Posttreatment FDG-PET-CT response is predictive of tumor progression and survival in anal carcinoma

Goldman, Kelly E.; White, E.C.; Rao, Aroor R.; Kaptein, John S.; Lien, W.W.

doi:10.1016/j.prro.2016.01.004

Cited by 19 publications

(22 citation statements)

References 22 publications

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“…For anal cancer, some studies have examined the value of posttreatment 18 F-FDG PET/CT (15,22,23), yet they are limited by their small number of patients. To our knowledge, this multicenter study is one of the largest investigations that aimed to assess treatment response and the predictive value of 18 F-FDG PET/CT after chemoradiotherapy for patients with anal squamous cell carcinoma with the recently published report (17). In the present study, posttreatment 18 F-FDG PET/CT had a high sensitivity (92%) and a high negative predictive value (96.4%), which is consistent with published data (17,22,24,25).…”

Section: Multivariable Analysissupporting

confidence: 90%

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Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

et al. 2017

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The aim of this study was to evaluate the relevance of PET/CT and F-FDG as a strategy for response evaluation after chemoradiotherapy for anal cancer. For this, the performance of posttreatmentF-FDG PET/CT, the impact on patient care, and the predictive value of metabolic response were assessed. This was a retrospective and multicenter analysis of 87 patients treated by chemoradiotherapy for anal squamous cell carcinoma between October 2007 and October 2013. All patients underwent systematic posttreatmentF-FDG PET/CT and were followed with at least a clinical examination every 4 mo for 2 y and every 6 mo thereafter. Disease progression was confirmed by biopsy for all patients in the case of local recurrence before surgery. Kaplan-Meier and Cox regression models were used to test for associations between metabolic or clinical endpoints and progression-free survival (PFS) or cause-specific survival (CSS). The median follow-up was 25 mo.F-FDG PET/CT was performed 1-8 mo (median, 4 mo) after completion of chemoradiotherapy. Overall, 25 patients relapsed and 13 died. The posttherapy F-FDG PET/CT did not show any abnormalF-FDG uptake (complete metabolic response [CMR]) in 55 patients whereas 32 displayed incomplete response (non-CMR): 15 patients with partial response and 17 with disease progression. The sensitivity of F-FDG PET/CT to detect residual tumor tissue was 92% (95% confidence interval [CI], 75%-97%), specificity was 85% (95% CI, 75%-92%), positive predictive value was 72% (95% CI, 61%-90%), and negative predictive value was 96.4% (95% CI, 90%-98.7%). The 2-y PFS was 96% (95% CI, 90-100) for patients with CMR and 28% (95% CI, 14-47) for non-CMR patients ( < 0.0001). The 2-y CSS was 100% for patients with CMR and 59% (95% CI, 42-84) for those without CMR ( < 0.0001). F-FDG PET/CT changed patient management in 14 cases (16%), with relevant modifications in 12 (14%). A Cox proportional hazards model of survival outcome indicated that a CMR was the only significant predictor of PFS and CSS ( < 0.0001). F-FDG PET/CT shows good accuracy in posttreatment evaluation of anal cancer and has a relevant impact on patient management. Moreover, CMR is associated with good survival outcome. Thus,F-FDG PET/CT may play a significant role during posttreatment follow-up of anal cancer.

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Section: Multivariable Analysissupporting

confidence: 90%

“…However, few studies have investigated 18 F-FDG PET/CT in evaluating the therapeutic response (15)(16)(17). To address this, a retrospective study was performed to evaluate the predictive value of systematic 18 F-FDG PET/CT performed after chemoradiotherapy for anal cancer and the impact of this strategy on patient management.…”

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confidence: 99%

Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

et al. 2017

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“…5. Of note, previous studies dealing with post-treatment PET examinations of anal cancer patients did not use quantitative data (nor SUV threshold or organ of reference) and were only based on visual assessment [3,23,24].…”

Section: Discussionmentioning

confidence: 99%

“…18 F-Fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) has been increasingly evaluated in the management of anal cancer patients, particularly for the initial staging of the disease and the evaluation of the therapeutic response after radiochemotherapy. In this context of post-treatment evaluation, thanks to its good negative predictive value with reported values superior to 90%, 18 F-FDG PET can avoid biopsies in case of a complete metabolic response [3][4][5]. This is clinically relevant as post radiotherapy biopsies can lead to necrosis and potentially complicated and delayed surgery.…”

