scholarly journals [18F]FDG-PET accurately identifies pathological response early upon neoadjuvant immune checkpoint blockade in head and neck squamous cell carcinoma

2021 ◽  
Author(s):  
Joris L. Vos ◽  
Charlotte L. Zuur ◽  
Laura A. Smit ◽  
Jan Paul de Boer ◽  
Abrahim Al-Mamgani ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Fdg Pet ◽  
Primary Tumour ◽  
Tumour Response ◽  
Immune Checkpoint Blockade ◽  
Pathological Response ◽  
Eortc Criteria ◽  
Node Metastases

Abstract Purpose To investigate the utility of [18F]FDG-PET as an imaging biomarker for pathological response early upon neoadjuvant immune checkpoint blockade (ICB) in patients with head and neck squamous cell carcinoma (HNSCC) before surgery. Methods In the IMCISION trial (NCT03003637), 32 patients with stage II‒IVb HNSCC were treated with neoadjuvant nivolumab with (n = 26) or without (n = 6) ipilimumab (weeks 1 and 3) before surgery (week 5). [18F]FDG-PET/CT scans were acquired at baseline and shortly before surgery in 21 patients. Images were analysed for SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG). Major and partial pathological responses (MPR and PPR, respectively) to immunotherapy were identified based on the residual viable tumour in the resected primary tumour specimen (≤ 10% and 11–50%, respectively). Pathological response in lymph node metastases was assessed separately. Response for the 2 [18F]FDG-PET-analysable patients who did not undergo surgery was determined clinically and per MR-RECIST v.1.1. A patient with a primary tumour MPR, PPR, or primary tumour MR-RECIST-based response upon immunotherapy was called a responder. Results Median ΔSUVmax, ΔSUVmean, ΔMTV, and ΔTLG decreased in the 8 responders and were significantly lower compared to the 13 non-responders (P = 0.05, P = 0.002, P < 0.001, and P < 0.001). A ΔMTV or ΔTLG of at least − 12.5% detected a primary tumour response with 95% accuracy, compared to 86% for the EORTC criteria. None of the patients with a ΔTLG of − 12.5% or more at the primary tumour site developed a relapse (median FU 23.0 months since surgery). Lymph node metastases with a PPR or MPR (5 metastases in 3 patients) showed a significant decrease in SUVmax (median − 3.1, P = 0.04). However, a SUVmax increase (median + 2.1) was observed in 27 lymph nodes (in 11 patients), while only 13 lymph nodes (48%) contained metastases in the corresponding neck dissection specimen. Conclusions Primary tumour response assessment using [18F]FDG-PET-based ΔMTV and ΔTLG accurately identifies pathological responses early upon neoadjuvant ICB in HNSCC, outperforming the EORTC criteria, although pseudoprogression is seen in neck lymph nodes. [18F]FDG-PET could, upon validation, select HNSCC patients for response-driven treatment adaptation in future trials. Trial registration https://www.clinicaltrials.gov/, NCT03003637, December 28, 2016.

P154 SAFETY AND ONCOLOGICAL EFFICACY OF BILATERAL RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Chao, Yin-Kai
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Lymph Node Metastases ◽  
Neoadjuvant Chemoradiotherapy ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Node Metastases

Abstract Aim We sought to evaluate the safety and oncological efficacy of bilateral recurrent laryngeal nerve (RLN) lymph node dissection (LND) in patients with esophageal squamous cell carcinoma (ESCC) who had undergone neoadjuvant chemoradiotherapy (nCRT). Methods The need to dissect RLN lymph nodes in patients who had undergone nCRT is controversial. No data are currently available on the clinical utility and implications of RLN nodal dissection in nCRT-treated patients with esophageal cancer. We retrospectively examined the records of ESCC patients who were judged to be ycN-RLN(-) following nCRT. Patients were divided into two groups according to the extent of LND (standard two-field LND [STL group] versus total two-field LND [TTL group]). Only lower mediastinal and upper abdominal lymph nodes were removed in the STL group. In addition to the standard procedure, patients in the TTL group underwent resection of upper mediastinal lymph nodes located along the bilateral RLN. Using propensity score matching, 29 pairs were identified and compared with regard to perioperative complications, lymph node metastases rates, overall survival (OS), and disease-specific survival (DSS). Results No significant intergroup differences were identified in terms of in-hospital mortality and morbidity. Metastases to the RLN lymph nodes were identified in 20.7% (6/29) of TTL patients, being the only site of lymph node metastases in three of them. TTL was associated with lower upper mediastinal lymph node recurrence rate(6.5%) compared with STL (21.5%, p=0.134), although the overall recurrence rate was similar (STL, 44.8% versus TTL, 46.4%). No significant intergroup differences were also evident with regard to 3-year DSS and OS rates. Conclusions RLN LND can be safely performed in ESCC patients who had undergone nCRT, ultimately resulting in an improved local control and should be practiced as part of the surgical routine.

