1
|
Mirshahvalad SA, Mesci A, Murad V, Kohan A, Ortega C, Veit-Haibach P, Metser U. [ 18F]-FDG PET in anal canal cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2023; 51:258-277. [PMID: 37592085 DOI: 10.1007/s00259-023-06393-z] [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] [Received: 06/22/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To provide comprehensive data on the diagnostic and prognostic value of [18F]-FDG PET (PET) in anal canal cancer patients. METHODS This study was designed following the PRISMA-DTA guidelines. For the meta-analysis, published original articles (until December 2022) that met the following criteria were included: Evaluated PET for locoregional and/or distant disease detection in patients with histopathology-proven anal canal cancer; Compared PET with a valid reference standard; Provided crude data to calculate meta-analytic estimates. Diagnostic measurements from subgroups were calculated in evaluating primary tumour detection, T stage, lymph node and distant metastases. Articles providing prognostic information on PET were also reported as a systematic review. For pooled meta-analytic calculations, the hierarchical method was used. The bivariate model was conducted to find the summary estimates. Analyses were performed using STATA 16. RESULTS After the screening, 28 studies were eligible to enter the meta-analytic calculations, and data from 15 were reported descriptively. For distinguishing T3/T4 from other T-stages, PET had pooled sensitivity and specificity of 91%(95%CI:72%-97%) and 96%(95%CI:88%-98%), respectively. The sensitivity and specificity for detecting metastatic (regional and/or distant) disease were 100% (95%CI:82%-100%) and 95% (95%CI:90%-98%), respectively. For therapy response assessment, the sensitivity and specificity of PET were 96%(95%CI:78%-99%) and 86%(95%CI:75%-93%), respectively. Higher pre-treatment total metabolic tumour volume was predictive of poorer survival. Conversely, for those achieving complete metabolic response, the 2-year PFS was 94%(95%CI:91%-97%) versus 51%(95%CI:42%-59%) for others (p-value < 0.001). CONCLUSION PET may be a useful tool for anal canal cancer therapy planning and provides valuable prognostic information.
Collapse
Affiliation(s)
- Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Aruz Mesci
- Department of Radiation Oncology, University of Toronto, 149 College Street, Unit 504, Toronto, ON, M5T 1P5, Canada
| | - Vanessa Murad
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Andres Kohan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital; Princess Margaret Cancer Centre, University Medical Imaging Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada.
- Department of Medical Imaging, University of Toronto, 263 McCaul St 4Th Floor, Toronto, ON, M5T 1W7, Canada.
| |
Collapse
|
2
|
Mac Curtain BM, Qian W, Bell J, O'Mahony A, Temperly HC, Ng ZQ. Pre- and post-treatment FDG PET-CT as a predictor of patient outcomes in anal squamous cell carcinoma: A systematic review and meta-analysis. J Med Imaging Radiat Oncol 2023; 67:634-646. [PMID: 37573606 DOI: 10.1111/1754-9485.13566] [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] [Received: 05/23/2023] [Accepted: 07/16/2023] [Indexed: 08/15/2023]
Abstract
Anal squamous cell carcinoma (ASCC) has a generally acceptable outlook in terms of survival. 18-fluorodeoxyglucose-positron emission tomography/computer tomography (FDG PET-CT) is not recommended for routine monitoring post-ASCC treatment. We examine herein if FDG PET-CT has a use in the prognostic evaluation of patients with ASCC, what FDG PET-CT metrics are of value and if a pre- or post-chemo/radiotherapy scan is more prognostic of outcomes. PubMed, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 3 May, 2023. A modified Newcastle Ottawa scale was used to assess for study bias. We present our systematic review alongside pooled hazard ratios (HR) for maximum standardised uptake values (SUV) as a predictor of overall survival (OS) and progression-free survival (PFS). Seven studies including 523 patients were included in our systematic review. Current evidence suggests that SUV maximum and median, metabolic tumour volume, total lesion glycolysis and complete and partial metabolic response may be prognostic when considering overall or progression-free survival (OS)/(PFS) along with local recurrence (LR). Pooled HR from two included studies indicate SUV max is prognostic of OS, HR 1.179, CI (1.039-1.338), P = 0.011 and PFS 1.176, CI (1.076-1.285), P < 0.01. FDG PET-CT may have a role to play in the prognostic evaluation of ASCC patients. Current evidence suggests post-treatment scanning may hold superior prognostic value at this time.
