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Title: Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix

Abstract

Purpose: To evaluate the utility of sequential {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for brachytherapy treatment planning in patients with carcinoma of the cervix. Methods and Materials: Twenty-four patients with carcinoma of the cervix were included in this prospective study. The clinical stage of their disease was Ib (7), IIa (1), IIb (7), and IIIb (9). Patients were treated with irradiation and brachytherapy, with the majority receiving concurrent weekly cisplatin chemotherapy. Patients underwent diagnostic FDG-PET imaging before treatment, sequential FDG-PET brachytherapy imaging during treatment, and diagnostic FDG-PET 3 months after treatment completion. Delineation of the gross tumor volume, bladder, and rectum was performed for all scans using a commercially available treatment-planning system. Actual treatment delivery was based on two-dimensional orthogonal planning. Results: The mean gross tumor volume and percent coverage by the target isodose surface for the initial, mid, and last implant were 37 cm{sup 3}, 17 cm{sup 3}, and 10 cm{sup 3} and 68%, 76%, and 79%, respectively. Nine of 11 patients were found to have continued decrease in tumor volume as measured by FDG-PET, with 3 patients having complete regression of their tumor before treatment was completed. The maximal bladder and rectal doses obtained from three-dimensional dose-volumemore » histograms were significantly higher than the International Commission on Radiation Units and Measurements Report 38 bladder and rectal points obtained by two-dimensional treatment-planning. Conclusions: Sequential FDG-PET brachytherapy imaging identifies the tumor response in individual patients, potentially making patient-specific brachytherapy treatment planning possible.« less

Authors:
 [1];  [2];  [1];  [2];  [1];  [2];  [1];  [2];  [3];  [2];  [1];  [4];  [1];  [2];  [5]
  1. Departments of Radiation Oncology and Radiology, Washington University School of Medicine, St. Louis, MO (United States)
  2. (United States)
  3. Alvin J. Siteman Cancer Center, St. Louis, MO (United States)
  4. Division of Radiological Sciences, Washington University School of Medicine, St. Louis, MO (United States)
  5. Departments of Radiation Oncology and Radiology, Washington University School of Medicine, St. Louis, MO (United States) and Alvin J. Siteman Cancer Center, St. Louis, MO (United States) and Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO (United States) and Division of Radiological Sciences, Washington University School of Medicine, St. Louis, MO (United States). E-mail: pgrigsby@wustl.edu
Publication Date:
OSTI Identifier:
20788245
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2005.05.035; PII: S0360-3016(05)00945-4; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; BRACHYTHERAPY; CARCINOMAS; CHEMOTHERAPY; FLUORINE 18; FLUORODEOXYGLUCOSE; PATIENTS; PLANNING; POSITRON COMPUTED TOMOGRAPHY; RADIATION SOURCE IMPLANTS; RECTUM

