scholarly journals 811 Management of Patients with HPV-associated Oropharyngeal Cancer: A Units' Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Fernando ◽  
J Leow ◽  
T Wildan
Keyword(s):  
Initial Treatment ◽  
Residual Disease ◽  
Treatment Phase ◽  
Needle Aspiration ◽  
Post Treatment ◽  
Surveillance Strategy ◽  
Primary Treatment Modality ◽  
Pet Ct ◽  
Results Management ◽  
Post Therapy

Abstract Aim The low positive predictive value (PPV) of initial post-therapy PET-CT in patients with Human papillomavirus (HPV-) associated oropharyngeal squamous cell carcinoma (OPSCC) presents a challenge for teams managing residual disease after initial treatment. We aimed to investigate current management, post treatment surveillance protocols and outcomes of these patients within our unit. Method A retrospective review was performed of p16 positive OPSCC patients treated in 2018. Their primary treatment modality (radiotherapy (RT) or chemoradiotherapy (CRT), neck dissection), post-therapy PET-CT results, management decisions and final clinical outcomes were recorded. Results 38 patients with p16 positive OPSCC were included in the study. 36 (94.7%) received primary CRT or RT, and 2 (5.3%) had primary neck dissections with adjuvant RT. 21 patients were found to have residual disease on the 3-month post-treatment PET-CT. Of these, 9 underwent further PET-CT surveillance, all showing no residual disease. 8 patients received ultrasound +/- fine needle aspiration, from which 1 showed incurable residual and distant metastasis. 2 underwent clinical surveillance, showing no residual disease. 1 had immediate salvage surgery, with further recurrence. 1 patient with persistent disease and lung metastasis received palliative immunotherapy. Conclusions 31 patients were disease free at the end point of this study. This study explores the need for further investigation into features of residual disease in post treatment PET-CT that would indicate initial treatment failure and possible further early intervention. A surveillance strategy following initial post treatment PET-CT needs to be developed to aid in making this decision as early as possible in the post treatment phase.

scholarly journals EP-1065: Post-treatment FDG-PET CT in detecting residual disease in head & neck squamous cell carcinoma

2016 ◽  
Vol 119 ◽  
pp. S513
Author(s):  
J. Price ◽  
A. Pascoe ◽  
C. Weston ◽  
S. Kathirgamakarthigeyan ◽  
M. Griffin ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Fdg Pet ◽  
Residual Disease ◽  
Post Treatment ◽  
Neck Squamous Cell Carcinoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Head Neck

Endoscopic ultrasound and fine-needle aspiration for the detection of residual nodal disease after neoadjuvant chemoradiotherapy for esophageal cancer

Endoscopy ◽  
2019 ◽  
Vol 52 (03) ◽  
pp. 186-192 ◽  
Author(s):  
Ruben D. van der Bogt ◽  
Berend J. van der Wilk ◽  
Jan-Werner Poley ◽  
Kausilia K. Krishnadath ◽  
Erik J. Schoon ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Residual Disease ◽  
Histopathological Examination ◽  
Neoadjuvant Chemoradiotherapy ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Specificity And Sensitivity ◽  
Pet Ct

Abstract Background Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are potential tools for the detection of residual disease after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. This study investigated yield of EUS and FNA for detection of malignant lymph nodes (LNs) after nCRT. Methods This was a post hoc analysis of the preSANO trial. EUS was performed 10 – 12 weeks after nCRT. 18F-fluorodeoxyglucose positron emission tomography – computed tomography (18F-FDG PET-CT) was used to guide targeting of suspicious LNs. Consecutive FNA sampling was performed for suspicious LNs identified on EUS and/or PET-CT. EUS nodal staging was compared with histopathological examination of the resection specimen. The primary outcome was the proportion of correctly identified patients with malignant LNs by radial EUS. Results 101 consecutive patients were included: 79 patients had no malignant LNs, of whom 62 were classified correctly by EUS (specificity 78 %); 22 patients had malignant LNs, of whom 11 were identified (sensitivity 50 %). Six of these patients had ≥ 1 suspicious LN not fulfilling EUS criteria (round, hypoechogenic, > 5 mm). Malignant LNs in falsely negative patients were predominantly located at distal LN stations. Specificity and sensitivity of conclusive FNA outcomes were 100 % (7/7) and 75 % (3/4), respectively. FNA outcome was uncertain in eight patients, half of whom appeared to have malignant LNs. Conclusions EUS only detected 50 % of patients with malignant LNs 10 – 12 weeks after nCRT. To optimize sensitivity and minimize the risk of missing residual disease, FNA of LNs should be performed even in cases of low endosonographic suspicion.

scholarly journals The Role of 68Ga-DOTA-Octreotate PET/CT in Follow-Up of SDH-Associated Pheochromocytoma and Paraganglioma

2019 ◽  
Vol 104 (11) ◽  
pp. 5091-5099 ◽  
Author(s):  
Grace Kong ◽  
Tess Schenberg ◽  
Christopher J Yates ◽  
Alison Trainer ◽  
Nirupa Sachithanandan ◽  
...  
Keyword(s):  
Residual Disease ◽  
Whole Body ◽  
Surveillance Program ◽  
Conventional Imaging ◽  
Mri Imaging ◽  
Surveillance Strategy ◽  
Mutation Carriers ◽  
Increased Risk ◽  
Pet Ct