Collapse
Affiliation(s)
- Benjamin M Mac Curtain
- Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Wanyang Qian
- Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Jack Bell
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aaron O'Mahony
- Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Hugo C Temperly
- Department of Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Zi Qin Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Theophanous S, Lønne PI, Choudhury A, Berbee M, Dekker A, Dennis K, Dewdney A, Gambacorta MA, Gilbert A, Guren MG, Holloway L, Jadon R, Kochhar R, Mohamed AA, Muirhead R, Parés O, Raszewski L, Roy R, Scarsbrook A, Sebag-Montefiore D, Spezi E, Spindler KLG, van Triest B, Vassiliou V, Malinen E, Wee L, Appelt AL. Development and validation of prognostic models for anal cancer outcomes using distributed learning: protocol for the international multi-centre atomCAT2 study. Diagn Progn Res 2022; 6:14. [PMID: 35922837 PMCID: PMC9351222 DOI: 10.1186/s41512-022-00128-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcomes conferred by state-of-the-art chemoradiotherapy, further improving disease control and reducing toxicity has proven challenging. Developing and validating prognostic models using routinely collected data may provide new insights for treatment development and selection. However, due to the rarity of the cancer, it can be difficult to obtain sufficient data, especially from single centres, to develop and validate robust models. Moreover, multi-centre model development is hampered by ethical barriers and data protection regulations that often limit accessibility to patient data. Distributed (or federated) learning allows models to be developed using data from multiple centres without any individual-level patient data leaving the originating centre, therefore preserving patient data privacy. This work builds on the proof-of-concept three-centre atomCAT1 study and describes the protocol for the multi-centre atomCAT2 study, which aims to develop and validate robust prognostic models for three clinically important outcomes in anal cancer following chemoradiotherapy. METHODS This is a retrospective multi-centre cohort study, investigating overall survival, locoregional control and freedom from distant metastasis after primary chemoradiotherapy for anal squamous cell carcinoma. Patient data will be extracted and organised at each participating radiotherapy centre (n = 18). Candidate prognostic factors have been identified through literature review and expert opinion. Summary statistics will be calculated and exchanged between centres prior to modelling. The primary analysis will involve developing and validating Cox proportional hazards models across centres for each outcome through distributed learning. Outcomes at specific timepoints of interest and factor effect estimates will be reported, allowing for outcome prediction for future patients. DISCUSSION The atomCAT2 study will analyse one of the largest available cross-institutional cohorts of patients with anal cancer treated with chemoradiotherapy. The analysis aims to provide information on current international clinical practice outcomes and may aid the personalisation and design of future anal cancer clinical trials through contributing to a better understanding of patient risk stratification.
Collapse
Affiliation(s)
- Stelios Theophanous
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - Per-Ivar Lønne
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Ananya Choudhury
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Maaike Berbee
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Andre Dekker
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | | | | | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lois Holloway
- Ingham Research Institute and Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | | | | | | | | | - Rajarshi Roy
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Andrew Scarsbrook
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | - Baukelien van Triest
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands
| | | | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Leonard Wee
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
4
|
Theophanous S, Samuel R, Lilley J, Henry A, Sebag-Montefiore D, Gilbert A, Appelt AL. Prognostic factors for patients with anal cancer treated with conformal radiotherapy-a systematic review. BMC Cancer 2022; 22:607. [PMID: 35659632 PMCID: PMC9164501 DOI: 10.1186/s12885-022-09729-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 02/07/2023] Open
Abstract
AIMS Anal cancer is primarily treated using concurrent chemoradiotherapy (CRT), with conformal techniques such as intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) now being the standard techniques utilised across the world. Despite this, there is still very limited consensus on prognostic factors for outcome following conformal CRT. This systematic review aims to evaluate the existing literature to identify prognostic factors for a variety of oncological outcomes in anal cancer, focusing on patients treated with curative intent using contemporary conformal radiotherapy techniques. MATERIALS AND METHODS A literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results. RESULTS The results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study - pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors. CONCLUSION Establishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.
