Scheidhauer MD Markus Schwaiger MD Ken Herrmann MD 《Cancer》2013,119(6):1227-1234
BACKGROUND:
The clinical utility of modern hybrid imaging modalities for detecting recurrent bone or soft tissue sarcoma remains to be determined. In this report, the authors present a clinical study on the diagnostic accuracy and incremental value of integrated 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) in patients with a history of sarcoma who have clinically suspected disease recurrence.METHODS:
Forty‐three patients who had a history of bone or soft tissue sarcoma and had documented complete remission underwent 18F‐FDG PET/CT. Image analysis was performed independently for 18F‐FDG PET (n = 43) and for contrast‐enhanced spiral CT (CE‐CT) (n = 30) by 2 separate readers, whereas combined 18F‐FDG PET/CT (n = 43) images were analyzed in consensus by both readers. Imaging findings were rated on a 5‐point scale and finally were reported as malignant, benign, or equivocal. Imaging findings were validated either by histopathology (n = 24) or by clinical follow‐up (n = 19).RESULTS:
18F‐FDG PET/CT had greater sensitivity and specificity compared with CE‐CT alone (94% and 92% vs 78% and 67%, respectively), resulting in significantly greater accuracy (93% vs 73%; P = .03). 18F‐FDG PET/CT was particularly superior regarding detection of local recurrence or soft tissue lesions (sensitivity and specificity: 83% and 100% vs 50% and 100%, respectively) or bone metastases (100% and 100% vs 85% and 88%, respectively).CONCLUSIONS:
18F‐FDG PET/CT had greater diagnostic accuracy in the detection of recurrent bone or soft tissue sarcoma compared with CE‐CT alone. The detection of local recurrence was the most evident advantage of 18F‐FDG PET/CT over CE‐CT. Cancer 2013. © 2012 American Cancer Society. 相似文献2.
Johnny Kao MD Ha Linh Vu BA Eric M. Genden MD Bharat Mocherla MD Eunice E. Park MD MPH Stuart Packer MD Peter M. Som MD Lale Kostakoglu MD 《Cancer》2009,115(19):4586-4594
BACKGROUND:
The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow‐up program incorporating serial 18F?fluorodeoxyglucose?positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer.METHODS:
A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow?up, 21 months).RESULTS:
The sensitivity, specificity, and positive and negative predictive values of PET/CT‐based follow‐up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2‐year progression‐free survival and 2‐year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively).CONCLUSIONS:
Although post‐therapy follow‐up using PET/CT is reportedly associated with a high false‐positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value. Cancer 2009. © 2009 American Cancer Society. 相似文献3.
Kazushige Kawai Hiroaki Nozawa Keisuke Hata Toshiaki Tanaka Takeshi Nishikawa Koji Oba Toshiaki Watanabe 《Clinical colorectal cancer》2018,17(2):e163-e170
Introduction
Although 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) has been increasingly used to evaluate the response to preoperative chemoradiotherapy (CRT) in patients with rectal cancer, the optimal intervals between completion of CRT, PET, and surgery have not been fully investigated.Patients and Methods
A total of 148 consecutive patients with rectal adenocarcinoma who received CRT followed by FDG-PET and radical surgery were retrospectively analyzed. The association between the FDG-PET maximum standardized uptake value (SUVmax) and pathological response was assessed using a logistic regression model, with a primary focus on the intervals between CRT and PET as well as between PET and surgery.Results
The baseline SUVmax showed no association with pathological response (P = .201; area under the curve [AUC] = 0.528), whereas the SUVmax after CRT completion showed a strong association (P < .001; AUC = 0.707). Logistic regression analysis revealed that the ability of the SUVmax to accurately predict pathological good responders was significantly associated with a long CRT–PET interval (≥ 7 weeks; P = .027), but was not affected by the length of PET–surgery interval. In patients with a short CRT–PET interval (< 7 weeks), the ability of the SUVmax to predict good responders was poor (P = .201; AUC = 0.669); however, in patients with long intervals (≥ 7 weeks), the predictive ability markedly improved (P < .001; AUC = 0.879).Conclusion
A minimum wait time of 7 weeks is recommended before performing FDG-PET after neoadjuvant CRT for rectal cancer to obtain maximal predictive accuracy for pathological response. 相似文献4.
