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Kang HB, Kim SH, Lee JH, Lee HC, Kang NK, Lee JH. MRI-based volumetric tumor parameters before and during chemoradiation predict tumor recurrence and patient survival in locally advanced cervical cancer: a subgroup analysis of a phase II prospective trial. Int J Clin Oncol 2024; 29:620-628. [PMID: 38530569 DOI: 10.1007/s10147-024-02490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This subgroup analysis of a prospective phase II trial aimed to identify valuable and accessible prognostic factors for overall survival (OS) and progression-free survival (PFS) of patients with locally advanced cervical cancer (LACC). METHODS Patients with FIGO II to IVA cervical cancer were assessed in this study. All patients underwent concurrent chemoradiotherapy (CCRT) followed by brachytherapy. Tumor parameters based on MRI scans before and during CCRT were evaluated for Overall survival (OS) and Progression-free survival (PFS). RESULTS A total of 86 patients were included in this analysis with a median follow-up period of 31.7 months. Three-year OS and PFS rates for all patients were 87.1% and 76.5%, respectively. Univariate Cox regression analysis showed that restaging tumor size (rTS) over 2.55 cm (p < 0.001), initial tumor volume (iTV) over 55.99 cc (p < 0.001), downstaging (p = 0.042), and restaging tumor volume (rTV) over 6.25 cc (p = 0.006) were significantly associated with OS. rTS (p < 0.001), iTV (p < 0.001), downstaging (p = 0.027), and rTV (p < 0.001) were identified as significant prognostic factors for PFS. In the stepwise multivariable analysis, only rTS > 2.55 cm showed statistically significant with OS (HR: 5.47, 95% CI 1.80-9.58, p = 0.035) and PFS (HR: 3.83, 95% CI 1.50-11.45; p = 0.025). CONCLUSIONS Initial tumor size and restaging tumor volume that are easily accessible during radiotherapy provide valuable prognostic information for cervical cancer. MRI-based measurable volumetric scoring system can be readily applied in real-world practice of cervical cancer. CLINICAL TRIAL INFORMATION This study is a subgroup analysis of prospective trial registered at ClinicalTrials.gov Identifier: NCT02993653.
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Affiliation(s)
- Han Byul Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joo Hwan Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Nam Kyu Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Bremm J, Brunner S, Celik E, Damanakis A, Schlösser H, Fuchs HF, Schmidt T, Zander T, Maintz D, Bruns CJ, Quaas A, Pinto Dos Santos D, Schroeder W. Correlation of primary tumor volume and histopathologic response following neoadjuvant treatment of esophageal adenocarcinoma. Eur J Surg Oncol 2024; 50:108003. [PMID: 38401351 DOI: 10.1016/j.ejso.2024.108003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION In esophageal cancer, histopathologic response following neoadjuvant therapy and transthoracic esophagectomy is a strong predictor of long-term survival. At the present, it is not known whether the initial tumor volume quantified by computed tomography (CT) correlates with the degree of pathologic regression. METHODS In a retrospective analysis of a consecutive patient cohort with esophageal adenocarcinoma, tumor volume in CT prior to chemoradiotherapy or chemotherapy alone was quantified using manual segmentation. Primary tumor volume was correlated to the histomorphological regression based on vital residual tumor cells (VRTC) (Cologne regression scale, CRS: grade I, >50% VRTC; grade II, 10-50% VRTC; grade III, <10% VRTC and grade IV, complete response without VRTC). RESULTS A total of 287 patients, 165 with neoadjuvant chemoradiotherapy according to the CROSS protocol and 122 with chemotherapy according to the FLOT regimen, were included. The initial tumor volume for patients following CROSS and FLOT therapy was measured (CROSS: median 24.8 ml, IQR 13.1-41.1 ml, FLOT: 23.4 ml, IQR 10.6-37.3 ml). All patients underwent an Ivor-Lewis esophagectomy. 180 patients (62.7 %) were classified as minor (CRS I/II) and 107 patients (37.3 %) as major or complete responder (CRS III/IV). The median tumor volume was calculated as 24.2 ml (IQR 11.9-40.3 ml). Ordered logistic regression revealed no significant dependence of CRS from tumor volume (OR = 0.99, p-value = 0.99) irrespective of the type of multimodal treatment. CONCLUSION The initial tumor volume on diagnostic CT does not aid to differentiate between potential histopathological responders and non-responders to neoadjuvant therapy in esophageal cancer patients. The results emphasize the need to establish other biological markers of prediction.
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Affiliation(s)
- Johannes Bremm
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Germany
| | - Stefanie Brunner
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Erkan Celik
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Germany
| | - Alexander Damanakis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Hans Schlösser
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Hans F Fuchs
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Thomas Schmidt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Thomas Zander
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Germany
| | - Christiane J Bruns
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany
| | - Alexander Quaas
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pathology, Germany
| | - Daniel Pinto Dos Santos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Germany; University Hospital of Frankfurt, Department of Radiology, Germany
| | - Wolfgang Schroeder
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Germany.
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Kristensen MH, Sørensen MK, Tramm T, Alsner J, Sørensen BS, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen CA, Andersen M, Lilja-Fischer JK, Holm AIS, Samsøe E, Hansen CR, Zukauskaite R, Overgaard J, Eriksen JG. Tumor volume and cancer stem cell expression as prognostic markers for high-dose loco-regional failure in head and neck squamous cell carcinoma - A DAHANCA 19 study. Radiother Oncol 2024; 193:110149. [PMID: 38341096 DOI: 10.1016/j.radonc.2024.110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Reliable and accessible biomarkers for patients with Head and Neck Squamous Cell Carcinoma (HNSCC) are warranted for biologically driven radiotherapy (RT). This study aimed to investigate the prognostic value of putative cancer stem cell (CSC) markers, hypoxia, and tumor volume using loco-regional high-dose failure (HDF) as endpoint. MATERIALS AND METHODS Tumor tissue was retrieved from patients treated with primary chemo-(C-)RT and nimorazole for HNSCC in the Danish Head and Neck Cancer Study Group (DAHANCA) 19 study. Tumor volume, hypoxic classification, and expression of CSC markers CD44, SLC3A2, and MET were analyzed. For patients with eligible data on all parameters (n = 340), the risk of HDF following primary chemo-(C-)RT were analyzed by these biomarkers as a whole and stratified for p16-positive oropharynx (p16 + OPSCC) vs p16-negative (p16-) tumors (oral cavity, p16- oropharynx, hypopharynx and larynx). RESULTS Higher risk of HDF was seen for patients with larger primary and nodal volume (>25 cm3, Hazard Ratio (HR): 3.00 [95 % CI: 1.73-5.18]), high SLC3A2 (HR: 2.99 [1.28-6.99]), CD44 (>30 % positive, HR: 2.29 [1.05-5.00]), and p16- tumors (HR: 2.53 [1.05-6.11]). p16- tumors had a higher CSC marker expression than p16 + OPSCC. The factors associated with the highest risk of HDF were larger volume (HR: 3.29 [1.79-6.04]) for p16- tumors (n = 178) and high SLC3A2 (HR: 6.19 [1.58-24.23]) for p16 + OPSCC (n = 162). CONCLUSION Tumor volume, p16, and CSC markers are potential biomarkers for HDF for patients with HNSCC treated with (C-)RT. Lower expression of CSC in p16 + OPSCC may contribute to better tumor control.
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Affiliation(s)
| | - Mia Kristina Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Kinggaard Lilja-Fischer
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Otolaryngology - Head & Neck Surgery, Aarhus University Hospital, Denmark
| | | | - Eva Samsøe
- Zealand University Hospital, Department of Oncology, Næstved, Denmark
| | - Christian Rønn Hansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Odense University Hospital, Laboratory of Radiation Physics, Odense, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Hu J, Huang Q, Hu W, Liang F, Gao J, Yang J, Qiu X, Zhang H, Zhang G, Lu JJ, Kong L. Tumor volume instead of recurrent T category predicts clinical outcome of patients with locally recurrent nasopharyngeal carcinoma salvaged by carbon ion radiation therapy. Oral Oncol 2024; 151:106683. [PMID: 38387259 DOI: 10.1016/j.oraloncology.2024.106683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Although carbon ion radiation therapy (CIRT) substantially improves the overall survival (OS) of patients with LR-NPC, approximately 40% of the patients may develop local recurrence. The purpose of study is to assess the value of tumor volume (TV) as a predictive tool to guide individualized CIRT. METHODS Consecutive patients with LR-NPC treated using CIRT at Shanghai Proton and Heavy Ion Center between April 2015 and May 2019 were included. TV before CIRT was delineated and calculated. The generalized additive Cox model was used to examine the relationship between TV and OS and local progression-free survival (LPFS). A cutoff value of tumor volume was identified to best discriminate patients with different 2-year OS rates, using receiver operating characteristic (ROC) analysis. RESULTS A total of 157 patients were enrolled. The median tumor volume was 22.49 (2.52-90.13) ml. In the univariable analyses, tumor volume was significantly associated with OS (p < 0.001) and LPFS (p = 0.01). The relationships with OS (p = 0.009) and LPFS (p = 0.020) remained significant in multivariable analyses. Using ROC analysis, a TV of 26.69 ml was identified to predict the 2-year OS rate. To facilitate potential clinical use, 25 ml was designated as the final cutoff value. The 2-year OS and LPFS rates were 88.6 % vs 62.3 %, and 54.7 % vs 35.5 %, for patients with a TV ≤ 25 ml and > 25 ml, respectively. CONCLUSION Tumor volume could predict the OS and LPFS of patients. We propose that tumor volume should be considered in the risk stratification and CIRT-based treatment for patients with LR-NPC.
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Affiliation(s)
- Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Qingting Huang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Gao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Jing Yang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Xianxin Qiu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Haojiong Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Guangyuan Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Jiade Jay Lu
- Department of Radiation Oncology, Proton and Heavy Ion Center, Heyou International Hospital, Foshan 523000, China.
| | - Lin Kong
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology(20dz2261000, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China.
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Rsetam K, Al-Rawi M, Cao Z, Alsadoon A, Wang L. Model based smooth super-twisting control of cancer chemotherapy treatment. Comput Biol Med 2024; 169:107957. [PMID: 38190767 DOI: 10.1016/j.compbiomed.2024.107957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/11/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
Chemotherapy is one of the most efficient methods for treating cancer patients. Chemotherapy aims to eliminate cancer cells as thoroughly as possible. Delivering medications to patients' bodies through various methods, either oral or intravenous is part of the chemotherapy process. Different cell-kill hypotheses take into account the interactions of the expansion of the tumor volume, external drugs, and the rate of their eradication. For the control of drug usage and tumor volume, a model based smooth super-twisting control (MBSSTC) is proposed in this paper. Firstly, three nonlinear cell-kill mathematical models are considered in this work, including the log-kill, Norton-Simon, and Emax hypotheses subject to parametric uncertainties and exogenous perturbations. In accordance with clinical recommendations, the tumor volume follows a predefined trajectory after chemotherapy. Secondly, the MBSSTC is applied for the three cell-kill models to attain accurate trajectory tracking even in the presence of uncertainties and disturbances. Compared to conventional super-twisting control (STC), the non-smooth term is introduced in the proposed control to enhance the anti-disturbance capability. Finally, simulation comparisons are performed across the proposed MBSSTC, conventional STC, and proportional-integral (PI) control methods to show the effectiveness and merits of our designed control method.
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Affiliation(s)
- Kamal Rsetam
- Al Khwarizmi College of Engineering, University of Baghdad, Baghdad, Iraq; School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, 3122, Australia.
| | - Mohammad Al-Rawi
- Faculty of Engineering, Chemical and Materials Engineering, The University of Auckland, Auckland, New Zealand; Centre for Engineering and Industrial Design, Waikato Institute of Technology, Hamilton, New Zealand.
| | - Zhenwei Cao
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, 3122, Australia.
| | - Abeer Alsadoon
- School of Computing Mathematics and Engineering, Charles Sturt University (CSU), Wagga Wagga, Australia; Asia Pacific International College (APIC), Sydney, Australia.
| | - Lulu Wang
- Biomedical Device Innovation Center, Shenzhen Technology University, Shenzhen 518118, China.
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Shenouda M, Gudmundsson E, Li F, Straus CM, Kindler HL, Dudek AZ, Stinchcombe T, Wang X, Starkey A, Armato SG. Convolutional Neural Networks for Segmentation of Malignant Pleural Mesothelioma: Analysis of Probability Map Thresholds (CALGB 30901, Alliance). ArXiv 2023:arXiv:2312.00223v1. [PMID: 38076518 PMCID: PMC10705569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Malignant pleural mesothelioma (MPM) is the most common form of malignant mesothelioma, with exposure to asbestos being the primary cause of the disease. To assess response to treatment, tumor measurements are acquired and evaluated based on a patient's longitudinal computed tomography (CT) scans. Tumor volume, however, is the more accurate metric for assessing tumor burden and response. Automated segmentation methods using deep learning can be employed to acquire volume, which otherwise is a tedious task performed manually. The deep learning-based tumor volume and contours can then be compared with a standard reference to assess the robustness of the automated segmentations. The purpose of this study was to evaluate the impact of probability map threshold on MPM tumor delineations generated using a convolutional neural network (CNN). Eighty-eight CT scans from 21 MPM patients were segmented by a VGG16/U-Net CNN. A radiologist modified the contours generated at a 0.5 probability threshold. Percent difference of tumor volume and overlap using the Dice Similarity Coefficient (DSC) were compared between the standard reference provided by the radiologist and CNN outputs for thresholds ranging from 0.001 to 0.9. CNN annotations consistently yielded smaller tumor volumes than radiologist contours. Reducing the probability threshold from 0.5 to 0.1 decreased the absolute percent volume difference, on average, from 43.96% to 24.18%. Median and mean DSC ranged from 0.58 to 0.60, with a peak at a threshold of 0.5; no distinct threshold was found for percent volume difference. The CNN exhibited deficiencies with specific disease presentations, such as severe pleural effusion or disease in the pleural fissure. No single output threshold in the CNN probability maps was optimal for both tumor volume and DSC. This study emphasized the importance of considering both figures of merit when evaluating deep learning-based tumor segmentations across probability thresholds. This work underscores the need to simultaneously assess tumor volume and spatial overlap when evaluating CNN performance. While automated segmentations may yield comparable tumor volumes to that of the reference standard, the spatial region delineated by the CNN at a specific threshold is equally important.
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Affiliation(s)
- Mena Shenouda
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | | | - Feng Li
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | | | - Hedy L Kindler
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Arkadiusz Z Dudek
- Metro Minnesota Community Oncology Research Consortium, St. Louis Park, MN, USA
| | | | - Xiaofei Wang
- Alliance Statistics and Data Management Center, Duke University, Durham, NC, USA
| | - Adam Starkey
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Samuel G Armato
- Department of Radiology, The University of Chicago, Chicago, IL, USA
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Kim CA, Yoo J, Oh HS, Jeon MJ, Chung SR, Baek JH, Kim WB, Shong YK, Kim WG. Undercover active surveillance of small highly suspicious thyroid nodules without fine needle aspiration. Endocrine 2023:10.1007/s12020-023-03601-6. [PMID: 37995012 DOI: 10.1007/s12020-023-03601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Active surveillance (AS) is an alternative treatment approach for small, low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to assess the clinical outcomes of small, highly suspicious nodules lacking initial cytological confirmation. METHODS This study included 112 patients with highly suspicious nodules measuring ≤ 10 mm who underwent serial ultrasound at Asan Medical Center, Korea, between 2010 and 2023. RESULTS The median participant age was 51.9 years, and 74.1% were female. The median maximal tumor diameter and tumor volume (TV) were 4.5 (interquartile range [IQR] 3.7-5.2, range 2.2-9.3) mm and 25.2 (IQR 13.1-49.2) mm3, respectively. During a median follow-up period of 4.8 years, four (3.6%) patients showed a ≥ 3 mm increase in maximal diameter, and two (1.8%) developed new lymph node (LN) metastasis. Disease progression was associated with a TV doubling time (TVDT) of < 5 years and a ≥ 75% increase in TV (p = 0.017 and p < 0.005, respectively). Furthermore, 34.8% of patients underwent fine needle aspiration (FNA), primarily at their own request, yielding 46.2%, 5.1%, 41.0%, and 12.8 % malignant, benign, indeterminate, and non-diagnostic results, respectively. Of 18 patients with PTMC, 8 (44.4%) underwent surgery and 10 continued AS, with no LN metastasis during AS and no postoperative recurrence. CONCLUSION Small, highly suspicious nodules had a low disease progression rate during AS without FNA. Disease progression was associated with a TVDT of < 5 years and a ≥ 75% increase in TV. FNA can be performed more conservatively than it currently is in patients with highly suspicious nodules measuring ≤ 10 mm.
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Affiliation(s)
- Chae A Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungmin Yoo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kandler C, Elsayad K, Evers G, Siats J, Kittel C, Scobioala S, Bleckmann A, Eich HT. Reduction of tumor volume during radiotherapy in patients with small-cell lung cancer and its prognostic significance. Strahlenther Onkol 2023; 199:1011-1017. [PMID: 37733039 PMCID: PMC10598169 DOI: 10.1007/s00066-023-02146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/13/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Several studies have reported the potential prognostic significance of tumor volume reduction ratio (VRR) induced by radiotherapy (RT) in patients with non-small-cell lung cancer. However, there are no data yet on the prognostic significance of volumetric shrinkage in patients with small-cell lung cancer (SCLC). This study aimed to demonstrate the correlation between tumor volume reduction ratio and treatment outcomes. MATERIALS AND METHODS The study included 61 patients with SCLC treated with fractionated RT of the primary tumor at our institution between 2013 and 2020. The relationship between volumetric changes in gross tumor volume (GTV) during radiotherapy and outcomes were analyzed and reported. RESULTS The median radiation dose was 59.4 Gy (median fraction dose was 1.8 Gy). The median GTV before radiotherapy was 74 cm3, with a median GTV reduction of 48%. There was a higher VRR in patients receiving concurrent radiochemotherapy (p = 0.05). No volumetric parameters were identified as relevant predictors of outcome in the entire cohort. In multivariate analysis, only age had an impact on survival, while prophylactic whole-brain radiation influenced the progression-free survival significantly. CONCLUSION Concurrent chemotherapy was associated with a higher VRR than sequential chemotherapy. No significant impact of VRR on patients' outcome or survival was detected.
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Affiliation(s)
- Christian Kandler
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Georg Evers
- Department of Medicine A (Hematology, Oncology, Hemostaseology and Pulmonology), University Hospital Muenster, Muenster, Germany
| | - Jan Siats
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Sergiu Scobioala
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A (Hematology, Oncology, Hemostaseology and Pulmonology), University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Keven A, Yetim EE, Elmalı A, Arslan AG, Çubuk SM. The role of diffusion magnetic resonance imaging in determining tumor aggressiveness during preoperative surgical planning in early-stage endometrial cancer. Radiologie (Heidelb) 2023; 63:41-48. [PMID: 37014376 DOI: 10.1007/s00117-023-01134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE The present study aimed to evaluate the relationship between tumor volume and apparent diffusion coefficient (ADC) in preoperative magnetic resonance imaging and deep myometrial invasion, tumor grade, and lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer. METHODS The study included 73 patients diagnosed with early-stage endometrial cancer based on histopathological examination between May 2014 and July 2019. Receiver operating characteristic (ROC) curve analysis was used to estimate the accuracy of ADC and tumor volume in predicting the LVSI, the depth of myometrial invasion (DMI), and the histopathological tumor grade in these patients. RESULTS The areas under the ROC curves (AUCs) of ADC and tumor volume in predicting LVI, DMI, and high tumor grade were significantly greater than those for superficial myometrial invasion and low-grade tumors. The ROC analysis revealed that higher tumor volume was significantly associated with the prediction of DMI and tumor grade (p = 0.002 and p = 0.015). The corresponding cut-off values of tumor volume were > 7.12 and > 9.38 mL. The sensitivity of ADC in predicting DMI was higher than its sensitivity in predicting LVSI and grade 1 tumors. Furthermore, tumor volume was significantly associated with the prediction of DMI and tumor grade. CONCLUSION In the absence of pathological pelvic lymph nodes in early-stage endometrial cancer, tumor volume in DWI sequences determines the active tumor load and tumor aggressiveness. Furthermore, a low ADC indicates deep myometrial invasion and helps differentiate stage IA and stage IB tumors.
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Affiliation(s)
- Ayşe Keven
- Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey.
| | - Emel Emir Yetim
- Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey
| | - Aygül Elmalı
- Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey
| | - Ahmet Gökhan Arslan
- Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey
| | - Süleyman Metin Çubuk
- Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey
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Karamani L, McLean AL, Kamp MA, Mayer TE, Müller W, Dinc N, Senft C. Tumor size, treatment patterns, and survival in neuro-oncology patients before and during the COVID-19 pandemic. Neurosurg Rev 2023; 46:226. [PMID: 37670022 PMCID: PMC10480251 DOI: 10.1007/s10143-023-02132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
The COVID-19 pandemic has disrupted healthcare delivery worldwide, leading to significant delays in cancer diagnosis and treatment. This study aimed to investigate the impact of the pandemic on the diagnosis and treatment of malignant brain tumors, specifically glioblastoma (GBM) and cerebral metastasis (CM), in a specialized neuro-oncology center. We analyzed data from 236 patients diagnosed with previously unknown malignant brain tumors between January 2018 and December 2021. Patients were classified into two groups: pre-COVID (January 2018 to December 2019) and COVID (January 2020 to December 2021). Tumor volumes were compared between the two groups and factors affecting tumor volumes were studied. Of 236 patients diagnosed with previously unknown malignant brain tumors, 114 were in the pre-COVID group and 122 were in the COVID group. Median tumor volumes at first diagnosis were significantly larger in the COVID group compared to the pre-COVID group (21.7 vs 15.7 cm3; p < 0.05). The survival times for the overall cohort and the GBM and CM subgroups did not differ significantly between the pre-COVID and COVID periods. Delays in diagnosis and treatment during the COVID-19 pandemic led to larger tumor volumes at diagnosis for patients with malignant brain tumors. However, these larger tumors did not result in worse survival outcomes. This counterintuitive finding highlights the crucial role of specialized neuro-oncological centers in mitigating the potential negative impact of delayed treatment and emphasizes the need for continued access to specialized care during times of crisis.
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Affiliation(s)
- Lydia Karamani
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany.
- Comprehensive Cancer Center Central Germany, Leipzig, Germany.
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Thomas E Mayer
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
- Institute of Diagnostic and Interventional Radiology, Neuroradiology Section, Jena University Hospital, FriedrichSchillerUniversity, Jena, Germany
| | - Wolf Müller
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
- Paul Flechsig Institute of Neuropathology, University Medicine Leipzig, Leipzig, Germany
| | - Nazife Dinc
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
- Center for Neuro-Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
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Nan L, Ruimeng Y, Guangqi C, Yonghui H. Preoperative embolization is necessary for large-volume carotid body tumor (≥ 6670 mm 3) resection. Eur Arch Otorhinolaryngol 2023; 280:4177-4183. [PMID: 37395760 DOI: 10.1007/s00405-023-07990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND To investigate the impact of preoperative embolization (p-TAE) on CBT surgical resection and explore the optimal tumor volume for p-TAE of CBT resection. METHODS This retrospective study reviewed 139 surgically excised CBTs. According to Shamblin classification, tumor volumes, and whether to carry out the p-TAE, the patients were classified into different groups. The demographic, clinical features, and the intraoperative and post-operative information about the patients were retrieved and analyzed from the patient records. RESULTS A total of 139 CBTs was excised in 130 patients. According to the results of subgroup analysis, there were no significant differences in surgical time, blood loss, adverse events (AEs), and the revascularization when compared with non-embolization group (NEG) for type I, II, III, respectively (all p > 0.05) except for the surgical time in type I (p < 0.05). Then the X-tile program was employed and determine the cutoff point (tumor volume = 6670 mm3) for tumor volumes and blood loss. The average tumor volume was (29,782.37 vs. 31,345.10 mm3, p = 0.65) for embolization group (EG) and NEG. The mean surgical time (208.86 vs. 264.67 min, p > 0.05) and intraoperative blood loss (252.78 vs. 430.00 mL, p < 0.05) were less, and the incidence of revascularization required (35.56 vs. 52.38%, p > 0.05) and total complications (27.78 vs. 57.14%, p < 0.05) were lower in EG when compared with NEG (tumor volume ≥ 6670 mm3). However, the results were not statistically significant when the tumor size was less than 6670 mm3. No surgery-related mortality was observed during the follow-up. CONCLUSIONS Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors (≥ 6670 mm3).
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Affiliation(s)
- Li Nan
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
- Department of Interventional Radiology, Guangzhou First People's Hospital, Guangzhou, 510180, China
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Yang Ruimeng
- Department of Interventional Radiology, Guangzhou First People's Hospital, Guangzhou, 510180, China
| | - Chang Guangqi
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Huang Yonghui
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
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Özkul Y, İşlek A, Bayrak AF, Akdağ E, Etit D. Tumor Volume Staging Provides a Comparable Stratifying for Laryngeal Squamous Cell Cancer According to T Stages. Indian J Otolaryngol Head Neck Surg 2023; 75:1344-1351. [PMID: 37636709 PMCID: PMC10447356 DOI: 10.1007/s12070-023-03522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023] Open
Abstract
The prognostic significance of tumor volume (TV) in laryngeal squamous cell cancer (LSCC) has been demonstrated previously. Still, its clinical use is uncertain, and a method for accurate staging for TV is lacking. This study aimed to develop an objective staging and determine the effect of tumor volume on disease outcome after surgical treatment for LSCC. This study was designed retrospectively. Patients with LSCC who underwent laryngectomy were identified. Discretization for optimal scaling level of Tumor Volume (TV) was performed by Catreg Version 3.0. The rate of cancer recurrence, disease-free survival (DFS), and overall survival (OS) rate were calculated and compared between T stage and TV staging. Kaplan-Meier survival analysis was performed for comparison. 206 LSCC patients enrolled in the study. TV was found significantly higher in patients with cartilage invasion, contralateral nodal metastasis, and extranodal extension (p = 0.004, 0.010, and 0.021, respectively). TV and lymph node density LND showed a low significant positive correlation (p = 0.015, r = 0.169). TV was 7.25 + 7.53 ml on average, and TV above the mean value was found to be an independent risk factor for OS and DFS (p = 0.043, HR = 1.8; CI95% for HR: 1.02-3.44 and p < 0.001, HR = 3.7; CI95% for HR: 1.8-7.3, respectively). The optimal scaling level of TV was found in three-level; group 1: TV ≤ 7.07, group 2: 7.07 < TV ≤ 14.09, and group 3: TV ≥ 14.10. This categorization of TV has obtained significant discretization between patients for DFS and OS (Long-Rank = 0.038 and < 0.001). This classification may provide better performance in addition to helping the T stage in determining prognosis, especially in patients with advanced laryngeal SCC.
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Affiliation(s)
- Yılmaz Özkul
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Akif İşlek
- Otolaryngology-Head & Neck Surgery Clinic, Acibadem Eskişehir Hospital, Hoşnudiye Mah, Acıbadem Sk. No: 19, Tepebaşı, Eskişehir, Turkey
| | - Asuman Feda Bayrak
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Ecem Akdağ
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Demet Etit
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
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Kjems J, Elisabet Håkansson K, Andrup Kristensen C, Grau Eriksen J, Horsholt Kristensen M, Ivalu Sander Holm A, Overgaard J, Rønn Hansen C, Zukauskaite R, Johansen J, Richter Vogelius I, Friborg J. The influence of tumor volume on the risk of distant metastases in head and neck squamous cell carcinomas. Radiother Oncol 2023; 186:109771. [PMID: 37385382 DOI: 10.1016/j.radonc.2023.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Distant metastases (DM) in head and neck squamous cell carcinomas (HNSCC) are in most circumstances non-curable. The TNM staging system is insufficient to predict the risk of DM. This study investigates if the DM risk can be predicted using a multivariate model including pre-treatment total tumor volume for both p16-positive oropharyngeal squamous cell carcinoma (OPSCC) and all other sites (other HNSCC). MATERIALS AND METHODS The study includes patients with localized pharyngeal and laryngeal squamous cell carcinomas treated with primary radiotherapy from 2008-2017 from three head and neck cancer centers. Patients were identified in the Danish Head and Neck Cancer (DAHANCA) database. Total (nodal and primary) tumor volume (Gross Tumor Volume, GTV) was extracted from local treatment planning systems. The GTV was grouped by volume (cm3) in four intervals and included in a multivariate Cox proportional hazard regression controlled for pre-selected clinical values incl. stage. RESULTS The study includes 2,865 patients, of which 321 (11 %) had DM post-treatment. The risk of DM was assessed in a multivariate model based on 2,751 patients (p16-positive OPSCC: 1,032; and other HNSCC: 1,719). There was a significant association between GTV and the risk of DM, and in tumor volumes ≥ 50 cm3 hazard ratios of 7.6 (2.5-23.4) for p16-positive OPSCC and 4.1 (2.3-7.2) in other HNSCC were observed. CONCLUSION Tumor volume is an independent risk factor for DM. The addition of total tumor volume to a predictive model is important to identify subgroups of HNSCC patients at high risk of DM.
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Affiliation(s)
- Julie Kjems
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | | | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | | | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | - Christian Rønn Hansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense 5000, Denmark; Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark.
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Ivan Richter Vogelius
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
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Yu X, Hong W, Ye M, Lai M, Shi C, Li L, Ye K, Xu J, Ai R, Shan C, Cai L, Luo L. Atypical primary central nervous system lymphoma and glioblastoma: multiparametric differentiation based on non-enhancing volume, apparent diffusion coefficient, and arterial spin labeling. Eur Radiol 2023; 33:5357-5367. [PMID: 37171492 PMCID: PMC10326108 DOI: 10.1007/s00330-023-09681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/02/2023] [Accepted: 02/24/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To evaluate the multiparametric diagnostic performance with non-enhancing tumor volume, apparent diffusion coefficient (ADC), and arterial spin labeling (ASL) to differentiate between atypical primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM). METHODS One hundred and fifty-eight patients with pathologically confirmed typical PCNSL (n = 59), atypical PCNSL (hemorrhage, necrosis, or heterogeneous contrast enhancement, n = 29), and GBM (n = 70) were selected. Relative minimum ADC (rADCmin), mean (rADCmean), maximum (rADCmax), and rADCmax-min (rADCdif) were obtained by standardization of the contralateral white matter. Maximum cerebral blood flow (CBFmax) was obtained according to the ASL-CBF map. The regions of interests (ROIs) were manually delineated on the inner side of the tumor to further generate a 3D-ROI and obtain the non-enhancing tumor (nET) volume. The area under the curve (AUC) was used to evaluate the diagnostic performance. RESULTS Atypical PCNSLs showed significantly lower rADCmax, rADCmean, and rADCdif than that of GBMs. GBMs showed significantly higher CBFmax and nET volume ratios than that of atypical PCNSLs. Combined three-variable models with rADCmean, CBFmax, and nET volume ratio were superior to one- and two-variable models. The AUC of the three-variable model was 0.96, and the sensitivity and specificity were 90% and 96.55%, respectively. CONCLUSION The combined evaluation of rADCmean, CBFmax, and nET volume allowed for reliable differentiation between atypical PCNSL and GBM. KEY POINTS • Atypical PCNSL is easily misdiagnosed as glioblastoma, which leads to unnecessary surgical resection. • The nET volume, ADC, and ASL-derived parameter (CBF) were lower for atypical PCNSL than that for glioblastoma. • The combination of multiple parameters performed well (AUC = 0.96) in the discrimination between atypical PCNSL and glioblastoma.
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Affiliation(s)
- Xiaojun Yu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China
| | - Weiping Hong
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Minting Ye
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Mingyao Lai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China
| | - Linzhen Li
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China
| | - Kunlin Ye
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China
| | - Jiali Xu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China
| | - Ruyu Ai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Changguo Shan
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China.
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangdong Province, Guangzhou, 510630, China.
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15
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Wiengnon R, Chakkabat C, Tangjaturonrasme N, Rawangban W. Imaging nodal volume and survival in oral tongue cancer with cervical lymph node metastasis. Braz J Otorhinolaryngol 2023; 89:101269. [PMID: 37271115 PMCID: PMC10242625 DOI: 10.1016/j.bjorl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/24/2023] [Accepted: 03/11/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES Oral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication. METHODS Medical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. RESULTS From A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p ≤ 0.001 and p = 0.005, respectively), but not the disease-free survival (p = 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis. CONCLUSIONS In patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Rattawut Wiengnon
- Chulalongkorn University, Faculty of Medicine, Department of Otolaryngology, Bangkok, Thailand
| | - Chakkapong Chakkabat
- Chulalongkorn University, Faculty of Medicine, Department of Radiology, Bangkok, Thailand
| | | | - Worawat Rawangban
- Chulalongkorn University, Faculty of Medicine, Department of Otolaryngology, Bangkok, Thailand.
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Kim M, Seifert R, Fragemann J, Kersting D, Murray J, Jonske F, Pomykala KL, Egger J, Fendler WP, Herrmann K, Kleesiek J. Evaluation of thresholding methods for the quantification of [ 68Ga]Ga-PSMA-11 PET molecular tumor volume and their effect on survival prediction in patients with advanced prostate cancer undergoing [ 177Lu]Lu-PSMA-617 radioligand therapy. Eur J Nucl Med Mol Imaging 2023; 50:2196-2209. [PMID: 36859618 PMCID: PMC10199857 DOI: 10.1007/s00259-023-06163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE The aim of this study was to systematically evaluate the effect of thresholding algorithms used in computer vision for the quantification of prostate-specific membrane antigen positron emission tomography (PET) derived tumor volume (PSMA-TV) in patients with advanced prostate cancer. The results were validated with respect to the prognostication of overall survival in patients with advanced-stage prostate cancer. MATERIALS AND METHODS A total of 78 patients who underwent [177Lu]Lu-PSMA-617 radionuclide therapy from January 2018 to December 2020 were retrospectively included in this study. [68Ga]Ga-PSMA-11 PET images, acquired prior to radionuclide therapy, were used for the analysis of thresholding algorithms. All PET images were first analyzed semi-automatically using a pre-evaluated, proprietary software solution as the baseline method. Subsequently, five histogram-based thresholding methods and two local adaptive thresholding methods that are well established in computer vision were applied to quantify molecular tumor volume. The resulting whole-body molecular tumor volumes were validated with respect to the prognostication of overall patient survival as well as their statistical correlation to the baseline methods and their performance on standardized phantom scans. RESULTS The whole-body PSMA-TVs, quantified using different thresholding methods, demonstrate a high positive correlation with the baseline methods. We observed the highest correlation with generalized histogram thresholding (GHT) (Pearson r (r), p value (p): r = 0.977, p < 0.001) and Sauvola thresholding (r = 0.974, p < 0.001) and the lowest correlation with Multiotsu (r = 0.877, p < 0.001) and Yen thresholding methods (r = 0.878, p < 0.001). The median survival time of all patients was 9.87 months (95% CI [9.3 to 10.13]). Stratification by median whole-body PSMA-TV resulted in a median survival time from 11.8 to 13.5 months for the patient group with lower tumor burden and 6.5 to 6.6 months for the patient group with higher tumor burden. The patient group with lower tumor burden had significantly higher probability of survival (p < 0.00625) in eight out of nine thresholding methods (Fig. 2); those methods were SUVmax50 (p = 0.0038), SUV ≥3 (p = 0.0034), Multiotsu (p = 0.0015), Yen (p = 0.0015), Niblack (p = 0.001), Sauvola (p = 0.0001), Otsu (p = 0.0053), and Li thresholding (p = 0.0053). CONCLUSION Thresholding methods commonly used in computer vision are promising tools for the semiautomatic quantification of whole-body PSMA-TV in [68Ga]Ga-PSMA-11-PET. The proposed algorithm-driven thresholding strategy is less arbitrary and less prone to biases than thresholding with predefined values, potentially improving the application of whole-body PSMA-TV as an imaging biomarker.
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Affiliation(s)
- Moon Kim
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany.
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Jana Fragemann
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jacob Murray
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Frederic Jonske
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), Essen, Germany
| | - Kelsey L Pomykala
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Jan Egger
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), Essen, Germany
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Zhu X, Liu Z, He J, Li Z, He W, Lu J. MRI-derived tumor volume as a predictor of biochemical recurrence and adverse pathology in patients after radical prostatectomy: a propensity score matching study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04825-9. [PMID: 37148292 DOI: 10.1007/s00432-023-04825-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To investigate the predictive value of MRI-derived tumor volume (TV) of biochemical recurrence (BCR) and adverse pathology (AP) in patients following radical prostatectomy (RP). METHODS The data of 565 patients receiving RP in a single institution between 2010 and 2021 were retrospectively analyzed. All suspicious tumor foci were delineated manually using ITK-SNAP software as the regions of interest (ROIs). The sum of the TV of all lesions was calculated automatically based on the voxel in the ROIs to acquire the final TV parameter. TV was categorized as low-volume (≤ 6.5 cm3) and high-volume (> 6.5 cm3) based on the cut-off value. Univariate and multivariate Cox and logistic regression analyses were performed to identify independent predictors of BCR and AP. The Kaplan-Meier with the log-rank test was conducted to compare the BCR-free survival (BFS) between the low and high-volume groups. RESULTS All the included patients were divided into the low-volume group (n = 337) and the high-volume group (n = 228). The TV was an independent predictor of BFS in the multivariate Cox regression analysis (Hazard Ratio (HR) [95% CI]: 1.550 [1.066-2.256], P = 0.022). The Kaplan-Meier analysis demonstrated that low volume was associated with a better BFS than high volume before propensity score matching (PSM) (P < 0.001). One hundred and fifty-eight pairs were obtained by 1:1 PSM to balance the baseline parameters between the two groups. After the PSM, low-volume remained to be associated with a better BFS than high-volume (P = 0.006). TV as a categorical variable was an independent factor of AP in multivariate logistic regression analysis (Odd ratio (OR) [95% CI]: 1.821 [1.064-3.115], P = 0.029). After balancing the potential factors influencing AP by 1:1 PSM, 162 new pairs were identified. The high-volume group had a higher AP rate than the low-volume group after PSM (75.9 vs. 64.8%, P = 0.029). CONCLUSION We adopted a novel approach to acquiring the TV on preoperative MRI. TV was significantly associated with BFS and AP of patients undergoing RP, which was further illustrated by PSM analysis. MRI-derived TV may serve as a predictive marker for assessing BFS and AP in further studies, which will facilitate clinical decision-making and patient counseling.
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Affiliation(s)
- Xuehua Zhu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zenan Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jide He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ziang Li
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Wei He
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China.
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Tofanelli M, Boscolo Nata F, Giudici F, Cadenar A, Gardenal N, Marcuzzo AV, Degrassi F, Boscolo-Rizzo P, Tirelli G. Is there a role for tumor volume in prediction of prognosis for oral cancer? Am J Otolaryngol 2023; 44:103740. [PMID: 36586323 DOI: 10.1016/j.amjoto.2022.103740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/04/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE New prognostic factors in oral squamous cell carcinoma (OSCC) (tumor-, host-, and environment-related) have been introduced recently to complete those traditionally considered. Among them, tumor volume (TV) could be the most interesting and applicable in clinical practice, considering the routine use of computed tomography in tumor staging. In this retrospective study we aimed to investigate whether a correlation exists among these new prognostic factors and survival outcomes. METERIALS AND METHODS We collected data about 140 patients affected by OSCC who underwent primary surgery. Prognostic factors were collected and Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS) were estimated using Kaplan-Meier method; the Log-Rank test (Mantel-Cox) and Cox regression models were applied to investigate predictors of survival. RESULTS The 5-year OS, DSS and DFS were 73.6 %, 89.2 % and 75.2 % respectively. Nodal metastasis (pN+), relapse and American Society of Anesthesiologists ASA-II were found independent prognostic factors for OS, and significantly associated to worst DSS (p < 0.001). TV significantly correlated with higher relapse occurrence (p = 0.03). CONCLUSIONS In our experience, lymph-node status, ASA classification and relapse significantly influenced DSS on univariate analysis. TV could represent an interesting additional parameter, since it significantly influenced DFS. However, prospective studies with standardized TV measurements and a greater number of patients are needed to validate this result.
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Affiliation(s)
- Margherita Tofanelli
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Fabiola Giudici
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Anna Cadenar
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Nicoletta Gardenal
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Alberto Vito Marcuzzo
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Ferruccio Degrassi
- Department of Radiology, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, Trieste, Italy
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Lin MY, Mileshkin L, McNally O, Kondalsamy-Chennakesavan S, Narayan K. Prognostic significance of FIGO 2018 staging of loco-regionally advanced cervical cancer (LRACC) with the use of MRI and PET and implications for treatment selection. Gynecol Oncol 2023; 169:91-7. [PMID: 36521354 DOI: 10.1016/j.ygyno.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The FIGO 2018 staging of cervix cancer recognizes a total of 11 categories of loco-regionally advanced cervix cancer (LRACC). Whilst incorporating imaging is an improvement over clinical staging (FIGO 2009), this had led to more categories of disease which are not prognostically discrete groups. We aimed to analyze survival according to 2018 FIGO stages of cervix cancer and identify isoprognostic groups of patients based on primary tumor volume and nodal status. METHODS Patients referred for radiotherapy with curative intent between 1996 and 2014 were eligible. Baseline clinico-pathological and follow up information was retrieved from an ethics-approved institutional prospective database. Patients were classified according to FIGO 2018 staging based on histo-pathology, MRI (tumor volume and local compartmental spread assessment) and PET results (nodal spread). Kaplan-Meier method was used to estimate survival at five years. Following survival analysis using recognized prognostic factors, isoprognostic categories were identified and merged to form 5 isoprognostic groups. RESULTS Seven hundred and forty-four LRACC patients were included. The median (IQR) follow-up was 5.1 (2.6-8.4) yrs. Stage migration occurred in most patients, showing heterogeneous 5 years survival according to 2018 FIGO stages. In contrast progressively worsening prognosis could be demonstrated in the 5 observed isoprognostic clusters (p < 0.002). CONCLUSION/IMPLICATIONS Prognosis in LRACC depends on the interplay between primary tumor characteristics, type of local spread and nodal disease. A prospective study of survival and patterns of failure according to isoprognostic clusters would be useful to determine the most appropriate treatment modality and estimate survival as well as better patient selection for clinical trials.
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Ramaswamy A, Proudfoot JA, Ross AE, Davicioni E, Schaeffer EM, Hu JC. Prostate Cancer Tumor Volume and Genomic Risk. EUR UROL SUPPL 2023; 48:90-97. [PMID: 36743402 PMCID: PMC9895765 DOI: 10.1016/j.euros.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
Background Despite the historic association of higher prostate cancer volume with worse oncologic outcomes, little is known about the impact of tumor volume on cancer biology. Objective To characterize the relationship between tumor volume (measured by percent positive cores [PPC]) and cancer biology (measured by Decipher genomic risk classifier [GC]) in men who underwent prostate biopsy. Design setting and participants Prostate biopsies from 52 272 men profiled with Decipher captured in a population-based prospective tumor registry were collected from 2016 to 2021. Outcome measurements and statistical analysis The degree of distribution and correlation of PPC with a GC score across grade group (GG) strata were examined using the Mann-Whitney U test, Pearson correlation coefficient, and multivariable linear regression controlled for clinicopathologic characteristics. Results and limitations A total of 38 921 (74%) biopsies passed quality control (14 331 GG1, 16 159 GG2, 5661 GG3, 1775 GG4, and 995 GG5). Median PPC and GC increased with sequentially higher GG. There was an increasingly positive correlation (r) between PPC and GC in GG2-5 prostate cancer (r [95% confidence interval {CI}]: 0.07 [0.5, 0.8] in GG2, 0.15 [0.12, 0.17] in GG3, 0.20 [0.15, 0.24] in GG4, and 0.25 [0.19, 0.31] in GG5), with no correlation in GG1 disease (r = 0.01, 95% CI [-0.001, 0.03]). In multivariable linear regression, GC was significantly associated with higher PPC for GG2-5 (all p < 0.05) but was not significantly associated with PPC for GG1. Limitations include retrospective design and a lack of final pathology from radical prostatectomy specimens. Conclusions Higher tumor volume was associated with worse GC for GG2-5 prostate cancer, whereas tumor volume was not associated with worse GC for GG1 disease. The finding that tumor volume is not associated with worse cancer biology in GG1 disease encourages active surveillance for most patients irrespective of tumor volume. Patient summary We studied the relationship between prostate cancer tumor volume and cancer biology, as measured by the Decipher genomic risk score, in men who underwent prostate biopsy. We found that tumor volume was not associated with worse cancer biology for low-grade prostate cancer. Our findings reassuringly support recent guidelines to recommend active surveillance for grade group 1 prostate cancer in most patients, irrespective of tumor volume.
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Affiliation(s)
- Ashwin Ramaswamy
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | | | - Ashley E. Ross
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Edward M. Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA,Corresponding author. 525 East 68th Street Starr 946, New York, NY 10065, USA. Tel. +1 (646) 962-9600; Fax: +1 (646) 962-0715.
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Karimdjee M, Delaby G, Huglo D, Baillet C, Willaume A, Dujardin S, Bailliez A. Evaluation of a convolution neural network for baseline total tumor metabolic volume on [ 18F]FDG PET in diffuse large B cell lymphoma. Eur Radiol 2023; 33:3386-3395. [PMID: 36600126 DOI: 10.1007/s00330-022-09375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES New PET data-processing tools allow for automatic lesion selection and segmentation by a convolution neural network using artificial intelligence (AI) to obtain total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) routinely at the clinical workstation. Our objective was to evaluate an AI implemented in a new version of commercial software to verify reproducibility of results and time savings in a daily workflow. METHODS Using the software to obtain TMTV and TLG, two nuclear physicians applied five methods to retrospectively analyze data for 51 patients. Methods 1 and 2 were fully automated with exclusion of lesions ≤ 0.5 mL and ≤ 0.1 mL, respectively. Methods 3 and 4 were fully automated with physician review. Method 5 was semi-automated and used as reference. Time and number of clicks to complete the measurement were recorded for each method. Inter-instrument and inter-observer variation was assessed by the intra-class coefficient (ICC) and Bland-Altman plots. RESULTS Between methods 3 and 5, for the main user, the ICC was 0.99 for TMTV and 1.0 for TLG. Between the two users applying method 3, ICC was 0.97 for TMTV and 0.99 for TLG. Mean processing time (± standard deviation) was 20 s ± 9.0 for method 1, 178 s ± 125.7 for method 3, and 326 s ± 188.6 for method 5 (p < 0.05). CONCLUSION AI-enabled lesion detection software offers an automated, fast, reliable, and consistently performing tool for obtaining TMTV and TLG in a daily workflow. KEY POINTS • Our study shows that artificial intelligence lesion detection software is an automated, fast, reliable, and consistently performing tool for obtaining total metabolic tumor volume and total lesion glycolysis in a daily workflow.
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Affiliation(s)
- Mourtaza Karimdjee
- Nuclear Medicine Department, CHU Lille University Hospital, Lille, France.
| | - Gauthier Delaby
- Nuclear Medicine Department, CHU Lille University Hospital, Lille, France
| | - Damien Huglo
- Nuclear Medicine Department, CHU Lille University Hospital, Lille, France
| | - Clio Baillet
- Nuclear Medicine Department, CHU Lille University Hospital, Lille, France
| | - Alexandre Willaume
- Hematology Department, Group of Hospitals of the Catholic Institute of Lille, Lille, France
| | - Simon Dujardin
- Nuclear Medicine Department, CHU Lille University Hospital, Lille, France
| | - Alban Bailliez
- Nuclear Medicine Department, Group of Hospitals of the Catholic Institute of Lille, Lille, France
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Dos Santos Silva J, Schreiner CA, de Lima L, Brigido CEPL, Wilson CD, McVeigh L, Acchiardo J, Landeiro JA, Acioly MA, Cohen-Gadol A. Volumetric measurement of intracranial meningiomas: a comparison between linear, planimetric, and machine learning with multiparametric voxel-based morphometry methods. J Neurooncol 2023; 161:235-43. [PMID: 36058985 DOI: 10.1007/s11060-022-04127-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare the accuracy of three volumetric methods in the radiological assessment of meningiomas: linear (ABC/2), planimetric, and multiparametric machine learning-based semiautomated voxel-based morphometry (VBM), and to investigate the relevance of tumor shape in volumetric error. METHODS Retrospective imaging database analysis at the authors' institutions. We included patients with a confirmed diagnosis of meningioma and preoperative cranial magnetic resonance imaging eligible for volumetric analyses. After tumor segmentation, images underwent automated computation of shape properties such as sphericity, roundness, flatness, and elongation. RESULTS Sixty-nine patients (85 tumors) were included. Tumor volumes were significantly different using linear (13.82 cm3 [range 0.13-163.74 cm3]), planimetric (11.66 cm3 [range 0.17-196.2 cm3]) and VBM methods (10.24 cm3 [range 0.17-190.32 cm3]) (p < 0.001). Median volume and percentage errors between the planimetric and linear methods and the VBM method were 1.08 cm3 and 11.61%, and 0.23 cm3 and 5.5%, respectively. Planimetry and linear methods overestimated the actual volume in 79% and 63% of the patients, respectively. Correlation studies showed excellent reliability and volumetric agreement between manual- and computer-based methods. Larger and flatter tumors had greater accuracy on planimetry, whereas less rounded tumors contributed negatively to the accuracy of the linear method. CONCLUSION Semiautomated VBM volumetry for meningiomas is not influenced by tumor shape properties, whereas planimetry and linear methods tend to overestimate tumor volume. Furthermore, it is necessary to consider tumor roundness prior to linear measurement so as to choose the most appropriate method for each patient on an individual basis.
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Massager N, Renier C. MRI Changes in Failed Radiosurgery for Vestibular Schwannomas. Stereotact Funct Neurosurg 2022; 100:282-290. [PMID: 36366815 DOI: 10.1159/000526967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Radiosurgery is now a recognized treatment of vestibular schwannoma (VS); however, radiosurgical irradiation sometimes fails to stop tumor growth in the long term. Some changes in MR imaging after radiosurgery that are supposed to be related to permanent tumor control may be observed in patients with failed treatment. The objective of the present study was to evaluate the MRI changes observed early after radiosurgery in a cohort of patients with failed radiosurgery for VS. METHODS From a large series of VS treated radiosurgically for 15 years, we reviewed the follow-up MRI data in a subgroup of VS that presented obvious treatment failure. T1-weighted MR imaging with standard timing of gadolinium injection was applied for image acquisition during the radiosurgical procedure and all follow-up MR imaging. Evolution of tumor volume and contrast enhancement were assessed on 3D-co-registered MRI. RESULTS Twenty-nine of 728 patients (4%) were retreated for the same VS after >2 years (median 3.14 years, range 2.04-9.47) following initial radiosurgical treatment. The median tumor volume was 0.94 cc at first radiosurgical treatment and 2.19 cc at retreatment. Fourteen patients (48.3%) had continuous increase in tumor volume. For 10 patients (34.5%), the tumor volume reduced significantly after irradiation before it increased again. Four patients (13.8%) showed a transient increase in tumor volume after irradiation, followed by significant volume reduction, then a very significant tumor regrowth. A significant loss of contrast enhancement at the center of the tumor was observed for 25 patients (86.2%); full recovery of contrast enhancement of the tumor was observed for 23 patients. DISCUSSION/CONCLUSION Tumor volume reduction and central loss of contrast enhancement of the tumor are MRI changes frequently observed during follow-up of VS treated radiosurgically even in patients with failed long-term tumor control and may therefore not be considered as signs of successful response of the tumor to the radiosurgical treatment.
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Affiliation(s)
- Nicolas Massager
- Department of Neurological Surgery, CHU de Charleroi - Site Hôpital Civil Marie Curie, Lodelinsart, Charleroi, Belgium.,Department of Radiation Therapy, CHU de Charleroi - site hôpital Vésale, Montignies-Le-Tilleul, Belgium.,Department of Neurological Surgery, CHU Tivoli ULB, La Louvière, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Cecile Renier
- Department of Radiophysics, CHU UCL Namur - site hôpital Sainte-Elisabeth, Namur, Belgium
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Osipitan OO, Sun M, Gordish-Dressman H, Wendt R, Wight-Carter M, Balkus KJ, Di Pasqua AJ. Laminated holmium-166-containing electrospun bandages for use against skin cancer. Nucl Med Biol 2022; 114-115:78-85. [PMID: 36270073 DOI: 10.1016/j.nucmedbio.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022]
Abstract
The number of non-melanoma skin cancer (NMSC) cases in the US will increase significantly over the next decade due to a rise in UV exposure. One of the treatment methods used to remove NMSC lesions is radiation therapy. The two types of radiation therapy used in the clinic are external beam therapy and brachytherapy. However, both require specialized on-site instrumentation and for patients to remain immobile. In this work, we studied an alternative radiation therapy - one that does not require expensive on-site equipment and would allow for enhanced patient mobility and, thus, comfort. We prepared sealed source, nylon-laminated holmium-166-containing radiotherapeutic bandages and used them in C3H/HeN mice with murine SCCVII tumor grafts. Overall, tumor sizes were smallest when treated with therapeutically relevant radiation doses via radiotherapeutic bandages (compared to controls), and no histological evidence of toxicity to tissues was observed. Thus, our optimized radiotherapeutic bandage offers a flexible approach to treating NMSC.
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Affiliation(s)
- Ositomiwa O Osipitan
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, 96 Corliss Ave., Johnson City, NY 13790, United States of America; Department of Biomedical Engineering, The Thomas J. Watson College of Engineering and Applied Science, Binghamton University, 4400 Vestal Pkwy. E., Binghamton, NY 13902, United States of America
| | - Mengwei Sun
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, 96 Corliss Ave., Johnson City, NY 13790, United States of America; Department of Biomedical Engineering, The Thomas J. Watson College of Engineering and Applied Science, Binghamton University, 4400 Vestal Pkwy. E., Binghamton, NY 13902, United States of America
| | - Heather Gordish-Dressman
- Center for Translational Science, Division of Biostatistics and Study Design, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States of America
| | - Richard Wendt
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Unit 1352, 1515 Holcombe Blvd., Houston, TX 77030, United States of America
| | - Mary Wight-Carter
- Animal Resource Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States of America
| | - Kenneth J Balkus
- Department of Chemistry, University of Texas at Dallas, Richardson, 800 West Campbell Road, Richardson, TX 75080, United States of America.
| | - Anthony J Di Pasqua
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, 96 Corliss Ave., Johnson City, NY 13790, United States of America; Department of Biomedical Engineering, The Thomas J. Watson College of Engineering and Applied Science, Binghamton University, 4400 Vestal Pkwy. E., Binghamton, NY 13902, United States of America.
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Hildingsson S, Gebre-Medhin M, Zschaeck S, Adrian G. Hypoxia in relationship to tumor volume using hypoxia PET-imaging in head & neck cancer - A scoping review. Clin Transl Radiat Oncol 2022; 36:40-46. [PMID: 35769424 PMCID: PMC9234341 DOI: 10.1016/j.ctro.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023] Open
Abstract
Primary tumor volume and hypoxic volume has previously not been convincingly related. 367 patients with head and neck squamous cell carcinoma from 21 different studies using hypoxia-PET The hypoxic volume increased significantly with primary tumor volume. In larger tumor the hypoxic fraction was significantly higher than in smaller tumors.
Background Hypoxia and large tumor volumes are negative prognostic factors for patients with head and neck squamous cell carcinoma (HNSCC) treated with radiation therapy (RT). PET-scanning with specific hypoxia-tracers (hypoxia-PET) can be used to non-invasively assess hypoxic tumor volume. Primary tumor volume is readily available for patients undergoing RT. However, the relationship between hypoxic volume and primary tumor volume is yet an open question. The current study investigates the hypotheses that larger tumors contain both a larger hypoxic volume and a higher hypoxic fraction. Methods PubMed and Embase were systematically searched to identify articles fulfilling the predefined criteria. Individual tumor data (primary tumor volume and hypoxic volume/fraction) was extracted. Relationship between hypoxic volume and primary tumor volume was investigated by linear regression. The correlation between hypoxic fraction and log2(primary tumor volume) was determined for each cohort and in a pooled analysis individual regression slopes and coefficients of determination (R2) were weighted according to cohort size. Results 21 relevant articles were identified and individual data from 367 patients was extracted, out of which 323 patients from 17 studies had quantifiable volumes of interest. A correlation between primary tumor volume and PET-determined hypoxic volume was found (P <.001, R2 = 0.46). Larger tumors had a significantly higher fraction of hypoxia compared with smaller tumors (P<.01). The weighted analysis of all studies revealed that for each doubling of the tumor volume, the hypoxic fraction increased by four percentage points. Conclusion This study shows correlations between primary tumor volume and hypoxic volume as well as primary tumor volume and the hypoxic fraction in patients with HNSCC. The findings suggest that not only do large tumors contain more cancer cells, they also have a higher proportion of potentially radioresistant hypoxic cells. This knowledge can be important when individualizing RT.
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Affiliation(s)
- Sofia Hildingsson
- Division of Oncology and Pathology, Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Gebre-Medhin
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriel Adrian
- Division of Oncology and Pathology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
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Khaksar S, Kiarostami K, Alinaghi S. The Effects of Methanol Extracts of Hyssopus officinalis on Model of Induced Glioblastoma Multiforme (GBM) in Rats. J Mol Neurosci 2022; 72:2045-2066. [PMID: 35963984 DOI: 10.1007/s12031-022-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022]
Abstract
Given the complexity of pathophysiological processes of brain tumors, ineffective therapies, and high mortality rate, new therapeutic options with less toxicity are necessary. Hyssopus officinalis (hyssop) is an aromatic plant with important biological activities. The aim of this study is to assess the anti-cancer effect of hyssop extract on damages of glioblastoma multiforme. In this study, total flavonoids, phenolic content, and quantification of phenolic compound of hyssop extracts were analyzed. In vitro antioxidant properties of hyssop extract were also examined. In addition, cell viability, apoptosis, and cell cycle were evaluated in C6 glioma cell culture. In vivo, the rats were divided randomly into four main groups: intact, control, vehicle, and treatment groups. 1 × 106 C6 rat glioma cells were implanted into the right caudate nucleus of the rat's brain. The treatment group received the methanol extract of hyssop (100 mg/kg) for 7 days. Evolution of locomotor activity, tumor volume, survival rate, activities of antioxidant enzymes (superoxide dismutase (SOD) and catalase (CAT)), vascular endothelial growth factor (VEGF) expression, TUNEL-positive cells, p53 and p21 mRNA expression, and histological alterations were performed. The results showed that the methanol extract of hyssop increased the apoptosis and reduced the cell division of C6 glioma cells in cell culture. Moreover, methanol extract decreased the tumor volume and prolonged survival. Also, the activity of SOD and CAT enzymes was reduced in tumor tissue and enhanced in surrounding tissue. TUNEL-positive cells were increased in methanol extract of hyssop group. The expression of p53 and p21 mRNA was upregulated in the treatment group. Moreover, the histological analysis indicated a considerable decrease in invasion of tumor cells and inflammation in the hyssop-treated rats. According to the achieved results, it can be stated that hyssop has sufficient potential to inhibit damage of brain tumors, at least in part, by affecting the oxidative stress and cell proliferation pathways.
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Affiliation(s)
- Sepideh Khaksar
- Department of Plant Sciences, Faculty of Biological Sciences, Alzahra University, Tehran, Iran.
| | - Khadijeh Kiarostami
- Department of Plant Sciences, Faculty of Biological Sciences, Alzahra University, Tehran, Iran
| | - Shahrzad Alinaghi
- Department of Plant Sciences, Faculty of Biological Sciences, Alzahra University, Tehran, Iran
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Kawashima M, Akabane A, Noda R, Segawa M, Tsunoda S, Inoue T. Interfractional change of tumor volume during fractionated stereotactic radiotherapy using gamma knife for brain metastases. J Neurooncol 2022; 159:409-416. [PMID: 35809149 DOI: 10.1007/s11060-022-04075-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Fractionated stereotactic radiotherapy (FSRT) using gamma knife is useful for brain metastases. However, several uncertainties derived from fractionation pose issues for maintaining high-level accuracy. This study analyzed interfractional tumor change by performing radiological reassessment at the midterm of FSRT with ≥ 10 fractions, and the significance of replanning was evaluated. METHODS Data of FSRT using gamma knife with ≥ 10 fractions were retrospectively collected. Interfractional volume changes in MRI at the midterm of the irradiation period were analyzed. Radiological changes after FSRT and final outcomes were also investigated. RESULTS Overall, 114 lesions in 74 treatments from 66 patients were included, with previously irradiated lesions accounting for 46%. The median interval between planning and the interfractional MRI was 7 days. The interfractional change rates of tumor volume ranged from - 48 to + 72%. Significant interfractional enlargement was observed in 16 lesions (14%); evident regression was confirmed in 17 lesions (15%). Predictive factors for interfractional enlargement were small tumor and cystic lesion; high biologically effective dose was associated with regression. After FSRT, most lesions regressed within 6 months despite interfractional change type. The incidences of tumor control and radiation necrosis indicated no differences between interfractionally-regressed lesions and others. CONCLUSION This is the first study to evaluate interfractional tumor change in FSRT using gamma knife with ≥ 10 fractions, indicating significant volume changes in 29% of the lesions. These preliminary results suggest that interfractional reassessment of a treatment plan in FSRT with irradiation periods exceeding a week is necessary for more adaptive treatment.
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Affiliation(s)
| | - Atsuya Akabane
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ryuichi Noda
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan.,Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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Singh D, Gupta M, Sarwat M, Siddique HR. Apigenin in cancer prevention and therapy: A systematic review and meta-analysis of animal models. Crit Rev Oncol Hematol 2022; 176:103751. [PMID: 35752426 DOI: 10.1016/j.critrevonc.2022.103751] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Apigenin is being increasingly recognized as a cancer chemopreventive agent. We aimed to investigate the anticancer effects of Apigenin in in-vivo studies to know its present research status and how close or how far it is from the clinics. METHODS Several electronic databases such as PubMed, Springer, Cochrane, and ctri.gov.in were searched to fetch the relevant articles. We focused only on published animal studies that reported the anticancer effects of Apigenin against various cancers. Two reviewers independently assessed the risk of bias for each analysis, and the conflicting views were resolved later by consensus. RESULTS A total of 25 studies focused on the anticancer effects of Apigenin on various cancer types, including liver, prostate, pancreatic, lung, nasopharyngeal, skin, colon, colorectal, colitis-associated carcinoma, head and neck squamous cell carcinoma, leukemia, renal cell carcinoma, Ehrlich ascites carcinoma, and breast cancer were included. Overall, Apigenin reduces tumor volume (SMD=-3.597, 95% CI: -4.502 to -2.691, p < 0.001), tumor-weight (SMD=-2.213, 95% CI: -2.897 to -1.529, p < 0.001), tumor number (SMD=-1.081, 95% CI: -1.599 to -0.563, p < 0.001) and tumor load (SMD=-1.556, 95% CI: -2.336 to -0.776, p < 0.001). Further, it has no significant effect on the animal's body-weight (SMD=-0.345, 95% CI: -0.832 to 0.143, p = 0.165). Apigenin exerts anti-tumor effects mainly by inducing apoptosis/cell-cycle arrest. CONCLUSIONS Our analysis suggests that Apigenin has potential anticancer effects against various cancers. However, the poor symmetry of the funnel plot suggested publication bias. Thus, it warrants further research to evaluate the potential of Apigenin alone or as an adjuvant for cancer treatment.
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Sugio T, Baba S, Mori Y, Yoshimoto G, Kamesaki K, Takashima S, Urata S, Shima T, Miyawaki K, Kikushige Y, Kunisaki Y, Numata A, Takenaka K, Iawasaki H, Miyamoto T, Ishigami K, Akashi K, Kato K. Prognostic value of pre-transplantation total metabolic tumor volume on 18fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in relapsed and refractory aggressive lymphoma. Int J Hematol 2022; 116:603-611. [PMID: 35701707 DOI: 10.1007/s12185-022-03394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Relapsed and refractory aggressive lymphoma have a poor prognosis. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is effective in chemosensitive patients. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is among the few options for non-chemosensitive patients. 18Fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (18FDG-PET/CT) is the standard tool for evaluating response to chemotherapy and residual tumor volume. However, accurate assessment of residual tumor volume is not currently being achieved in clinical practice, and its value in prognostic and therapeutic stratification remains unclear. To answer this question, we investigated the efficacy of quantitative indicators, including total metabolic tumor volume (TMTV), in predicting prognosis after auto-HSCT and allo-HSCT. We retrospectively analyzed 39 patients who received auto-HSCT and 28 who received allo-HSCT. In the auto-HSCT group, patients with a higher TMTV had a poor prognosis due to greater risk of relapse. In the allo-HSCT group, patients with a higher TMTV had a lower progression-free survival rate and a significantly higher relapse rate. Neither Deauville score nor other clinical parameters were associated with prognosis in either group. Therefore, pre-transplant TMTV on PET is effective for prognostic prediction and therapeutic decision-making for relapsed or refractory aggressive lymphoma.
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Affiliation(s)
- Takeshi Sugio
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuo Mori
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goichi Yoshimoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenjiro Kamesaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shuichiro Takashima
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shingo Urata
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takahiro Shima
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kohta Miyawaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshikane Kikushige
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuya Kunisaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akihiko Numata
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Katsuto Takenaka
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiromi Iawasaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | | | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Li F, Chen JH, Liu Y, Guan GX, Lu CH. Stage cT3 low rectal cancer: analysis of prognostic factors. J Gastrointest Oncol 2022; 13:672-682. [PMID: 35557560 DOI: 10.21037/jgo-22-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Whether all cT3 low rectal cancer patients should receive neoadjuvant chemoradiotherapy (nCRT) remains controversial. The depth of invasion beyond the muscularis propria of the cT3 rectal cancer is of great significance to the selection of a treatment plan and the evaluation of prognosis. Methods A retrospective analysis was conducted of 187 patients with stage cT3 low rectal cancer, who had been treated at the Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University from June 2010 to December 2012. The patients were divided into the nCRT group (88 cases) and no-nCRT group (99 cases). Possible significant prognostic factors [i.e., primary tumor volume (PTV), cell differentiation, circumferential resection margin (CRM), nCRT, age, sex, carcinoembryonic antigen (CEA), lymph node status, surgical procedure, etc.] were collected for estimation of disease-free survival (DFS), distant metastases rate (DM), local recurrence rate (LR). Independent predictive factors or survival were determined using Cox proportional hazards model. Results The mean PTV was 16.2±11.1 (2.07-72.68) cm3. In the univariate and multivariate analyses: nCRT hazards ratio (HR) =4.258, 95% confidence interval (CI): 1.912-9.483 (P<0.001); PTV HR =0.381, 95% CI: 0.181-0.804 (P=0.011); CRM HR =0.227, 95% CI: 0.097-0.532 (P=0.001). For the PTV ≤15 cm3 group, there were no significant differences between the nCRT and no-nCRT group in 3-year follow-up (P>0.05). For the PTV >15 cm3 group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (84.2% vs. 51.1%; P=0.001), DM (13.1% vs. 31.2%; P=0.017) and LR (2.9% vs. 26.6%; P=0.009). For the CRM negative group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (94.0% vs. 79.0%; P=0.008), LR (1.5% vs. 10.7%; P=0.028) and DM (4.5% vs. 13.5%; P=0.039). Conclusions For stage cT3 low rectal cancer patients, nCRT, PTV, and CRM were independent prognostic factors. NCRT may improve the survival of PTV >15 cm3 patients, but may not have a significant effect on patient with PTV ≤15 cm3 and CRM negative. Direct surgery is recommended for this group of patients.