Collapse
Affiliation(s)
- Stelios Theophanous
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK.
| | - Robert Samuel
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - John Lilley
- Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, Beckett Street, Leeds, LS9 7TF, UK
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - David Sebag-Montefiore
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - Alexandra Gilbert
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - Ane L Appelt
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
- Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, Beckett Street, Leeds, LS9 7TF, UK
| |
Collapse
|
5
|
Braun L, Reinert C, Zips D, Nikolaou K, Pfannenberg C, Gani C. Treatment outcome after radiochemotherapy in anal cancer patients staged with 18F-FDG-PET-CT. Clin Transl Radiat Oncol 2020; 24:83-87. [PMID: 32642564 PMCID: PMC7334798 DOI: 10.1016/j.ctro.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anal cancer (AC) is a malignancy with increasing incidence and commonly treated with radiochemotherapy. Positron-emission tomography-computed tomography (PET/CT) has been shown to improve treatment outcome in various oncological diseases, however, for AC long-term outcome data is sparse. The aim of the present study is therefore to report outcomes in our cohort of PET/CT staged AC patients treated with radiochemotherapy. METHODS Patients with AC who were treated with radiochemotherapy in curative intent were included in this retrospective study if a PET/CT scan was performed pre-therapeutically. Information from PET/CT was considered for nodal and primary target volume definition. Radiotherapy dose to the primary tumor was 50-66 Gy and concomitant chemotherapy included 5-fluorouracil and mitomycin-C. The uptake of 18F-fluorodeoxyglucose (FDG) was quantified using 50%-isocontour volumes of interests (VOIs) and measuring the standardized uptake value (SUV) and the metabolic tumor volume (MTV).18F-FDG uptake was correlated with baseline clinical parameters and long-term oncological outcome. Survival estimates were determined according to Kaplan-Meier. RESULTS A total of 60 patients were included in this study. Estimates for three-year overall survival (OS) and disease free survival (DFS) were 94.5% and 80%. Five patients developed local (n = 2) or locoregional and local (n = 3) failure. Baseline PET/CT related parameters correlated with primary tumor stage, nodal stage and tumor grading. DFS was independent of T-stage, N-stage and baseline 18F-FDG-uptake. CONCLUSION In this cohort of PET/CT staged AC patients, excellent outcomes for DFS were seen. PET-based markers of tumor burden correlate with local stage of AC, however, are not of prognostic relevance for disease-free survival.
Collapse
Affiliation(s)
- L.H. Braun
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Germany
- Klinik für Strahlentherapie und Palliativmedizin, Marienhospital Stuttgart, Germany
| | - C.P. Reinert
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tubingen, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Germany
- German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - K. Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tubingen, Germany
| | - C. Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tubingen, Germany
| | - C. Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Germany
- German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Tübingen, Germany
| |
Collapse
|
6
|
Additional Value of 2-[ 18F]FDG PET/CT Comparing to MRI in Treatment Approach of Anal Cancer Patients. J Clin Med 2020; 9:jcm9092715. [PMID: 32842617 PMCID: PMC7563850 DOI: 10.3390/jcm9092715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Accurate staging and treatment planning are imperative for precise management in Anal Cancer (ACa) patients. We aimed to evaluate the additive and prognostic value of pre-treatment 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) in the staging and management of ACa compared to magnetic resonance imaging (MRI). This retrospective study was conducted on 54 patients. Pre-treatment 2-[18F]FDG PET/CT studies and MRI reports were compared considering the primary tumor, pelvic lymph nodes, and metastatic lesions. The impact of 2-[18F]FDG PET/CT in the management and its prognostic value, using maximum standardized uptake value (SUVmax), were assessed. Discordant findings were found in 46.3% of patients (5 in T; 1 in T and N; 18 in N; and 1 in M stage). 2-[18F]FDG PET/CT resulted in up-staging in 9.26% and down-staging in 3.7% of patients. Perirectal lymph nodes were metabolically inactive in 12.9% of patients. Moreover, 2-[18F]FDG PET/CT resulted in management change in 24.1% of patients. Finally, SUVmax provided no prognostic value. 2-[18F]FDG PET/CT altered staging and management in a sizable number of patients in this study, and supports a need for a change in guidelines for it to be used as a routine complementary test in the initial management of ACa.