Allen S. Ho MD Gabriel J. Tsao MD Frank W. Chen BA Tianjie Shen MD Michael J. Kaplan MD A. Dimitrios Colevas MD Nancy J. Fischbein MD Andrew Quon MD Quynh‐Thu Le MD Harlan A. Pinto MD Willard E. Fee Jr MD John B. Sunwoo MD Davud Sirjani MD Wendy Hara MD Mike Yao MD 《Cancer》2013,119(7):1349-1356
BACKGROUND:
In head and neck cancer (HNC), 3‐month post‐treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post‐treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.METHODS:
A 10‐year retrospective analysis of HNC patients was carried out with long‐term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3‐month scans, 175 had 3‐ and 12‐month scans, and 77 had 3‐, 12‐, and 24‐month scans.RESULTS:
PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT‐detected and clinically detected recurrences, with similar 3‐year disease‐free survival (41% vs 46%, P = .91) and 3‐year overall survival (60% vs 54%, P = .70) rates. Compared with 3‐month PET/CT, 12‐month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.CONCLUSIONS:
HNC patients with negative 3‐month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT‐detected and clinically detected recurrences, although larger prospective studies are needed for further investigation. Cancer 2013. © 2012 American Cancer Society. 相似文献5.
Brian R. Weston MD Revathy B. Iyer MD Wei Qiao MS Jeffrey H. Lee MD Robert S. Bresalier MD William A. Ross MD 《Cancer》2010,116(6):1454-1461
BACKGROUND:
The ability of integrated positron emission tomography and computed axial tomography (PET‐CT) to detect colonic pathology is not fully defined. The purpose of this study was to assess the ability of PET‐CT to detect colonic pathology and to determine the significance of (18F)2‐fluoro‐2‐deoxyglucose (18F‐FDG) activity noted incidentally in the colon on PET‐CT.METHODS:
Records for all patients who underwent PET‐CT and colonoscopy at our institution were reviewed. Patients with history of colonic malignancy or colon surgery were excluded.RESULTS:
Fifty‐eight patients had incidental colonic 18F‐FDG activity on PET (Group A) and 272 had none (Group B). In Group A, 65% of patients had pathologic findings detected on colonoscopy that corresponded to the site of PET activity. Standardized uptake value (SUV) readings were not helpful in distinguishing true‐positives from false‐positives. In Group B, 11.8% of patients were found to have significant colonic findings. Lesions not detected by PET‐CT included 4 colon cancers, 7 advanced adenomas, and 10 patients with colonic lymphoma. Overall, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET‐CT for detecting significant pathology were 53%, 93%, 65%, 89%, and 85%, respectively. For detecting colon cancer and adenomas 10 mm or more, the sensitivity, specificity, PPV, NPV, and accuracy of PET‐CT were 72%, 90%, 45%, 96%, and 88%, respectively.CONCLUSIONS:
Incidental colonic activity detected by PET‐CT warrants further evaluation with colonoscopy. However, negative PET‐CT does not rule out significant colonic pathology including colon cancer, advanced adenomas, or lymphoma. Cancer 2010. © 2010 American Cancer Society. 相似文献6.
Daisy Mak Michael Chao Michael Lim Joon Malcolm Feigen Angelina Mercuri Aurora Poon 《Radiotherapy and oncology》2010,97(2):205-211
Purpose
To assess the correlation of 18F-FDG-PET (PET) response to pathological response after neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer.Methods and materials
Twenty patients with locally advanced rectal cancer were identified between 2001 and 2005. The median age was 57 years (range 37-72) with 14 males and 6 females. All patients were staged with endorectal ultrasound and/or MRI, CT, and PET. The clinical staging was T3N0M0 (16), T3N1M0 (2), and T3N0M1 (2). Restaging PET was performed after CRT, and prior to definitive surgery. The response on PET and pathology was assessed and correlated. Patient outcome according to PET response was also assessed.Results
Following CRT, a complete PET response occurred in 7 patients, incomplete response in 10, and no response in 3 patients. At surgery, complete pathological response was recorded in 7 patients, incomplete response in 10 and no response in 3. There was a good correlation of PET and pathological responses in complete responders (5/7 cases) and non-responders (3/3 cases). After a median follow-up of 62 months (range 7-73), twelve patients were alive with no evidence of disease. All patients achieving complete metabolic response were alive with no evidence of disease, while as those who had no metabolic response, all died as a result of metastatic disease.Conclusions
PET is a promising complementary assessment tool for assessing tumor response after CRT if there is a complete or no response. PET response may also predict for outcome. 相似文献7.