scholarly journals Therapeutic approach of cervical lymph nodes metastases of squamous cell carcinoma from an unknown primary tumors

2015 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Anca Ruxandra MOŞOIU ◽  
◽  
Alina Lavinia OANCEA ◽  
Roxana Mihaela MATEI ◽  
Marian STAMATE ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Unknown Primary ◽  
Cervical Lymph Nodes ◽  
Node Metastases

Cervical lymph node metastases of squamous cell carcinoma from occult primary constitute about 3-5% of all patients with carcinoma of unknown primary site (CUP). Identification of subgroups with favorable prognosis is of decisive importance for the therapy of patients with CUP syndrome, including prolonged survival from directed treatment. The patients with neck node metastases from occult head and neck cancer have clinical features and prognosis similar to other head and neck malignancies. Treatment of patients with metastatic squamous cell carcinoma involving cervical lymph nodes of an unknown primary origin should be similar to that of patients with locally advanced carcinoma of the head and neck. Therapeutic approaches include surgery (lymph node excision or neck dissection), with or without post-operative radiotherapy, radiotherapy alone and radiotherapy followed by surgery. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) necessitate combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable. A potential benefit from extensive radiotherapy should be weighted against its acute and late morbidity and difficulties in re-irradiation in the case of subsequent primary emergence. The role of other methods, such as chemotherapy and hyperthermia, remains to be determined.

scholarly journals Coal worker’s pneumoconiosis and sarcoid-like reaction mimicking lymph node metastases in a patient with lung cancer: A case report

2017 ◽  
Vol 5 (21) ◽  
pp. 21
Author(s):  
Chad Duncan ◽  
Lukman Tijani ◽  
Suzanne Graham ◽  
Ruc Tran ◽  
Cynthia Jumper
Keyword(s):  
Lung Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Fdg Pet ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Node Dissection ◽  
Coal Miner ◽  
Node Metastases

Sarcoid-like reactions occur in a small percentage of cancer patients. This reaction causeslymph nodes to appear hypermetabolic when viewed with Fludeoxyglucose-Positron EmissionTomography (FDG-PET). This is clinically important, because it could be confused with tumormetastasis and could affect the staging and treatment of the cancer. In addition to sarcoid-likereactions and metastasis, several other disease processes can cause lymph nodes to appearhypermetabolic with FDG-PET, including coal worker’s pneumoconiosis. We present the caseof a 61-year-old coal miner who was diagnosed with lung cancer. FDG-PET showed increaseduptake in ipsilateral and contralateral mediastinal lymph. The patient had bronchoscopy withendobronchial ultrasound (EBUS) guided biopsy of the mass and needle aspiration of bilaterallymph nodes of the mediastinum. All the biopsies were negative. The patient then had a leftupper lobectomy and left mediastinal lymph node dissection. The PET findings were originallyattributed to metastasis of the tumor, but pathology of the ipsilateral nodes showed silicoticchanges due to pneumoconiosis and non-caseating granulomas from a sarcoid-like reaction.Because the ipsilateral lymph nodes had no evidence of metastasis and EBUS biopsy ofthe contralateral nodes was negative, it was unlikely that the changes in the contralateralnodes were due to metastasis, and no adjuvant treatment was offered. At more than oneyear after surgery, the patient remains stable with no evidence of recurrence, and we haveclinical assurance that the changes in the lymph nodes were due to the sarcoid-like reactionand pneumoconiosis and not metastasis. FDG-PET is useful for detection of lung cancer, butpathology is necessary for staging and determining treatment for the patient.

scholarly journals A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection

2017 ◽  
Vol 10 (1) ◽  
pp. 182-191 ◽  
Author(s):  
Byoung Jo Suh
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Fdg Pet ◽  
Subtotal Gastrectomy ◽  
Pet Ct ◽  
Node Metastases ◽  
Folfox Chemotherapy ◽  
Fdg Pet Ct