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Affiliation(s)
- Fan Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jin-Hai Chen
- Department of Endoscopy Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Guo-Xian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chuan-Hui Lu
- Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
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Kirchweger P, Kupferthaler A, Burghofer J, Webersinke G, Jukic E, Schwendinger S, Weitzendorfer M, Petzer A, Függer R, Rumpold H, Wundsam H. Circulating tumor DNA correlates with tumor burden and predicts outcome in pancreatic cancer irrespective of tumor stage. Eur J Surg Oncol 2022; 48:1046-1053. [PMID: 34876329 DOI: 10.1016/j.ejso.2021.11.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Circulating tumor DNA (ctDNA) represents a promising tool for diagnosis, prognosis and treatment monitoring of several malignancies. Its association with tumor burden in pancreatic ductal cancer (PDAC), especially in localized disease, is not fully explored yet. We aimed to investigate the association of pretherapeutic ctDNA levels in localized and metastatic PDAC with tumor volume and clinical outcomes. MATERIAL AND METHODS Liquid biopsy for ctDNA detection was prospectively obtained from patients with localized or disseminated PDAC prior to either resection or systemic treatment. Detection rates and levels of ctDNA (digital droplet PCR) were correlated to tumor volume, relapse rate and survival. RESULTS 60 patients with localized and 47 patients with metastatic PDAC were included. ctDNA was detected in 10% of localized and 57.4% of metastasized PDAC samples. In localized disease, ctDNA detection significantly correlated with the numbers of involved locoregional lymph nodes (p = 0.030). Primary tumor volume did not correlate with ctDNA levels in neither localized (p = 0.573) nor metastasized disease (p = 0.878). In disseminated disease, ctDNA levels correlated with total tumor volume (p = 0.026) and especially with liver metastases volume (p = 0.004), but not with other metastases. Detection of pretherapeutic ctDNA was associated with shorter DFS in localized (3.3 vs. 18.1 months, p = 0.000), whereas ctDNA levels were associated with worse survival in metastatic PDAC (5.7 vs. 7.8 months, p = 0.036). CONCLUSION ctDNA positivity indicates major nodal involvement or even presence of undetected distant metastases associated with early recurrence in localized PDAC. Moreover, it predicts worse clinical outcome in both localized and metastatic disease.
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Affiliation(s)
- Patrick Kirchweger
- Gastrointestinal Cancer Center, Linz, Austria; Department of Surgery, Ordensklinikum Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | | | - Jonathan Burghofer
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Austria
| | - Emina Jukic
- Institute of Human Genetics, Medical University of Innsbruck, Austria
| | | | | | - Andreas Petzer
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria; Department of Internal Medicine I for Hematology with Stem Cell Transplantaation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Austria
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Holger Rumpold
- Gastrointestinal Cancer Center, Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria
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Chen W, Xiu S, Xie X, Guo H, Xu Y, Bai P, Xia X. Prognostic value of tumor measurement parameters and SCC-Ag changes in patients with locally-advanced cervical cancer. Radiat Oncol 2022; 17:6. [PMID: 35012582 PMCID: PMC8751300 DOI: 10.1186/s13014-021-01978-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the prognostic relevance of specific measurement parameters such as tumor diameter, tumor volume, tumor volume reduction rate (TVRR), and changes in the squamous cell carcinoma antigen (SCC-Ag) level in patients with locally-advanced cervical cancer (LACC) undergoing concurrent radiotherapy and chemotherapy. METHODS This was a retrospective study of 203 patients with stage IIA-IVA cervical squamous cell carcinoma who were newly diagnosed at our hospital between January 2011 and March 2015. Clinical data and pre-and post-treatment imaging information were collected and each parameter was calculated using 3DSlicer software. The pre/post-treatment tumor diameter (TDpre/post), tumor volume (TVpre/post), SCC-Ag (SCCpre/post), and TVRR, SCC-Ag reduction rate (SCCRR) were analyzed and their prognostic relevance evaluated. RESULTS The median follow-up was 69 months. The 5-year overall survival (OS) and disease progression-free survival (PFS) rates were 69.5% and 64.5%, respectively. On univariate analysis, TDpre/post, TVpre/post, TVRR, SCCpre/post and SCCRR showed significant association with OS and PFS (P < 0.05). On multivariate analysis, TDpre [Hazard ratio (HR) = 0.373, P = 0.028], TDpost (HR = 0.376, P = 0.003) and SCCpost (HR = 0.374, P = 0.001) were independent predictors of OS. TVRR (HR = 2.998, P < 0.001), SCCpre (HR = 0.563, P = 0.041), and SCCpost (HR = 0.253, P < 0.001) were independent predictors of PFS. Tumor measurement parameters showed a positive correlation with SCC-Ag (P < 0.05). CONCLUSION TDpre/post, TVpre/post, TVRR, SCCpre/post, and SCCRR were prognostic factors in LACC. TDpre/post and SCCpost showed the most significant prognostic value. TVRR and SCCpre/post were closely related to disease progression. Further studies should investigate the correlation between measurement parameters of tumor and SCC-Ag.
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Affiliation(s)
- Wenjuan Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China.
| | - Siyi Xiu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
| | - Xingyun Xie
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
| | - Huiming Guo
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
| | - Penggang Bai
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
| | - Xiaoyi Xia
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350000, Fujian, China
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Armato SG, Nowak AK, Francis RJ, Katz SI, Kholmatov M, Blyth KG, Gudmundsson E, Kidd AC, Gill RR. Imaging in pleural mesothelioma: A review of the 15th International Conference of the International Mesothelioma Interest Group. Lung Cancer 2021; 164:76-83. [PMID: 35042132 DOI: 10.1016/j.lungcan.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
Imaging of mesothelioma plays a role in all aspects of patient management, including disease detection, staging, evaluation of treatment options, response assessment, pre-surgical evaluation, and surveillance. Imaging in this disease impacts a wide range of disciplines throughout the healthcare enterprise. Researchers and clinician-scientists are developing state-of-the-art techniques to extract more of the information contained within these medical images and to utilize it for more sophisticated tasks; moreover, image-acquisition technology is advancing the inherent capabilities of these images. This paper summarizes the imaging-based topics presented orally at the 2021 International Conference of the International Mesothelioma Interest Group (iMig), which was held virtually from May 7-9, 2021. These topics include an update on the mesothelioma staging system, novel molecular targets to guide therapy in mesothelioma, special considerations and potential pitfalls in imaging mesothelioma in the immunotherapy setting, tumor measurement strategies and their correlation with patient survival, tumor volume measurement in MRI and CT, CT-based texture analysis for differentiation of histologic subtype, diffusion-weighted MRI for the assessment of biphasic mesothelioma, and the prognostic significance of skeletal muscle loss with chemotherapy.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, The University of Chicago, Chicago, IL, USA.
| | - Anna K Nowak
- Medical School and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Medical School and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia, Australia; Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Manizha Kholmatov
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, UK; Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Andrew C Kidd
- Institute of Cancer Sciences, University of Glasgow, UK; Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ritu R Gill
- Department of Radiology, Beth Israel Lahey Health, Harvard Medical School, Boston, MA, USA
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Schakenraad A, Hashemi S, Twisk J, Houda I, Ulas E, Daniels JMA, Veltman J, Bahce I. The effect of tumor size and metastatic extent on the efficacy of first line pembrolizumab monotherapy in patients with high PD-L1 expressing advanced NSCLC tumors. Lung Cancer 2021; 162:36-41. [PMID: 34666276 DOI: 10.1016/j.lungcan.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumor size and metastatic extent may influence tumor response to immunotherapy in non-small cell lung cancer (NSCLC). The aim of this study was to examine the relationship between both baseline sum of longest diameters (bSLD) and number of metastatic organs (NMO) and the tumor response to pembrolizumab. Secondly, we aimed to analyze the association of baseline SLD and NMO with progression-free survival (PFS) and overall survival (OS). METHODS This retrospective study included patients with high PD-L1 expressing tumors (≥50%) and a good performance score (ECOG ≤ 2) that received first-line pembrolizumab monotherapy. Tumor response was calculated as the 'SLD-change score' and 'early treatment discontinuation' within 3 months on therapy (ETD). The relationship of both bSLD (based on RECIST v1.1) and NMO with tumor response and survival outcome (PFS, OS) was evaluated. RESULTS No significant differences in SLD-change score could be found using bSLD (OR = 1.010, 95%CI = 0.999-1.021), or using NMO at baseline (OR = 1.608, 95%CI = 0.943-2.743). A bSLD cut-off value of 90 mm was found to be most distinctive for ETD. This cut-off value showed a significant difference for PFS (HR = 2.28, 95%CI = 1.12-4.64, p = 0.023) and OS (HR = 2.99, 95%CI = 1.41-6.34, p = 0.004). NMO also showed a difference for PFS and OS, however, not statistically significant. CONCLUSIONS Tumor size and metastatic extent could not discriminate for tumor response, however, a bSLD of 90 mm could differentiate for PFS and OS.
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Affiliation(s)
- Alexandra Schakenraad
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sayed Hashemi
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Jos Twisk
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ilias Houda
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ezgi Ulas
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Joris Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - I Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Oymak E, Guler OC, Onal C. Significance of liver metastasis volume in breast cancer patients treated with stereotactic body radiotherapy. Strahlenther Onkol 2021. [PMID: 34477885 DOI: 10.1007/s00066-021-01845-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study analyzed the impact of liver metastasis (LM) volume on treatment outcomes in breast cancer (BC) patients treated with stereotactic body radiotherapy (SBRT). METHODS This single-institution retrospective analysis included 40 oligometastatic (≤ 5 metastases) BC patients with 58 liver metastases treated with SBRT between April 2013 and March 2021. The prognostic factors for local control (LC), overall survival (OS), and progression-free survival (PFS) rates were assessed. RESULTS Median follow-up time was 28.1 months. Isolated and solitary LM were seen in 26 (65%) and 24 (60%) patients, respectively. Median time to disease recurrence was 10.7 months post liver SBRT. The 2‑year OS, PFS, and LC rates were 71.4%, 27.5%, and 86.8%, respectively. In univariate analysis, patients with a gross tumor volume (GTV) of ≤ 6 cc and a planning target volume (PTV) of ≤ 38 cc demonstrated a significantly better median OS than those with GTV > 6 cc and PTV > 38 cc. In multivariate analysis, the predictive factors for worse OS were GTV > 6 cc (HR = 3.07 [95% CI, 1.14-8.22; p = 0.03]) and PTV > 38 cc (HR = 5.91 [95% CI, 1.92-18.21; p = 0.002]). No significant factor for PFS was found. Only 2 patients experienced rib fracture at 4 and 6 months post treatment, and 1 patient had a grade II duodenal ulcer. CONCLUSION Liver SBRT is an effective and safe treatment option for oligometastatic BC patients with excellent LC, promising survival, and limited toxicity. Patients with smaller tumors displayed better OS than their counterparts, validating the effectiveness of a local treatment for this group.
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Cander S, Oz Gul O, Eylemer E, Gullulu Boz E, Gunes E, Hakyemez B, Yilmazlar S, Ersoy C. Comparison of the effects of medical and surgical treatments in giant prolactinoma: a single-center experience. Hormones (Athens) 2021; 20:491-498. [PMID: 34236607 DOI: 10.1007/s42000-021-00307-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas. METHODS Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function. RESULTS The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 ± 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12). CONCLUSION In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.
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Affiliation(s)
- Soner Cander
- Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey.
| | - Ozen Oz Gul
- Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey
| | - Eda Eylemer
- Internal Medicine, Bursa Uludag University Medical School, Bursa, Turkey
| | - Elif Gullulu Boz
- Internal Medicine, Bursa Uludag University Medical School, Bursa, Turkey
| | - Elif Gunes
- Endocrinology and Metabolism, Bursa City Hospital, Bursa, Turkey
| | | | | | - Canan Ersoy
- Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey
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Taugner J, Käsmann L, Karin M, Eze C, Flörsch B, Guggenberger J, Li M, Tufman A, Reinmuth N, Duell T, Belka C, Manapov F. Planning target volume as a predictor of disease progression in inoperable stage III non-small cell lung cancer patients treated with chemoradiotherapy and concurrent and/or sequential immune checkpoint inhibition. Invest New Drugs 2021; 40:163-171. [PMID: 34351518 PMCID: PMC8763767 DOI: 10.1007/s10637-021-01143-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022]
Abstract
Background. The present study evaluates outcome after chemoradiotherapy (CRT) with concurrent and/or sequential Programmed Cell Death 1 (PD-1) or Ligand 1 (PD-L1) immune checkpoint inhibition (CPI) for inoperable stage III NSCLC patients depending on planning target volume (PTV). Method and patients. Prospective data of thirty-three consecutive patients with inoperable stage III NSCLC treated with CRT and sequential durvalumab (67%, 22 patients) or concurrent and sequential nivolumab (33%, 11 patients) were analyzed. Different PTV cut offs and PTV as a continuous variable were evaluated for their association with progression-free (PFS), local–regional progression-free (LRPFS), extracranial distant metastasis-free (eMFS) and brain-metastasis free-survival (BMFS). Results. All patients were treated with conventionally fractionated thoracic radiotherapy (TRT); 93% to a total dose of at least 60 Gy, 97% of patients received two cycles of concurrent platinum-based chemotherapy. Median follow-up for the entire cohort was 19.9 (range: 6.0–42.4) months; median overall survival (OS), LRFS, BMFS and eMFS were not reached. Median PFS was 22.8 (95% CI: 10.7–34.8) months. Patients with PTV ≥ 900ccm had a significantly shorter PFS (6.9 vs 22.8 months, p = 0.020) and eMFS (8.1 months vs. not reached, p = 0.003). Furthermore, patients with PTV ≥ 900ccm and stage IIIC disease (UICC-TNM Classification 8th Edition) achieved a very poor outcome with a median PFS and eMFS of 3.6 vs 22.8 months (p < 0.001) and 3.6 months vs. not reached (p = 0.001), respectively. PTV as a continuous variable also had a significant impact on eMFS (p = 0.048). However, no significant association of different PTV cut-offs or PTV as a continuous variable with LRPFS and BMFS could be shown. The multivariate analysis that was performed for PTV ≥ 900ccm and age (≥ 65 years), gender (male), histology (non-ACC) as well as T- and N-stage (T4, N3) as covariates also revealed PTV ≥ 900ccm as the only factor that had a significant correlation with PFS (HR: 5.383 (95% CI:1.263–22.942, p = 0.023)). Conclusion. In this prospective analysis of inoperable stage III NSCLC patients treated with definitive CRT combined with concurrent and/or sequential CPI, significantly shorter PFS and eMFS were observed in patients with initial PTV ≥ 900ccm.
