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de Jongh C, van der Meulen MP, Gertsen EC, Brenkman HJF, van Sandick JW, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, Wijnhoven BPL, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, Daams F, van der Peet DL, van Grieken NCT, Heisterkamp J, van Etten B, van den Berg JW, Pierie JP, Eker HH, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, Wevers KP, Hol L, Wessels FJ, Haj Mohammad N, Frederix GWJ, van Hillegersberg R, Siersema PD, Vegt E, Ruurda JP. Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study. Ann Surg Oncol 2024; 31:4005-4017. [PMID: 38526832 PMCID: PMC11076388 DOI: 10.1245/s10434-024-15103-4] [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: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging. MATERIALS AND METHODS In this cost analysis, four staging strategies were modeled in a decision tree: (1) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations). RESULTS 18FFDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding 18FFDG-PET/CT to SL increased costs by €1058 per patient; IQR €870-1253 in the sensitivity analysis. CONCLUSIONS For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine 18FFDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs. TRIAL REGISTRATION NCT03208621. This trial was registered prospectively on 30-06-2017.
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Affiliation(s)
- Cas de Jongh
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | | | - Emma C Gertsen
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Hylke J F Brenkman
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Johanna W van Sandick
- Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Misha D P Luyer
- Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Jan J B van Lanschot
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | | | | | - Jan H M B Stoot
- Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands
| | | | | | - Marc J van Det
- Surgery Department, ZGT Hospital, Almelo, The Netherlands
| | | | - Freek Daams
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nicole C T van Grieken
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joos Heisterkamp
- Surgery Department, Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | | | | | - Jean-Pierre Pierie
- Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Hasan H Eker
- Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Annemieke Y Thijssen
- Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Eric J T Belt
- Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Eelco Wassenaar
- Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Kevin P Wevers
- Surgery Department, Isala Hospital, Zwolle, The Netherlands
| | - Lieke Hol
- Gastroenterology Department, Maasstad Hospital, Rotterdam, The Netherlands
| | - Frank J Wessels
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Nadia Haj Mohammad
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Gastroenterology and Hepatology Department, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands
| | - Erik Vegt
- Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
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2
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Cox CPW, Brabander T, Vegt E, de Lussanet de la Sablonière QG, Graven LH, Verburg FA, Segbers M. Reduction of [ 68Ga]Ga-DOTA-TATE injected activity for digital PET/MR in comparison with analogue PET/CT. EJNMMI Phys 2024; 11:27. [PMID: 38488989 DOI: 10.1186/s40658-024-00629-z] [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: 11/30/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND New digital detectors and block-sequential regularized expectation maximization (BSREM) reconstruction algorithm improve positron emission tomography (PET)/magnetic resonance (MR) image quality. The impact on image quality may differ from analogue PET/computed tomography (CT) protocol. The aim of this study is to determine the potential reduction of injected [68Ga]Ga-DOTA-TATE activity for digital PET/MR with BSREM reconstruction while maintaining at least equal image quality compared to the current analogue PET/CT protocol. METHODS NEMA IQ phantom data and 25 patients scheduled for a diagnostic PET/MR were included. According to our current protocol, 1.5 MBq [68Ga]Ga-DOTA-TATE per kilogram (kg) was injected. After 60 min, scans were acquired with 3 (≤ 70 kg) or 4 (> 70 kg) minutes per bedposition. PET/MR scans were reconstructed using BSREM and factors β 150, 300, 450 and 600. List mode data with reduced counts were reconstructed to simulate scans with 17%, 33%, 50% and 67% activity reduction. Image quality was measured quantitatively for PET/CT and PET/MR phantom and patient data. Experienced nuclear medicine physicians performed visual image quality scoring and lesion counting in the PET/MR patient data. RESULTS Phantom analysis resulted in a possible injected activity reduction of 50% with factor β = 600. Quantitative analysis of patient images revealed a possible injected activity reduction of 67% with factor β = 600. Both with equal or improved image quality as compared to PET/CT. However, based on visual scoring a maximum activity reduction of 33% with factor β = 450 was acceptable, which was further limited by lesion detectability analysis to an injected activity reduction of 17% with factor β = 450. CONCLUSION A digital [68Ga]Ga-DOTA-TATE PET/MR together with BSREM using factor β = 450 result in 17% injected activity reduction with quantitative values at least similar to analogue PET/CT, without compromising on PET/MR visual image quality and lesion detectability.
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Affiliation(s)
- Christina P W Cox
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Tessa Brabander
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Quido G de Lussanet de la Sablonière
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Laura H Graven
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marcel Segbers
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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Gertsen EC, van der Veen A, Brenkman HJF, Brosens LAA, van der Post RS, Verhoeven RHA, Luijten JCHBM, Vissers PAJ, Vegt E, van Hillegersberg R, Siersema PD, Ruurda JP. Multimodal Therapy Versus Primary Surgery for Gastric and Gastroesophageal Junction Diffuse Type Carcinoma, with a Focus on Signet Ring Cell Carcinoma: A Nationwide Study. Ann Surg Oncol 2024; 31:1760-1772. [PMID: 38127213 DOI: 10.1245/s10434-023-14690-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: 05/31/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Diffuse type adenocarcinoma and, more specifically, signet ring cell carcinoma (SRCC) of the stomach and gastroesophageal junction (GEJ) have a poor prognosis and the value of neoadjuvant chemo(radio)therapy (nCRT) is unclear. METHODS All patients who underwent surgery for diffuse type gastric and GEJ carcinoma between 2004 and 2015 were retrospectively included from the Netherlands Cancer Registry. The primary outcome was overall survival after surgery. Kaplan-Meier curves were plotted. Furthermore, multivariable Poisson and Cox regressions were performed, correcting for confounders. To comply with the Cox regression proportional hazard assumption, gastric cancer survival was split into two groups, i.e. <90 days and >90 days, postoperatively by adding an interaction variable. RESULTS Analyses included 2046 patients with diffuse type cancer: 1728 gastric cancers (50% SRCC) and 318 GEJ cancers (39% SRCC). In the gastric cancer group, 49% received neoadjuvant chemotherapy (nCT) and 51% received primary surgery (PS). All-cause mortality within 90 days postoperatively was lower after nCT (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.20-0.44; p < 0.001). Also after 90 days, mortality was lower in the nCT group (HR for the interaction variable 2.84, 95% CI 1.87-4.30, p < 0.001; total HR 0.29*2.84 = 0.84). In the GEJ group, 38% received nCT, 22% received nCRT, and 39% received PS. All-cause mortality was lower after nCT (HR 0.63, 95% CI 0.43-0.93; p = 0.020) compared with PS. The nCRT group was removed from the Cox regression analysis since the Kaplan-Meier curves of nCRT and PS intersected. The results for gastric and GEJ carcinomas were similar between the SRCC and non-SRCC subgroups. CONCLUSION For gastric and GEJ diffuse type cancer, including SRCC, nCT was associated with increased survival.
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Affiliation(s)
- Emma C Gertsen
- Division Cancer Center, Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Arjen van der Veen
- Division Cancer Center, Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hylke J F Brenkman
- Division Cancer Center, Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Josianne C H B M Luijten
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard van Hillegersberg
- Division Cancer Center, Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle P Ruurda
- Division Cancer Center, Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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4
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Andel D, Lam MGEH, de Bruijne J, Smits MLJ, Braat AJAT, Moelker A, Vegt E, Ruiter SJS, Noordzij W, Grazi G, Vallati GE, Bennink RJ, van Delden OM, Kranenburg OW, Ijzermans JNM, Nijkamp MW, Erdmann JI, Sciuto R, Hagendoorn J, Borel Rinkes IHM. Dose finding study for unilobar radioembolization using holmium-166 microspheres to improve resectability in patients with HCC: the RALLY protocol. BMC Cancer 2023; 23:771. [PMID: 37596578 PMCID: PMC10436405 DOI: 10.1186/s12885-023-11280-9] [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: 10/26/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND High dose unilobar radioembolization (also termed 'radiation lobectomy')-the transarterial unilobar infusion of radioactive microspheres as a means of controlling tumour growth while concomitantly inducing future liver remnant hypertrophy-has recently gained interest as induction strategy for surgical resection. Prospective studies on the safety and efficacy of the unilobar radioembolization-surgery treatment algorithm are lacking. The RALLY study aims to assess the safety and toxicity profile of holmium-166 unilobar radioembolization in patients with hepatocellular carcinoma ineligible for surgery due to insufficiency of the future liver remnant. METHODS The RALLY study is a multicenter, interventional, non-randomized, open-label, non-comparative safety study. Patients with hepatocellular carcinoma who are considered ineligible for surgery due to insufficiency of the future liver remnant (< 2.7%/min/m2 on hepatobiliary iminodiacetic acid scan will be included. A classical 3 + 3 dose escalation model will be used, enrolling three to six patients in each cohort. The primary objective is to determine the maximum tolerated treated non-tumourous liver-absorbed dose (cohorts of 50, 60, 70 and 80 Gy). Secondary objectives are to evaluate dose-response relationships, to establish the safety and feasibility of surgical resection following unilobar radioembolization, to assess quality of life, and to generate a biobank. DISCUSSION This will be the first clinical study to assess the unilobar radioembolization-surgery treatment algorithm and may serve as a stepping stone towards its implementation in routine clinical practice. TRIAL REGISTRATION Netherlands Trial Register NL8902 , registered on 2020-09-15.