Collapse
|
7
|
Abstract
BACKGROUND US health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical, especially in cancers treated with high control rates. To optimize patient care, this study assessed time to disease recurrence or toxicity in patients with anal carcinoma. MATERIALS AND METHODS In total, 140 patients with biopsy-proven, nonmetastatic anal carcinoma, treated with chemoradiation utilizing intensity-modulated radiation therapy, were identified from our institutional database. This retrospective study evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥grade 3 toxicity (LG3T). Patients were followed posttreatment every 3 months for 2 years, every 6 months in years 3 to 5, then yearly thereafter per NCCN recommendations. RESULTS The median age and follow-up was 58 years and 27 months, respectively. Patients were categorized into high (n=61; 44%) and low (n=77; 55%) risk groups based on stage. The 2-year LC, DMFS, and OS were 93%, 94%, and 89% and 5-year LC, DMFS, OS were 92%, 87%, and 85%, respectively. Overall, there were 29 events (9 LR, 11 DM, and 9 LG3T), with 62% of events occurring within year 1 and 79% within 2 years. Stratified by event type, at 2 years 89% of LR, 64% of DM, and 89% LG3T were identified. At the remaining follow-up points, the event incidence rate was 1.3%. CONCLUSION With the majority of recurrences/toxicities occurring within the first 2 years, a reduction in follow-up during years 3 to 5 may provide adequate surveillance. Revisions of the current recommendations could maximize resources while improving patient quality of life.
Collapse
|
8
|
Oyama T, Hosokawa Y, Abe K, Hasegawa K, Fukui R, Aoki M, Kobayashi W. Prognostic value of quantitative FDG-PET in the prediction of survival and local recurrence for patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy. Oncol Lett 2020; 19:3775-3780. [PMID: 32382329 PMCID: PMC7202323 DOI: 10.3892/ol.2020.11488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022] Open
Abstract
The current study aimed to evaluate the relationship between 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET-CT) standardized uptake value (SUV) [pre-treatment SUV (pre-SUV) and post-treatment SUV (post-SUV)] and treatment results in patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy (SSIACRT). A total of 37 patients with advanced oral cancer were treated with SSIACRT. The treatment consisted of superselective intra-arterial chemotherapy (docetaxel (DOC) 40 mg/mm2 and nedaplatin (CDGP) 80 mg/mm2) and concurrent radiotherapy (60-70 Gy) for a period of seven weeks. Pre-SUV and post-SUV of the primary tumor were measured. Overall survival (OS) and local control (LC) rates were selected as endpoints to evaluate prognosis. The median follow-up was 40 months (range 6-112 months). The 5-year OS and LC rates were 64.5 and 85.5%, respectively, and SSIACRT achieved high LC rate even in advanced oral cancers. In the log-rank test, post-SUV was a significant prognostic factor for OS and LC rates. The results of the current study demonstrated that SSIACRT is a reliable treatment with respect to survival in advanced oral cancer and post-SUV was a significant prognostic factor for OS and LC rates.