Citation Formats

Lin, Lilie L., Alvin J. Siteman Cancer Center, St. Louis, MO, Mutic, Sasa M.S., Alvin J. Siteman Cancer Center, St. Louis, MO, Malyapa, Robert S., Alvin J. Siteman Cancer Center, St. Louis, MO, Low, Daniel A., Alvin J. Siteman Cancer Center, St. Louis, MO, Miller, Tom R., Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, Vicic, Milos, LaForest, Richard, Zoberi, Imran, Alvin J. Siteman Cancer Center, St. Louis, MO, and Grigsby, Perry W.. Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix. United States: N. p., 2005. Web. doi:10.1016/J.IJROBP.2005.0.
Lin, Lilie L., Alvin J. Siteman Cancer Center, St. Louis, MO, Mutic, Sasa M.S., Alvin J. Siteman Cancer Center, St. Louis, MO, Malyapa, Robert S., Alvin J. Siteman Cancer Center, St. Louis, MO, Low, Daniel A., Alvin J. Siteman Cancer Center, St. Louis, MO, Miller, Tom R., Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, Vicic, Milos, LaForest, Richard, Zoberi, Imran, Alvin J. Siteman Cancer Center, St. Louis, MO, & Grigsby, Perry W.. Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix. United States. doi:10.1016/J.IJROBP.2005.0.
Lin, Lilie L., Alvin J. Siteman Cancer Center, St. Louis, MO, Mutic, Sasa M.S., Alvin J. Siteman Cancer Center, St. Louis, MO, Malyapa, Robert S., Alvin J. Siteman Cancer Center, St. Louis, MO, Low, Daniel A., Alvin J. Siteman Cancer Center, St. Louis, MO, Miller, Tom R., Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, Vicic, Milos, LaForest, Richard, Zoberi, Imran, Alvin J. Siteman Cancer Center, St. Louis, MO, and Grigsby, Perry W.. Thu . "Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788245,
title = {Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix},
author = {Lin, Lilie L. and Alvin J. Siteman Cancer Center, St. Louis, MO and Mutic, Sasa M.S. and Alvin J. Siteman Cancer Center, St. Louis, MO and Malyapa, Robert S. and Alvin J. Siteman Cancer Center, St. Louis, MO and Low, Daniel A. and Alvin J. Siteman Cancer Center, St. Louis, MO and Miller, Tom R. and Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO and Vicic, Milos and LaForest, Richard and Zoberi, Imran and Alvin J. Siteman Cancer Center, St. Louis, MO and Grigsby, Perry W.},
abstractNote = {Purpose: To evaluate the utility of sequential {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for brachytherapy treatment planning in patients with carcinoma of the cervix. Methods and Materials: Twenty-four patients with carcinoma of the cervix were included in this prospective study. The clinical stage of their disease was Ib (7), IIa (1), IIb (7), and IIIb (9). Patients were treated with irradiation and brachytherapy, with the majority receiving concurrent weekly cisplatin chemotherapy. Patients underwent diagnostic FDG-PET imaging before treatment, sequential FDG-PET brachytherapy imaging during treatment, and diagnostic FDG-PET 3 months after treatment completion. Delineation of the gross tumor volume, bladder, and rectum was performed for all scans using a commercially available treatment-planning system. Actual treatment delivery was based on two-dimensional orthogonal planning. Results: The mean gross tumor volume and percent coverage by the target isodose surface for the initial, mid, and last implant were 37 cm{sup 3}, 17 cm{sup 3}, and 10 cm{sup 3} and 68%, 76%, and 79%, respectively. Nine of 11 patients were found to have continued decrease in tumor volume as measured by FDG-PET, with 3 patients having complete regression of their tumor before treatment was completed. The maximal bladder and rectal doses obtained from three-dimensional dose-volume histograms were significantly higher than the International Commission on Radiation Units and Measurements Report 38 bladder and rectal points obtained by two-dimensional treatment-planning. Conclusions: Sequential FDG-PET brachytherapy imaging identifies the tumor response in individual patients, potentially making patient-specific brachytherapy treatment planning possible.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 63,
place = {United States},
year = {Thu Dec 01 00:00:00 EST 2005},
month = {Thu Dec 01 00:00:00 EST 2005}
}
  • Purpose: A dosimetric study was conducted to compare intracavitary brachytherapy using both a conventional and a custom loading intended to cover a positron emission tomography (PET)-defined tumor volume in patients with cervix cancer. Methods and Materials: Eleven patients who underwent an [{sup 18}F]-fluoro-deoxy-D-glucose (FDG)-PET in conjunction with their first, middle, or last brachytherapy treatment were included in this prospective study. A standard plan that delivers 6.5 Gy to point A under ideal conditions was compared with an optimized plan designed to conform the 6.5-Gy isodose surface to the PET defined volume. Results: A total of 31 intracavitary brachytherapy treatments inmore » conjunction with an FDG-PET were performed. The percent coverage of the target isodose surface for the first implant with and without optimization was 73% and 68% (p = 0.21). The percent coverage of the target isodose surface for the mid/final implant was 83% and 70% (p = 0.02), respectively. The dose to point A was higher with the optimized plans for both the first implant (p = 0.02) and the mid/last implants (p = 0.008). The dose to 2 cm{sup 3} and 5 cm{sup 3} of both the bladder and rectum were not significantly different. Conclusions: FDG-PET based treatment planning allowed for improved dose coverage of the tumor without significantly increasing the dose to the bladder and rectum.« less