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Affiliation(s)
- Julian Taugner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany. .,Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Monika Karin
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Flörsch
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Guggenberger
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Amanda Tufman
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.,Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, LMU Munich, Munich, Germany
| | - Niels Reinmuth
- Asklepios Kliniken GmbH, Asklepios Fachkliniken Muenchen, Gauting, Germany
| | - Thomas Duell
- Asklepios Kliniken GmbH, Asklepios Fachkliniken Muenchen, Gauting, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Muratori F, Foschi L, Roselli G, Frenos F, Tamburini A, Palomba A, Greto D, Loi M, Beltrami G, Capanna R, Mondanelli N, Campanacci DA. Ewing family tumors of the appendicular skeleton: a retrospective analysis of prognostic factors. Eur J Orthop Surg Traumatol 2021; 31:1557-1565. [PMID: 34324030 DOI: 10.1007/s00590-021-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Authors retrospectively analyzed possible prognostic factors in a series of patients affected by Ewing sarcoma of extremities (eEWS) and treated over a 20-year period at a single institution. METHODS Between 1997 and 2017, 88 bone eEWS were treated at our institution. Staging, age, gender, tumoral volume, local treatment, surgical margins, post-ChT necrosis were investigated for prognostic correlation with overall survival (OS) and event-free survival (EFS). Median follow-up was 74 months (1-236). RESULTS Staging of disease correlated with OS (81% vs 59%, p = 0.01) and not with EFS (68% vs 57%, p = 0.28) in localized vs metastatic eEWS at presentation. Age ≥ 14 years (p = 0.002) and volume ≥ 100 cm3 (p = 0.04) were significant negative prognostic factors. No difference was found in local treatment: OS was 76% vs 63% (p = 0.33), while EFS was 68% vs 49% (p = 0.06) after surgery alone or surgery + radiotherapy, respectively. Regarding surgical margins, OS was 76% vs 38% (p = 0.14), and EFS was 65% vs 33% (p = 0.14) in adequate vs not adequate, respectively. OS was 86% and 68% in good and poor responders, respectively (p = 0.13). CONCLUSION In eEWS, metastatic disease at presentation, age > 14 years and tumoral volume > 100 cm3 are negative prognostic factors. Intensified adjuvant ChT can improve prognosis in poor responders and metastatic patients.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy.
| | - Lorenzo Foschi
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Giuliana Roselli
- Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Angela Tamburini
- Department of Paediatric Oncoematology, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Daniela Greto
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Mauro Loi
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Nicola Mondanelli
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
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Wetterauer C, Federer-Gsponer JR, Leboutte FDJP, Mona R, Ebbing J, Rentsch CA, Manka L, Seifert HH, Wyler S, Recker F, Kwiatkowski M. Indication for Active Surveillance in the Era of MRI-Targeted Prostate Biopsies. Urol Int 2021; 106:83-89. [PMID: 34350895 DOI: 10.1159/000517300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Active surveillance (AS) strategies were established to avoid overtreatment of low-risk prostate cancer (PCa) patients. Low tumor volume represents one indication criteria; however, applying this criterion after MRI-targeted prostate biopsies may lead to overestimation of tumor volume; wherefore, patients suitable for AS would be exposed to the risk of overtreatment. METHODS This retrospective analysis included 318 patients in which PCa was detected by MRI-TRUS fusion prostate biopsy. Classic and extended indication for AS included Gleason 6 and Gleason 3 + 4 cancer, respectively. We assessed the effect of targeted biopsies and temporary rating strategies on eligibility for AS and developed new "composite" algorithms to more accurately assess eligibility for AS. RESULTS Forty-four (13.8%) and 60 (18.9%) of the 318 patients qualified for AS according to "classic" and "extended" criteria, respectively. Application of the "composite 1" definition led to AS eligibility of 52 of 248 patients (20.97%) in the classic and of 77 of 248 patients (31.05%) in the "extended" group. CONCLUSIONS We could demonstrate that classic algorithms led to ineligibility of patients for AS. We propose a new rating algorithm to improve tumor assessment for a more accurate indication for AS.
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Affiliation(s)
| | | | | | - Robin Mona
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Cyrill A Rentsch
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Hans H Seifert
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Stephen Wyler
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Franz Recker
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Maciej Kwiatkowski
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.,Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
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Xiao D, Shi J, Zhou M, Yan L, Zhao Z, Hu T, Guo X, Zhao H, Yan P, Jiang X. Tumor volume and the dural tail sign enable the differentiation of intracranial solitary fibrous tumor/hemangiopericytoma from high-grade meningioma. Clin Neurol Neurosurg 2021; 207:106769. [PMID: 34171585 DOI: 10.1016/j.clineuro.2021.106769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal neoplasm with imaging features mimicking high-grade meningioma (HGM) and can easily be misdiagnosed. We sought to determine the value of routine preoperative data in differentiating these tumors. PATIENTS AND METHODS Patients with confirmed SFT/HPC or HGM between January 2012 and June 2020 were identified. A total of 28 preoperative variables (including age, sex, tumor location, tumor volume, 10 traditional MRI features, and 14 peripheral blood indices) were collected for each patient. The top features were selected sequentially based on the least absolute shrinkage and selection operator (LASSO) and support vector machines-recursive feature elimination (SVM-RFE) methods. Differentiation and calibration of the classifiers were assessed by receiver operating characteristic (ROC) curves and calibration curves, respectively. Nomograms were constructed based on multivariate analysis. RESULTS A total of 127 patients, including 29 with SFT/HPC and 98 with HGM, were analyzed. Three features were first selected using the LASSO and SVM-RFE methods, and corresponding models were developed. Although the area under the curve (AUC) of model 1 was the highest, a comprehensive analysis suggested the superiority of model 2, which consisted only of the features tumor volume (TV) and dural tail sign (DTS) (AUC: 0.942, sensitivity: 93.10%, p-value of H-L test: 0.734, Brier score: 0.07). A risk score formula and a nomogram were constructed. CONCLUSIONS TV can be used to effectively identify SFT/HPC and HGM, whereas adding DTS can improve the overall prediction accuracy. As these two variables are routinely available and are easy for clinicians to master, they can provide a powerful reference for clinical decision-making.
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Vogl TJ, Langenbach MC, Hammerstingl R, Albrecht MH, Chatterjee AR, Gruber-Rouh T. Evaluation of two different transarterial chemoembolization protocols using Lipiodol and degradable starch microspheres in therapy of hepatocellular carcinoma: a prospective trial. Hepatol Int 2021; 15:685-694. [PMID: 34043158 PMCID: PMC8286929 DOI: 10.1007/s12072-021-10193-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND This prospective randomized trial is designed to compare the performance of conventional transarterial chemoembolization (cTACE) using Lipiodol-only with additional use of degradable starch microspheres (DSM) for hepatocellular carcinoma (HCC) in BCLC-stage-B based on metric tumor response. METHODS Sixty-one patients (44 men; 17 women; range 44-85) with HCC were evaluated in this IRB-approved HIPPA compliant study. The treatment protocol included three TACE-sessions in 4-week intervals, in all cases with Mitomycin C as a chemotherapeutic agent. Multiparametric magnetic resonance imaging (MRI) was performed prior to the first and 4 weeks after the last TACE. Two treatment groups were determined using a randomization sheet: In 30 patients, TACE was performed using Lipiodol only (group 1). In 31 cases Lipiodol was combined with DSMs (group 2). Response according to tumor volume, diameter, mRECIST criteria, and the development of necrotic areas were analyzed and compared using the Mann-Whitney-U, Kruskal-Wallis-H-test, and Spearman-Rho. Survival data were analyzed using the Kaplan-Meier estimator. RESULTS A mean overall tumor volume reduction of 21.45% (± 62.34%) was observed with an average tumor volume reduction of 19.95% in group 1 vs. 22.95% in group 2 (p = 0.653). Mean diameter reduction was measured with 6.26% (± 34.75%), for group 1 with 11.86% vs. 4.06% in group 2 (p = 0.678). Regarding mRECIST criteria, group 1 versus group 2 showed complete response in 0 versus 3 cases, partial response in 2 versus 7 cases, stable disease in 21 versus 17 cases, and progressive disease in 3 versus 1 cases (p = 0.010). Estimated overall survival was in mean 33.4 months (95% CI 25.5-41.4) for cTACE with Lipiosol plus DSM, and 32.5 months (95% CI 26.6-38.4), for cTACE with Lipiodol-only (p = 0.844), respectively. CONCLUSIONS The additional application of DSM during cTACE showed a significant benefit in tumor response according to mRECIST compared to cTACE with Lipiodol-only. No benefit in survival time was observed.
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Affiliation(s)
- T J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - M C Langenbach
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - R Hammerstingl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - M H Albrecht
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany
| | - A R Chatterjee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - T Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai, 760590, Frankfurt am Main, Germany.
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Kunisaki C, Takahashi M, Sato S, Tsuchiya N, Watanabe J, Sato T, Takeda K, Tanaka Y, Kasahara K, Kosaka T, Akiyama H, Endo I. Prognostic impact of dimensional factors in pT1 gastric cancer. Surg Oncol 2021; 38:101584. [PMID: 33962215 DOI: 10.1016/j.suronc.2021.101584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The significance of the dimensional factors (tumor diameter, area and volume) as the prognostic factor has not been precisely evaluated in pT1 gastric cancer. OBJECTIVES This study aimed to identify the clinical impact and to confirm the clinical feasibility of the dimensional factors as prognostic factors in pT1 gastric cancer. METHODS We analyzed prognostic factors for disease-specific survival (DSS), overall survival (OS) using clinicopathological factors by univariate and multivariate analyses and the pattern of recurrence in 2011 pT1 gastric cancer (mucosal and submucosal cancers) undergoing R0 gastrectomy. The cut-off values of each dimensional factor was decided by the ROC curve. RESULTS Cox proportional hazard regression model showed that older age (≥75) and more advanced pN stage were adverse independent prognostic factors for DSS, and revealed that older age (≥75), greater preoperative co-morbid diseases, proximal and total gastrectomy, operative method and Clavien-Dindo classification (≥grade III) were independent adverse factors for OS. Any dimensional factors were not independent prognostic factors for any survival. CONCLUSIONS The dimensional factors do not influence both OS and DSS in pT1 gastric cancer patients and so it is difficult to apply these dimensional factors for conducting therapeutic strategies.
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Sistonen HJ, Aro K, Atula T, Jouhi L, Lindén R, Tapiovaara L, Loimu V, Markkola A. Prognostic Value of Apparent Diffusion Coefficient in Oropharyngeal Carcinoma. Clin Neuroradiol 2021. [PMID: 33877396 DOI: 10.1007/s00062-021-01014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose To investigate clinical and radiological factors predicting worse outcome after (chemo)radiotherapy ([C]RT) in oropharyngeal squamous cell carcinoma (OPSCC) with a focus on apparent diffusion coefficient (ADC). Methods This retrospective study included 67 OPSCC patients, treated with (C)RT with curative intent and diagnosed during 2013–2017. Human papilloma virus (HPV) association was detected with p16 immunohistochemistry. Of all 67 tumors, 55 were p16 positive, 9 were p16 negative, and in 3 the p16 status was unknown. Median follow-up time was 38 months. We analyzed pretreatment magnetic resonance imaging (MRI) for factors predicting disease-free survival (DFS) and locoregional recurrence (LRR), including primary tumor volume and the largest metastasis. Crude and p16-adjusted hazard ratios were analyzed using Cox proportional hazards model. Interobserver agreement was evaluated. Results Disease recurred in 13 (19.4%) patients. High ADC predicted poor DFS, but not when the analysis was adjusted for p16. A break in RT (hazard ratio, HR = 3.972, 95% confidence interval, CI 1.445–10.917, p = 0.007) and larger metastasis volume (HR = 1.041, 95% CI 1.007–1.077, p = 0.019) were associated with worse DFS. A primary tumor larger than 7 cm3 was associated with increased LRR rate (HR = 4.861, 1.042–22.667, p = 0.044). Among p16-positive tumors, mean ADC was lower in grade 3 tumors compared to lower grade tumors (0.736 vs. 0.883; p = 0.003). Conclusion Low tumor ADC seems to be related to p16 positivity and therefore should not be used independently to evaluate disease prognosis or to choose patients for treatment deintensification.