Section: Introductionmentioning

confidence: 99%

HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake

et al. 2020

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Background: Anal cancer is a relatively rare tumor of which incidence increases in developed countries. 18 F-FDG PET has been increasingly used for its post radio-chemotherapy evaluation. However, several authors have reported the risk of local false-positive findings leading to low specificity and positive predictive values. These false-positive results could be due to post-radiotherapy inflammation or infection but certainly also to physiological anal canal uptake that is observed on a regular basis in clinical practice. The purpose of this prospective study (NCT03506529; HYPHYCA) was therefore to seek predictive factors of physiological anal canal hypermetabolism. Materials and methods: Over a 2-month period, patients aged 18 years old and more, referred for 18 F-FDG PET-CT at two EARL-accredited PET centers were included, after obtaining their informed and written consent. They were asked to fill in a questionnaire including seven closed questions about usual intestinal transit, ongoing medications relative to intestinal transit, history of digestive, and anal and/or pelvic diseases. Age, gender, and body mass index (BMI) were recorded. A single nuclear medicine physician visually and quantitatively analyzed anal canal uptake (SUV max_EARL) and assessed visual rectal content (air, feces, or both) and the largest rectal diameter (mm). Results: Six hundred and thirteen patients were included (sex ratio F/M = 0.99) and 545 (89%) questionnaires were entirely completed. Significantly more males presented anal canal hypermetabolism (sex ratio (M/F) = 1.18 versus 0.85, p = 0.048). Moreover, patients with anal canal hypermetabolism had higher BMI (27.6 (5.7) kg/m 2 versus 23.9 (4.5) kg/m 2 , p < 0.0001), higher rate of hemorrhoid history (43% versus 27%, p = 0.016), and higher rate of rectum filled with only feces (21% versus 12%, p = 0.019) as compared to patients with no anal canal uptake. On logistic regression, all these variables were found to be independent predictors of the occurrence of an anal canal hypermetabolism. Odds ratio were 1.16 (1.12-1.20) per unit of BMI (kg/m 2) (p < 0.0001), 1.48 (1.04-2.11) for males (p = 0.030), 1.64 (1.10-2.45) for hemorrhoids history (p = 0.016), and 1.94 (1.147-3.22) for the rectum filled with only feces (p = 0.010).

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“…[15][16][17][18][19][20][21] Previous studies on FDG-PET of anal cancer have addressed the predictive role of PET-derived markers assessed by pre-or posttherapy imaging. [22][23][24][25][26] First, these studies did not evaluate HPV status in the same patient cohort. Second, only a limited panel of PET markers has previously been evaluated for anal cancers.…”

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confidence: 99%

Anal cancer chemoradiotherapy outcome prediction using 18F-fluorodeoxyglucose positron emission tomography and clinicopathological factors

Rusten

Rekstad

Undseth

et al. 2019

The British Journal of Radiology

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Anal cancer is a rare disease with increasing incidence 1,2 and chemoradiotherapy is the recommended curative treatment. 3 State-of-the-art radiotherapy is delivered as intensity modulated radiation therapy (IMRT) with concomitant mitomycin (MMC) and 5-fluorouracil (5-FU) chemotherapy. 4,5 Different treatment regimens are used based on tumor and lymph node stage. 3 Complete tumor remission may be achieved in up to 90% of the patients and the 3 year progression-free survival is around 70%. 6 Recurrences are mostly locoregional 7,8 and curatively intended salvage surgery usually involves extensive pelvic surgery. 9 The majority of anal squamous cell carcinomas are HPV positive, and HPV status is both a prognostic factor and predictive of treatment outcome. 10,11 Other clinicopathological features such as gender, tumor and lymph node stage, radiotherapy dose, and tumor-infiltrating lymphocytes have shown prognostic value, 11-13 but there is currently no

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Posttreatment FDG-PET-CT response is predictive of tumor progression and survival in anal carcinoma

Cited by 19 publications

References 22 publications

Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake

Anal cancer chemoradiotherapy outcome prediction using 18F-fluorodeoxyglucose positron emission tomography and clinicopathological factors

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Posttreatment FDG-PET-CT response is predictive of tumor progression and survival in anal carcinoma

Cited by 19 publications

References 22 publications

Role of 18F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

Role of 18F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake

Anal cancer chemoradiotherapy outcome prediction using 18F-fluorodeoxyglucose positron emission tomography and clinicopathological factors

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Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma

Role of ¹⁸F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma