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Lee EYP, Philip Ip PC, Tse KY, Kwok ST, Chiu WK, Ho G. PET/Computed Tomography Transformation of Oncology: Ovarian Cancers. PET Clin 2024; 19:207-216. [PMID: 38177053 DOI: 10.1016/j.cpet.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Over the last quarter of a century, fluorine-18-fluorodeoxyglucose (FDG) PET/computed tomography (CT) has revolutionized the diagnostic algorithm of ovarian cancer, impacting on the initial disease evaluation including staging and surgical planning, treatment response assessment and prognostication, to the most important role in detection of recurrent disease. The role of FDG PET/CT is expanding with the adoption of new therapeutic agents. Other non-FDG tracers have been explored with fibroblast activation protein inhibitor being promising. Novel tracers may provide the basis for future theragnostic work. This article will review the evolution and impact of PET/CT in ovarian cancer management.
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Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Pun Ching Philip Ip
- Department of Pathology, School of Clinical Medicine, University of Hong Kong, Room 019, 7/F, Block T, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Wan Kam Chiu
- Department of Obstetrics and Gynaecology, United Christian Hospital, 5/F, Block S, Kwun Tong, Kowloon, Hong Kong, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
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Lee EYP, Ip PPC, Tse KY, Chiu KWH, Chu MMY, Chai YK, Wu PY, Law JYP, Kwok ST, Chiu WK, Ngan HYS. Prospective validation of the role of PET/CT in detecting disease after neoadjuvant chemotherapy in advanced ovarian cancer. Eur Radiol 2024:10.1007/s00330-024-10674-y. [PMID: 38460014 DOI: 10.1007/s00330-024-10674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The study aimed to compare the diagnostic accuracies of 2-[18F]FDG PET/CT and contrast-enhanced CT (ceCT) after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer (OC). MATERIALS AND METHODS This study consisted historical observational cohort and prospective validation cohort. Patients with newly diagnosed stage III-IV OC scheduled for NACT were recruited, with imaging performed after three to six cycles of NACT before interval debulking surgery. Nineteen regions in the abdominopelvic cavity were scored for the presence and absence of disease, referenced to the intra-operative findings or histological specimens. Diagnostic metrics were compared using McNemar's test. RESULTS In the historical cohort (23 patients, age 58 ± 13), 2-[18F]FDG PET had an overall accuracy (Acc) 82%, sensitivity (Sen) 38%, specificity (Spe) 97%, positive predictive value (PPV) 79% and negative predictive value (NPV) 82%; ceCT had an overall Acc 86%, Sen 64%, Spe 93%, PPV 75% and NPV 89%. In the prospective cohort (46 patients, age 59 ± 9), 2-[18F] FDG PET had an overall Acc 87%, Sen 48%, Spe 98%, PPV 84% and NPV 88%; ceCT had an overall Acc 89%, Sen 66%, Spe 95%, PPV 77% and NPV 91%. No significant difference was demonstrated between the two imaging modalities (p > 0.05). High false-negative rates were observed in the right subdiaphragmatic space, omentum, bowel mesentery and serosa. High omental metabolic uptake after NACT was associated with histological non-responders (p < 0.05). CONCLUSION 2-[18F]FDG PET/CT had no additional value over ceCT with comparable diagnostic accuracy in detecting disease after NACT in advanced OC. CLINICAL RELEVANCE STATEMENT 2-[18F]FDG PET/CT is not superior to contrast-enhanced CT in determining disease after neoadjuvant chemotherapy in advanced ovarian cancer; contrast-enhanced CT should be suffice for surgical planning before interval debulking surgery. KEY POINTS • Additional value of 2-[18F]FDG PET/CT over contrast-enhanced CT is undefined in detecting disease after neoadjuvant chemotherapy. • 2-[18F]FDG PET/CT has comparable diagnostic accuracy compared to contrast-enhanced CT. • Contrast-enhanced CT will be suffice for surgical planning after neoadjuvant chemotherapy.
