Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer

Mistrangelo, Massimiliano; Pelosi, Ettore; Bellò, Marilena; Ricardi, Umberto; Milanesi, E.; Cassoni, Paola; Baccega, Massimo; Filippini, Claudia; Racca, Patrizia; Lesca, Adriana; Muñoz, Fernándo; Fora, Gianluca; Skanjeti, Andrea; Cravero, Francesca; Morino, Mario

doi:10.1016/j.ijrobp.2011.10.048

Cited by 83 publications

(67 citation statements)

References 20 publications

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“…MRI complements clinical assessment but can assign a worse stage prognosis to a patient, particularly lymph node status because enlarged lymph nodes can be recorded as node positive although many do not contain tumours. Metabolic and functional imaging techniques, such as diffusion-weighted MRI, 24 or PET with 18 F-fluorodeoxyglucose,25, 26, 27 might offer an alternative option to assess response at an early timepoint without the potential morbidity of a biopsy, but large prospective studies are required.…”

Section: Discussionmentioning

confidence: 99%

Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial

Glynne‐Jones

Sebag‐Montefiore

Meadows

et al. 2017

The Lancet Oncology

131

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SummaryBackgroundGuidelines for anal cancer recommend assessment of response at 6–12 weeks after starting treatment. Using data from the ACT II trial, we determined the optimum timepoint to assess clinical tumour response after chemoradiotherapy.MethodsThe previously reported ACT II trial was a phase 3 randomised trial of patients of any age with newly diagnosed, histologically confirmed, squamous cell carcinoma of the anus without metastatic disease from 59 centres in the UK. We randomly assigned patients (by minimisation) to receive either intravenous mitomycin (one dose of 12 mg/m2 on day 1) or intravenous cisplatin (one dose of 60 mg/m2 on days 1 and 29), with intravenous fluorouracil (one dose of 1000 mg/m2 per day on days 1–4 and 29–32) and radiotherapy (50·4 Gy in 28 daily fractions); and also did a second randomisation after initial therapy to maintenance chemotherapy (fluorouracil and cisplatin) or no maintenance chemotherapy. The primary outcome was complete clinical response (the absence of primary and nodal tumour by clinical examination), in addition to overall survival and progression-free survival from time of randomisation. In this post-hoc analysis, we analysed complete clinical response at three timepoints: 11 weeks from the start of chemoradiotherapy (assessment 1), 18 weeks from the start of chemoradiotherapy (assessment 2), and 26 weeks from the start of chemoradiotherapy (assessment 3) as well as the overall and progression-free survival estimates of patients with complete clinical response or without complete clinical response at each assessment. We analysed both the overall trial population and a subgroup of patients who had attended each of the three assessments by modified intention-to-treat. This study is registered at controlled-trials.com, ISRCTN 26715889.FindingsWe enrolled 940 patients from June 4, 2001, until Dec 16, 2008. Complete clinical response was achieved in 492 (52%) of 940 patients at assessment 1 (11 weeks), 665 (71%) of patients at assessment 2 (18 weeks), and 730 (78%) of patients at assessment 3 (26 weeks). 691 patients attended all three assessments and in this subgroup, complete clinical response was reported in 441 (64%) patients at assessment 1, 556 (80%) at assessment 2, and 590 (85%) at assessments 3. 151 (72%) of the 209 patients who had not had a complete clinical response at assessment 1 had a complete clinical response by assessment 3. In the overall trial population of 940 patients, 5 year overall survival in patients who had a clinical response at assessments 1, 2, 3 was 83% (95% CI 79–86), 84% (81–87), and 87% (84–89), respectively and was 72% (66–78), 59% (49–67), and 46% (37–55) for patients who did not have a complete clinical response at assessments 1, 2, 3, respectively. In the subgroup of 691 patients, 5 year overall survival in patients who had a clinical response at assessment 1, 2, 3 was 85% (81–88), 86% (82–88), and 87% (84–90), respectively, and was 75% (68–80), 61% (50–70), and 48% (36–58) for patients who did not have a complete clinical respo...