Collapse
Affiliation(s)
- Tomoyuki Oyama
- Faculty of Graduate School of Biomedical Sciences and Engineering, Hokkaido University, Hokkaido 061-0293, Japan
| | - Yoichiro Hosokawa
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Kazuki Abe
- Faculty of Graduate School of Biomedical Sciences and Engineering, Hokkaido University, Hokkaido 061-0293, Japan
| | - Kazuki Hasegawa
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Roman Fukui
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Masahiko Aoki
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, Aomori 036-8562, Japan
| | - Wataru Kobayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Hirosaki University, Aomori 036-8562, Japan
| |
Collapse
|
9
|
Diagnostic performance and prognostic role of FDG PET/CT performed at staging in anal cancer. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
A prospective, multi-centre trial of multi-parametric MRI as a biomarker in anal carcinoma. Radiother Oncol 2020; 144:7-12. [DOI: 10.1016/j.radonc.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/12/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
|
11
|
Dosimetric comparison of organs at risk using different contouring guidelines for definition of the clinical target volume in anal cancer. Strahlenther Onkol 2020; 196:368-375. [PMID: 32016496 PMCID: PMC7089901 DOI: 10.1007/s00066-020-01587-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/16/2020] [Indexed: 12/21/2022]
Abstract
Background There are different contouring guidelines for definition of the clinical target volume (CTV) for intensity-modulated radiation therapy (IMRT) of anal cancer (AC). We conducted a planning comparison study to evaluate and compare the dose to relevant organs at risk (OARs) while using different CTV definitions. Methods Twelve patients with a primary diagnosis of anal cancer, who were treated with primary chemoradiation (CRT), were selected. We generated four guideline-specific CTVs and subsequently planned target volumes (PTVs) on the planning CT scan of each patient. An IMRT plan for volumetric arc therapy (VMAT) was set up for each PTV. Dose parameters of the planned target volume (PTV) and OARs were evaluated and compared, too. Results The mean volume of the four PTVs ranged from 2138 cc to 2433 cc. The target volumes contoured by the authors based on the recommendations of each group were similar in the pelvis, while they differed significantly in the inguinal region. There were no significant differences between the four target volumes with regard to the dose parameters of the cranially located OARs. Conversely, some dose parameters concerning the genitals and the skin varied significantly among the different guidelines. Conclusion The four contouring guidelines differ significantly concerning the inguinal region. In order to avoid inguinal recurrence and to protect relevant OARs, further investigations are needed to generate uniform standards for definition of the elective clinical target volume in the inguinal region.
Collapse
|
12
|
Leccisotti L, Manfrida S, Barone R, Ripani D, Tagliaferri L, Masiello V, Privitera V, Gambacorta MA, Rufini V, Valentini V, Giordano A. The prognostic role of FDG PET/CT before combined radio-chemotherapy in anal cancer patients. Ann Nucl Med 2019; 34:65-73. [DOI: 10.1007/s12149-019-01416-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/23/2019] [Indexed: 01/20/2023]
|
13
|
Peiffert D. [Anal channel cancer: customization of dose, volume and breaching]. Cancer Radiother 2019; 23:773-777. [PMID: 31471250 DOI: 10.1016/j.canrad.2019.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
The conservative treatment of squamous cell carcinoma of anal canal by irradiation is recommended as first indication. Despite its rarity, significant improvements were obtained by retrospective or prospective clinical studies these 20 past years, evaluating concomitant chemotherapy and IMRT. Nevertheless, the individualisation of the treatment, over dose distribution, has poor data available. Fractionation remains classic (1.8-2.0Gy/Fr), but the optimal dose level remains under discussion. The strategy concerning the volumes and doses for the prophylactic volumes remains under discussion. This paper will describe the data published, and the recommendations of working Groups, and the main options under evaluation. To conclude, today only the absence of gap is recommended, the benefit of a one-step schedule reducing the treatment time, then increasing local control and survival, but personalised schedules remain under investigation.
Collapse
Affiliation(s)
- D Peiffert
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France.
