Short-course PET based simultaneous integrated boost for locally advanced cervical cancer

Arnesen, Marius Røthe; Rekstad, B.L.; Stokke, Caroline; Bruheim, Kjersti; Løndalen, Ayca; Hellebust, Taran Paulsen; Malinen, Eirik

doi:10.1186/s13014-016-0612-z

Cited by 13 publications

(11 citation statements)

References 40 publications

(49 reference statements)

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“…FDG PET/CT has the advantage of identifying the metabolic activity and providing information on tumour biology. It is increasingly recognized as a useful tool for directing RT planning during intensity-modulated radiation therapy, volumetric-modulated arc treatment [ 20 ] and image-guided brachytherapy [ 33 ], thereby allowing targeted dose escalation to target tissues with high metabolic activity, and reducing dose to surrounding tissues [ 34 ]. The utility of FDG PET/CT has been shown to lead to less gastrointestinal toxicity in patients with gynaecological malignancies [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…FDG PET/CT has been employed to define radiotherapy targets using a threshold based on the standardised uptake value (SUV) for over a decade [ 18 ], and that for cervical cancer has been recently demonstrated [ 19 ]. Modification of radiation treatment volumes to FDG-avid lymph nodes and primary tumour can facilitate the accurate definition of tissues with metabolically active disease and the avoidance of normal tissue; hence allowing dose boosts to FDG-avid tumour volumes and lower doses to the bone marrow, urinary bladder and rectum [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Concordance of FDG PET/CT metabolic tumour volume versus DW-MRI functional tumour volume with T2-weighted anatomical tumour volume in cervical cancer

Lai

Perucho

et al. 2017

BMC Cancer

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Background 18F–fluoro-deoxyglucose positron emission tomography with computed tomography (FDG PET/CT) has been employed to define radiotherapy targets using a threshold based on the standardised uptake value (SUV), and has been described for use in cervical cancer. The aim of this study was to evaluate the concordance between the metabolic tumour volume (MTV) measured on FDG PET/CT and the anatomical tumour volume (ATV) measured on T2-weighted magnetic resonance imaging (T2W-MRI); and compared with the functional tumour volume (FTV) measured on diffusion-weighted MRI (DW-MRI) in cervical cancer, taking the T2W-ATV as gold standard.MethodsConsecutive newly diagnosed cervical cancer patients who underwent FDG PET/CT and DW-MRI were retrospectively reviewed from June 2013 to July 2017.Volumes of interest was inserted to the focal hypermetabolic activity corresponding to the cervical tumour on FDG PET/CT with automated tumour contouring and manual adjustment, based on SUV 20%–80% thresholds of the maximum SUV (SUVmax) to define the MTV20–80, with intervals of 5%.Tumour areas were manually delineated on T2W-MRI and multiplied by slice thickness to calculate the ATV.FTV were derived by manually delineating tumour area on ADC map, multiplied by the slice thickness to determine the FTV(manual). Diffusion restricted areas was extracted from b0 and ADC map using K-means clustering to determine the FTV(semi-automated).The ATVs, FTVs and the MTVs at different thresholds were compared using the mean and correlated using Pearson’s product-moment correlation.ResultsTwenty-nine patients were evaluated (median age 52 years). Paired difference of mean between ATV and MTV was the closest and not statistically significant at MTV30 (−2.9cm3, −5.2%, p = 0.301). This was less than the differences between ATV and FTV(semi-automated) (25.0cm3, 45.1%, p < 0.001) and FTV(manual) (11.2cm3, 20.1%, p = 0.001). The correlation of MTV30 with ATV was excellent (r = 0.968, p < 0.001) and better than that of the FTVs.ConclusionsOur study demonstrated that MTV30 was the only parameter investigated with no statistically significant difference with ATV, had the least absolute difference from ATV, and showed excellent positive correlation with ATV, suggesting its superiority as a functional imaging modality when compared with DW-MRI and supporting its use as a surrogate for ATV for radiotherapy tumour contouring.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Concordance of FDG PET/CT metabolic tumour volume versus DW-MRI functional tumour volume with T2-weighted anatomical tumour volume in cervical cancer

Lai

Perucho

et al. 2017

BMC Cancer

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“…[44–46] In the literature, several types of bulky tumors have been irradiated by integrating SIB, such as lung cancer, [47] esophagus cancer, [48] and soft tissue sarcoma. [49] In general, significant tumor volume reduction with a prolong progression-free survival is frequently observed.…”