Sarah Everitt PhD Alan Herschtal BE PostGradDip Jason Callahan BAppSci Nikki Plumridge FRANZCR David Ball MD FRANZCR Tomas Kron PhD FCCPM FACPSEM Michal Schneider‐Kolsky PhD David Binns DipAppSci Rodney J. Hicks MD FRACP Michael MacManus MD FRCR FRANZCR 《Cancer》2010,116(21):5030-5037
BACKGROUND:
The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)‐positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo‐RT.METHODS:
Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG‐PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent.RESULTS:
Eighty‐two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8‐176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%‐49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P = .022), 16% in average SUV (P = .004), and 116% in percentage injected dose (P = .002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51‐95 days).CONCLUSIONS:
Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG‐PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy. Cancer 2010. © 2010 American Cancer Society. 相似文献8.
Haruhiko Nakayama MD PhD Sakae Okumura MD PhD Hiromitsu Daisaki PhD Yasufumi Kato MD PhD Hirofumi Uehara MD PhD Shuji Adachi MD PhD Masahiro Yoshimura MD PhD Morihito Okada MD PhD 《Cancer》2010,116(13):3170-3177
BACKGROUND:
The malignant biological behavior of small‐sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose‐positron emission tomography/computed tomography (PET/CT) in addition to high‐resolution CT (HRCT) and pathological analysis in a multicenter setting.METHODS:
A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground‐glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study.RESULTS:
The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease‐free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R2] = 0.1699) was much weaker than that reported with the GGO ratio (R2 = 0.5860) or TDR (R2 = 0.5082).CONCLUSIONS:
Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010. © 2010 American Cancer Society. 相似文献9.
BACKGROUND:
A study was undertaken to investigate the detection of relapse and survival outcomes in patients with cervical cancer treated with curative intent chemoradiotherapy, and evaluated with a post‐therapy 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) scan.METHODS:
Between January 2002 and June 2007, 105 consecutive patients were prospectively enrolled into a registry study designed to assess outcomes of chemoradiotherapy. A FDG‐PET scan was performed between 3 and 12 months (median, 4.9 months) post‐treatment at clinician discretion. Tumor response was graded as complete metabolic response, partial metabolic response, or progressive metabolic disease.RESULTS:
Median follow‐up was 36 months. At post‐therapy FDG‐PET, 73 (70%) patients had complete metabolic response, 10 (9%) had partial metabolic response, and 22 (21%) had progressive metabolic disease. Overall survival at 3 years was 77% in all patients, and 95% for those with complete metabolic response. On multivariate analysis, complete metabolic response (P < .0001) and pretreatment tumor volume (P = .041) were strong predictors for overall survival. The number of involved lymph nodes (P < .005) and International Federation of Gynecology and Obstetrics stage (P = .04) were predictive of relapse‐free survival. In total, 18 patients relapsed at a single site, and 13 underwent salvage, with a 3‐year survival of 67%. Patients with complete metabolic response had a distant failure rate 36‐fold less than those with partial metabolic response (P < .0001). After complete metabolic response, only 1 patient (1.6%) relapsed without symptoms and was detected through physical examination.CONCLUSIONS:
The presence of a complete metabolic response at post‐therapy FDG‐PET is a powerful predictor for survival after chemoradiation. The very low rate of recurrence in patients with a complete metabolic response justifies a conservative follow‐up approach for these patients, because relapse is usually symptomatic and not detected by routine clinical review. Cancer 2011. © 2011 American Cancer Society. 相似文献10.