  • Purpose: Squamous cell carcinoma antigen (SCC Ag) is a serum biomarker for squamous cell carcinoma (SCC) of the cervix. We investigated the prognostic significance of SCC Ag levels before and at the completion of chemoradiotherapy and compared these levels with the results of pre- and posttreatment positron emission tomography/computed tomography (PET/CT) using [{sup 18}F]fluorodeoxyglucose (FDG). Methods and Materials: The records of 63 women who underwent definitive chemoradiotherapy for SCC of the cervix were reviewed. SCC Ag levels were obtained before and at the completion of radiotherapy. Patients were divided into two groups on the basis of their pretreatment SCC Agmore » level (>30 ng/mL vs. {<=}30 ng/mL). Pre- and posttreatment FDG-PET/CT characteristics and progression-free survival (PFS) were analyzed according to SCC Ag groups. Results: Median follow-up was 12 months. Women with SCC Ag >30 ng/mL at diagnosis had more advanced lymph node disease on pretreatment FDG-PET/CT than those with SCC Ag {<=}30 ng/mL (p = .002). Women whose SCC Ag normalized at the completion of chemoradiotherapy were more likely to have a complete metabolic response on their 3-month posttreatment FDG-PET/CT than those whose SCC Ag did not normalize (p = .006). The 2-year PFS was 73% for patients with a SCC Ag level {<=}30 ng/mL at diagnosis compared with 0% for those with a SCC Ag level >30 ng/mL at diagnosis (p < .0001). The 2-year PFS was 62% for patients whose SCC Ag normalized at the completion of chemoradiotherapy compared with 0% for those whose SCC Ag did not normalize (p = .0004). Conclusion: Elevated SCC Ag at diagnosis and failure of the SCC Ag to normalize at the completion of treatment are associated with incomplete metabolic response and decreased PFS.« less
  • Purpose: Induction chemotherapy (ICT) has been used to select patients for organ preservation and determine subsequent treatments in patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN). Still, the clinical outcomes of LASCCHN patients who showed response to ICT are heterogeneous. We evaluated the efficacy of interim 18-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) after ICT in this specific subgroup of LASCCHN patients who achieved partial response (PR) after ICT to predict clinical outcomes after concurrent chemoradiotherapy (CCRT). Methods and Materials: Twenty-one patients with LASCCHN who showed PR to ICT by Response Evaluation Criteria In Solid Tumors beforemore » definitive CCRT were chosen in this retrospective analysis. FDG-PET was performed before and 2-4 weeks after ICT to assess the extent of disease at baseline and the metabolic response to ICT, respectively. We examined the correlation of the metabolic response by the percentage decrease of maximum standardized uptake value (SUVmax) on the primary tumor or lymph node after ICT or a specific threshold of SUVmax on interim FDG-PET with clinical outcomes including complete response (CR) rate to CCRT, progression-free survival (PFS), and overall survival (OS). Results: A SUVmax of 4.8 on interim FDG-PET could predict clinical CR after CCRT (100% vs. 20%, p = 0.001), PFS (median, not reached vs. 8.5 mo, p < 0.001), and OS (median, not reached vs. 12.0 months, p = 0.001) with a median follow-up of 20.3 months in surviving patients. A 65% decrease in SUVmax after ICT from baseline also could predict clinical CR after CCRT (100% vs. 33.3%, p = 0.003), PFS (median, not reached vs. 8.9 months, p < 0.001) and OS (median, not reached vs. 24.4 months, p = 0.001) of the patients. Conclusion: These data suggest that interim FDG-PET after ICT might be a useful determinant to predict clinical outcomes in patients with LASCCHN receiving sequential ICT followed by CCRT.« less
  • Purpose: Assuming F-18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) to be more accurate in representing the true disease extent than CT alone, we prospectively designed this study to evaluate how the addition of FDG-PET influences CT-based radiotherapy planning for locally recurrent nasopharyngeal carcinoma. Patients and Methods: All patients underwent FDG-PET/CT simulation scans. For each patient, the gross tumor volume (GTV) was separately delineated with or without the addition of PET information and defined as GTV{sub PET/CT} and GTV{sub CT}, respectively. Corresponding planning target volumes (PTV) were generated for the GTV{sub CT} (PTV{sub CT}) and GTV{sub PET/CT} (PTV{sub PET/CT}). Three-dimensional conformalmore » radiotherapy plans were separately created for PTV{sub CT} and PTV{sub PET/CT}. To assess the potential geographic miss of the PET/CT-based disease in CT-based treatment planning, the size and location of the GTV{sub PET/CT}, PTV{sub PET/CT}, and PTV{sub CT} were analyzed, and the three-dimensional conformal radiotherapy plans created using the PTV{sub CT} were evaluated with the GTV{sub PET/CT} and PTV{sub PET/CT} information. Results: A total of 43 patients were enrolled in this study. Distant metastasis was found in 4 patients with the addition of the PET information. The 39 patients without distant metastasis proceeded to three-dimensional conformal radiotherapy planning. Inadequate coverage of the GTV{sub PET/CT} and PTV{sub PET/CT} by the PTV{sub CT} occurred in 7 (18%) and 20 (51%) patients, respectively. This resulted in <95% of the GTV{sub PET/CT} and PTV{sub PET/CT} receiving {>=}95% of the prescribed dose in 4 (10%) and 13 (33%) patients, respectively. Conclusions: The addition of FDG-PET information might influence CT-based radiotherapy planning for locally recurrent nasopharyngeal carcinoma by altering the definition of the target volume, with the potential to avoid a geographic miss of true disease.« less
  • Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women's Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general,more » the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.« less