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Affiliation(s)
- Daan Andel
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simeon J S Ruiter
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Gianluca Grazi
- Hepatopancreatobiliary Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giulio E Vallati
- Interventional Radiology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Onno W Kranenburg
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten W Nijkamp
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Cancer Center, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rosa Sciuto
- Nuclear Medicine, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
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5
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Pullen LCE, Noortman WA, Triemstra L, de Jongh C, Rademaker FJ, Spijkerman R, Kalisvaart GM, Gertsen EC, de Geus-Oei LF, Tolboom N, de Steur WO, Dantuma M, Slart RHJA, van Hillegersberg R, Siersema PD, Ruurda JP, van Velden FHP, Vegt E. Prognostic Value of [ 18F]FDG PET Radiomics to Detect Peritoneal and Distant Metastases in Locally Advanced Gastric Cancer-A Side Study of the Prospective Multicentre PLASTIC Study. Cancers (Basel) 2023; 15:cancers15112874. [PMID: 37296837 DOI: 10.3390/cancers15112874] [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: 03/13/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/12/2023] Open
Abstract
AIM To improve identification of peritoneal and distant metastases in locally advanced gastric cancer using [18F]FDG-PET radiomics. METHODS [18F]FDG-PET scans of 206 patients acquired in 16 different Dutch hospitals in the prospective multicentre PLASTIC-study were analysed. Tumours were delineated and 105 radiomic features were extracted. Three classification models were developed to identify peritoneal and distant metastases (incidence: 21%): a model with clinical variables, a model with radiomic features, and a clinicoradiomic model, combining clinical variables and radiomic features. A least absolute shrinkage and selection operator (LASSO) regression classifier was trained and evaluated in a 100-times repeated random split, stratified for the presence of peritoneal and distant metastases. To exclude features with high mutual correlations, redundancy filtering of the Pearson correlation matrix was performed (r = 0.9). Model performances were expressed by the area under the receiver operating characteristic curve (AUC). In addition, subgroup analyses based on Lauren classification were performed. RESULTS None of the models could identify metastases with low AUCs of 0.59, 0.51, and 0.56, for the clinical, radiomic, and clinicoradiomic model, respectively. Subgroup analysis of intestinal and mixed-type tumours resulted in low AUCs of 0.67 and 0.60 for the clinical and radiomic models, and a moderate AUC of 0.71 in the clinicoradiomic model. Subgroup analysis of diffuse-type tumours did not improve the classification performance. CONCLUSION Overall, [18F]FDG-PET-based radiomics did not contribute to the preoperative identification of peritoneal and distant metastases in patients with locally advanced gastric carcinoma. In intestinal and mixed-type tumours, the classification performance of the clinical model slightly improved with the addition of radiomic features, but this slight improvement does not outweigh the laborious radiomic analysis.
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Affiliation(s)
- Lieke C E Pullen
- Biomedical Photonic Imaging Group, University of Twente, 7522 NB Enschede, The Netherlands
| | - Wyanne A Noortman
- Biomedical Photonic Imaging Group, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Lianne Triemstra
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Cas de Jongh
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Fenna J Rademaker
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Romy Spijkerman
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Gijsbert M Kalisvaart
- Department of Radiology, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Emma C Gertsen
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Biomedical Photonic Imaging Group, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Maura Dantuma
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Riemer H J A Slart
- Biomedical Photonic Imaging Group, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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6
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Mehra N, Kloots I, Vlaming M, Aluwini S, Dewulf E, Oprea-Lager DE, van der Poel H, Stoevelaar H, Yakar D, Bangma CH, Bekers E, van den Bergh R, Bergman AM, van den Berkmortel F, Boudewijns S, Dinjens WN, Fütterer J, van der Hulle T, Jenster G, Kroeze LI, van Kruchten M, van Leenders G, van Leeuwen PJ, de Leng WW, van Moorselaar RJA, Noordzij W, Oldenburg RA, van Oort IM, Oving I, Schalken JA, Schoots IG, Schuuring E, Smeenk RJ, Vanneste BG, Vegt E, Vis AN, de Vries K, Willemse PPM, Wondergem M, Ausems M. Genetic Aspects and Molecular Testing in Prostate Cancer: A Report from a Dutch Multidisciplinary Consensus Meeting. EUR UROL SUPPL 2023; 49:23-31. [PMID: 36874601 PMCID: PMC9975012 DOI: 10.1016/j.euros.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 01/27/2023] Open
Abstract
Background Germline and tumour genetic testing in prostate cancer (PCa) is becoming more broadly accepted, but testing indications and clinical consequences for carriers in each disease stage are not yet well defined. Objective To determine the consensus of a Dutch multidisciplinary expert panel on the indication and application of germline and tumour genetic testing in PCa. Design setting and participants The panel consisted of 39 specialists involved in PCa management. We used a modified Delphi method consisting of two voting rounds and a virtual consensus meeting. Outcome measurements and statistical analysis Consensus was reached if ≥75% of the panellists chose the same option. Appropriateness was assessed by the RAND/UCLA appropriateness method. Results and limitations Of the multiple-choice questions, 44% reached consensus. For men without PCa having a relevant family history (familial PCa/BRCA-related hereditary cancer), follow-up by prostate-specific antigen was considered appropriate. For patients with low-risk localised PCa and a family history of PCa, active surveillance was considered appropriate, except in case of the patient being a BRCA2 germline pathogenic variant carrier. Germline and tumour genetic testing should not be done for nonmetastatic hormone-sensitive PCa in the absence of a relevant family history of cancer. Tumour genetic testing was deemed most appropriate for the identification of actionable variants, with uncertainty for germline testing. For tumour genetic testing in metastatic castration-resistant PCa, consensus was not reached for the timing and panel composition. The principal limitations are as follows: (1) a number of topics discussed lack scientific evidence, and therefore the recommendations are partly opinion based, and (2) there was a small number of experts per discipline. Conclusions The outcomes of this Dutch consensus meeting may provide further guidance on genetic counselling and molecular testing related to PCa. Patient summary A group of Dutch specialists discussed the use of germline and tumour genetic testing in prostate cancer (PCa) patients, indication of these tests (which patients and when), and impact of these tests on the management and treatment of PCa.
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Affiliation(s)
- Niven Mehra
- Department of Medical Oncology, Radboud UMC, Nijmegen, The Netherlands
- Corresponding author. Department of Medical Oncology, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Tel. +31 243610354; Fax: +31 243615025.
| | - Iris Kloots
- Department of Medical Oncology, Radboud UMC, Nijmegen, The Netherlands
| | - Michiel Vlaming
- Division Laboratories, Pharmacy and biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, UMCG, Groningen, The Netherlands
| | - Els Dewulf
- Centre for Decision Analysis & Support, Ismar Healthcare NV, Lier, Belgium
| | - Daniela E. Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Urology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Herman Stoevelaar
- Centre for Decision Analysis & Support, Ismar Healthcare NV, Lier, Belgium
| | - Derya Yakar
- Department of Radiology, UMCG, Groningen, The Netherlands
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Chris H. Bangma
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Elise Bekers
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Andries M. Bergman
- Department of Medical Oncology and Oncogenomics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Steve Boudewijns
- Department of Medical Oncology, Bravis Hospital, Roosendaal, The Netherlands
| | | | - Jurgen Fütterer
- Department of Medical Imaging, Radboud UMC, Nijmegen, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Guido Jenster
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Michel van Kruchten
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | | | - Walter Noordzij
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Irma Oving
- Department of Internal Medicine, Ziekenhuis Groep Twente, Almelo, The Netherlands
| | | | - Ivo G. Schoots
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J. Smeenk
- Department of Radiation Oncology, Radboud UMC, Nijmegen, The Netherlands
| | - Ben G.L. Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht UMC, Maastricht, The Netherlands
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Erik Vegt
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - André N. Vis
- Department of Urology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Kim de Vries
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Maurits Wondergem
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Margreet Ausems
- Division Laboratories, Pharmacy and biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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7
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Einerhand SM, Voskuilen CS, van de Putte EEF, Donswijk ML, Bruining A, van der Heijden MS, Mertens LS, Hendricksen K, Vegt E, van Rhijn BW. Prospective Evaluation of FDG-PET/CT for On-treatment Assessment of Response to Neoadjuvant or Induction Chemotherapy in Invasive Bladder Cancer. Bladder Cancer 2022. [DOI: 10.3233/blc-220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: Neoadjuvant/induction chemotherapy (NAIC) improves survival in patients with muscle-invasive bladder carcinoma (MIBC). On-treatment response assessment may aid in decisions to continue or cease NAIC. OBJECTIVE: We investigated whether 18F-fluoro-2-deoxy-D-glucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) could predict response to NAIC and compared to contrast-enhanced Computed Tomography (CECT). METHODS: We prospectively included 83 patients treated for MIBC (i.e. high-risk cT2-4N0M0 or cT1-4N+M0-1a) between 2014 and 2018. Response to NAIC was assessed after 2-3 cycles with FDG-PET/CT (Peter-Mac and EORTC criteria) and CECT (RECIST1.1 criteria). We assessed prediction of complete pathological response (pCR; ypT0N0), complete pathological down-staging (pCD;≤ypT1N0), any down-staging from baseline (ypTN < cTN) and progression (inoperable tumor/ypN+/M+). The reference standard was histopathological assessment or clinical follow-up. Sensitivity, specificity, and accuracy were calculated. RESULTS: Pathological response rates were 21% for pCR, 29% for pCD, and 10% progressed. All patients underwent FDG-PET/CT and 61 patients also underwent CECT (73%). Accuracy of FDG-PET/CT for prediction of pCR, pCD, and progression were 73%, 48%, and 73%, respectively. Accuracy of CECT for prediction of pCR, pCD, and progression were 78%, 65%, and 67%, respectively. Specificity of CECT was significantly higher than FDG-PET/CT for prediction of pCD and any down-staging (p = 0.007 and p = 0.022). In all other analyses, no significant differences between FDG-PET/CT and CECT were found. CONCLUSIONS: Routine FDG-PET/CT has insufficient predictive power to aid in response assessment compared to CECT.
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Affiliation(s)
- Sarah M.H. Einerhand
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands
| | - Charlotte S. Voskuilen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands
| | | | - Maarten L. Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michiel S. van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Laura S. Mertens
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands
| | - Erik Vegt
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W.G. van Rhijn
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, TheNetherlands
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
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8
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Reinders MT, van Erpecum KJ, Smits ML, Braat AJ, de Bruijne J, Bruijnen R, Sprengers D, de Man RA, Vegt E, IJzermans JN, Moelker A, Lam MG. Safety and Efficacy of 166Ho Radioembolization in Hepatocellular Carcinoma: The HEPAR Primary Study. J Nucl Med 2022; 63:1891-1898. [PMID: 35589409 PMCID: PMC9730925 DOI: 10.2967/jnumed.122.263823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/15/2022] [Revised: 04/18/2022] [Indexed: 01/11/2023] Open
Abstract
The safety and efficacy of 166Ho radioembolization was first determined in the HEPAR and HEPAR II studies, which, however, excluded patients with hepatocellular carcinoma (HCC). The aim of this prospective clinical early phase II study was to establish the toxicity profile of 166Ho radioembolization in patients with measurable, liver-dominant HCC; Barcelona clinic liver cancer stage B or C; a Child-Pugh score of no more than B7; and an Eastern Cooperative Oncology Group performance status of 0-1 without curative treatment options. Methods: The primary endpoint was a rate of unacceptable toxicity defined as grade 3 hyperbilirubinemia (Common Terminology Cancer Adverse Events, version 4.03) in combination with a low albumin or ascites level in the absence of disease progression or treatment-related serious adverse events. Secondary endpoints included overall toxicity, response, survival, change in α-fetoprotein, and quality of life. Thirty-one patients with Barcelona clinic liver cancer stage B (71%) or C (29%) HCC were included, mostly multifocal (87%) or bilobar (55%) disease. Results: Common grade 1 or 2 clinical toxicity included fatigue (71%), back pain (55%), ascites (32%), dyspnea (23%), nausea (23%), and abdominal pain (23%), with no more than 10% grade 3-5 toxicity. Grade 3 laboratory toxicity (>10%) included an aspartate transaminase and γ-glutamyltransferase increase (16%), hyperglycemia (19%), and lymphopenia (29%). Treatment-related unacceptable toxicity occurred in 3 of 31 patients. At 3 mo, 54% of target lesions showed a complete or partial response according to modified RECIST. Median overall survival was 14.9 mo (95% CI, 10.4-24.9 mo). No significant changes in quality of life or pain were observed. Conclusion: The safety of 166Ho radioembolization was confirmed in HCC, with less than 10% unacceptable toxicity. Efficacy data support further evaluation.