A.M. Maffione S. Chondrogiannis C. Capirci F. Galeotti A. Fornasiero G. Crepaldi G. Grassetto L. Rampin M.C. Marzola D. Rubello 《European journal of surgical oncology》2014
Aim
To assess the predictive value of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in early assessing response during neo-adjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer.Materials and methods
A systematic review was performed by search of MEDLINE Library for the following terms: “rectal carcinoma OR rectal cancer”, “predictive OR prediction OR response assessment OR response OR assessment”, “early OR ad interim”, “therapy”, “FDG OR 18F-FDG”, “PET OR PET/CT”. Articles performed by the use of stand-alone PET scanners were excluded.Results
10 studies met the inclusion criteria, including 302 patients. PET/CT demonstrated a good early predictive value in the global cohort (mean sensitivity = 79%; mean specificity = 78%). SUV and its percentage decrease (response index = RI) were calculated in all studies. A higher accuracy was demonstrated for RI (mean sensitivity = 82%; pooled specificity = 85%) with a mean cut-off of 42%. The mean time point to perform PET scan during CRT resulted to be at 1.85 weeks. Some PET parameters resulted to be both predictive and not statistical predictive of response, maybe due to the small population and few studies bias.Conclusion
PET showed high accuracy in early prediction response during preoperative CRT, increased with the use of RI as parameter. In the era of tailored treatment, the precocious assessment of non-responder patients allows modification of the subsequent strategy especially the timing and the type of surgical approach. 相似文献11.
Ramirez PT Jhingran A Macapinlac HA Euscher ED Munsell MF Coleman RL Soliman PT Schmeler KM Frumovitz M Ramondetta LM 《Cancer》2011,117(9):1928-1934
BACKGROUND:
Failure to detect metastasis to para‐aortic nodes in patients with locally advanced cervical cancer leads to suboptimal treatment. No previous studies have prospectively compared positron emission tomography (PET)/computed tomography (CT) with laparoscopic extraperitoneal staging in the evaluation of para‐aortic lymph nodes.METHODS:
Sixty‐five patients were enrolled; 60 were available for analysis. Patients with stage IB2‐IVA cervical cancer without evidence of para‐aortic lymphadenopathy on preoperative CT or magnetic resonance imaging (MRI) were prospectively enrolled. All patients underwent preoperative PET/CT. Laparoscopic extraperitoneal lymphadenectomy was performed from the common iliac vessels to the left renal vein.RESULTS:
The median age at diagnosis was 48 years (range, 23‐84). The median operative time was 140 minutes (range, 89‐252). The median blood loss was 22.5 mL (range, 5‐150). The median length of hospital stay was 1 day (range, 0‐4). The median number of lymph nodes retrieved was 11 (range, 1‐39). Fourteen (23%) patients had histopathologically positive para‐aortic nodes. Of the 26 patients with negative pelvic and para‐aortic nodes on PET/CT, 3 (12%) had histopathologically positive para‐aortic nodes. Of the 27 patients with positive pelvic but negative para‐aortic nodes on PET/CT, 6 (22%) had histopathologically positive para‐aortic nodes. The sensitivity and specificity of PET/CT in detecting positive para‐aortic nodes when nodes were negative on CT or MRI were 36% and 96%, respectively. Eleven (18.3%) patients had a treatment modification based on surgical findings.CONCLUSIONS:
Laparoscopic extraperitoneal para‐aortic lymphadenectomy is safe and feasible. Surgical staging of patients with locally advanced cervical cancer should be considered before planned radiation and chemotherapy. Cancer 2011. © 2010 American Cancer Society. 相似文献12.
Mato AR Svoboda J Feldman T Zielonka T Agress H Panush D Miller M Toth P Lizotte PM Nasta S Goldberg S Chong E Schuster S Pecora AL Goy A 《Cancer》2012,118(14):3565-3570
BACKGROUND:
Although convincing data exist regarding the prognostic utility of positron emission tomographic (PET)‐computed tomographic (CT) imaging in Hodgkin lymphoma and diffuse large B‐cell lymphoma, its prognostic utility both during treatment and immediately after treatment have not been systematically evaluated in a large mantle cell lymphoma (MCL) patient cohort to support its use in clinical practice.METHODS:
The authors conducted a retrospective cohort study to examine the prognostic utility of PET‐CT imaging in a uniform MCL patient cohort undergoing dose‐intensive chemotherapy (R‐HyCVAD) in the frontline setting. The primary study endpoints were progression‐free survival (PFS) and overall survival (OS). PET‐CT images were centrally reviewed for the purposes of this study using standardized response criteria.RESULTS:
Fifty‐three patients with advanced stage MCL with PET‐CT data were identified. With median follow‐up of 32 months, 3‐year PFS and OS estimates were 76% (95% confidence interval [CI], 64%‐84%) and 84% (95% CI, 72%‐90%), respectively. Interim PET‐CT status was not associated with PFS (hazard ratio [HR], 0.9; 95% CI, 0.3‐2.7; P = .8) or OS (HR, 0.6; 95% CI, 0.1‐2.9; P = .5). Post‐treatment PET‐CT status was statistically significantly associated with PFS (HR, 5.2; 95% CI, 2.0‐13.6; P = .001) and trended toward significant for OS (HR, 2.8; 95% CI, 0.8‐9.6; P = .07).CONCLUSIONS:
These data do not support the prognostic utility of PET‐CT in pretreatment and interim treatment settings. A positive PET‐CT after the completion of therapy identifies a patient subset with an inferior PFS and a trend toward inferior OS. Cancer 2012;3565–3570. © 2011 American Cancer Society. 相似文献13.