Section: Discussionmentioning

confidence: 99%

Significant symptoms alleviation and tumor volume reduction after combined simultaneously integrated inner-escalated boost and volumetric-modulated arc radiotherapy in a patient with unresectable bulky hepatocellular carcinoma

et al. 2016

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Background:Clinically, elderly patients with unresectable bulky hepatocellular carcinoma (HCC) are difficult to manage, especially in those with co-infections of hepatitis B and C virus. Herein, we reported such a case treated with radiotherapy (RT) by using combined simultaneously integrated inner-escalated boost and volumetric-modulated arc radiotherapy (SIEB-VMAT). After RT, significant symptoms alleviation and durable tumor control were observed.Case Summary:At presentation, an 85-year-old male patient complained abdominal distention/pain, poor appetite, and swelling over bilateral lower limbs for 1 month. On physical examination, a jaundice pattern was noted. Laboratory studies showed impaired liver and renal function. Abdominal computed tomography (CT) revealed a 12.5-cm bulky tumor over the caudate lobe of the liver. Biopsy was done, and hepatocellular carcinoma (HCC) was reported histopathologically. As a result, AJCC stage IIIA (cT3aN0M0) and BCLC stage C were classified. Surgery, radiofrequency ablation (RFA), trans-catheter arterial chemoembolization (TACE), and sorafenib were not recommended because of his old age, central bulky tumor, and a bleeding tendency. Thus, RT with SIEB-VMAT technique was given alternatively. RT was delivered in 26 fractions, with dose gradience as follows: 39 Gy on the outer Plan Target Volume (PTV), 52 Gy in the middle PTV, and 57.2 Gy in the inner PTV. Unexpectedly, cyproheptadine (a newly recognized potential anti-HCC agent) was retrospectively found to be prescribed for alleviating skin itching and allergic rhinitis since the last 2 weeks of the RT course (2 mg by mouth Q12h for 24 months).After RT, significant symptoms alleviation and tumor volume reduction were observed for 32 months till multiple bone metastases. Before and after RT, a large tumor volume reduction rate of 88.7% was observed (from 608.4 c.c. to 68.7 c.c.). No severe treatment toxicity was noted during and after RT. The patient died due to aspiration pneumonia with septic shock at 4 months after bone metastases identified.Conclusions:SIEB-VMAT physically demonstrated double benefits of intratumor dose escalation and extra-tumor dose attenuation. Significant tumor regression and symptoms alleviation were observed in this elderly patient with unresectable bulky HCC. Further prospective randomized trials are encouraged to demarcate effective size of SIEB-VMAT with or without cyproheptadine.

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“…For brachytherapy, a residual gross tumor volume (GTV), a high-risk clinical target volume (CTV-HR) and an intermediate-risk clinical target volume (CTV-IR) are defined according to (i) gynecological examination and (ii) MRI at diagnosis and at the time of brachytherapy [6]. However, the role of PET in radiotherapy planning and particularly in volume delineation has been poorly studied in patients with CC [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Impact of suboptimal dosimetric coverage of pretherapeutic 18F-FDG PET/CT hotspots on outcome in patients with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy

Lucia¹,

Bourbonne²,

Gujral³

et al. 2020

Clinical and Translational Radiation Oncology

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Introduction: Areas of high uptake on pre-treatment 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT), denoted as ''hotspots", have been identified as preferential sites of local relapse in locally advanced cervical cancer (LACC). The purpose of this study was to analyze the dosimetric coverage of these hotspots with high dose-rate brachytherapy (BT). Methods: For each patient, a rigid registration of the CT from the pre-treatment PET/CT with the radiotherapy planning CT was performed using 3D Slicer TM , followed by a manual volume correction by translation and deformation if necessary. The fuzzy locally adaptive Bayesian (FLAB) algorithm was applied to PET images to simultaneously define an overall tumour volume and the high-uptake sub-volume V1. The inclusion of V1 in the high-risk clinical target volume (CTV HR) and its dosimetric coverage were evaluated using 3D Slicer TM. The average of the 3-4 BT sessions was reported. Results: Forty-two patients with recurrence after chemoradiotherapy (CRT) for LACC were matched to 42 patients without recurrence. Mean ± standard deviation follow-up was 26 ± 11 months. In the recurrence group, V1 was not included in the CTV HR and not covered by the 85 Gy isodose in 17/42 patients (41%) (1/20 with pelvic recurrence and 16/22 with distant recurrence) and not by the 80 Gy isodose in 7/42 patients (17%) (all with distant recurrence). In the non-recurrence group, V1 was not included in CTV HR and not covered by the 85 Gy isodose in 3 patients only (7%). The hotspots coverage by the 85 Gy isodose was significantly better in patients who did not recur, but only when compared to patients with distant relapse (p < 0.0001). Conclusion: Suboptimal dosimetric coverage of high FDG uptakes on pretherapeutic PET could be associated with an increased risk of recurrence.

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Short-course PET based simultaneous integrated boost for locally advanced cervical cancer

Cited by 13 publications

References 40 publications

Concordance of FDG PET/CT metabolic tumour volume versus DW-MRI functional tumour volume with T2-weighted anatomical tumour volume in cervical cancer

Concordance of FDG PET/CT metabolic tumour volume versus DW-MRI functional tumour volume with T2-weighted anatomical tumour volume in cervical cancer

Significant symptoms alleviation and tumor volume reduction after combined simultaneously integrated inner-escalated boost and volumetric-modulated arc radiotherapy in a patient with unresectable bulky hepatocellular carcinoma

Impact of suboptimal dosimetric coverage of pretherapeutic 18F-FDG PET/CT hotspots on outcome in patients with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy

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