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Affiliation(s)
- Margot T.M. Reinders
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Maarten L.J. Smits
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Arthur J.A.T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Rutger Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Robert A. de Man
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Jan N.M. IJzermans
- Department of Surgery, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Marnix G.E.H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
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Mulder EEAP, Stahlie EHA, Verver D, Lemstra C, Been LB, Mooyaart AL, Brabander T, Vegt E, Verburg FA, van der Veldt AAM, Verhoef C, van Akkooi ACJ, Grünhagen DJ. False positive FDG uptake in melanoma patients treated with talimogene laherparepvec (T-VEC). J Surg Oncol 2021; 124:1161-1165. [PMID: 34235758 PMCID: PMC8596632 DOI: 10.1002/jso.26607] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/18/2021] [Accepted: 07/01/2021] [Indexed: 11/08/2022]
Abstract
Talimogene laherparepvec (T-VEC) is a genetically modified herpes simplex virus-1-based oncolytic immunotherapy and has been approved for the local treatment of unresectable (stage IIIB/C and IVM1a) cutaneous melanoma. During T-VEC treatment, tumor response is often evaluated using [18F]2-fluoro-2-deoxy- d-glucose(FDG) positron emission tomography/computed tomography (PET/CT). In a Dutch cohort (n = 173), almost one-third of patients developed new-onset FDG uptake in uninjected locoregional lymph nodes during T-VEC. In 36 out of 53 (68%) patients with new nodal FDG uptake, nuclear medicine physicians classified this FDG uptake as "suspected metastases" without clinical or pathological confirmation in the majority of patients. These false positive results indicate that new-onset FDG uptake in locoregional lymph nodes during T-VEC treatment does not necessarily reflect progressive disease, but may be associated with immune infiltration. In current clinical practice, physicians should be aware of the high false positive rate of FDG uptake during treatment with T-VEC in patients with melanoma. Therefore, pathological examination of lymph node lesions with new FDG uptake is recommended to differentiate between progressive disease and immune infiltration after treatment with T-VEC.
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Affiliation(s)
- Evalyn E. A. P. Mulder
- Department of Surgical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
- Department of Medical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Emma H. A. Stahlie
- Department of Surgical OncologyNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Daniëlle Verver
- Department of Surgical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Clara Lemstra
- Department of Surgical OncologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Lukas B. Been
- Department of Surgical OncologyUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Tessa Brabander
- Department of Radiology & Nuclear MedicineErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Erik Vegt
- Department of Radiology & Nuclear MedicineErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Frederik A. Verburg
- Department of Radiology & Nuclear MedicineErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Astrid A. M. van der Veldt
- Department of Medical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
- Department of Radiology & Nuclear MedicineErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Cornelis Verhoef
- Department of Surgical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Alexander C. J. van Akkooi
- Department of Surgical OncologyNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
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10
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Gertsen EC, Brenkman HJF, van Hillegersberg R, van Sandick JW, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, Wijnhoven BPL, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, van der Peet DL, Daams F, van Grieken NCT, Heisterkamp J, van Etten B, van den Berg JW, Pierie JP, Eker HH, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, van Laarhoven HWM, Wevers KP, Hol L, Wessels FJ, Haj Mohammad N, van der Meulen MP, Frederix GWJ, Vegt E, Siersema PD, Ruurda JP. 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC). JAMA Surg 2021; 156:e215340. [PMID: 34705049 DOI: 10.1001/jamasurg.2021.5340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance The optimal staging for gastric cancer remains a matter of debate. Objective To evaluate the value of 18F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer. Design, Setting, and Participants This multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (≥cT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020. Exposures All patients underwent an FDG-PET/CT and/or SL in addition to initial staging. Main Outcomes and Measures The primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay. Results Of the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days. Conclusions and Relevance This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT.
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Affiliation(s)
- Emma C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johanna W van Sandick
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Center, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam University Medical Center, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jan J B van Lanschot
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland MC, Sittard-Geleen, the Netherlands
| | - Karel W E Hulsewe
- Department of Surgery, Zuyderland MC, Sittard-Geleen, the Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT hospital, Almelo, the Netherlands
| | | | - Donald L van der Peet
- Department of Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nicole C T van Grieken
- Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Twee-Steden Hospital, Tilburg, the Netherlands
| | - Boudewijn van Etten
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Willem van den Berg
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jean Pierre Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Hasan H Eker
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Annemieke Y Thijssen
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Eelco Wassenaar
- Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Hanneke W M van Laarhoven
- Prospective Observational Cohort Study of Oesophageal-Gastric Cancer Patients (POCOP) of the Dutch Upper GI Cancer Group, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Center, location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Kevin P Wevers
- Department of Surgery, Isala Ziekenhuis, Zwolle, the Netherlands
| | - Lieke Hol
- Department of Gastroenterology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Miriam P van der Meulen
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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11
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Einerhand S, Voskuilen C, Fransen Van De Putte E, Donswijk M, Bruining A, Van Der Heijden M, Mertens L, Hendricksen K, Vegt E, Van Rhijn B. Prospective study on fdg-pet/ct for on-treatment assessment of response to neoadjuvant or induction chemotherapy in invasive bladder cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Gertsen EC, Borggreve AS, Brenkman HJF, Verhoeven RHA, Vegt E, van Hillegersberg R, Siersema PD, Ruurda JP. Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands. Ann Surg Oncol 2021; 28:2384-2393. [PMID: 32901312 PMCID: PMC7940330 DOI: 10.1245/s10434-020-09096-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) has increased in the preoperative staging of gastric cancer. Dutch national guidelines have recommended the use of FDG-PET/CT and SL for patients with locally advanced tumors since July 2016. OBJECTIVE The aim of this study was to evaluate the implementation of FDG-PET/CT and SL in The Netherlands. METHODS Between 2011 and 2018, all patients who underwent surgery for gastric cancer were included from the Dutch Upper GI Cancer Audit. The use of FDG-PET/CT and SL was evaluated before and after revision of the Dutch guidelines. Outcomes included the number of non-curative procedures (e.g. palliative and futile procedures) and the association of FDG-PET/CT and SL, with waiting times from diagnosis to the start of treatment. RESULTS A total of 3310 patients were analyzed. After July 2016, the use of FDG-PET/CT (23% vs. 61%; p < 0.001) and SL (21% vs. 58%; p < 0.001) increased. FDG-PET/CT was associated with additional waiting time to neoadjuvant therapy (4 days), as well as primary surgical treatment (20 days), and SL was associated with 8 additional days of waiting time to neoadjuvant therapy. Performing SL or both modalities consecutively in patients in whom it was indicated was not associated with the number of non-curative procedures. CONCLUSION During implementation of FDG-PET/CT and SL after revision of the guidelines, both have increasingly been used in The Netherlands. The addition of these staging methods was associated with increased waiting time to treatment. The number of non-curative procedures did not differ after performing none, solely one, or both staging modalities.
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Affiliation(s)
- Emma C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alicia S Borggreve
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Surgery, Division Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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13
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Mohan V, Bruin NM, Tesselaar MET, de Boer JP, Vegt E, Hendrikx JJMA, Al-Mamgani A, van de Kamer JB, Sonke JJ, Vogel WV. Muscarinic inhibition of salivary glands with glycopyrronium bromide does not reduce the uptake of PSMA-ligands or radioiodine. EJNMMI Res 2021; 11:25. [PMID: 33710423 PMCID: PMC7953192 DOI: 10.1186/s13550-021-00770-1] [Citation(s) in RCA: 3] [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: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023] Open
Abstract
RATIONALE Salivary glands are highly perfused and express the prostate-specific membrane antigen (PSMA) receptor as well as the sodium-iodide symporter. As a consequence, treatment with 177Lu/225Ac-PSMA for prostate cancer or 131I for thyroid cancer leads to a high radiation dose in the salivary glands, and patients can be confronted with persistent xerostomia and reduced quality of life. Salivation can be inhibited using an antimuscarinic pharmaceutical, such as glycopyrronium bromide (GPB), which may also reduce perfusion. The primary objective of this work was to determine if inhibition with GPB could provide a considerable (> 30%) reduction in the accumulation of administered 123I or 68Ga-PSMA-11 in salivary glands. METHODS Ten patients who already received a whole-body 68Ga-PSMA-11 PET/CT scan for (re)staging of prostate cancer underwent a repeat PET/CT scan with tracer administration at 90 min after intravenous injection of 0.2 mg GPB. Four patients in follow-up after thyroid cancer, who had been treated with one round of ablative 131I therapy with curative intent and had no signs of recurrence, received 123I planar scintigraphy at 4 h after tracer administration without GPB and a repeated scan at least one week later, with tracer administration at 30 min after intramuscular injection of 0.4 mg GPB. Tracer uptake in the salivary glands was quantified on PET and scintigraphy, respectively, and values with and without GPB were compared. RESULTS No significant difference in PSMA uptake in the salivary glands was seen without or with GPB (Mean SULmean parotid glands control 5.57, intervention 5.72, p = 0.50. Mean SULmean submandibular glands control 6.25, intervention 5.89, p = 0.12). Three out of 4 patients showed increased 123I uptake in the salivary glands after GPB (Mean counts per pixel control 8.60, intervention 11.46). CONCLUSION Muscarinic inhibition of salivation with GPB did not significantly reduce the uptake of PSMA-ligands or radioiodine in salivary glands, and can be dismissed as a potential strategy to reduce toxicity from radionuclide therapies.