Champion L Brain E Giraudet AL Le Stanc E Wartski M Edeline V Madar O Bellet D Pecking A Alberini JL 《Cancer》2011,117(8):1621-1629
BACKGROUND:
Breast cancer recurrence is often suspected on tumor marker rising in asymptomatic patients. The value of fluorine‐18 fluorodeoxyglucose (18FDG)–positron emission tomography/computed tomography (PET/CT) imaging to detect recurrence and its subsequent impact on patient management were retrospectively assessed.METHODS:
PET/CT scans were performed on 228 asymptomatic patients (mean, 60.8 years; range, 30‐91 years) presenting with rising CA 15‐3 and/or CEA serum levels.RESULTS:
PET/CT scans were positive in 181 patients (79.5%) and normal in 47 patients, whereas 187 true recurrences were diagnosed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT imaging for detection of breast cancer recurrence were 93.6%, 85.4%, 96.7%, 74.5%, and 92.1%, respectively. When compared with the standard workup available in 67 patients, PET/CT imaging had a higher sensitivity and accuracy (94.5% vs 33% and 94% vs 48%, respectively). Recurrences were confirmed by pathology, conventional imaging techniques, or radiological and clinical follow‐up beyond 1 year (mean, 34 months; range, 12‐67 years) in 32, 130, and 25 patients, respectively. The diagnosis of recurrence led to a treatment modification in 123 patients (54%).CONCLUSIONS:
18FDG‐PET/CT imaging is an efficient technique to detect breast cancer recurrence suspected on tumor marker rising in asymptomatic patients. It may thus contribute to improve patient management, providing an earlier diagnosis with complete whole‐body staging as a “one‐stop shop” procedure. Cancer 2011. © 2010 American Cancer Society. 相似文献14.
Guilherme Pagin São Julião Angelita Habr-Gama Bruna Borba Vailati Patricia Bailão Aguilar Jorge Sabbaga Sérgio Eduardo Alonso Araújo Adrian Mattacheo Flavia Andrea Alexandre Laura Melina Fernandez Diogo Bugano Gomes Joaquim Gama-Rodrigues Rodrigo Oliva Perez 《European journal of surgical oncology》2018,44(1):93-99
Patients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in “extended” nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3 patients undergoing standard or extended nCRT.
Methods
Patients with distal and non-metastatic T3 rectal cancer managed by nCRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5FU-based chemotherapy) were compared to those undergoing extended CRT (54 Gy and 6 cycles of 5FU-based chemotherapy). Patients were assessed for tumor response at 8–10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (Watch & Wait). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Cox's logistic regression was performed to identify independent features associated with improved surgery-free survival after cCR and distant-metastases-free survival.Results
155 patients underwent standard and 66 patients extended CRT. Patients undergoing extended CRT were more likely to harbor larger initial tumor size (p = 0.04), baseline nodal metastases (cN+; p < 0.001) and higher tumor location (p = 0.02). Cox-regression analysis revealed that the type of nCRT regimen was not independently associated with distinct surgery-free survival after cCR or distant-metastases-free survival (p > 0.05).Conclusions
Dose-escalation and consolidation chemotherapy are insufficient to increase long-term surgery-free survival among cT3 rectal cancer patients and provides no advantage in distant metastases-free survival. 相似文献15.