| |
Collapse
|
14
|
Jones MP, Hruby G, Metser U, Sridharan S, Capp A, Kumar M, Gallagher S, Rutherford N, Holder C, Oldmeadow C, Martin J. FDG-PET parameters predict for recurrence in anal cancer - results from a prospective, multicentre clinical trial. Radiat Oncol 2019; 14:140. [PMID: 31387597 PMCID: PMC6685144 DOI: 10.1186/s13014-019-1342-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background To investigate the prognostic significance of positron emission tomography (PET) parameters from F-18 fluorodeoxyglucose (FDG) PET scans performed pre- and post- chemo-radiotherapy (CRT) for squamous cell carcinoma of the anal canal (AC). Methods From January 2013 to January 2017, 19 patients with non-metastatic AC enrolled on a prospective trial underwent FDG-PET/CT imaging before and 12 weeks following CRT. A computer-generated volume of interest (VOI) was snapped around the primary tumour using six different standard uptake value (SUV) thresholds and the following parameters were extracted: SUV max, mean, median, standard deviation and peak as well as metabolic tumour volume (MTV) and total lesion glycolysis. Exact logistic regression and ROC AUC analyses were performed for each metric at each timepoint. Results With a median follow up of 15.8 months, 3/19 patients had a local recurrence and 5/19 had any recurrence. On post-CRT PET, the median SUV within a VOI bounded by an SUV of 3 correlated with local recurrence (p < 0.01) and demonstrated excellent discrimination (ROC AUC 1.00, perfect separation was achieved at a median SUV of 3.38). The mean SUV at this threshold did not quite reach significance for prediction of local recurrence (p = 0.06) but demonstrated excellent discrimination (ROC AUC 0.91). The MTV bounded by a threshold of 41% SUVmax on the pre-CRT PET predicted for any recurrence (p = 0.03) and showed excellent discrimination (ROC AUC 0.89). Conclusions FDG-PET parameters are predictive of recurrence in AC. FDG-PET may represent a valuable tool for prognostication and response assessment in AC. Trial registration ANZCTR, ACTRN12614001219673. Registered 19 November 2014 - Retrospectively registered.
Collapse
Affiliation(s)
- Michael Peter Jones
- WP Holman Clinic, Royal Hobart Hospital, Hobart, Tasmania, Australia. .,The University of Newcastle, Callaghan, New South Wales, Australia.
| | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Anne Capp
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Mahesh Kumar
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Sarah Gallagher
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Natalie Rutherford
- Department of Nuclear Medicine, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Carl Holder
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | | | - Jarad Martin
- The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| |
Collapse
|
15
|
Duimering A, Riauka T, Nijjar Y, Ghosh S, MacEwan R, Warkentin H, Schiller D, Tankel K, Usmani N, Severin D, Nijjar T, Fairchild A, Mulder K, Doll C, Wong C, Joseph K. Prognostic utility of pre- and post-treatment FDG-PET parameters in anal squamous cell carcinoma. Radiother Oncol 2019; 136:21-28. [PMID: 31015125 DOI: 10.1016/j.radonc.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE We prospectively assessed the contributions of PET to initial staging, early detection of treatment failures, and prognostication in patients with anal squamous cell carcinoma (ASCC). MATERIALS AND METHODS Consecutive patients with ASCC referred for radical chemoradiotherapy (CRT) consented to undergo FDG-PET imaging pre-treatment and at 3 and 6 months post-treatment. Clinicopathologic data were collected and CT and PET imaging reviewed for contribution to staging and recurrence detection. Maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were assessed for association with progression-free survival (PFS), cause-specific survival (CSS), and overall survival (OS) using the Kaplan-Meier and Cox regression models. RESULTS Between 2009 and 2016, 73 patients with clinical stages I-IIIB ASCC completed curative-intent CRT. Median follow-up was 48 months. 14 patients died and 18 patients experienced disease progression. 4-year PFS, CSS, and OS were 73%, 87%, and 84%, respectively. A pre-treatment MTV >35 cm3 predicted for worse PFS (p = 0.011) and CSS (p = 0.024) on univariate and multivariate analyses, employing an MTV definition of voxels ≥25% of SUVmax. Higher 6-month post-treatment SUVmax and SUVpeak predicted for worse PFS and OS (p ≤ 0.011). Pre-treatment SUVmax, SUVpeak, and TLG, and 3-month post-treatment SUVmax and SUVpeak did not significantly correlate with survival outcomes. CONCLUSIONS Our findings support that pre-treatment MTV provides meaningful prognostic information, with suggestion that an MTV delineation threshold of voxels ≥25% of SUVmax is appropriate in the anal region. Post treatment, the combination of clinical examination and PET effectively detected all treatment failures. Higher 6-month post-treatment SUVmax and SUVpeak predicted worse PFS and OS; however, the optimal timing of post-treatment PET imaging remains unclear.