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Section: Discussionmentioning

confidence: 99%

Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial

Glynne‐Jones

Sebag‐Montefiore

Meadows

et al. 2017

The Lancet Oncology

131

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“…The clinical evaluation included complete medical history with physical examination, comprising a digital rectal examination and complete laboratory testing. Disease staging included a chest, abdomen, and pelvis computed tomography scan (CT), a magnetic resonance imaging (MRI) of the pelvic region, positron-emission tomography (PET) and/or inguinal sentinel lymphnode biopsy (SLNB), and eventual endoscopic transrectal ultrasounds (EUS) (12,13).…”

Section: Pre-treatment Evaluationmentioning

confidence: 99%

Intensity-Modulated Radiation Therapy with Simultaneous Integrated Boost Combined with Concurrent Chemotherapy for the Treatment of Anal Cancer Patients: 4-Year Results of a Consecutive Case Series

Franco

Mistrangelo

Arcadipane

et al. 2015

Cancer Investigation

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thrombocytopenia-G3:2%. Four-year G2 chronic toxicity rates were 2.5% (95% CI: 3.6-16.4) for GU, 14.4% (95% CI: 7.1-28) for GI, 3.9% (95% CI: 1%-14.5%) for skin, and 4.2% (95% CI: 1.1-15.9) for genitalia. Conclusions: Our study shows the feasibility of IMRT in the combined modality treatment of anal cancer, with comparable results to the literature with respect to LC, sphincter preservation and survival. Acute toxicity is lower if compared to series employing standard techniques. Our results support the use of IMRT on a routine basis for the treatment of anal cancer.

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“…12,13 The role of 18 F-fluorodeoxyglucose (FDG)epositron emission tomography (PET)/computed tomography (CT) in the staging of SCCA has been evaluated by numerous studies. FDG-PET/CT has been shown to be a more sensitive imaging modality for detecting primary and nodal disease compared with CT. 14,15 In one study, FDG-PET/CT upstaged disease in 14% of cases and changed treatment planning in 17%. 16 A previous report detailed the qualitative metabolic response on posttreatment FDG-PET/CT and the association with cause-specific survival (CSS) and progression-free survival (PFS).…”

Section: Introductionmentioning

confidence: 99%

Quantitative FDG-PET/CT Predicts Local Recurrence and Survival for Squamous Cell Carcinoma of the Anus

Cardenas

Spencer

DeWees

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose:18 F-fluorodeoxyglucose (FDG) positron emission tomographye(PET)/computed tomography (CT) imaging is used for staging and treatment planning of patients with anal cancer. Quantitative pre-and posttreatment metrics that are predictive of recurrence are unknown. We evaluated the association between pre-and posttreatment FDG-PET/CT parameters and outcomes for patients with squamous cell carcinoma of the anus (SCCA). Methods and materials: The records of 110 patients treated between 2003 and 2013 with definitive radiation therapy for SCCA were reviewed under an institutional review boardeapproved protocol. The median radiation therapy dose was 50.4 Gy (range, 35-60 Gy). Concurrent chemotherapy was administered for 109 of 110 patients and generally consisted of 5-fluorouracil and mitomycin C (n Z 94). All patients underwent pretreatment FDG-PET/CT and 101 of 110 underwent posttreatment FDG-PET/CT 3 months after completion of radiation therapy. The maximum standard uptake value (SUV max ) was analyzed, in addition to multiple patient and treatment factors, by univariate and multivariate Cox regression for correlation with local recurrence (LR) and overall survival (OS). Results: The median follow-up was 28.6 months. LR occurred in 1 of 15 (6.7%), 5 of 47 (10.6%), and 6 of 48 (12.5%) patients with stage I, II, and III disease, respectively. On univariate analysis, a significant association was observed between reduced LR and posttreatment SUV max <6.1 (P Z .0095) and between increased OS and posttreatment SUV max <6.1 (P Z .0086). On multivariate analysis, a significant association was observed between reduced LR and posttreatment SUV max <6.1 (P Z .0013) and the use of intensity modulated radiation therapy (P < .001). A

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Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer

Cited by 83 publications

References 20 publications

Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial

Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial

Intensity-Modulated Radiation Therapy with Simultaneous Integrated Boost Combined with Concurrent Chemotherapy for the Treatment of Anal Cancer Patients: 4-Year Results of a Consecutive Case Series

Quantitative FDG-PET/CT Predicts Local Recurrence and Survival for Squamous Cell Carcinoma of the Anus

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