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Affiliation(s)
- V Mohan
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M E T Tesselaar
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J P de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Vegt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J J M A Hendrikx
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J-J Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - W V Vogel
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands. .,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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14
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Ottenhof SR, Djajadiningrat RS, Versleijen MWJ, Donswijk ML, van der Noort V, Brouwer OR, Graafland NM, Vegt E, Horenblas S. F-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography Has High Diagnostic Value for Pelvic and Distant Staging in Patients with High-risk Penile Carcinoma. Eur Urol Focus 2021; 8:98-104. [PMID: 33685842 DOI: 10.1016/j.euf.2021.02.012] [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] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND For penile cancer patients with pelvic metastases, multimodal treatment is advised, but pelvic lymph node metastases are often found upon surgical resection only. Early selection for multimodal treatment requires reliable noninvasive staging. OBJECTIVE To evaluate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) for staging pelvic lymph nodes and distant metastases in high-risk penile cancer patients. DESIGN, SETTING, AND PARTICIPANTS FDG-PET/CT scans performed in patients with clinically overt inguinal lymph node metastases and/or high-risk primary tumors (bulky T3 or T4) were retrospectively analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All scans were reviewed by two independent nuclear medicine physicians staging the pelvic nodes and distant metastases. FDG-PET/CT findings were compared with histology after node dissection if available, or with positive imaging or follow-up of at least 1 yr. RESULTS AND LIMITATIONS Between 2006 and 2016, 61 patients met the inclusion criteria. For staging of pelvic nodes, sensitivity was 85% (specificity 75%, negative predictive value [NPV] 90%, and positive predictive value [PPV] 65%). For the detection of distant metastases, FDG-PET/CT had a PPV of 93%. Results are limited by the retrospective design and the lack of direct comparison with CT scanning alone. CONCLUSIONS FDG-PET/CT has high sensitivity and a high NPV for staging of pelvic lymph nodes in high-risk penile cancer. It also has a high PPV for the detection of distant metastases, which were found in 23% of patients. Therefore, FDG-PET/CT enables early selection for multimodal treatment of patients with pelvic metastases and may help avoid futile treatment of patients with distant metastases. PATIENT SUMMARY We studied whether positron emission tomography with computed tomography (PET/CT) scans in patients with advanced penile cancer can detect metastases before lymph node surgery is done. PET/CT scans can detect or rule out pelvic lymph node metastases, and can detect distant metastases. This helps in making timely treatment decisions (before surgery).
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Affiliation(s)
- Sarah R Ottenhof
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niels M Graafland
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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15
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Voskuilen CS, van Gennep EJ, Einerhand SMH, Vegt E, Donswijk ML, Bruining A, van der Poel HG, Horenblas S, Hendricksen K, van Rhijn BWG, Mertens LS. Staging 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Changes Treatment Recommendation in Invasive Bladder Cancer. Eur Urol Oncol 2021; 5:366-369. [PMID: 33583752 DOI: 10.1016/j.euo.2021.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/28/2020] [Revised: 12/24/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
Given the high risk of systemic relapse following initial therapy for muscle-invasive bladder cancer (MIBC), improved pretreatment staging is needed. We evaluated the incremental value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) after standard conventional staging, in the largest cohort of MIBC patients to date. This is a retrospective analysis of 711 consecutive patients with invasive urothelial bladder cancer who underwent staging contrast-enhanced CT (chest and abdomen) and FDG-PET/CT in a tertiary referral center between 2011 and 2020. We recorded the clinical stage before and after FDG-PET/CT and treatment recommendation based on the stage before and after FDG-PET/CT. Clinical stage changed after FDG-PET/CT in 184/711 (26%) patients. Consequently, the recommended treatment strategy based on imaging changed in 127/711 (18%) patients. In 65/711 (9.1%) patients, potential curative treatment changed to palliative treatment because of the detection of distant metastases by FDG-PET/CT. Fifty (7.0%) patients were selected for neoadjuvant/induction chemotherapy based on FDG-PET/CT. Moreover, FDG-PET/CT detected lesions suspicious for second primary tumors in 15%; a second primary malignancy was confirmed in 28/711 (3.9%), leading to treatment change in ten (1.4%) patients. Contrarily 57/711 (8.1%) had false positive secondary findings. In conclusion, FDG-PET/CT provides important incremental staging information, which potentially influences clinical management in 18% of MIBC patients, but leads to false positive results as well. PATIENT SUMMARY: In this report, we investigated the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scanning on treatment of bladder cancer patients. We found that FDG-PET/CT potentially influences the treatment of almost one-fifth of patients. We therefore suggest performing FDG-PET/CT as part of bladder cancer staging.
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Affiliation(s)
- Charlotte S Voskuilen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Erik J van Gennep
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarah M H Einerhand
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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16
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Donswijk ML, van Leeuwen PJ, Vegt E, Cheung Z, Heijmink SWTPJ, van der Poel HG, Stokkel MPM. Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study. BMC Cancer 2020; 20:723. [PMID: 32758168 PMCID: PMC7409439 DOI: 10.1186/s12885-020-07192-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/19/2020] [Accepted: 07/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate the impact of Gallium-68 [68Ga] labeled prostate specific membrane antigen (PSMA) positron emission tomography (PET)/X-ray computed tomography (CT) compared with conventional imaging on staging and clinical management of men evaluated for primary prostate cancer (PCa). Methods Men with newly diagnosed biopsy-proven PCa who had been staged with a conventional staging protocol including bone scintigraphy (BS) and additionally underwent [68Ga]PSMA PET/CT, were evaluated retrospectively. Imaging findings from BS, magnetic resonance imaging (MRI) and/or CT were categorized regarding locoregional nodal (N) and distant metastasis (M) status as negative, positive or equivocal before and after addition of the information of PET/CT. Also, the imaging-based level of confidence (LoC) in correct assessment of N and M status was scored. Impact of PET/CT on clinical management was evaluated by the percentage of treatment category changes after PET/CT as determined in the multidisciplinary tumour board. Results Sixty-four men with intermediate and high-risk PCa were evaluated. With additional information of PET/CT, N status was upstaged in 23%, and downstaged in 9%. M status was upstaged in 13%, and downstaged in 23%. A net increase in LoC of 20% was noted, mainly regarding M status. Treatment category changed from palliative to curative in 9%, and from curative to palliative in 3%. An undecided treatment plan changed to curative in 14%, as well as to palliative in another 9%. In total, a 36% treatment category change was noted. High negative predictive value of PET/CT for M status was indicated by 27 patients that underwent robot-assisted radical prostatectomy and reached postoperative biochemical disease-free status or had a likely other site of disease recurrence. Conclusions PSMA PET/CT can cause considerable changes in N and M staging, as well as in management compared to conventional staging. Findings of this study support the replacement of BS and CT by PSMA PET/CT in staging primary PCa.
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Affiliation(s)
- Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands, 1066, CX.
| | - Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands, 1066, CX.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Zing Cheung
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands, 1066, CX
| | | | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands, 1066, CX
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17
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Badrising SK, Louhanepessy RD, van der Noort V, Coenen JLLM, Hamberg P, Beeker A, Wagenaar N, Lam MGEH, Celik F, Loosveld OJL, Oostdijk A, Zuetenhorst H, Haanen JB, Vegt E, Zwart W, Bergman AM. A prospective observational registry evaluating clinical outcomes of Radium-223 treatment in a nonstudy population. Int J Cancer 2020; 147:1143-1151. [PMID: 31875956 PMCID: PMC7383569 DOI: 10.1002/ijc.32851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
The ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit in metastatic Castration Resistant Prostate Cancer (mCRPC) patients treated with Radium-223 dichloride (Ra-223) over placebo. Here we report clinical outcomes of Ra-223 treatment in a nonstudy population. In this prospective registry, patients from 20 Dutch hospitals were included prior to Ra-223 treatment. Clinical parameters collected included previous treatments and Adverse Events. Primary outcome was 6 months Symptomatic Skeletal Event (SSE)-free survival, while secondary outcomes included Progression-Free Survival (PFS) and Overall Survival (OS). Of the 305 patients included, 300 were evaluable. The mean age was 73.6 years, 90% had ≥6 bone metastases and 74.1% were pretreated with Docetaxel, 19.5% with Cabazitaxel and 80.5% with Abiraterone and/or Enzalutamide. Of all patients, 96.7% were treated with Ra-223 and received a median of 5 cycles. After a median follow-up of 13.2 months, 6 months SSE-free survival rate was 83%, median PFS was 5.1 months and median OS was 15.2 months. Six months SSE-free survival rate and OS were comparable with those reported in ALSYMPCA. "Previous Cabazitaxel treatment" and "bone-only metastases" were independent predictors of a shorter and longer PFS, respectively, while above-median LDH and "bone-only metastases" were independent predictors of shorter and longer OS, respectively. Toxicity was similar as reported in the ALSYMPCA trial. These results suggest that in a nonstudy population, Ra-223 treatment is well-tolerated, equally effective as in the ALSYMPCA population and that patients not previously treated with Cabazitaxel benefit most from Ra-223.
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Affiliation(s)
- Sushil K Badrising
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rebecca D Louhanepessy
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Paul Hamberg
- Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Aart Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Nils Wagenaar
- Department of Nuclear Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Marnix G E H Lam
- Department of Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Filiz Celik
- Department of Nuclear Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Olaf J L Loosveld
- Department or Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Ad Oostdijk
- Department of Nuclear Medicine, Isala, Zwolle, The Netherlands
| | - Hanneke Zuetenhorst
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - John B Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilbert Zwart
- Division of Oncogenomics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andries M Bergman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Oncogenomics, Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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Reymen BJT, van Gisbergen MW, Even AJG, Zegers CML, Das M, Vegt E, Wildberger JE, Mottaghy FM, Yaromina A, Dubois LJ, van Elmpt W, De Ruysscher D, Lambin P. Nitroglycerin as a radiosensitizer in non-small cell lung cancer: Results of a prospective imaging-based phase II trial. Clin Transl Radiat Oncol 2019; 21:49-55. [PMID: 32021913 PMCID: PMC6993056 DOI: 10.1016/j.ctro.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/29/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023] Open
Abstract
Nitroglycerin didn’t improve overall survival of NSCLC patients. The toxicity of combining nitroglycerin with standard treatment was mild. Increased uptake of HX4 showed negative prognostic significance in NSCLC patients. Tumor perfusion after nitroglycerin treatment did not correlate with outcome.
Background Nitroglycerin is proposed as an agent to reduce tumour hypoxia by improving tumour perfusion. We investigated the potential of nitroglycerin as a radio-sensitizer in non-small cell lung cancer (NSCLC) and the potential of functional imaging for patient selection. Material and methods Trial NCT01210378 is a single arm phase II trial, designed to detect 15% improvement in 2-year overall survival (primary endpoint) in stage IB-IV NSCLC patients treated with radical (chemo-) radiotherapy and a Transiderm-Nitro 5 patch during radiotherapy. Patients underwent dynamic contrast-enhanced CTs (DCE-CT) and HX4 (hypoxia) PET/CTs before and after nitroglycerin. Secondary endpoints were progression-free survival, toxicity and the prognostic value of tumour perfusion/hypoxia at baseline and after nitroglycerin. Results The trial stopped after a futility analysis after 42 patients. At median follow-up of 41 months, two-year and median OS were 58% (95% CI: 44–78%) and 38 months (95% CI: 22–54 months), respectively. Nitroglycerin could not reduce tumour hypoxia. DCE-CT parameters did not correlate with OS, whereas hypoxic tumours had a worse OS (p = 0.029). Changes in high-uptake fraction of HX4 and tumour blood flow were negatively correlated (r = -0.650, p = 0.022). The heterogeneity in treatment modalities and patient characteristics combined with a small sample size made further subgroup analysis of survival results impossible. Toxicity related to nitroglyerin was limited to headache (17%) and hypotension (2.4%). Conclusion Nitroglycerin did not improve OS of NSCLC patients treated with (chemo-)radiotherapy. A general ability of nitroglycerin to reduce hypoxia was not shown.