Elizabeth Smyth MD Heiko Schöder MD Vivian E. Strong MD Marinela Capanu PhD David P. Kelsen MD Daniel G. Coit MD Manish A. Shah MD 《Cancer》2012,118(22):5481-5488
BACKGROUND:
The aim of this study was to examine prospectively the utility of adding preoperative [18F]fluorodeoxyglucose positron emission tomography (FDG‐PET)/computed tomography (CT) to routine CT, endoscopic ultrasound (EUS), and laparoscopic staging of localized gastric cancer.METHODS:
Patients with locally advanced gastric/gastroesophageal cancer were screened for 2 institutional review board–approved Memorial Sloan‐Kettering Cancer Center neoadjuvant chemotherapy protocols. Locally advanced disease was defined as T3 or T4, or lymph node–positive, based on EUS and high‐resolution CT scan. All patients underwent both standard FDG‐PET/CT and laparoscopy with cytological examination of washings. The sensitivity and specificity of FDG‐PET/CT for the identification of metastatic disease not seen on CT was determined. An economic model using Medicare/Medicaid reimbursement charges was developed to assess the cost‐effectiveness of these interventions.RESULTS:
A total of 113 patients were enrolled from 2003 to 2010. All patients were assessed as having locally advanced disease by CT/EUS. FDG uptake in the primary tumor was associated with male sex, proximal tumors, and nondiffuse Lauren's subtype. 31 (27%) patients had occult metastatic disease detected by PET/CT (n = 11, 10%) and/or laparoscopy (n = 21, 19%), with a single overlap. Economic modeling suggests that the addition of FDG‐PET/CT to the standard staging evaluation of patients with locally advanced gastric cancer resulted in an estimated cost savings of ~US $13,000 per patient.CONCLUSIONS:
FDG‐PET/CT identifies occult metastatic lesions in approximately 10% of patients with locally advanced gastric cancer. Because of reduced morbidity from fewer futile surgeries and lower patient care costs, PET/CT should be considered as a component of the standard staging algorithm for localized gastric cancer. Cancer 2012. © 2012 American Cancer Society. 相似文献16.
Chin A Yi MD Kyung Soo Lee MD Ho Yun Lee MD Seonwoo Kim PhD O Jung Kwon MD Hojoong Kim MD Joon Young Choi MD Byung‐Tae Kim MD Hye Sun Hwang MD Young Mog Shim MD 《Cancer》2013,119(10):1784-1791
BACKGROUND:
The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging‐positron emission tomography (MRI‐PET) would increase the number of correctly upstaged patients compared with WB PET‐computed tomography (PET‐CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC).METHODS:
From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI‐PET or WB PET‐CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging.RESULTS:
Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI‐PET group and in 26 of 120 patients (21.7%) in the PET‐CT plus brain MRI group (4.2% difference; 95% confidence interval, ?6.1% to 14.5%; P = .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI‐PET group and in 7 of 120 patients (5.8%) in the PET‐CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%‐20%; P = .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (?10.7% difference; 95% confidence interval, ?20.1% to ?1.4%; P = .022).CONCLUSIONS:
Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI‐PET did not appear to help identify significantly more correctly upstaged patients than PET‐CT plus brain MRI in patients with NSCLC. Cancer 2013. © 2013 American Cancer Society. 相似文献17.
Tracy Klayton Tianyu Li Jian Q. Yu Lanea Keller Jonathan Cheng Steven J. Cohen Neal J. Meropol Walter Scott Meng Xu-Welliver Andre Konski 《Journal of gastrointestinal cancer》2012,43(4):612-618
Objective
The aim of this study was to determine if a qualitative and quantitative assessment of pre- and post-chemoradiotherapy (CRT) F18-FDG PET scans of esophageal cancer patients could predict for residual disease in esophagectomy specimens.Methods
We retrospectively reviewed the records of esophageal cancer patients who had undergone CRT at a single institution. Analysis was limited to esophagectomy patients with both pre- and post-CRT F18-FDG PET scans. The maximum standardized uptake value (SUV), location, and measured length of esophagus with increased F18-FDG uptake were obtained from the PET scan before and 3–4 weeks following CRT (preoperatively). The pattern of F18-FDG uptake was qualitatively assigned a category of diffuse, focal, or diffuse with focal component.Results
Fifty-seven patients with localized esophageal carcinoma underwent F18-FDG PET/CT scans as part of their initial staging and post-CRT restaging workup, followed by esophagectomy. The pathologic complete response (pCR) rate was 25 %. The presence of a focal component on post-CRT PET predicted residual disease on univariate analysis (86 % vs. 64 %), and achieved significance when controlling for SUV and presence of diabetes on MVA (OR?=?5.59, p?=?0.028). There was no significant relationship between pre- or post-CRT SUV, tumor histology, or length of increased F18-FDG uptake and presence of residual disease. SUV and focality did not interact significantly to predict residual disease.Conclusions
Qualitative but not quantitative PET imaging can help predict increased likelihood of residual tumor in esophageal cancer patients following CRT; however, it is not sensitive enough to solely rule out the presence of residual disease. Additional investigation with a larger cohort of patients is warranted. 相似文献18.