Abstract Purpose Germline succinate dehydrogenase (SDHx) mutation carriers, especially SDHB, are at increased risk for malignancy and require life-long surveillance. Current guidelines recommend periodic whole-body MRI imaging. We assessed the incremental value of 68Ga-DOTA-octreotate (GaTate) positron emission tomography (PET)/CT compared with conventional imaging in such patients. Methods SDHx mutation carriers who had GaTate PET/CT were retrospectively reviewed. Detection of lesions were compared with MRI or CT on a per-patient and per-lesion basis. Proof of lesions were based on histopathology or clinical/imaging follow-up. Results Twenty consecutive patients (median age, 46 years; 10 males) were reviewed. Fourteen patients had SDHB, four, SDHD, one SDHC, and one SDHA mutation. Fifteen had prior surgery and/or radiotherapy. Indications for PET/CT were as follows: 7 patients for surveillance for previously treated disease, 9 residual disease, 2 asymptomatic mutation carriers, and 2 for elevated catecholamines. Median time between modalities was 1.5 months. GaTate PET/CT had higher sensitivity and specificity than conventional imaging. On a per-patient basis: PET/CT sensitivity 100%, specificity 100%; MRI/CT 85% and 50%. Per-lesion basis: PET/CT sensitivity 100%, specificity 75%; MRI/CT 80% and 25%. PET/CT correctly identified additional small nodal and osseous lesions. MRI/CT had more false-positive findings. Change of management resulted in 40% (8/20 patients): 3 received localized treatment instead of observation, 1 changed to observation given extra disease detected, 4 with metastases had radionuclide therapy. Conclusions GaTate PET/CT provided incremental diagnostic information with consequent management impact in SDHx-pheochromocytoma and paraganglioma. Incorporating this modality as part of a surveillance program seems prudent. Further research is needed to define the optimal surveillance strategy including use of MRI.

85 PRE-RADIATION TREATMENT PET/CT SCAN CAN PREDICT THE LOCALIZATION OF RESIDUAL DISEASE POST-TREATMENT IN LUNG CANCER

2009 ◽  
Vol 92 ◽  
pp. S27
Author(s):  
C. Lavoie ◽  
J. Migchielsen ◽  
G. Lim ◽  
D.C. Vines ◽  
S. Breen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Ct Scan ◽  
Radiation Treatment ◽  
Residual Disease ◽  
Post Treatment ◽  
Pet Ct ◽  
Pet Ct Scan

18 FDG PET/CT prediction of treatment outcomes in patients with p16-positive, non-smoking associated, locoregionally advanced oropharyngeal cancer (LA-OPC) receiving deintensified therapy: Results from NRG-HN002.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6563-6563
Author(s):  
Rathan M Subramaniam ◽  
Lyudmila Demora ◽  
Min Yao ◽  
Sue S. Yom ◽  
Maura L. Gillison ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Residual Tumor ◽  
Post Treatment ◽  
Ordinal Scale ◽  
Reduced Dose ◽  
Pet Ct ◽  
Left Neck ◽  
Ct Analysis ◽  
Fdg Pet Ct ◽  
Post Therapy

6563 Background: To determine the negative predictive value (NPV) of 12-14 week post-treatment PET/CT for 2-year progression-free survival (PFS) and 2-year locoregional control (LRC) in NRG-HN002, which is a two-arm phase II trial for patients with low-risk, non-smoking associated p16-positive LA-OPC randomized in a 1:1 ratio to reduced-dose IMRT with or without cisplatin. Methods: PET/CT scans were reviewed both centrally and locally by participating institutions. Tumor response evaluations for primary site, right neck, and left neck were carried out using a 5-point ordinal scale (‘Hopkins Criteria’). Overall scores were then assigned as ‘Negative,’ Positive,’ or ‘Indeterminate.’ Patients who had a ‘Negative’ score for all three evaluation sites were given an overall score of ‘Negative.’ The endpoints were NPV for LRC and PFS at 2 years testing NPV ≤ 90% vs > 90% (1-sided alpha 0.10 and 76% power). Results: There were 316 patients enrolled, of whom 306 were randomized and eligible. Of these, 131 (42.8%) patients consented to a post-therapy PET/CT, and 117 (89.3%) patients were eligible for PET/CT analysis. The median time from end of treatment to PET/CT scan was 94 days (range 52-139). The rates of 2-yr PFS and LRC in the analysis subgroup were 91.3% and 93.8%, respectively. Based on central review, post-treatment scans were negative for residual tumor for 115 patients (98.3%) and positive for 2 patients (1.7%). The NPV for 2-year LRC was 94.5% (90% lower confidence bound [LCB] 90.6%; p = 0.07). NPV for 2-year PFS was 92.0% (90% LCB 87.7%; p = 0.30). Similar NPV results were obtained based on analysis of local reviews. Conclusion: Within the context of deintensification with reduced-dose radiation, the NPV of a 12-14 week post-therapy PET/CT for 2-year LRC is statistically > 90%, similar to that reported for patients receiving standard chemoradiation. However, in this study, there was not enough evidence to conclude that the NPV of a 12-14 week post-therapy PET/CT for 2-year PFS is > 90%. Grant acknowledgement: This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), U24CA180803 (IROC), UG1CA189867 (NRG Oncology NCORP) from the National Cancer Institute (NCI). This project is funded, in part, under a Grant with the Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions. Clinical trial information: NCT02254278 .