Collapse
Affiliation(s)
- Adele Duimering
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Terence Riauka
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Canada
| | - Yugmel Nijjar
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Sunita Ghosh
- Divison of Medical Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Robert MacEwan
- Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Canada
| | - Heather Warkentin
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Canada
| | - Dan Schiller
- Department of Surgical Oncology, University of Alberta, Edmonton, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Diane Severin
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Karen Mulder
- Divison of Medical Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| | - Corinne Doll
- Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Clarence Wong
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, Edmonton, Canada
| |
Collapse
|
16
|
Ladbury C, A Goodman K, Schefter TE, Olsen JR. Anal Cancer in the Era of Dose Painted Intensity Modulated Radiation Therapy: Implications for Regional Nodal Therapy. Semin Radiat Oncol 2019; 29:137-143. [PMID: 30827451 DOI: 10.1016/j.semradonc.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the initial development of 5-fluorouracil and mitomycin as a standard of care platform for definitive anal cancer chemoradiotherapy, multiple studies have evaluated the optimal chemotherapy regimen, and radiotherapy technique. Refinements in treatment technique have taken place during an era of improved diagnostic imaging, including incorporation of FDG-PET, with implications for a possible stage migration effect. This has introduced an opportunity to develop stage-specific recommendations for primary tumor, involved nodal, and elective nodal irradiation dose. Elective nodal irradiation remains standard given the low rates of elective nodal failure with current practice, although may be subject to evolving controversy for patients with early stage disease. In this review, development of the current standard of care for anal cancer chemoradiotherapy is reviewed in the context of modern staging and dose-painted radiotherapy treatment techniques.
Collapse
Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Tracey E Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
| |
Collapse
|
17
|
Sabbagh A, Jacobs C, Cooke R, Chu KY, Ng SM, Strauss VY, Virdee PS, Hawkins MA, Aznar MC, Muirhead R. Is There a Role for an 18F-fluorodeoxyglucose-derived Biological Boost in Squamous Cell Anal Cancer? Clin Oncol (R Coll Radiol) 2019; 31:72-80. [PMID: 30583927 DOI: 10.1016/j.clon.2018.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
AIMS To investigate the potential role for a biological boost in anal cancer by assessing whether subvolumes of high 18F-fluorodeoxyglucose (FDG) avidity, identified at outset, are spatially consistent during a course of chemoradiotherapy (CRT). MATERIALS AND METHODS FDG-positron emission tomography (FDG-PET) scans from 21 patients enrolled into the ART study (NCT02145416) were retrospectively analysed. In total, 29 volumes including both primary tumours and involved nodes >2 cm were identified. FDG-PET scans were carried out before treatment and on day 8 or 9 of CRT. FDG subvolumes were created using a percentage of maximum FDG avidity at thresholds of 34%, 40%, 50%, on the pre-treatment scans, and 70% and 80% on the subsequent scans. Both FDG-PET scans were deformably registered to the planning computed tomography scan. The overlap fraction and the vector distance were calculated to assess spatial consistency. FDG subvolumes for further investigation had an overlap fraction >0.7, as this has been defined in previous publications as a 'good' correlation. RESULTS The median overlap fractions between the diagnostic FDG-PET subvolumes 34%, 40% and 50% of maximum standardised uptake value (SUVmax) and subsequent FDG-PET subvolumes of 70% of SUVmax were 0.97, 0.92 and 0.81. The median overlap fraction between the diagnostic FDG-PET subvolumes 34%, 40% and 50% and subsequent FDG-PET subvolumes of 80% were 1.00, 1.00 and 0.92. The median (range) vector distance values between diagnostic FDG-PET subvolumes 34%, 40% and 50% and subsequent FDG-PET subvolumes of 80% were 0.74 mm (0.19-2.94) 0.74 mm (0.19-3.39) and 0.71 mm (0.2-3.29), respectively. Twenty of 29 volumes (69.0%) achieved a threshold > 0.7 between the FDG 50% subvolume on the diagnostic scan and the FDG 80% subvolume on the subsequent scan. CONCLUSION FDG-avid subvolumes identified at baseline were spatially consistent during a course of CRT treatment. The subvolume of 50% of SUVmax on the pre-treatment scan could be considered as a potential target for dose escalation.