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Key Words
- BF, blood flow
- BV, blood volume
- CI, confidence interval
- CoR, coefficient of repeatability
- DCE-CT, dynamic contrast-enhanced CT
- FHV, fraction of hypoxic volume hypoxic fraction of the GTV
- GTV, gross tumour volume
- GTVln, gross tumour volume of the lymph nodes
- GTVp, gross tumour volume of the primary tumour
- HX4
- HX4, 2-nitroimidazole [18F]-HX4 (flortanidazole, 3-[18F]fluoro-2-(4-((2-nitro-1Himidazol-1-yl)methyl)-1H-1,2,3-triazol-1-yl)-propan-1-ol)
- HX4-HF, HX4 hypoxic fraction
- HX4-HV, HX4 hypoxic volume
- Hypoxia
- INDAR, individualized accelerated radiotherapy
- IQR, interquartile range
- LRPFS, loco-regional progression free survival
- MFS, metastasis-free survival
- Mitochondria
- NO, nitric oxide
- NSCLC
- NSCLC, non-small cell lung cancer
- Nitroglycerin
- OS, overall survival
- PET, positron emission tomography
- Perfusion
- SUVmax, maximum standardised uptake value
- SUVmean, mean standardised uptake value
- TBR, tumour-to-blood ratio
- TTD, total tumour dose
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Affiliation(s)
- Bart J T Reymen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marike W van Gisbergen
- The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Aniek J G Even
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Institute of Data Science, Maastricht University, The Netherlands
| | - Marco Das
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Ala Yaromina
- The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ludwig J Dubois
- The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab & The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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19
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Hinsenveld FJ, Wit EM, van Leeuwen PJ, Brouwer OR, Donswijk ML, Tillier CN, Vegt E, van Muilekom E, van Oosterom MN, van Leeuwen FW, van der Poel HG. Prostate-Specific Membrane Antigen PET/CT Combined with Sentinel Node Biopsy for Primary Lymph Node Staging in Prostate Cancer. J Nucl Med 2019; 61:540-545. [DOI: 10.2967/jnumed.119.232199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
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20
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Voncken F, Vegt E, Sandick J, van Dieren J, Grootscholten C, Bartels-Rutten A, Takken S, Sonke J, van de Kamer J, Aleman B. Motion-Compensated FDG PET/CT for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Blok JM, Kerst JM, Vegt E, Brouwer OR, Meijer RP, Bosch JLHR, Bex A, van der Poel HG, Horenblas S. Sentinel node biopsy in clinical stage I testicular cancer enables early detection of occult metastatic disease. BJU Int 2019; 124:424-430. [PMID: 30417511 PMCID: PMC6850062 DOI: 10.1111/bju.14618] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 02/05/2023]
Abstract
Objectives To report the long‐term results of the sentinel node (SN) approach in patients with clinical stage I testicular tumours in our facility. Patients and Methods We conducted an analysis of 27 consecutive patients suspected of clinical stage I testicular germ cell tumour (TGCT) and treated with an SN procedure at our tertiary referral centre. SNs were identified using lymphoscintigraphy with or without single‐photo‐emission computed tomography with CT (SPECT/CT). Patients underwent laparoscopic retroperitoneal SN excision with inguinal orchiectomy. Patients with a tumour‐positive SN underwent adjuvant treatment. Follow‐up was conducted according to then‐current guidelines. Results In two patients, no SNs were visualized on scintigraphy. In the remaining 25 patients, a median (range) of 3 (1–4) SNs per patient were removed. Two patients showed no malignancy on histopathological examination of the testis. Of the 23 patients diagnosed with TGCT (16 seminomas, seven non‐seminomas), three (13.0%) had occult metastatic disease. All 23 patients were without evidence of disease at a median (range) follow‐up of 63.9 (29.0–143.4) months. Conclusion The SN procedure allows early identification of patients with occult metastatic disease in clinical stage I TGCT, enabling early treatment.
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Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Axel Bex
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Louhanepessy R, Badrising S, van der Noort V, Coenen JLLM, Hamberg P, Beeker A, Wagenaar N, Lam MG, Celik F, Loosveld O, Oostdijk A, Zuetenhorst JM, Vegt E, Zwart W, Bergman AM. Clinical outcomes of a Dutch prospective observational registry of metastatic castration resistant prostate cancer (mCRPC) patients treated with radium-223 (Ra-223). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
323 Background: In 2012 the ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit of mCRPC patients treated with Ra-223 over placebo. To date clinical outcomes of Ra-223 treatment in a non-study population have not been prospectively evaluated. Methods: The ROTOR registry aimed to include 300 patients in 20 Dutch hospitals prior to Ra-223 treatment at the physician’s discretion. Clinical parameters collected included: positioning of Ra-223, Adverse Events (AE’s; CTCAE v4.03), Skeletal Related Events (SRE) and survival data. SRE was defined as radiotherapy to a bone metastasis, a new pathological fracture, spinal cord compression and/or bone surgery. Progression-Free Survival (PFS) was defined as survival until radiological or clinical progression, subsequent treatment or death. Results: Between April 2014 and September 2017, 305 patients were included of whom 300 were evaluable. The mean age of patients was 72.6 (range 46.3-91.5) years, 255 (85%) had ≥ 6 bone metastases and 197 (65.5%) were pretreated with taxanes and/or abiraterone or enzalutamide (214 (71.3%)). Two-hundred and ninety (96.7%) patients were treated with Ra-223. Twenty-nine (9.7%), 104 (34.7%), 96 (32%) and 66 (22%) patients received Ra-223 as a first, second, third, ≥ fourth mCRPC treatment line, respectively. Patients received an average of 4.6 (SD 1.8) cycles of Ra-223, while 140 (46.7%) completed all six cycles. After a median follow-up of 13.2 months, PFS was 5.1 (CI 4.5-5.8) months and OS 15.2 (CI 12.8-17.6) months. Eighty-two (27.3%) patients were hospitalized during Ra-223 treatment (Serious AE). Grade ≥ 3 anemia, neutropenia and thrombocytopenia was found in 54 (18.0%), 8 (2.7%) and 11 (3.7%) patients, respectively. Other frequent AE’s (all grades) were nausea (90 (30%)), diarrhea (83 (27.7%)) and fatigue (178 (59.3%)). SREs were observed in 46 (15.3%) patients; 22 (7.3%) received radiotherapy, 6 (2%) developed pathologic fractures, 17 (5.6%) spinal cord compression and 1 (0.3%) received bone surgery during Ra-223 therapy. Conclusions: The non-study ROTOR population had characteristics, all grade AEs and OS comparable with the treatment arm of ALSYMPCA. Clinical trial information: NCT03223597.
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Affiliation(s)
- Rebecca Louhanepessy
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | | | | | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Aart Beeker
- Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | | | | | | | | | | | | | - Erik Vegt
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Wilbert Zwart
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Andre M. Bergman
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Louhanepessy R, Badrising S, Vd Noort V, Coenen J, Oostdijk A, Hamberg P, Zuetenhorst J, Beeker A, Wagenaar N, Lam M, Celik F, Vegt E, Zwart W, Bergman A. Pain and quality of life in metastasized Castration Resistant Prostate Cancer patients treated with Radium-223 (ROTOR registry): A prospective observational registry in a non-study population. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Brenkman HJF, Gertsen EC, Vegt E, van Hillegersberg R, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, van der Peet DL, Daams F, van Sandick JW, van Grieken NCT, Heisterkamp J, van Etten B, Haveman JW, Pierie JP, Jonker F, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, van Laarhoven HWM, Wessels FJ, Haj Mohammad N, van Stel HF, Frederix GWJ, Siersema PD, Ruurda JP. Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study). BMC Cancer 2018; 18:450. [PMID: 29678145 PMCID: PMC5910577 DOI: 10.1186/s12885-018-4367-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/18/2017] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3–4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. Methods This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3–4b, N0–3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. Discussion In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. Trial registration NCT03208621. This trial was registered prospectively on June 30, 2017.
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Affiliation(s)
- H J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E Vegt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - S S Gisbertz
- Academic Medical Center, Amsterdam, The Netherlands
| | - M D P Luyer
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - S M Lagarde
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - W O de Steur
- Leiden University Medical Center, Leiden, The Netherlands
| | - H H Hartgrink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J H M B Stoot
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - K W E Hulsewe
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | | | | | - F Daams
- VU University Medical Center, Amsterdam, The Netherlands
| | - J W van Sandick
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Heisterkamp
- Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | - B van Etten
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W Haveman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Pierie
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F Jonker
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A Y Thijssen
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - E J T Belt
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - E Wassenaar
- Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - H W M van Laarhoven
- Academic Medical Center, Amsterdam, The Netherlands.,Propsective Observational Cohort study of Oesophageal-gastric cancer Patients (POCOP) of the Dutch Upper GI Cancer Group (DUCG), Amsterdam, The Netherlands
| | - F J Wessels
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - N Haj Mohammad
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H F van Stel
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - G W J Frederix
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P D Siersema
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Blok JM, Meijer RP, Kerst JM, Vegt E, Bosch R, Bex A, Van Der Poel H, Horenblas S. Sentinel node biopsy in clinical stage I testicular cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
550 Background: Approximately 20 – 30% of patients with testicular germ cell tumors (TGCTs) in clinical stage I (CS I) have occult metastatic disease at the time of presentation and will relapse under surveillance. The availability of a sentinel node procedure would enable early identification of patients with occult metastases. We report the long-term results of the sentinel node approach in CS I testicular tumor patients in our facility. Methods: Between 2001 and 2015, patients suspected of CS I TGCT in our third echelon referral center were asked to participate. SNs were identified using SPECT/CT and/or lymphoscintigraphy. Participants underwent laparoscopic retroperitoneal SN excision together with inguinal orchiectomy. Patients with a SN positive for occult metastases were treated with adjuvant chemotherapy. Follow-up was according to then current guidelines and consisted of clinical examination, tumor markers, abdominal/thoracic CT-scanning and chest X-rays. Results: Twenty-seven patients were included. In two patients, no sentinel nodes were visualized on scintigraphy. In twenty-five patients, a median of 3 SNs (range 1 – 4) per patient were removed. Two patients showed no malignancy on histopathologic examination of the testis. Of the 23 patients diagnosed with TGCT, three (13.0%) had occult metastatic disease. All 23 patients were without evidence of disease at a median follow-up of 62.2 months (range 22.3 – 143.4). Conclusions: The SN procedure enables early identification of patients with occult metastatic disease in CS I TGCT. Clinical trial information: M00LMT.