PO-1296 Usage of PET/CT as a post-treatment surveillance strategy in locoregionally advanced cervical cancer

2021 ◽  
Vol 161 ◽  
pp. S1066-S1067
Author(s):  
N. Cihoric ◽  
H. Astrid Elisabeth ◽  
S. Imboden ◽  
D. Aebersold ◽  
M. Blatti ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Post Treatment ◽  
Advanced Cervical Cancer ◽  
Surveillance Strategy ◽  
Pet Ct

MACHINE LEARNING BASED ON CT RADIOMIC FEATURES PREDICTS RESIDUAL TUMOR IN HEAD AND NECK CANCER PATIENTS TREATED WITH CHEMORADIOTHERAPY

2021 ◽  
Vol 57 (2) ◽  
pp. 199-211
Author(s):  
Edward Florez ◽  
◽  
Toms Vengaloor Thomas ◽  
Candace M. Howard ◽  
Hamid Khosravi ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Residual Disease ◽  
Predictive Ability ◽  
Residual Tumor ◽  
Post Treatment ◽  
Surveillance Imaging ◽  
Pet Ct ◽  
Ct Data ◽  
2D And 3D ◽  
Planning Ct

Surveillance imaging of HNSCC in patients treated with chemoradiotherapy suffers from difficulty in differentiating residual disease from radiation changes and inflammation. Thus, this study assessed ML models based on RadFs extracted from standard CT images pre- and post-chemoradiation to predict HNSCC treatment response. A retrospective analysis of HNSCC patients treated with definitive chemoradiotherapy at our institution between 2006 and 2015 was performed. Thirty-six patients with residual disease on CT scans of the soft tissue of the neck at a two- month interval-either in the primary site, nodal stations, or both-were enrolled. GTV contours from the treatment planning CT (CT1), post-treatment CT (CT2), and CT portion of the PET/CT (CT3) of the neck were exported to MatLab®, where 2D and 3D RadFs were extracted using different methods. Finally, ML models were used to identify the RadFs that predict changes and progression in HNSCC patients treated with chemoradiotherapy. SVM models using 2D RadFs, extracted from CT2, were associated with residual disease on PET/CT exams (AUC = 0.702). 2D RadFs extracted from PET/CT had moderate predictive ability to predict positive pathology for residual tumor (AUC = 0.667). NN and RF models of 3D RadFs extracted from CT2 and PET/CT had good and moderate predictive ability to predict positive pathology for residual tumor (AUC = 0.720 and 0.678, respectively). ML models using 2D and 3D RadFs derived from pre- and post-treatment CT data show promise for predicting residual tumor from radiation changes and inflammation in a small group of HNSCC cancer patients treated with chemoradiotherapy.

scholarly journals 18F-FDG-PET/CT in radiation therapy-induced parotid gland inflammation

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Alaa Mouminah ◽  
Austin J. Borja ◽  
Emily C. Hancin ◽  
Yu Cheng Chang ◽  
Thomas J. Werner ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Post Treatment ◽  
Parotid Glands ◽  
Positron Emission ◽  
Pet Ct ◽  
Average Maximum ◽  
Pre Treatment ◽  
Fdg Pet Ct

Abstract Background 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used in the clinical management of oncologic and inflammatory pathologies. It may have utility in detecting radiotherapy (RT)-induced damage of oral tissues. Thus, the aim of the present study was to use FDG-PET/CT to evaluate parotid gland inflammation following RT in patients with head and neck cancer (HNC). Methods This retrospective study included patients with HNC treated with photon, proton, or combined photon/proton RT, in addition to chemotherapy. All patients received FDG-PET/CT imaging pre-treatment and 3 months post-treatment. The average mean standardized uptake value (Avg SUVmean) and the average maximum standardized uptake value (Avg SUVmax) of the left and right parotid glands were determined by global assessment of FDG activity using OsiriX MD software. A two-tailed paired t test was used to compare Avg SUVmean and Avg SUVmax pre- and post-RT. Results Forty-seven HNC patients were included in the study. Parotid gland Avg SUVmean was significantly higher at 3 months post-treatment than pre-treatment (p < 0.05) in patients treated with photon RT, but no significant differences were found between pre- and post-treatment Avg SUVmean in patients treated with proton RT or combined photon/proton RT. Conclusion Our results suggest that photon RT may cause radiation-induced inflammation of the parotid gland, and that proton RT, which distributes less off-target radiation, is a safer treatment alternative.

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