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Title: FDG-PET/CT in the evaluation of anal carcinoma

Abstract

Purpose: Surgical staging and treatment of anal carcinoma has been replaced by noninvasive staging studies and combined modality therapy. In this study, we compare computed tomography (CT) and physical examination to [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of carcinoma of the anal canal, with special emphasis on determination of spread to inguinal lymph nodes. Methods and Materials: Between July 2003 and July 2005, 41 consecutive patients with biopsy-proved anal carcinoma underwent a complete staging evaluation including physical examination, CT, and 2-FDG-PET/CT. Patients ranged in age from 30 to 89 years. Nine men were HIV-positive. Treatment was with standard Nigro regimen. Results: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) detected 91% of nonexcised primary tumors, whereas CT visualized 59%. FDG-PET/CT detected abnormal uptake in pelvic nodes of 5 patients with normal pelvic CT scans. FDG-PET/CT detected abnormal nodes in 20% of groins that were normal by CT, and in 23% without abnormality on physical examination. Furthermore, 17% of groins negative by both CT and physical examination showed abnormal uptake on FDG-PET/CT. HIV-positive patients had an increased frequency of PET-positive lymph nodes. Conclusion: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography detects the primary tumor more often than CT. FDG-PET/CT detects substantially moremore » abnormal inguinal lymph nodes than are identified by standard clinical staging with CT and physical examination.« less

Authors:
 [1];  [2];  [3];  [4]
  1. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States)
  2. (United States)
  3. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States) and Division of Nuclear Medicine, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States). E-mail: pgrigsby@wustl.edu
  4. Division of Nuclear Medicine, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States) (and others)
Publication Date:
OSTI Identifier:
20842901
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 65; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2006.01.009; PII: S0360-3016(06)00114-3; Copyright (c) 2006 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; AIDS VIRUS; BIOPSY; CARCINOMAS; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; FLUORINE 18; FLUORODEOXYGLUCOSE; GLUCOSE; LYMPH NODES; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; SURGERY; THERAPY; UPTAKE

Citation Formats

Cotter, Shane E., Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, Grigsby, Perry W., and Siegel, Barry A. FDG-PET/CT in the evaluation of anal carcinoma. United States: N. p., 2006. Web. doi:10.1016/j.ijrobp.2006.01.009.
Cotter, Shane E., Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, Grigsby, Perry W., & Siegel, Barry A. FDG-PET/CT in the evaluation of anal carcinoma. United States. doi:10.1016/j.ijrobp.2006.01.009.
Cotter, Shane E., Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, Grigsby, Perry W., and Siegel, Barry A. 2006. "FDG-PET/CT in the evaluation of anal carcinoma". United States. doi:10.1016/j.ijrobp.2006.01.009.
@article{osti_20842901,
title = {FDG-PET/CT in the evaluation of anal carcinoma},
author = {Cotter, Shane E. and Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO and Grigsby, Perry W. and Siegel, Barry A.},
abstractNote = {Purpose: Surgical staging and treatment of anal carcinoma has been replaced by noninvasive staging studies and combined modality therapy. In this study, we compare computed tomography (CT) and physical examination to [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of carcinoma of the anal canal, with special emphasis on determination of spread to inguinal lymph nodes. Methods and Materials: Between July 2003 and July 2005, 41 consecutive patients with biopsy-proved anal carcinoma underwent a complete staging evaluation including physical examination, CT, and 2-FDG-PET/CT. Patients ranged in age from 30 to 89 years. Nine men were HIV-positive. Treatment was with standard Nigro regimen. Results: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) detected 91% of nonexcised primary tumors, whereas CT visualized 59%. FDG-PET/CT detected abnormal uptake in pelvic nodes of 5 patients with normal pelvic CT scans. FDG-PET/CT detected abnormal nodes in 20% of groins that were normal by CT, and in 23% without abnormality on physical examination. Furthermore, 17% of groins negative by both CT and physical examination showed abnormal uptake on FDG-PET/CT. HIV-positive patients had an increased frequency of PET-positive lymph nodes. Conclusion: [{sup 18}F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography detects the primary tumor more often than CT. FDG-PET/CT detects substantially more abnormal inguinal lymph nodes than are identified by standard clinical staging with CT and physical examination.},
doi = {10.1016/j.ijrobp.2006.01.009},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 65,
place = {United States},
year = 2006,
month = 7
}
  • Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. Methods and Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤3 cm or 54more » Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator’s ability to perform DP-IMRT. Results: Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. Conclusions: Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.« less
  • A case report is cited illustrating the development of carcinoma of the uterine cervix 18 yr after successful radiation treatment of a previous cervical carcinoma. The 23-yr-old patient had a rapidly growing squamouscell carcinoma of highest grade of malignancy in 1943. She was given deep x-ray therapy using 4 ports, 10 x 15 cm, 200 kv, and 20 ma on 20 different days for a total of 6720 r (168 r to each of 2 ports per treatment). Radium in a total dose of 5400 mg-hr was also given. Subsequent repeated examinations showed total disappearance of the tumor, but inmore » 1961 a cervical biopsy showed carcinoma in situ with no evidence of invasive or recurrent carcinoma. Recovery from this presumably primary tumor was complete but another apparently primary tumor developed in the rectum, diagnosed as a moderately differentiated squamous-cell carcinoma. Eight previously reported cases of such an in situ carcinoma developing after radiotherapy are reviewed. Various sequelae of radiation injury of the gastrointestinal and genitourinary tracts are described as a result of pathologic study of the case and their significance discussed. (BBB)« less
  • Surgery has historically been the standard treatment for anal, ano-rectal and rectal carcinoma but is prone to local or regional failure. Over the past 15 years there has been increasing interest in and success with radiation therapy and combined chemoradiotherapy for treatment of anal and ano-rectal cancers. Cf-252 brachytherapy combined with external beam teletherapy has been investigated for anal and ano-rectal lesions at the Univ. of Kentucky with encouraging results.