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Chen SH, Xu LY, Wu YP, Ke ZB, Huang P, Lin F, Li XD, Xue XY, Wei Y, Zheng QS, Xu N. Tumor volume: a new prognostic factor of oncological outcome of localized clear cell renal cell carcinoma. BMC Cancer 2021; 21:79. [PMID: 33468079 PMCID: PMC7816334 DOI: 10.1186/s12885-021-07795-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies; however, the present prognostic factors was deficient. This study aims to explore whether there is a relationship between tumor volume (TV) and oncological outcomes for localized ccRCC. METHODS Seven hundred forty-nine localized ccRCC patients underwent surgery in our hospital. TV was outlined and calculated using a three-dimensional conformal radiotherapy planning system. We used receiver operating characteristic (ROC) curves to identified optimal cut-off value. Univariable and multivariable Cox regression models were performed to explore the association between TV and oncological outcomes. Kaplan-Meier method and log-rank test were used to estimate survival probabilities and determine the significance, respectively. Time-dependent ROC curve was utilized to assess the prognostic effect. RESULTS Log rank test showed that higher Fuhrman grade, advanced pT classification and higher TV were associated with shortened OS, cancer-specific survival (CSS), freedom from metastasis (FFM) and freedom from local recurrence (FFLR). multivariable analysis showed higher Fuhrman grade and higher TV were predictors of adverse OS and CSS. The AUC of TV for FFLR was 0.822. The AUC of TV (0.864) for FFM was higher than that of pT classification (0.818) and Fuhrman grade (0.803). For OS and CSS, the AUC of TV was higher than that of Fuhrman grade (0.832 vs. 0.799; 0.829 vs 0.790). CONCLUSIONS High TV was an independent predictor of poor CSS, OS, FFLR and FFM of localized ccRCC. Compared with pT classification and Fuhrman grade, TV could be a new and better prognostic factor of oncological outcome of localized ccRCC, which might contribute to tailored follow-up or management strategies.
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Affiliation(s)
- Shao-Hao Chen
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Long-Yao Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yu-Peng Wu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Peng Huang
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Fei Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xiao-Dong Li
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xue-Yi Xue
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yong Wei
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Shui Zheng
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Li S, Shen L. The change in tumor volume after induction chemotherapy with docetaxel plus cisplatin in 259 nasopharyngeal carcinoma patients. Eur Arch Otorhinolaryngol 2021; 278:3027-3035. [PMID: 33386968 DOI: 10.1007/s00405-020-06477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the tumor volume change after induction chemotherapy with docetaxel plus cisplatin (DP) in nasopharyngeal carcinoma (NPC). METHODS A total of 259 non-metastatic NPC patients who received DP induction chemotherapy were retrospectively reviewed. Gross tumor volume of nasopharynx and lymph nodes (GTVnx and GTVnd) were contoured before and after chemotherapy. Univariate and multivariate analyses were performed to identify factors associated with tumor volume reduction. RESULTS For GTVnx, the mean volume before and after chemotherapy were 43.2 cm3 vs 37.4 cm3 (p < 0.001) and the mean relative volume reduction was 12.7%. For GTVnd, the mean volume before and after chemotherapy were 24.6 cm3 vs 17.6 cm3 (p < 0.001) and the mean relative volume reduction was 13.9%. There was a positive linear correlation between the reduction of GTVnx and GTVnd (r = 0.351, p < 0.001). For GTVnx volume reduction, pretreatment GTVnx volume (≤ 20 cm3 vs > 20 cm3, OR = 4.644, p = 0.001) and chemotherapy cycle (2 cycles vs 3 cycles, OR = 2.418, p = 0.009) were independently associated factors. For GTVnd volume reduction, pretreatment GTVnd volume (≤ 8 cm3 vs > 8 cm3, OR = 7.472, p < 0.001) and chemotherapy cycle (2 cycles vs 3 cycles, OR = 2.621, p = 0.007) were independently associated factors. CONCLUSION DP induction chemotherapy reduces tumor volumes moderately in NPC. Larger pre-treatment tumor volumes and three cycles of chemotherapy are associated with higher likelihood of tumor volume reduction.
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Affiliation(s)
- Shan Li
- Department of Oncology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, Hunan Province, China.
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Gong H, Zhou L, Hsueh CY, Wu H, Tao L, Zhang M, Chen X, Li C, Mo M, Zhou J. Prognostic value of pathological tumor size in patients with supraglottic carcinoma. Am J Otolaryngol 2021; 42:102757. [PMID: 33128995 DOI: 10.1016/j.amjoto.2020.102757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association between pathological tumor size and predictive value in patients with supraglottic carcinoma who receive surgery is poorly understood. To gain further insight into this association, the influence of postoperative tumor size assessed via pathological evaluation on survival outcomes in patients with supraglottic carcinoma was fully analyzed. MATERIALS AND METHODS This study collected data from 375 consecutive supraglottic carcinoma patients who underwent primary surgical treatment between 2005 and 2010. The parameters of tumor size, including tumor diameter, tumor area, and tumor volume, were used to analyze the prognostic abilities of overall survival (OS) and disease-free survival (DFS) in supraglottic carcinoma. RESULTS Twelve women and 363 men were included, with a mean age of 61.2 years. The 5-year OS and DFS rates were 65.4% and 56.2%, respectively. The mean tumor diameter, tumor area, and tumor volume of all patients was 3.1 cm, 8.6 cm2, and 9.1 cm3, respectively. Tumors with higher pT stages had a larger tumor diameter, tumor area, and tumor volume. These three factors were significantly correlated with pT stage, and tumor volume was the strongest factor contributing to pT stage. Patients with a larger tumor diameter, tumor area, and tumor volume had worse OS and DFS. Tumor area and tumor volume were independent prognostic factors of OS and DFS in supraglottic carcinoma patients. CONCLUSIONS Patients with a larger tumor size have inferior survival outcomes, and tumor area and tumor volume are independent predictive parameters of survival in supraglottic carcinoma patients who are treated with primary surgery.
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Lam VK, Zhang J, Wu CC, Tran HT, Li L, Diao L, Wang J, Rinsurongkawong W, Raymond VM, Lanman RB, Lewis J, Roarty EB, Roth J, Swisher S, Lee JJ, Gibbons DL, Papadimitrakopoulou VA, Heymach JV. Genotype-Specific Differences in Circulating Tumor DNA Levels in Advanced NSCLC. J Thorac Oncol 2020; 16:601-609. [PMID: 33388476 DOI: 10.1016/j.jtho.2020.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Plasma-based circulating tumor DNA (ctDNA) is an established biomarker for molecular profiling with emerging applications in disease monitoring in multiple tumor types, including, NSCLC. However, determinants of ctDNA shedding and correlation with tumor burden are incompletely understood, particularly in advanced-stage disease. METHODS We retrospectively analyzed ctDNA-based and tissue-based genomic data and imaging from 144 patients with NSCLC. Tumor burden was quantified with computed tomography (CT) and brain magnetic resonance imaging for the overall cohort and 18F-fludeoxyglucose positron emission tomography-CT in a subset of patients. RESULTS There was a moderate but statistically significant correlation between ctDNA variant allele frequency and multiple imaging measures of tumor burden such as CT volume (rho = 0.34, p ≤ 0.0001) and metabolic tumor volume (rho = 0.36, p = 0.003). This correlation was strongest in KRAS-mutant tumors (rho = 0.56, p ≤ 0.001), followed by TP53 mutants (rho = 0.43, p ≤ 0.0001), and weakest in EGFR-mutated (EGFR+) tumors (rho = 0.24, p = 0.077). EGFR+ tumors with EGFR copy number gain had significantly higher variant allele frequency than EGFR+ without copy number gain (p ≤ 0.00001). In multivariable analysis, TP53 and EGFR mutations, visceral metastasis, and tumor burden were independent predictors of increased ctDNA shedding. CONCLUSIONS Levels of detectable ctDNA were affected not only by tumor burden but also by tumor genotype. The genotype-specific differences observed may be due to variations in DNA shedding and cellular turnover. These findings have implications for the emerging use of ctDNA in NSCLC disease monitoring and early detection.
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Affiliation(s)
- Vincent K Lam
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol C Wu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hai T Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lerong Li
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lixia Diao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Waree Rinsurongkawong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jeff Lewis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily B Roarty
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Roth
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Swisher
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Takahashi S, Go T, Anada M, Kinoshita T, Nishide T, Yokomise H, Shibata T. Correlation of Pathological Complete Response With Tumor Volume Reduction During Neoadjuvant Chemoradiotherapy in Lung Cancer. Anticancer Res 2020; 40:4327-4330. [PMID: 32727760 DOI: 10.21873/anticanres.14435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We retrospectively investigated the relationship between pathological complete response (pCR) and tumor volume (TV) reduction during neoadjuvant chemoradiation therapy (NACRT) in non-small cell lung cancer (NSCLC). PATIENTS AND METHODS We evaluated patients who received NACRT (50 Gy/25 fractions with platinum-doublet) plus surgery for NSCLC. TVs before and during NACRT (TVbefore and TVduring, respectively) were measured based on the sums of the volumes of primary tumors and clinically positive lymph nodes. Relative change in TV was computed as % (TVduring - TVbefore)/TVbefore Results: In total, 31 patients were analyzed. The median of the relative change in TV was - 49% and ranged from -83 to -10%. Postoperatively, pCR was achieved in 11 patients (35%). In multivariate analysis, the relative change in TV was found to be an independent predictor of pCR (p=0.003). CONCLUSION TV reduction during NACRT appears to be associated with pCR in NSCLC.
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Affiliation(s)
- Shigeo Takahashi
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | - Tetsuhiko Go
- Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masahide Anada
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | | | - Takamasa Nishide
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | - Hiroyasu Yokomise
- Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Toru Shibata
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
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Bartolotta TV, Sidoti Pinto A, Cannella R, Porrello G, Taravella R, Randazzo A, Taibbi A. Focal liver lesions: interobserver and intraobserver agreement of three-dimensional contrast-enhanced ultrasound-assisted volume measurements. Ultrasonography 2020; 40:333-341. [PMID: 33080667 PMCID: PMC8217797 DOI: 10.14366/usg.20025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE This study was conducted to assess the interobserver and intraobserver agreement of three-dimensional contrast-enhanced ultrasound (3D-CEUS) volume calculations of focal liver lesions (FLLs). METHODS Thirty-nine patients (15 men and 24 women; mean age, 55.4 years) with 39 FLLs (mean size, 3.1±1.8 cm; size range, 1 to 8 cm) prospectively underwent 3D-CEUS. Four readers calculated the volume of each lesion in an independent and blinded fashion in two separate sessions by means of a semi-automatic, commercially available proprietary software. The differences in lesion volumes (cm3) among sessions and readers were assessed using the Mann-Whitney U test and the Kruskal-Wallis test. Bland-Altman analysis was also performed. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) were calculated. The statistical significance level was set at P<0.05. RESULTS Among readers, there were no statistically significant differences in the first (P=0.953) and second (P=0.592) reading sessions for volume calculations of the 39 FLLs, with almost perfect inter-reader agreement (ICC values of the first reading session, 0.996; 95% CI, 0.992 to 0.998 and ICC value of the second reading session, 0.994; 95% CI, 0.990 to 0.997, respectively). For each of the four readers, there were no significant differences in volume calculations between the two sessions (P=0.503-0.924), and the intrareader agreement was almost perfect for each reader (R1: ICC, 0.995; 95% CI, 0.991 to 0.998; R2: ICC, 0.995; 95% CI, 0.988 to 0.997; R3: ICC, 0.996; 95% CI, 0.992 to 0.998; R4: ICC, 0.985; 95% CI, 0.971 to 0.992). CONCLUSION 3D-CEUS volume calculations provided consistent measurements across different readers with almost perfect intrareader agreement.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy.,Department of Radiology, Fondazione Istituto Giuseppe Giglio, Palermo, Italy
| | - Antonio Sidoti Pinto
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Roberto Cannella
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Giorgia Porrello
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Rossana Taravella
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Angelo Randazzo
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy
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Kiesel B, Prihoda R, Borkovec M, Mercea PA, Steindl A, Berghoff AS, Furtner J, Leitner J, Roetzer T, Preusser M, Roessler K, Widhalm G. Postoperative Magnetic Resonance Imaging After Surgery of Brain Metastases: Analysis of Extent of Resection and Potential Risk Factors for Incomplete Resection. World Neurosurg 2020; 143:e365-73. [PMID: 32730972 DOI: 10.1016/j.wneu.2020.07.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Extent of resection (EOR) constitutes a crucial factor for patient prognosis in surgery of brain metastases (BMs). According to early studies using postoperative magnetic resonance imaging (MRI), an unexpected residual tumor was not uncommon. Knowledge of potential risk factors for incomplete BM resection would be of major importance to optimize surgical strategies. The aim of this study was to evaluate EOR in a large cohort and analyze potential risk factors for incomplete BM resection. METHODS Patients with BM resection and available postoperative MRI were included. Intraoperative estimation of EOR by the neurosurgeon was noted. Additionally, EOR was determined by postoperative MRI. Potential risk factors for incomplete resection were investigated. RESULTS There were 145 patients with 163 BMs included. According to postoperative MRI, complete resection was achieved in 103 (63%) BMs, and resection was incomplete in 44 (27%) BMs. Postoperative MRI detected unexpected residual tumor in 32 (25%) BMs, and a misjudgment of the EOR by the neurosurgeon was found in 29% of cases. Regarding risk factors for incomplete resection, preoperative tumor volume was significantly larger in incompletely resected BMs compared with completely resected BMs (P = 0.011). All other analyzed risk factors had no significant influence on EOR. CONCLUSIONS Our data indicate that postoperative MRI is able to detect a high portion of unexpected residual tumors after surgery of BMs. Preoperative tumor volume in particular represents an important risk factor for incomplete resection, and hence neurosurgeons should pay special attention to avoid residual tumor tissue.
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