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Affiliation(s)
- Joost Marijn Blok
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Jan M. Kerst
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Erik Vegt
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ruud Bosch
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Axel Bex
- Netherlands Cancer Center, Amsterdam, Netherlands
| | - Henk Van Der Poel
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Simon Horenblas
- Netherlands Cancer Center - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Abstract
Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) combined with computed tomography (CT) provides functional imaging combined with anatomic information, improving diagnostic accuracy and confidence. Although virtually all primary penile tumors are FDG-avid, PET/CT is not recommended for primary tumor staging as it has limited spatial resolution and is hampered by urinary FDG excretion. The accuracy of PET/CT for lymph node staging seems to improve with the pretest likelihood of metastatic nodes. In groins with normal physical examination, sensitivity is only 57%. In groins with palpably enlarged lymph nodes, sensitivity of PET/CT reaches 96%. For pelvic lymph nodes and distant metastases, PET/CT is more accurate if inguinal metastases are present. However, these results are based on a very limited number of studies. Overall, the role of PET/CT imaging in penile cancer remains ambiguous, especially in inguinal lymph nodes. During staging and follow-up, it may be particularly useful in detecting pelvic lymph node metastases and occult distant metastases prior to systemic chemotherapy and/or extensive surgery, improving selection of patients that are most likely to benefit from such therapies.
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Affiliation(s)
- Sarah R Ottenhof
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Steinberg JD, Vogel W, Vegt E. Factors influencing brown fat activation in FDG PET/CT: a retrospective analysis of 15,000+ cases. Br J Radiol 2017; 90:20170093. [PMID: 28590773 DOI: 10.1259/bjr.20170093] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Brown fat can exhibit high uptake of fluorine-18 fludeoxyglucose (18F-FDG) on positron emission tomography (PET) and interferes with interpretation of the scan. The goal of this study was to identify factors that may influence brown adipose tissue (BAT) activation. METHODS A retrospective study of 18F-FDG PET scans was performed using a database of 15,109 PET/CT reports. BAT activation reported by nuclear medicine physicians and factors influencing BAT activation were gathered. The data were analyzed using in-house software. RESULTS The total reported BAT activation was 3.6%. BAT activation was reported significantly more often in patients who were female (p < 0.0001), younger (p < 0.0001), with lower body mass index (p < 0.0001), with lower blood glucose levels (p = 0.01), indicated for breast cancer (p = 0.004), not administered chemotherapy recently before the scan (p < 0.0001) and shown to have BAT activation in a previous scan (p < 0.0001). BAT activation was also reported significantly more for lower outdoor temperatures (p < 0.0001) and for late morning scans than for afternoon (p = 0.005) and early morning (p = 0.001) scans. CONCLUSION This retrospective study of 15,109 scans highlights multiple factors contributing to BAT activation on 18F-FDG PET. The identification of new factors influencing BAT and confirmation of previously identified factors with a larger data set can be used to more accurately identify patients at risk for BAT activation so that prevention strategies can be implemented. Advances in knowledge: This study presents new factors associated with higher incidence of BAT activation, such as time of day, previous BAT activation and breast cancer. Conversely, recent chemotherapy was associated with reduced incidence of BAT activation.
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Affiliation(s)
- Jeffrey D Steinberg
- 1 Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wouter Vogel
- 2 Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Erik Vegt
- 2 Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
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Reymen B, Even A, Zegers C, Van Elmpt W, Das M, Wldberger J, Mottaghy F, Vegt E, De Ruysscher D, Lambin P. OC-0481: Effects of nitroglycerin on perfusion and hypoxia in non-small cell lung cancer lesions. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aalbersberg EA, de Wit-van der Veen BJ, Zwaagstra O, Codée-van der Schilden K, Vegt E, Vogel WV. Preclinical imaging characteristics and quantification of Platinum-195m SPECT. Eur J Nucl Med Mol Imaging 2017; 44:1347-1354. [PMID: 28190123 DOI: 10.1007/s00259-017-3643-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 08/22/2016] [Accepted: 01/29/2017] [Indexed: 11/29/2022]
Abstract
AIMS In vivo biodistribution imaging of platinum-based compounds may allow better patient selection for treatment with chemo(radio)therapy. Radiolabeling with Platinum-195m (195mPt) allows SPECT imaging, without altering the chemical structure or biological activity of the compound. We have assessed the feasibility of 195mPt SPECT imaging in mice, with the aim to determine the image quality and accuracy of quantification for current preclinical imaging equipment. METHODS Enriched (>96%) 194Pt was irradiated in the High Flux Reactor (HFR) in Petten, The Netherlands (NRG). A 0.05 M HCl 195mPt-solution with a specific activity of 33 MBq/mg was obtained. Image quality was assessed for the NanoSPECT/CT (Bioscan Inc., Washington DC, USA) and U-SPECT+/CT (MILabs BV, Utrecht, the Netherlands) scanners. A radioactivity-filled rod phantom (rod diameter 0.85-1.7 mm) filled with 1 MBq 195mPt was scanned with different acquisition durations (10-120 min). Four healthy mice were injected intravenously with 3-4 MBq 195mPt. Mouse images were acquired with the NanoSPECT for 120 min at 0, 2, 4, or 24 h after injection. Organs were delineated to quantify 195mPt concentrations. Immediately after scanning, the mice were sacrificed, and the platinum concentration was determined in organs using a gamma counter and graphite furnace - atomic absorption spectroscopy (GF-AAS) as reference standards. RESULTS A 30-min acquisition of the phantom provided visually adequate image quality for both scanners. The smallest visible rods were 0.95 mm in diameter on the NanoSPECT and 0.85 mm in diameter on the U-SPECT+. The image quality in mice was visually adequate. Uptake was seen in the kidneys with excretion to the bladder, and in the liver, blood, and intestine. No uptake was seen in the brain. The Spearman correlation between SPECT and gamma counter was 0.92, between SPECT and GF-AAS it was 0.84, and between GF-AAS and gamma counter it was0.97 (all p < 0.0001). CONCLUSION Preclinical 195mPt SPECT is feasible with acceptable tracer doses and acquisition times, and provides good image quality and accurate signal quantification.
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Affiliation(s)
- E A Aalbersberg
- Department of Nuclear Medicine, The Netherlands Cancer Institute (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - B J de Wit-van der Veen
- Department of Nuclear Medicine, The Netherlands Cancer Institute (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - O Zwaagstra
- Nuclear Research and Consultancy Group (NRG), Petten, The Netherlands
| | | | - E Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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KleinJan GH, van den Berg NS, de Jong J, Wit EM, Thygessen H, Vegt E, van der Poel HG, van Leeuwen FWB. Multimodal hybrid imaging agents for sentinel node mapping as a means to (re)connect nuclear medicine to advances made in robot-assisted surgery. Eur J Nucl Med Mol Imaging 2016; 43:1278-87. [PMID: 26768422 PMCID: PMC4865539 DOI: 10.1007/s00259-015-3292-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/10/2015] [Indexed: 12/14/2022]
Abstract
Purpose Radical prostatectomy and complementary extended pelvic lymph node dissection (ePLND) of sentinel lymph nodes (SNs) and non-sentinel lymph nodes (LNs) at risk of containing metastases are increasingly being performed using high-tech robot-assisted approaches. Although this technological evolution has clear advantages, the physical nature of robotic systems limits the integrated use of routine radioguided surgery technologies. Hence, engineering effort in robotics are focused on the integration of fluorescence guidance technologies. Using the hybrid SN tracer indocyanine green-99mTc-nanocolloid (radioactive and fluorescent), for the first time in combination with a robot-integrated laparoscope, we investigated whether the robot-assisted approach affects the accuracy of fluorescence detection of SNs identified preoperatively using nuclear medicine. Methods The study included 55 patients (Briganti nomogram-based risk >5 % on LN metastases) scheduled for robot-assisted radical prostatectomy, SN biopsy and ePLND. Following indocyanine green-99mTc-nanocolloid injection, preoperative nuclear imaging (lymphoscintigraphy and SPECT/CT) was used to locate the SN(s). The fluorescence laparoscope was used intraoperatively to identify the SN(s) with standard fluorescence settings (in 50 patients) and with customized settings (in 5 patients). The number and location of the SNs, the radioactive, fluorescence (both in vivo and ex vivo) and tumour status of the resected SNs/LNs, and postoperative complications were recorded and analysed. Results Combined, preoperative lymphoscintigraphy and SPECT/CT imaging identified 212 SNs (median 4 per patient). Intraoperative fluorescence imaging using standard fluorescence settings visualized 80.4 % (148/184 SNs; 50 patients; ex vivo 97.8 %). This increased to 85.7 % (12/14 SNs; 5 patients; ex vivo 100 %) with customized fluorescence settings. SPECT/CT images provided guidance towards the residual SNs. Ex vivo all removed SNs were radioactive. SNs were tumour-positive in 25.4 % of patients (14/55; false-negative rate 7 %, 1/14 patients). In ten patients, the SN was the only tumour-positive LN. Surgical complications were minimal. Conclusion Directly linking 3D preoperative nuclear imaging information on SNs to a robot-integrated fluorescence laparoscope improved the surgeon’s use of the technology and did not influence the sensitivity or morbidity of the procedure. To our surprise, however, the detection rates with the current fluorescence camera did not improve.