We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT) scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU), oxaliplatin, and leucovorin (FOLFOX) was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI) and radiotherapy, the patient died 38 months after the operation.

scholarly journals Motion-Compensated FDG PET/CT for Oesophageal Cancer

2020 ◽  
Author(s):  
Francine E.M. Voncken ◽  
Erik Vegt ◽  
Johana W. van Sandick ◽  
Jolanda M. van Dieren ◽  
Cecile Grootscholten ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Oesophageal Cancer ◽  
Lymph Node Metastases ◽  
Primary Tumour ◽  
Standardized Uptake Value ◽  
Reconstruction Method ◽  
Pet Ct ◽  
Medicine Physician ◽  
Node Metastases

Abstract PurposeRespiratory-induced motion of oesophageal tumours and lymph nodes can influence positron emission tomography/computed tomography (PET/CT). The aim was to compare standard three-dimensional (3D) and motion-compensated PET/CT regarding standardized uptake value (SUV), metabolic tumour volume (MTV) and detection of lymph node metastases. MethodsThis prospective observational study (NCT02424864) included thirty-seven newly diagnosed oesophageal cancer patients. Diagnostic PET/CT was reconstructed in 3D and motion-compensated PET/CT. MTVs of the primary tumour were calculated using an automated region-growing algorithm with SUV thresholds of 2.5 (MTV2.5) and ≥50% of SUVmax (MTV50%). Blinded for reconstruction method, a nuclear medicine physician assessed all lymph nodes showing 18F-fluorodeoxyglucose uptake for their degree of suspicion. ResultsThe mean (95% CI) SUVmax of the primary tumour was 13.1(10.6-15.5) versus 13.0(10.4-15.6) for 3D and motion-compensated PET/CT, respectively. MTVs were also similar between the two techniques. Bland-Altman analysis showed mean differences between both measurements (95% limits of agreement) of 0.08(-3.60 - 3.75), -0.26(-2.34 – 1.82), 4.66(-29.61 – 38.92)cm3 and -0.95(-19.9 – 18.0)cm3 for tumour SUVmax, lymph node SUVmax, for MTV2.5 and MTV50%, respectively. Lymph nodes were classified as highly suspicious (30/34 nodes), suspicious (20/22) and dubious (66/59) for metastases on 3D/motion-compensated PET/CT. No additional lymph node metastases were found on motion-compensated PET/CT. SUVmax of the most intense lymph nodes was similar for both scans: mean (95% CI) 6.6(4.3-8.8) and 6.8(4.5-9.1) for 3D and motion-compensated, respectively.ConclusionsSUVmax of the primary oesophageal tumour and lymph nodes was comparable on 3D and motion-compensated PET/CT. The use of motion-compensated PET/CT did not improve lymph node detection. Trial registration(www.clinicaltrials.gov: NCT02424864)

Role of Clinical Palpation in Evaluation of Cervical Lymph Node in Oral Squamous Cell Carcinoma

2013 ◽  
Vol 1 (2) ◽  
pp. 02-06
Author(s):  
SM Anwar Sadat ◽  
Sufia Nasrin Rita ◽  
Shoma Banik ◽  
Md Nazmul Hasan Khandker ◽  
Md Mahfuz Hossain ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Value ◽  
Cervical Lymph Node ◽  
Betel Quid ◽  
Cervical Lymph Nodes

A cross sectional study of 29 cases of oral squamous cell carcinoma with or without  cervical lymph node metastasis was done among Bangladeshi patients from January 2006 to December 2007. Majority of the study subjects (34.5%) belonged to the age group of 40-49 years. 58.6% of the study subjects were male, while remaining 41.4% of them were female. 51.7% of the lesions were located in the alveolar ridge where the other common sites were buccal mucosa (27.6%) and retro molar area (13.8%). Half of the study subjects (51.7%) were habituated to betel quid chewing followed by 37.9% and 10.3% were habituated to smoking and betel quid-smoking respectively. Grade I lesions was most prevalent (75.9%) in the study subjects.  Majority of cases presented with Stage IV lesions (55.2%). The sensitivity, specificity, positive predictive value, negative predictive value & accuracy of clinical palpation method for determining metastatic cervical lymph nodes were 93.33%, 64.29%, 73.68%, 90% and 79.3% respectively. Careful and repeated clinical palpation plays important role in evaluation of cervical lymph nodes though several modern techniques may help additionally in the management of oral cancer.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13978 Update Dent. Coll. j. 2011: 1(2): 02-06

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