Clinical evidence on PET-CT for radiation therapy planning in head and neck tumours (original) (raw)
Related papers
Radiotherapy and Oncology, 2011
Background and purpose: The present study evaluates the incidence of 11 C-choline PET/CT positive findings in patients with recurrent prostate cancer referred for salvage radiotherapy (SRT) and the influence on the definition of the planning target volume (PTV). Material and methods: Thirty-seven patients treated with radical prostatectomy and referred to SRT to the prostatic fossa because of biochemical relapse, were analysed retrospectively. All patients underwent 11 C-choline PET/CT before radiotherapy. The influence of PET/CT on the extent of the PTV was analysed. The median total follow up after SRT was 51.2 months. Results: 11/37 (30%) patients had a positive finding in the 11 C-choline PET/CT, 5 (13%) outside of the prostatic fossa (iliac lymph nodes), implicating an extension of the PTV. Patients with positive 11 C-choline PET/CT had a significant higher PSA value than patients with no pathologic uptake (p = 0.03). Overall, at the end of follow up 56% of the patients had a PSA 6 0.2 ng/ml and 44% had a biochemical relapse of prostate cancer.
Clinical Nuclear Medicine, 2015
Introduction: Aim of the study is to evaluate the impact of Cho-PET/CT in decision-making strategy of patients with localized prostate cancer (PC) eligible to definitive radiotherapy (RT). Materials and Methods: Sixty patients Cho-PET/CT before RT were prospectively enrolled. All patients were treated with volumetric modulated arc therapy with simultaneous integrated boost in 28 fractions. Androgen deprivation therapy was prescribed according to National Comprehensive Cancer Network (NCCN) risk classification. Therapeutic strategy based on the Cho-PET/CT evaluation was compared with the strategy that would have been proposed in case of PET not available and/or not strictly indicated, according to international and national PC guidelines. Results: Cho-PET/CT was positive in 57 cases (95%): T in 45 (79%); T in combination with N in 8 (14%); and M (bone) in combination with T or N, or both, in 4 (7%). After Cho-PET/CT, patients were stratified as follows: 26 (43%) low risk, 10 (16%) intermediate risk, and 24 (41%) high risk. Cho-PET/CT shifted treatment indication in 13 cases (21%). The changes regarding radiation treatment volumes were as follows: 6 intermediate risk (10%) shifted to high risk and consequently were irradiated on prostate, seminal vesicles, and pelvic nodes PTVs; in 7 high risk (11%), the Cho-PET/CT showed bone and/or N uptake, and consequently, a simultaneous integrated boost on PET positive sites was prescribed. Conclusions: Cho-PET/CT seems to be a promising diagnostic tool in patients who are candidates for radical RT and supporting the decision making in treatment planning, in particular in intermediate-high risk.
Clinical Genitourinary Cancer, 2014
A modification of therapy in light of the [ 11 C]cholineepositron emission tomography/computed tomography (cho-PET/CT) assessment was found in approximately 30% of patients with prostate cancer in our study. The reported outcomes are put forward to support the important role of cho-PET/CT as a steering factor in the choice of the most appropriate therapeutic approach for patients with cancer. Background: The purpose of our study was to analyze the role of [ 11 C]cholineepositron emission tomography/ computed tomography (cho-PET/CT) in the management of patients with cancer referred for radiotherapy. Patients and Methods: Inclusion criteria for this retrospective study were (1) presence of prostate cancer, (2) referral for first radiotherapy course (for primary or recurrent tumor) between February 2007 and July 2010, and (3) performance of cho-PET/CT. All cho-PET/CT scans were classified according to whether they were positive in the prostate/prostate bed (T), pelvic lymph nodes (N), and distant metastases (M) or negative. Therapeutic strategy based on the cho-PET/CT evaluation was compared with the strategy that would have been proposed had cho-PET/CT imaging not been available, following international and national prostate cancer guidelines. Results: Eighty-two cho-PET/CT scans performed in 74 patients were analyzed. Cho-PET/CT was positive in 49 studies (60%): T only in 22 (45% of all positive studies); N only in 4 (8%); T in combination with N in 3 (6%); and M in combination with T or N, or both, in 16 (33%). Treatment after positive cho-PET/CT examination included radiotherapy AE androgen deprivation (29 patients), surgery AE radiotherapy (6 patients), androgen deprivation only (8 patients), and other treatment (6 patients). In 22 cases, cho-PET/CT (27%) altered the treatment approach compared with the treatment that would have been adopted in the absence of cho-PET/CT analysis. Conclusion: Cho-PET/CT is valuable in defining the extent of disease and supporting therapeutic decisions in the management of prostate cancer. The therapeutic strategy turned out to be influenced by cho-PET/CT imaging in about one third of the patients included in this study.