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Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Philip Pun Ching Ip
- Department of Pathology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Mandy Man Yee Chu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yu Ka Chai
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Philip Yuguang Wu
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Jessica Yun Pui Law
- Department of Obstetrics and Gynecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wan Kam Chiu
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Khessib T, Jha P, Davidzon GA, Iagaru A, Shah J. Nuclear Medicine and Molecular Imaging Applications in Gynecologic Malignancies: A Comprehensive Review. Semin Nucl Med 2024; 54:270-292. [PMID: 38342655 DOI: 10.1053/j.semnuclmed.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
Gynecologic malignancies, consisting of endometrial, cervical, ovarian, vulvar, and vaginal cancers, pose significant diagnostic and management challenges due to their complex anatomic location and potential for rapid progression. These tumors cause substantial morbidity and mortality, often because of their delayed diagnosis and treatment. An estimated 19% of newly diagnosed cancers among women are gynecologic in origin. In recent years, there has been growing evidence supporting the integration of nuclear medicine imaging modalities in the diagnostic work-up and management of gynecologic cancers. The sensitivity of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) combined with the anatomical specificity of computed tomography (CT) and magnetic resonance imaging (MRI) allows for the hybrid evaluation of metabolic activity and structural abnormalities that has become an indispensable tool in oncologic imaging. Lymphoscintigraphy, using technetium 99m (99mTc) based radiotracers along with single photon emission computed tomography/ computed tomography (SPECT/CT), holds a vital role in the identification of sentinel lymph nodes to minimize the surgical morbidity from extensive lymph node dissections. While not yet standard for gynecologic malignancies, promising therapeutic nuclear medicine agents serve as specialized treatment options for patients with advanced or recurrent disease. This article aims to provide a comprehensive review on the nuclear medicine applications in gynecologic malignancies through the following objectives: 1) To describe the role of nuclear medicine in the initial staging, lymph node mapping, response assessment, and recurrence/surveillance imaging of common gynecologic cancers, 2) To review the limitations of 18F-FDG PET/CT and promising applications of 18F-FDG PET/MRI in gynecologic malignancy, 3) To underscore the promising theragnostic applications of nuclear medicine, 4) To highlight the current role of nuclear medicine imaging in gynecologic cancers as per the National Comprehensive Cancer Network (NCCN), European Society of Surgical Oncology (ESGO), and European Society of Medical Oncology (ESMO) guidelines.
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Affiliation(s)
- Tasnim Khessib
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Priyanka Jha
- Division of Body Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94035
| | - Guido A Davidzon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Jagruti Shah
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305.
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Ferron G, De Rauglaudre G, Becourt S, Delanoy N, Joly F, Lortholary A, You B, Bouchaert P, Malaurie E, Gouy S, Kaminsky MC, Meunier J, Alexandre J, Berton D, Dohollou N, Dubot C, Floquet A, Favier L, Venat-Bouvet L, Fabbro M, Louvet C, Lotz JP, Abadie-Lacourtoisie S, Desauw C, Del Piano F, Leheurteur M, Bonichon-Lamichhane N, Rastkhah M, Follana P, Gantzer J, Ray-Coquard I, Pujade-Lauraine E. Neoadjuvant chemotherapy with or without nintedanib for advanced epithelial ovarian cancer: Lessons from the GINECO double-blind randomized phase II CHIVA trial. Gynecol Oncol 2023; 170:186-194. [PMID: 36706645 DOI: 10.1016/j.ygyno.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
AIM The oral anti-angiogenic therapy nintedanib prolongs progression-free survival (PFS) when combined with chemotherapy after primary surgery for advanced epithelial ovarian cancer. The randomized phase II CHIVA trial evaluated the impact of combining nintedanib with neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer. METHODS Patients with newly diagnosed unresectable FIGO stage IIIC-IV epithelial ovarian cancer received 3-4 cycles of carboplatin plus paclitaxel every 3 weeks as NACT before interval debulking surgery (IDS), followed by 2-3 post-operative cycles. Patients were randomized 2:1 to receive either nintedanib 200 mg twice daily or placebo on days 2-21 every 3 weeks during NACT (omitting peri-operative cycles), and then as maintenance therapy for up to 2 years. The primary endpoint was PFS. RESULTS Between January 2013 and May 2015, 188 patients were randomized (124 to nintedanib, 64 to placebo). PFS was significantly inferior with nintedanib (median 14.4 versus 16.8 months with placebo; hazard ratio 1.50, p = 0.02). Overall survival (OS) was also inferior (median 37.7 versus 44.1 months, respectively; hazard ratio 1.54, p = 0.054). Nintedanib was associated with increased toxicity (grade 3/4 adverse events: 92% versus 69%, predominantly hematologic and gastrointestinal), lower response rate by RECIST (35% versus 56% before IDS), and lower IDS feasibility (58% versus 77%) versus placebo. CONCLUSIONS Adding nintedanib to chemotherapy and in maintenance as part of NACT for advanced epithelial ovarian cancer cannot be recommended as it increases toxicity and compromises chemotherapy efficacy (IDS, PFS, OS). CLINICALTRIALS govregistration: NCT01583322.
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Affiliation(s)
- Gwénaël Ferron
- Institut Claudius Regaud, Département de Chirurgie Oncologique, IUCT Oncopole, Toulouse, France.
| | | | | | - Nicolas Delanoy
- Institut du Cancer Paris CARPEM, Assistance Publique Hôpitaux de Paris (AP-HP), APHP. Centre, Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France.
| | - Florence Joly
- Centre François Baclesse, Oncologie Médicale, Unicaen, Caen, France.
| | - Alain Lortholary
- Hôpital Privé du Confluent, Centre Catherine de Sienne, Nantes, France.
| | - Benoît You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EA3738 Centre pour l'Innovation en Cancérologie de LYon (CICLY), Lyon, France; GINECO-GINEGEPS, Paris, France.