Prognostic significance of metabolic tumor burden by positron emission tomography/computed tomography in patients with relapsed/refractory diffuse large B‐cell lymphoma 下载免费PDF全文
Ukihide Tateishi Mitsuaki Tatsumi Takashi Terauchi Kiyoshi Ando Nozomi Niitsu Won Seog Kim Cheolwon Suh Michinori Ogura Kensei Tobinai 《Cancer science》2015,106(2):186-193
The aim of the present study was to investigate the feasibility of measuring metabolic tumor burden using [F‐18] fluorodeoxyglucose (18F‐FDG) positron emission tomography/computed tomography (PET/CT) in patients with relapsed or refractory diffuse large B‐cell lymphoma (DLBCL) treated with bendamustine–rituximab. Because the standardized uptake value is a critical parameter of tumor characterization, we carried out a phantom study of 18F‐FDG PET/CT to ensure quality control for 28 machines in the 24 institutions (Japan, 17 institutions; Korea, 7 institutions) participating in our clinical study. Fifty‐five patients with relapsed or refractory DLBCL were enrolled. The 18F‐FDG PET/CT was acquired before treatment, after two cycles, and after the last treatment cycle. Treatment response was assessed after two cycles and after the last cycle using the Lugano classification. Using this classification, remission was complete in 15 patients (27%) and incomplete in 40 patients (73%) after two cycles of therapy, and remission was complete in 32 patients (58%) and incomplete in 23 patients (42%) after the last treatment cycle. The percentage change in all PET/CT parameters except for the area under the curve of the cumulative standardized uptake value–volume histogram was significantly greater in complete response patients than in non‐complete response patients after two cycles and the last cycle. The Cox proportional hazard model and best subset selection method revealed that the percentage change of the sum of total lesion glycolysis after the last cycle (relative risk, 5.24; P = 0.003) was an independent predictor of progression‐free survival. The percent change of sum of total lesion glycolysis, calculated from PET/CT, can be used to quantify the response to treatment and can predict progression‐free survival after the last treatment cycle in patients with relapsed or refractory DLBCL treated with bendamustine–rituximab. 相似文献
19.
Ferrandina G Petrillo M Restaino G Rufini V Macchia G Carbone A Zannoni GF Lucidi A D'Angelo G Scambia G 《Cancer》2012,118(2):392-403
BACKGROUND:
The goal of this study was to prospectively analyze the diagnostic performances of magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT) in predicting pathologically assessed residual disease in a large, single‐institution series of locally advanced cervical cancer (LACC) patients triaged to neoadjuvant treatments followed by radical surgery.METHODS:
Between April 2007 and March 2010, 96 patients with histologically documented cervical cancer (any histology) and FIGO stage IB2‐IVA were enrolled. MRI and PET/CT were recommended to be performed within 4‐6 weeks from the end of treatment, and histology was the reference standard. Sensitivity, specificity, and accuracy were compared using the McNemar test.RESULTS:
For residual disease in the cervix, sensitivity was higher for MRI than for PET/CT (86.1% vs 63.1%; P = .002), while specificity was significantly higher for PET/CT compared with MRI (P = .002). There was no difference in accuracy values between the 2 imaging modalities. For MRI analysis of lymph node groups, sensitivity, specificity, and accuracy were 35.7%, 95.9%, and 88.0%, respectively. Conversely, sensitivity, specificity, and accuracy for PET/CT were 28.6%, 97.8%, and 88.7%, respectively. Absence of follicular structures replaced by prevalent sclerosis and/or sinus histiocytosis was the most frequently documented morphological pattern in false‐positive cases.CONCLUSION:
Neither MRI nor PET/CT accurately detected residual disease in LACC patients triaged to radical surgery after neoadjuvant treatment, disallowing the option of avoiding or modulating completion surgery. Cancer 2011;. © 2011 American Cancer Society. 相似文献20.
Ayman Soubra Mehmet Gencturk Jerry Froelich Priya Balaji Shilpa Gupta Gautam Jha Badrinath R. Konety 《Clinical genitourinary cancer》2018,16(5):360-364