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Affiliation(s)
- Gijs H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, 2300RC, Leiden, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, 2300RC, Leiden, The Netherlands.,Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Esther M Wit
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Helene Thygessen
- Department of Biostatistics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, 2300RC, Leiden, The Netherlands. .,Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. .,Department of Head and Neck Surgery & Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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Reesink DJ, Fransen van de Putte EE, Vegt E, De Jong J, van Werkhoven E, Mertens LS, Bex A, van der Poel HG, van Rhijn BWG, Horenblas S, Meijer RP. Clinical Relevance of Incidental Prostatic Lesions on FDG-Positron Emission Tomography/Computerized Tomography-Should Patients Receive Further Evaluation? J Urol 2015; 195:907-12. [PMID: 26598424 DOI: 10.1016/j.juro.2015.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Accepted: 11/07/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE FDG ((18)F-fluoro-2-deoxy-D-glucose)-PET/CT (positron emission tomography)/(computerized tomography) is a widely used diagnostic tool for whole body imaging. Incidental prostatic uptake is often found on FDG-PET/CT. The objective of this study was to determine the clinical relevance of incidental prostatic uptake on FDG-PET/CT. MATERIALS AND METHODS We analyzed 108 consecutive male patients with bladder cancer who underwent FDG-PET/CT and subsequently radical cystoprostatectomy between May 2009 and November 2014. PET/CT scans were blindly reviewed by a dedicated nuclear medicine physician for incidental prostatic FDG uptake. If present, the maximum standardized uptake value was determined. Subsequently incidental prostatic uptake was categorized as suspect, indeterminate or nonsuspect for prostate cancer. RESULTS Incidental prostatic uptake was present in 43 of 108 patients (40%). Of these 43 patients 13 (30%) had occult prostate cancer in cystoprostatectomy specimens. Overall prostate cancer was found in 25 of 108 specimens (23%). If all incidental prostatic uptake was regarded as prostate cancer, the sensitivity and specificity of FDG-PET/CT for prostate cancer detection were 52% and 64%, respectively. Positive and negative predictive values were 30% and 82%, respectively. If only lesions labeled suspect or indeterminate were regarded as prostate cancer, sensitivity, specificity, and positive and negative predictive values were 32%, 76%, 29% and 79%, respectively. Categorizing indeterminate lesions as nonprostate cancer did not improve diagnostic accuracy. Gleason score did not correlate with maximum standardized uptake value or serum prostate specific antigen. CONCLUSIONS Incidental prostatic uptake on FDG-PET/CT has a low positive predictive value for prostate cancer. An attempt to classify lesions as suspect or nonsuspect did not increase diagnostic accuracy. Based on these results physicians should be cautious about applying invasive diagnostic methods to detect prostate cancer in case of incidental prostatic uptake on FDG-PET/CT.
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Affiliation(s)
- Daan J Reesink
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Erik Vegt
- Department of Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen De Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Medical Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Djajadiningrat RS, Bergman AM, van Werkhoven E, Vegt E, Horenblas S. Neoadjuvant Taxane-Based Combination Chemotherapy in Patients With Advanced Penile Cancer. Clin Genitourin Cancer 2015; 13:44-9. [DOI: 10.1016/j.clgc.2014.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 12/26/2022]
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Vogel WV, Lam MGEH, Vegt E, Prompers L, Roef MJ. [The quality of patient information brochures can be improved: a discussion using radium-223 therapy as an example]. Ned Tijdschr Geneeskd 2015; 159:A8948. [PMID: 26288138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients and their peers need to be adequately informed to ensure proper treatment selection, and to facilitate optimal realisation and outcome of treatment. Written patient information can contribute, but only when brochures are of sufficient quality. An evaluation of patient brochures for radium-223 therapy in the Netherlands revealed significant differences in the information provided, as well as discrepancies between the brochures and national guidelines and product documentation. This potentially leads to confusion, false expectations, wrong treatment decisions, suboptimal realisation and outcome of treatment, and unnecessary toxicity and in radiation hygiene risks. Here we discuss the option of national patient information brochures that can be used by all centres in order to circumvent such issues. This would require collaboration between all medical professions, patient organisations and other groups involved, and responsibilities for medical information, distribution and updates must be properly defined. A national patient information brochure of this kind is currently under development for radium-223 therapy.
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Affiliation(s)
- Wouter V Vogel
- Antoni van Leeuwenhoek, afd. Nucleaire Geneeskunde, Amsterdam
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Chícharo de Freitas J, KleinJan G, van der Poel H, van den Berg N, Vegt E, Stokkel M, Valdés Olmos R. Utility of SPECT/CT scan for anatomical localization of pararectal and presacral sentinel nodes in prostate cancer. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mertens LS, Mir MC, Scott AM, Lee ST, Fioole-Bruining A, Vegt E, Vogel WV, Manecksha R, Bolton D, Davis ID, Horenblas S, van Rhijn BWG, Lawrentschuk N. 18F-fluorodeoxyglucose--positron emission tomography/computed tomography aids staging and predicts mortality in patients with muscle-invasive bladder cancer. Urology 2014; 83:393-8. [PMID: 24468513 DOI: 10.1016/j.urology.2013.10.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/23/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the association between extravesical (18)F-fluorodeoxyglucose (FDG) avid lesions on FDG-positron emission tomography/computed tomography (PET/CT) and mortality in patients with muscle-invasive bladder cancer. METHODS An international, bi-institutional cohort study of 211 patients with muscle-invasive bladder cancer who underwent staging CT and FDG-PET/CT imaging. On the basis of the presence of extravesical FDG-avid lesions suspicious for malignancy on PET/CT images, patients were divided into a PET/CT-positive and PET/CT-negative group. Data on staging and mortality were retrospectively analyzed from prospective databases. Kaplan-Meier analyses were performed to compare overall (OS) and disease-specific survival (DSS) between the groups. Multivariable Cox regression models were used to investigate the association between extravesical PET/CT lesions and mortality. Extravesical lesions suspicious for malignancy on conventional CT were included in the models. RESULTS Of the 211 patients, 98 (46.4%) had 1 or more extravesical lesions on PET/CT, 113 (53.5%) had a negative PET/CT. Conventional CT revealed extravesical lesions in 51 patients (24.4%). Median follow-up was 18 months. Patients with a positive PET/CT had a significantly shorter OS and DSS (median OS: 14 vs 50 months, P = .001; DSS: 16 vs 50 months, P <.001). In multivariable analysis, the presence of extravesical lesions on PET/CT was an independent prognostic indicator of mortality (OS: hazard ratio = 3.0, confidence interval 95% 1.7-5.1). This association was not statistically significant for conventional CT (hazard ratio = 1.6 (95% confidence interval 0.9-2.7). CONCLUSION On the basis of our results, the presence of extravesical FDG-avid lesions on PET/CT might be considered an independent indicator of mortality.
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Affiliation(s)
- Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - M Carmen Mir
- Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
| | - Andrew M Scott
- Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
| | - Sze Ting Lee
- Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
| | | | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rustom Manecksha
- Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
| | - Damien Bolton
- Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
| | | | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nathan Lawrentschuk
- Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia
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Mathéron H, van den Berg N, Brouwer O, KleinJan G, van Driel W, Trum J, Vegt E, Kenter G, van Leeuwen F, Valdés Olmos R. Multimodal surgical guidance towards the sentinel node in vulvar cancer. Gynecol Oncol 2013; 131:720-5. [DOI: 10.1016/j.ygyno.2013.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/31/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
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Verspoor FGM, van der Geest ICM, Vegt E, Veth RPH, van der Graaf WT, Schreuder HWB. Pigmented villonodular synovitis: current concepts about diagnosis and management. Future Oncol 2013; 9:1515-31. [DOI: 10.2217/fon.13.124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
At present, the treatment strategies in patients with localized and diffuse forms of pigmented villonodular synovitis have more or less been standardized. However, these strategies are not optimal because high recurrence rates persist and studies with a sufficient level of evidence are lacking. This systematic review article describes all known treatment options for intra-articular pigmented villonodular synovitis and their clinical results. Based on this research, we provide guidelines to support physicians in making the optimal treatment decisions. Given the rarity of the disease, randomized studies are not to be expected, but an international registry through existing networks would offer the benefit of getting a better insight into the outcome of this disease. Therefore, we propose a basic set of data to be investigated and ideally to be reported on in such a registry.
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Affiliation(s)
- Floortje GM Verspoor
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ingrid CM van der Geest
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rene PH Veth
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - HW Bart Schreuder
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S. Detecting primary bladder cancer using delayed (18)F-2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography imaging after forced diuresis. Indian J Nucl Med 2013; 27:145-50. [PMID: 23919066 PMCID: PMC3728734 DOI: 10.4103/0972-3919.112718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of delayed pelvic (18)F-2-fluoro-2-deoxy-D-glucose-positron emission tomography combined with the computed tomography (FDG-PET/CT) imaging, according to a standardized protocol including, pre-hydration and forced diuresis, for the detection of primary bladder cancer. MATERIALS AND METHODS We evaluated 38 consecutive patients with primary cT1-4 bladder cancer. They underwent standard FDG-PET/CT followed by delayed pelvic imaging after administration of 20 mg furosemide intravenously and extra oral water intake of 0.5 L. Two observers, blinded for patient data, scored both image sets for tumor visibility using a 3-point ordinal scale: (1) negative; (2) indeterminate; (3) positive. FDG-PET/CT findings were compared with histopathology and/or follow-up imaging. RESULTS The procedure was completed successfully in 37/38 patients and the reference standard revealed a bladder tumor in 26/37 patients. Delayed PET/CT images showed reduction of urinary bladder activity to (near) background levels in 17 of 37 cases (45.9%). Standard PET/CT detected hyper-metabolic bladder lesions in 15/37 patients (40.5%) of which 8 were indeterminate. Delayed FDG-PET/CT showed hyper-metabolic bladder lesions in 30/37 (81.1%) patients, of which 5 were indeterminate. When indeterminate lesions were considered positive, the sensitivity of standard and delayed PET/CT was 46% versus 88%, respectively. The specificity was 72% versus 36%. When indeterminate lesions were considered negative, the sensitivity of standard and delayed PET/CT was 23% and 85%. The specificity was 93% versus 73%. CONCLUSIONS Our data suggest that delayed pelvic FDG-PET/CT imaging after forced detects more primary bladder tumors than standard FDG-PET/CT protocols. However, indeterminate bladder lesions on delayed PET/CT remain a problem and should be interpreted cautiously in order to avoid false positive results.