Collapse
Affiliation(s)
- A Sabbagh
- Department of Oncology, Oxford University Hospitals Trust, Oxford, UK
| | - C Jacobs
- Department of Oncology, Oxford University Hospitals Trust, Oxford, UK
| | - R Cooke
- Department of Oncology, Oxford University Hospitals Trust, Oxford, UK; CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - K-Y Chu
- Department of Oncology, Oxford University Hospitals Trust, Oxford, UK; CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S M Ng
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | - V Y Strauss
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - P S Virdee
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M A Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - M C Aznar
- Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Muirhead
- Department of Oncology, Oxford University Hospitals Trust, Oxford, UK.
| |
Collapse
|
18
|
Prognostic Significance of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in Anal Squamous Cell Carcinoma: A Systematic Review and a Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9760492. [PMID: 30627062 PMCID: PMC6305045 DOI: 10.1155/2018/9760492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/04/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022]
Abstract
Purpose Prognostic significance of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in anal squamous cell carcinoma (SCC) has been evaluated in several studies; however, the results seem to be controversial and no consensus exists about its predictive capability. The current meta-analysis was carried out to comprehensively investigate the prognostic significance of 18F-FDG-PET parameters in patients with anal SCC. Methods A comprehensive literature search of PubMed/MEDLINE and Scopus databases was performed to retrieve pertinent articles published until August 5th 2018, concerning the prognostic significance of 18F-FDG-PET in patients with anal SCC. No language restriction was used. Several prognostic factors were reported for progression-free survival (PFS) and overall survival (OS) including pretreatment maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), inguinal nodal uptake, and metabolic response to therapy. Results Eleven studies (741 patients) were included. The pooled hazard ratio (HR) for the probability of PFS was 5.36 (95% confidence interval (95% CI): 3.12–9.21, p < 0.001) for metabolic response to therapy and 1.98 (95% CI: 1.26–3.12, p=0.003) for SUVmax. The pooled HR for the probability of OS was 5.87 (3.02–11.39, p < 0.0001) for metabolic response to therapy. On the other hand, the study revealed that the pooled HRs of MTV and inguinal nodal uptake for PFS were 1.56 (95% CI: 0.96–2.53, p=0.072) and 1.79 (95% CI: 1–3.21, p=0.051), respectively. Conclusions Our findings propose that some 18F-FDG-PET parameters could serve as prognostic indicators in anal SCC, but further larger studies are needed in this setting.
Collapse
|
19
|
Martin D, Balermpas P, Winkelmann R, Rödel F, Rödel C, Fokas E. Anal squamous cell carcinoma - State of the art management and future perspectives. Cancer Treat Rev 2018; 65:11-21. [PMID: 29494827 DOI: 10.1016/j.ctrv.2018.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
Anal squamous cell carcinoma (ASCC) is associated with infection with high-risk strains of human papilloma virus (HPV) in 70-90% of cases and a rise in incidence has been observed in the last decades. Definitive chemoradiotherapy (CRT) using 5-fluorouracil and mitomycin C constitutes the standard treatment for localized disease, but about 30% of patients do not respond or relapse locally. Phase I/II trials testing targeted agents, such as epidermal-growth-factor receptor (EGFR) inhibitors, have failed to improve clinical outcome and resulted in increased toxicities. Modern imaging methods and biomarkers, also in the context of HPV status, should be further explored to improve patient stratification. In the present review, we will discuss the current clinical evidence and future perspectives in the management of ASCC. HPV-positive ASCC is more immunogenic with a higher density of tumor infiltrating lymphocytes that correlate with better response to CRT and more favorable prognosis compared to HPV-negative tumors. Immunotherapies including immune checkpoint inhibitors have brought new hope and promising results were recently demonstrated in metastatic ASCC. The addition of immunotherapies to CRT for localized disease is tested in early phase trials, and these results could have a profound impact on the way we treat ASCC in near future. Further research and novel approaches are expected to enhance our understanding of tumor biology and immunology, and improve patient stratification and treatment adaptation in the context of personalized medicine.
Collapse
Affiliation(s)
- Daniel Martin
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site: Frankfurt a. M., Germany
| | - Ria Winkelmann
- Senckenberg Institute for Pathology, University of Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site: Frankfurt a. M., Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site: Frankfurt a. M., Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site: Frankfurt a. M., Germany.
| |
Collapse
|