PET-CT guided SIB-IMRT combined with concurrent 5-FU/MMC for the treatment of anal cancer

Zimmermann, Michel; Beer, Jürgen; Moos, Roger von; Vlachopoulou, Vasiliki; Zwahlen, Daniel R.; Oehler, Christoph

doi:10.1080/0284186x.2017.1325003

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…Consequently, such data might be a strong tool for personalizing treatment in terms of radiation dose. Indeed, also for anal cancer, tracer uptake after radiochemotherapy has been shown to be of prognostic value [23,[36][37].…”

Section: Discussionmentioning

confidence: 99%

Treatment outcome after radiochemotherapy in anal cancer patients staged with 18F-FDG-PET-CT

Braun

Reinert

Zips

et al. 2020

Clinical and Translational Radiation Oncology

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Background: Anal cancer (AC) is a malignancy with increasing incidence and commonly treated with radiochemotherapy. Positron-emission tomography-computed tomography (PET/CT) has been shown to improve treatment outcome in various oncological diseases, however, for AC long-term outcome data is sparse. The aim of the present study is therefore to report outcomes in our cohort of PET/CT staged AC patients treated with radiochemotherapy. Methods: Patients with AC who were treated with radiochemotherapy in curative intent were included in this retrospective study if a PET/CT scan was performed pre-therapeutically. Information from PET/CT was considered for nodal and primary target volume definition. Radiotherapy dose to the primary tumor was 50-66 Gy and concomitant chemotherapy included 5-fluorouracil and mitomycin-C. The uptake of 18 F-fluorodeoxyglucose (FDG) was quantified using 50%-isocontour volumes of interests (VOIs) and measuring the standardized uptake value (SUV) and the metabolic tumor volume (MTV). 18 F-FDG uptake was correlated with baseline clinical parameters and long-term oncological outcome. Survival estimates were determined according to Kaplan-Meier. Results: A total of 60 patients were included in this study. Estimates for three-year overall survival (OS) and disease free survival (DFS) were 94.5% and 80%. Five patients developed local (n = 2) or locoregional and local (n = 3) failure. Baseline PET/CT related parameters correlated with primary tumor stage, nodal stage and tumor grading. DFS was independent of T-stage, N-stage and baseline 18 F-FDG-uptake. Conclusion: In this cohort of PET/CT staged AC patients, excellent outcomes for DFS were seen. PET-based markers of tumor burden correlate with local stage of AC, however, are not of prognostic relevance for disease-free survival.

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Section: Discussionmentioning

confidence: 99%

Treatment outcome after radiochemotherapy in anal cancer patients staged with 18F-FDG-PET-CT

Braun

Reinert

Zips

et al. 2020

Clinical and Translational Radiation Oncology

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“…In the last 5 years, some studies on the use of IMRT-SIB in this setting have been published [17,18,19,20,21]. The use of IMRT is promising, since a reduction in acute toxicity has been demonstrated with the use of this technique.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis

