The Role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis

Jones, Michael P.; Hruby, George; Solomon, Michael J.; Rutherford, Natalie; Martin, Jarad

doi:10.1245/s10434-015-4391-9

Cited by 104 publications

(57 citation statements)

References 36 publications

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“…In our series, by delivering 36 Gy with IMRT to the elective regions prevented all nodal failures, with acceptable acute haematological toxicity rates and grade 3 skin toxicity limited to the anal margin, as previously reported [9,12]. Overtreatment is, however, not excluded, thus molecular imaging techniques [22] and sentinel node mapping [23] may help an optimised staging to better select candidates for small-volume strategies.…”

Section: Discussionsupporting

confidence: 67%

Early-stage Favourable Anal Cancer: A Retrospective Analysis of Clinical Outcomes of a Moderately Low Dose Elective Nodal Intensity-modulated Radiotherapy Schedule

et al. 2017

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In this retrospective study we evaluated the long-term results of 35 early-stage favourable T1-2 N0 M0 anal cancer patients treated with intensity-modulated radiotherapy techniques combining low dose prophylactic inguinal-pelvic irradiation with dose-escalated boost. Optimal locoregional control and good tolerance makes this treatment a valuable alternative to brachytherapy boost and involved-field radiotherapy plans.

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Section: Discussionsupporting

confidence: 67%

Early-stage Favourable Anal Cancer: A Retrospective Analysis of Clinical Outcomes of a Moderately Low Dose Elective Nodal Intensity-modulated Radiotherapy Schedule

et al. 2017

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“…Third, the addition of PET to MRI might add further refinement. A recent meta-analysis [34], albeit with small numbers of studies, suggests that PET might correctly assess complete response in over 80 % of cases. Finally, while we focused on the seven early local relapses in the current analysis, there were an additional four patients with late relapse.…”

Section: Discussionmentioning

confidence: 99%

The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer

et al. 2016

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ObjectivesTo assess the use of MRI-determined tumour regression grading (TRG) in local response assessment and detection of salvageable early local relapse after chemoradiotherapy (CRT) in patients with anal squamous cell carcinoma (ASCC).MethodsFrom a prospective database of patients with ASCC managed through a centralised multidisciplinary team, 74 patients who completed routine post-CRT 3- and 6-month MRIs (2009–2012) were reviewed. Two radiologists blinded to the outcomes consensus read and retrospectively assigned TRG scores [1 (complete response) to 5 (no response)] and related these to early local relapse (within 12 months) and disease-free survival (DFS).ResultsSeven patients had early local relapse. TRG 1/2 scores at 3 and 6 months had a 100 % negative predictive value; TRG 4/5 scores at 6 months had a 100 % positive predictive value. All seven patients underwent salvage R0 resections. We identified a novel ‘tram-track’ sign on MRI in over half of patients, with an NPV for early local relapse of 83 % at 6 months. No imaging characteristic or TRG score independently prognosticated for late relapse or 3-year DFS.ConclusionsPost-CRT 3- and 6-month MRI-determined TRG scores predicted salvageable R0 early local relapses in patients with ASCC, challenging current clinical guidelines.Key Points• Post-chemoradiotherapy MRI (3 and 6 months) helps local response assessment in ASCC.• The MRI-TRG system can be used reproducibly in patients with ASCC.• The TRG system facilitates patient selection for examination under anaesthesia and biopsy.• The use of MRI-TRG predicts for detection of salvageable early local relapses.• The TRG system allows for a standardised follow-up pathway.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4337-z) contains supplementary material, which is available to authorized users.

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“…The role of imaging in treatment stratification and assessment of response/relapse has evolved in recent years reflecting the technological advances that have enabled high resolution anatomical imaging to be combined with functional imaging techniques, exemplified by multi-parametric magnetic resonance imaging (MRI) (Jones et al , 2015) and 18-F fluorodeoxyglucose positron emission tomography (18F-FDG PET) either integrated with computed tomography (CT) (Jones et al , 2015) or more recently with MRI (Goh et al , 2016). Combining the metabolic information from 18F-FDG PET with the high spatial and contrast resolution of anatomical MRI allows accurate delineation of the primary tumour and locoregional nodes for staging and radiotherapy planning, particularly with the incorporation of diffusion-weighted MRI (Mandegaran et al , 2016) and also prognostic information (Mohammadkhani et al , 2016).…”

Section: Imaging-based Prognostic Factors Detection Of Relapse and Fmentioning

confidence: 99%

Biomarkers in anal cancer: from biological understanding to stratified treatment

et al. 2016

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Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review.

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The Role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis

Abstract: Compared with conventional imaging, PET or PET/CT alters the nodal status in a sufficient number of cases to justify its routine use in the staging of patients with anal SCC.

Cited by 104 publications

References 36 publications

Early-stage Favourable Anal Cancer: A Retrospective Analysis of Clinical Outcomes of a Moderately Low Dose Elective Nodal Intensity-modulated Radiotherapy Schedule

Early-stage Favourable Anal Cancer: A Retrospective Analysis of Clinical Outcomes of a Moderately Low Dose Elective Nodal Intensity-modulated Radiotherapy Schedule

The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer

Biomarkers in anal cancer: from biological understanding to stratified treatment

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