| | - Patrick Bouchaert
- Hôpital de la Milétrie - Centre Hospitalier Universitaire de Poitiers, Pôle Régional de Cancérologie, Service d'Oncologie, Poitiers, France.
| | - Emmanuelle Malaurie
- Centre Hospitalier Intercommunal de Créteil, Oncologie Radiothérapie, Créteil, France.
| | - Sebastien Gouy
- Gustave Roussy, Gynécologie Médicale, Villejuif, France.
| | | | - Jérôme Meunier
- Centre Hospitalier Régional d'Orléans, Service Oncologie Médicale, Orléans, France.
| | - Jérôme Alexandre
- Université de Paris Cité, Service d'Oncologie Médicale, AP-HP, Hôpital Cochin Port Royal, Paris, France.
| | - Dominique Berton
- ICO Centre René Gauducheau, Boulevard Jacques Monod, Saint Herblain, France.
| | - Nadine Dohollou
- Polyclinique Bordeaux Nord, Oncologie Radiothérapie, Bordeaux, France.
| | - Coraline Dubot
- Hôpital René Huguenin, Institut Curie, Oncologie Médicale, Saint Cloud, France.
| | | | - Laure Favier
- Centre Georges François Leclerc, Oncologie Médicale, Dijon, France.
| | | | | | | | | | | | - Christophe Desauw
- Centre Hospitalier Régional Universitaire de Lille - Hôpital Huriez, Lille, France.
| | | | | | | | | | | | - Justine Gantzer
- ICANS, Institut de Cancérologie Strasbourg-Europe, Strasbourg, France.
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The Evaluation Value of CT in the Efficacy of Neoadjuvant Chemotherapy in Ovarian Cancer Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7195888. [PMID: 35800240 PMCID: PMC9200539 DOI: 10.1155/2022/7195888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Aim To discuss the evaluation value of CT in the efficacy of neoadjuvant chemotherapy in patients with ovarian cancer. Methods The clinical, pathological, and CT imaging information of 72 patients with ovarian cancer treated in our hospital from January 2018 to January 2022 were retrospectively analyzed. CT examination and pathological examination were compared to evaluate the efficacy of neoadjuvant chemotherapy. Results Using the CRS grading system, 26 cases (36.11%) scored 1, 42 cases (58.33%) scored 2, and 4 cases (5.56%) scored 3. CRS grading system scores of 1, 2, 3, and 4–7 patients were compared, P > 0.05. The CT manifestations of lymphadenectasis, degree of peritoneal thickening, ascites, and maximum length diameter of the mass were compared between the patients before and after chemotherapy, P < 0.05. According to RECIST 1.1, there were 1 (1.39%) CR, 38 (52.78%) PR, 29 (40.28%) SD, and 4 (5.56%) PD. The comparison was done between RECIST 1.1 and CRS grading system, P > 0.05. Conclusion CT could be used to evaluate the efficacy of neoadjuvant chemotherapy for ovarian cancer.
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Delgado Bolton RC, Aide N, Colletti PM, Ferrero A, Paez D, Skanjeti A, Giammarile F. EANM guideline on the role of 2-[ 18F]FDG PET/CT in diagnosis, staging, prognostic value, therapy assessment and restaging of ovarian cancer, endorsed by the American College of Nuclear Medicine (ACNM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the International Atomic Energy Agency (IAEA). Eur J Nucl Med Mol Imaging 2021; 48:3286-3302. [PMID: 34215923 DOI: 10.1007/s00259-021-05450-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
In most patients with ovarian carcinoma, the diagnosis is reached when the disease is long past the initial stages, presenting already an advanced stage, and they usually have a very bad prognosis. Cytoreductive or debulking surgical procedures, platinum-based chemotherapy and targeted agents are key therapeutic elements. However, around 7 out of 10 patients present recurrent disease within 36 months from the initial diagnosis. The metastatic spread in ovarian cancer follows three pathways: contiguous dissemination across the peritoneum, dissemination through the lymphatic drainage and, although less importantly in this case, through the bloodstream. Radiological imaging, including ultrasound, CT and MRI, are the main imaging techniques in which management decisions are supported, CT being considered the best available technique for presurgical evaluation and staging purposes. Regarding 2-[18F]FDG PET/CT, the evidence available in the literature demonstrates efficacy in primary detection, disease staging and establishing the prognosis and especially for relapse detection. There is limited evidence when considering the evaluation of therapeutic response. This guideline summarizes the level of evidence and grade of recommendation for the clinical indications of 2-[18F]FDG PET/CT in each disease stage of ovarian carcinoma.
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Affiliation(s)
- Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain.
| | - Nicolas Aide
- Department of Nuclear Medicine, Caen University Hospital, Caen, France.,INSERM U1086 ANTICIPE, Normandie Université, Caen, France
| | - Patrick M Colletti
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Annamaria Ferrero
- Academic Division Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Andrea Skanjeti
- Department of Nuclear Medicine, Hospices Civils de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria.,Department of Nuclear Medicine, Centre Léon Bérard, Lyon, France
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