Arcelli¹,

Buwenge²,

Macchia³

et al. 2019

jcb

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PurposeConcurrent chemoradiation (CCRT) is the standard curative treatment of anal canal cancer (ACC). The role of a brachytherapy (BRT) boost in this setting is still debated. Therefore, the aim of this analysis was to retrospectively evaluate the clinical outcomes in a large cohort of ACC patients treated with CCRT plus BRT boost or external beam radiotherapy (EBRT) boost.Material and methodsPatients with non-metastatic ACC, treated in our department between January 2003 and December 2014 were included in this analysis. The initial treatment was based on EBRT to the pelvis (prescribed dose, 45 Gy/1.8 Gy) plus concurrent chemotherapy (5-fluorouracil and mitomycin-C). Patients received a pulsed-dose-rate BRT boost on the primary tumor (median dose, 20 Gy; range, 13-25 Gy) 2-3 weeks after the end of CCRT. In patients with contraindications to BRT, an EBRT boost (prescribed dose, 16 Gy, 2 Gy/fraction) was delivered immediately after CCRT.ResultsOne-hundred-twenty-three patients were included in this analysis (median age, 61 years; range, 36-93 years; squamous-cell carcinoma, 78%; HIV+, 6%; median follow-up, 71 months; range, 2-158 months). The actuarial 5-year local control (LC), distant metastasis-free survival, colostomy-free survival, and overall survival (OS) rates were 81.7%, 92.3%, 62.3%, and 74.0%, respectively. At univariate analysis, patients aged ≤ 65 years (p < 0.010), cT1-2 stage (p = 0.004), and receiving a BRT boost (p = 0.015) showed significantly improved OS. At multivariate analysis, advanced tumor stage cT3-cT4 (HR, 2.12; 95% CI: 1.09-4.14; p = 0.027), and age > 65 years (HR, 3.03; 95% CI: 1.54-5.95; p = 0.001) significantly predicted increased risk of mortality. The crude rate of toxicity-related colostomies was 4.9%.ConclusionsThe role of BRT boost in ACC remains unclear since the outcomes were not clearly different compared to CCRT alone. However, further improvement of clinical results in ACC treatment is needed, and therefore prospective trials based on advanced (image-guided/adapted) BRT techniques are warranted.

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“…The accurate radiation planning is still a debated issue. In a survey by Zimmermann et al investigating the impact of 2-[ 18 F]FDG PET/CT (versus MRI) on treatment planning with intensity modulation radiation therapy, a major change in treatment planning was observed in 17% of the patients [ 21 ]. Moreover, recently, for delineation of radiation field, Dapper et al showed that 20–26% of 2-[ 18 F]FDG PET/CT-positive lymph nodes (mainly in the inguinal, parailiac and paraaortic regions) are missed using the current recommended contouring for clinical target volume [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Chemoradiotherapy (CRT) is a well-known standard approach in the treatment of ACa in the majority of patients, and surgery is preserved for salvage therapy [ 6 , 19 , 20 ]. A precise determination of the radiotherapy field is of substantial importance to reduce toxicities, becoming bolder by the introduction of novel sophisticated methods [ 21 , 22 ]. 2-[ 18 F]FDG PET/CT has changed the radiotherapy field in approximately 25% of patients, and changed curative treatment to palliative in 3% [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Additional Value of 2-[18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients

Manafi‐Farid

Kupferthaler

Wundsam

et al. 2020

JCM

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Accurate staging and treatment planning are imperative for precise management in Anal Cancer (ACa) patients. We aimed to evaluate the additive and prognostic value of pre-treatment 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) in the staging and management of ACa compared to magnetic resonance imaging (MRI). This retrospective study was conducted on 54 patients. Pre-treatment 2-[18F]FDG PET/CT studies and MRI reports were compared considering the primary tumor, pelvic lymph nodes, and metastatic lesions. The impact of 2-[18F]FDG PET/CT in the management and its prognostic value, using maximum standardized uptake value (SUVmax), were assessed. Discordant findings were found in 46.3% of patients (5 in T; 1 in T and N; 18 in N; and 1 in M stage). 2-[18F]FDG PET/CT resulted in up-staging in 9.26% and down-staging in 3.7% of patients. Perirectal lymph nodes were metabolically inactive in 12.9% of patients. Moreover, 2-[18F]FDG PET/CT resulted in management change in 24.1% of patients. Finally, SUVmax provided no prognostic value. 2-[18F]FDG PET/CT altered staging and management in a sizable number of patients in this study, and supports a need for a change in guidelines for it to be used as a routine complementary test in the initial management of ACa.

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PET-CT guided SIB-IMRT combined with concurrent 5-FU/MMC for the treatment of anal cancer

Abstract: PET-CT provided additional information leading to major changes in treatment planning for 17% of patients. Considering our excellent outcomes, routine use of PET-CT as standard staging modality and IMRT planning procedure appears justified for patients with SCCAC.

Cited by 15 publications

References 28 publications

Treatment outcome after radiochemotherapy in anal cancer patients staged with 18F-FDG-PET-CT

Treatment outcome after radiochemotherapy in anal cancer patients staged with 18F-FDG-PET-CT

Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis

Additional Value of 2-[18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients

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