International Journal of Radiation Oncology Biology Physics, 2016
Staging the extent and location of prostate cancer in biochemical relapse (BR) is critical to informing further management of both post-surgical and post-radiation patients with focal or systemic therapies. This retrospective, observational study hypothesized that the investigational amino acid PET tracer fluciclovine F18 could effectively detect disease recurrence in this patient group and would be well tolerated. Diagnostic performance of fluciclovine F18, as compared to histopathology and clinical follow-up, was determined in a patient cohort with sufficient data for truth determination. The safety profile and imaging positivity rate relative to PSA level were evaluated in the larger cohort. Materials/Methods: Overall, 714 cancer patients underwent fluciclovine F18 PET-CT scanning at 4 sites in Norway, Italy and USA, including 596 patients who presented with BR of prostate cancer. Imaging positivity or detection rate (DR) was determined according to PSA quartile. To determine diagnostic performance in prostate cancer BR, fluciclovine F18 PET-CT results were compared to available histopathological findings (n Z 143) and to histopathology plus clinical follow-up (n Z 125). Determination of DR, sensitivity and specificity, positive and negative predictive value (PPV, NPV) were made, as applicable, at lesion, regional and subject level (prostate/prostate bed (P/B) or extraprostatic (E/P)). Results: Fluciclovine F18 was very well tolerated: adverse events possibly related to fluciclovine were reported by 0.6% of patients; no significant treatment-related effects on laboratory values or ECG variables were noted. Risk factors for the prostate cancer BR cohort included: Gleason score 7 (80%); intermediate/high risk by D'Amico criteria at initial treatment (65%); median PSA before imaging: 2.03 ng/mL. For diagnostic performance vs. histopathology (n Z 143) the sensitivity for detection of P/B disease was 88.1%, with specificity of 32.6% and PPV of 71.8%. The PPV for E/P disease was higher at 92.3%. For diagnostic performance vs pathology plus clinical follow up (n Z 125), sensitivity, specificity, PPV,
Choline PET/CT in recurrent prostate cancer
Frontiers in Oncology
PurposeBiochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patientsPatients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes.ResultsData from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyze...
Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer
European Journal of Nuclear Medicine and Molecular Imaging, 2012
PURPOSE: To investigate the clinical value of (18)F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA). METHODS: The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14-64 months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires. RESULTS: Mean follow-up was 42 months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted. CONCLUSION: CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment.
Radiotherapy and Oncology, 2009
F-fluorocholine Image segmentation Gross tumour volume Recurrent prostate cancer a b s t r a c t Background and purpose: We evaluate the contribution of 18 F-choline PET/CT in the delineation of gross tumour volume (GTV) in local recurrent prostate cancer after initial irradiation using various PET image segmentation techniques. Materials and methods: Seventeen patients with local-only recurrent prostate cancer (median = 5.7 years) after initial irradiation were included in the study. Rebiopsies were performed in 10 patients that confirmed the local recurrence. Following injection of 300 MBq of 18 F-fluorocholine, dynamic PET frames (3 min each) were reconstructed from the list-mode acquisition. Five PET image segmentation techniques were used to delineate the 18 F-choline-based GTVs. These included manual delineation of contours (GTV man ) by two teams consisting of a radiation oncologist and a nuclear medicine physician each, a fixed threshold of 40% and 50% of the maximum signal intensity (GTV 40% and GTV 50% ), signal-to-background ratio-based adaptive thresholding (GTV SBR ), and a region growing (GTV RG ) algorithm. Geographic mismatches between the GTVs were also assessed using overlap analysis. Results: Inter-observer variability for manual delineation of GTVs was high but not statistically significant (p = 0.459). In addition, the volumes and shapes of GTVs delineated using semi-automated techniques were significantly higher than those of GTVs defined manually. Conclusions: Semi-automated segmentation techniques for 18 F-choline PET-guided GTV delineation resulted in substantially higher GTVs compared to manual delineation and might replace the latter for determination of recurrent prostate cancer for partial prostate re-irradiation. The selection of the most appropriate segmentation algorithm still needs to be determined.
European Journal of Nuclear Medicine and Molecular Imaging
Aims To report long-term outcomes of relapsed prostate cancer (PC) patients treated in a prospective single-arm study with extended-nodal radiotherapy (ENRT) and [11C]-choline positron emission tomography (PET)/computed tomography (CT)guided simultaneous integrated boost (SIB) to positive lymph nodes (LNs). Methods From 12/2009 to 04/2015, 60 PC patients with biochemical relapse and positive LNs only were treated in this study. ENRT at a median total dose (TD) = 51.8 Gy/28 fr and PET/CT-guided SIB to positive LNs at a median TD = 65.5 Gy was prescribed. Median PSA at relapse was 2.3 (interquartile range, IQR:1.3-4.0) ng/ml. Median number of positive LNs: 2 (range: 1-18). Androgen deprivation therapy (ADT) was prescribed for 48 patients for a median of 30.7 (IQR: 18.5-43.1) months.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2015
Positron Emission Tomography/Computed Tomography is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by (11)C-choline PET/CT (choline-PET/CT) on survival outcomes: overall survival (OS), loco regional- (lRFS), clinical- (cRFS) and biochemical relapse free survival (bRFS) in patients treated with helical tomotherapy (HTT) for LN recurrence. This retrospective study included 68 patients affected by PCa (mean age: 68 years; range: 51-81 years) with biochemical recurrence after primary treatment (median PSA0: 2.42 ng/ml; range: 0.61-27.56 ng/ml) who underwent choline-PET/CT from January 2005 to January 2013 and then treated with HTT in correspondence of the pathological choline LN uptake. PET derived parameters, including maximum/mean standardized uptake value (SUVmax/mean) and metabolic tumor volume (MTV) with a threshold of...