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Affiliation(s)
- Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S. Impact of18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle. BJU Int 2013; 112:729-34. [DOI: 10.1111/bju.12109] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Laura S. Mertens
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
| | - Annemarie Fioole-Bruining
- Department of Radiology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
| | - Wouter V. Vogel
- Department of Nuclear Medicine; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
| | - Bas W. van Rhijn
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
| | - Simon Horenblas
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam; The Netherlands
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Mertens LS, Fioole-Bruining A, van Rhijn BWG, Kerst JM, Bergman AM, Vogel WV, Vegt E, Horenblas S. FDG-positron emission tomography/computerized tomography for monitoring the response of pelvic lymph node metastasis to neoadjuvant chemotherapy for bladder cancer. J Urol 2012; 189:1687-91. [PMID: 23142689 DOI: 10.1016/j.juro.2012.11.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE We evaluated FDG-positron emission tomography/computerized tomography for monitoring the response of pelvic lymph node metastasis to neoadjuvant chemotherapy for bladder cancer. We compared this to contrast enhanced computerized tomography. MATERIALS AND METHODS Included in study were 19 consecutive patients with lymph node positive bladder cancer who underwent FDG-positron emission tomography/computerized tomography and contrast enhanced computerized tomography before and after a median of 4 cycles (range 2 to 4) of neoadjuvant chemotherapy between September 2011 and April 2012. Metabolic response was assessed according to EORTC (European Organisation for Research and Treatment of Cancer) recommendations based on the change in FDG uptake on FDG-positron emission tomography/computerized tomography. Radiological response was assessed on contrast enhanced computerized tomography according to RECIST (Response Evaluation Criteria in Solid Tumors) 1.1. All patients underwent pelvic lymph node dissection. Histopathological evaluation served as the gold standard for the nodal response. RESULTS Before neoadjuvant chemotherapy, hypermetabolic FDG uptake was seen in all 19 patients, which matched the lymph node metastasis. Evaluating the nodal response with positron emission tomography/computerized tomography was feasible in all patients. On histopathology 16 patients were responders, including 14 with a complete pathological response of the lymph nodes. Positron emission tomography/computerized tomography and contrast enhanced computerized tomography correctly distinguished responders from nonresponders (18 of 19 patients or 94.7% and 15 of 19 or 78.9%) and complete responders from patients with residual disease (13 of 19 or 68.4% and 12 of 19 or 63.2%, respectively). CONCLUSIONS Although no definitive conclusions can be drawn from these preliminary data, positron emission tomography/computerized tomography appears feasible for evaluating the nodal response to neoadjuvant chemotherapy and distinguishing responders from nonresponders.
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Affiliation(s)
- Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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van Loon J, Offermann C, Ollers M, van Elmpt W, Vegt E, Rahmy A, Dingemans AMC, Lambin P, De Ruysscher D. Early CT and FDG-metabolic tumour volume changes show a significant correlation with survival in stage I-III small cell lung cancer: a hypothesis generating study. Radiother Oncol 2011; 99:172-5. [PMID: 21571382 DOI: 10.1016/j.radonc.2011.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 03/07/2011] [Accepted: 03/27/2011] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many patients with stage I-III small cell lung cancer (SCLC) experience disease progression short after the completion of concurrent chemoradiotherapy (CRT). The purpose of the current study was to evaluate whether CT or FDG metabolic response early after the start of chemotherapy, but before the beginning of chest RT, is predictive for survival in SCLC. METHODS Fifteen stage I-III SCLC patients treated with concurrent CRT with an FDG-PET and CT scan available before the start of chemotherapy and after or during the first cycle of chemotherapy, but before the start of radiotherapy, were selected. The metabolic volume (MV) was defined both within the primary tumour and in the involved nodal stations using the 40% (MV40) and 50% (MV50) threshold of the maximum SUV. Metabolic and CT response was assessed by the relative change in MV and CT volume, respectively, between both time points. The association between response and overall survival (OS) was analysed by univariate cox regression analysis. The minimum follow-up was 18 months. RESULTS Reductions in MV40 and MV50 were -36±38% (126.4 to 68.7cm(3)) and -44±38% (90.2 to 27.8cm(3)), respectively. The median CT volume reduction was -40±64% (190.6 to 113.8cm(3)). MV40 and MV50 changes showed a significant association with survival (HR=1.02, 95% CI: 1.00-1.04 (p=0.042); HR=1.02, 95% CI: 1.00-1.04 (p=0.048), respectively), indicating a 2% increase in survival probability for 1% reduction in metabolic volume. The CT volume change was also significantly correlated with survival (HR=1.01, 95% CI: 1.00-1.03, p=0.007). CONCLUSIONS This hypothesis generating study shows that both the early CT and the MV changes show a significant correlation with survival in SCLC. A prospective study is planned in a larger patient cohort to allow multivariate analysis, with the final aim to select patients early during treatment that could benefit from dose intensification or alternative treatment.
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Affiliation(s)
- Judith van Loon
- Department of Radiation Oncology, Maastricht University Medical Centre, The Netherlands.
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Vegt E, Melis M, Eek A, de Visser M, Brom M, Oyen WJG, Gotthardt M, de Jong M, Boerman OC. Renal uptake of different radiolabelled peptides is mediated by megalin: SPECT and biodistribution studies in megalin-deficient mice. Eur J Nucl Med Mol Imaging 2010; 38:623-32. [PMID: 21170526 PMCID: PMC3053449 DOI: 10.1007/s00259-010-1685-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/15/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Radiolabelled peptides used for peptide receptor radionuclide therapy are excreted mainly via the kidneys and are partly reabsorbed and retained in the proximal tubular cells. The resulting high renal radiation dose can cause nephrotoxicity, limiting the maximum activity dose and the effectiveness of peptide receptor radionuclide therapy. The mechanisms of kidney reabsorption of these peptides are incompletely understood, but the scavenger receptor megalin has been shown to play a role in the reabsorption of (111)In-octreotide. In this study, the role of megalin in the renal reabsorption of various relevant radiolabelled peptides was investigated. METHODS Groups of kidney-specific megalin-deficient mice and wild-type mice were injected with (111)In-labelled somatostatin, exendin, neurotensin or minigastrin analogues. Single photon emission computed tomographic (SPECT) images of the kidneys were acquired and analysed quantitatively, or the animals were killed 3 h after injection and the activity concentration in the kidneys was measured. RESULTS Megalin-deficient mice showed significantly lower uptake of all studied radiolabelled peptides in the kidneys, ranging from 22% ((111)In-octreotide) to 65% ((111)In-exendin) of uptake in wild-type kidneys. Quantitative analysis of renal uptake by SPECT and ex vivo measurements showed a very good correlation. CONCLUSION Megalin is involved in the renal reabsorption of radiolabelled octreotide, octreotate, exendin, neurotensin and minigastrin. This knowledge may help in the design of strategies to reduce this reabsorption and the resulting nephrotoxicity in peptide receptor radionuclide therapy, enabling more effective therapy. Small-animal SPECT is an accurate tool, allowing in vivo quantification of renal uptake and serial measurements in individual mice.
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Affiliation(s)
- Erik Vegt
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Petit S, van Elmpt W, Oberije C, Vegt E, Dingemans A, Lambin P, Dekker A, De Ruysscher D. 18F-Fluorodeoxyglucose Uptake Patterns in the Lung before Radiotherapy Identify Areas that are More Susceptible to Radiation-induced Lung Toxicity in Non-small Cell Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vegt E, de Jong M, Wetzels JF, Masereeuw R, Melis M, Oyen WJ, Gotthardt M, Boerman OC. Renal Toxicity of Radiolabeled Peptides and Antibody Fragments: Mechanisms, Impact on Radionuclide Therapy, and Strategies for Prevention. J Nucl Med 2010; 51:1049-58. [DOI: 10.2967/jnumed.110.075101] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Melis M, Vegt E, Konijnenberg MW, de Visser M, Bijster M, Vermeij M, Krenning EP, Boerman OC, de Jong M. Nephrotoxicity in mice after repeated imaging using 111In-labeled peptides. J Nucl Med 2010; 51:973-7. [PMID: 20484435 DOI: 10.2967/jnumed.109.074310] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We determined the renal radiation dose of a series of (111)In-labeled peptides using animal SPECT. Because the animals' health deteriorated, renal toxicity was assessed. METHODS Wild-type and megalin-deficient mice were imaged repeatedly at 3- to 6-wk intervals to quantify renal retention after injection of 40-50 MBq of (111)In-diethylenetriaminepentaacetic acid-labeled peptides (octreotide, exendin, octreotate, neurotensin, and minigastrin analogs), and the absorbed kidney radiation doses were estimated. Body weight, renal function parameters, and renal histology were determined at 16-20 wk after the first scan and compared with those in naive animals. RESULTS Because of high renal retention, (111)In-diethylenetriaminepentaacetic acid-exendin-4 scans resulted in a 70-Gy kidney radiation dose in wild-type mice. Megalin-deficient kidneys received 20-40 Gy. The other peptides resulted in much lower renal doses. Kidney function monitoring indicated renal damage in imaged animals. CONCLUSION Micro-SPECT enables longitudinal studies in 1 animal. However, long-term nephrotoxic effects may be induced after high renal radiation doses, even with (111)In-labeled radiotracers.
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Affiliation(s)
- Marleen Melis
- Department of Nuclear Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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Vegt E, Eek A, Oyen WJG, de Jong M, Gotthardt M, Boerman OC. Albumin-derived peptides efficiently reduce renal uptake of radiolabelled peptides. Eur J Nucl Med Mol Imaging 2009; 37:226-34. [PMID: 19722105 PMCID: PMC2816240 DOI: 10.1007/s00259-009-1239-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 07/13/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE In peptide-receptor radionuclide therapy (PRRT), the maximum activity dose that can safely be administered is limited by high renal uptake and retention of radiolabelled peptides. The kidney radiation dose can be reduced by coinfusion of agents that competitively inhibit the reabsorption of radiolabelled peptides, such as positively charged amino acids, Gelofusine, or trypsinised albumin. The aim of this study was to identify more specific and potent inhibitors of the kidney reabsorption of radiolabelled peptides, based on albumin. METHODS Albumin was fragmented using cyanogen bromide and six albumin-derived peptides with different numbers of electric charges were selected and synthesised. The effect of albumin fragments (FRALB-C) and selected albumin-derived peptides on the internalisation of (111)In-albumin, (111)In-minigastrin, (111)In-exendin and (111)In-octreotide by megalin-expressing cells was assessed. In rats, the effect of Gelofusine and albumin-derived peptides on the renal uptake and biodistribution of (111)In-minigastrin, (111)In-exendin and (111)In-octreotide was determined. RESULTS FRALB-C significantly reduced the uptake of all radiolabelled peptides in vitro. The albumin-derived peptides showed different potencies in reducing the uptake of (111)In-albumin, (111)In-exendin and (111)In-minigastrin in vitro. The most efficient albumin-derived peptide (peptide #6), was selected for in vivo testing. In rats, 5 mg of peptide #6 very efficiently inhibited the renal uptake of (111)In-minigastrin, by 88%. Uptake of (111)In-exendin and (111)In-octreotide was reduced by 26 and 33%, respectively. CONCLUSIONS The albumin-derived peptide #6 efficiently inhibited the renal reabsorption of (111)In-minigastrin, (111)In-exendin and (111)In-octreotide and is a promising candidate for kidney protection in PRRT.
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Affiliation(s)
- Erik Vegt
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Vegt E, van Eerd JEM, Eek A, Oyen WJG, Wetzels JFM, de Jong M, Russel FGM, Masereeuw R, Gotthardt M, Boerman OC. Reducing renal uptake of radiolabeled peptides using albumin fragments. J Nucl Med 2008; 49:1506-11. [PMID: 18703613 DOI: 10.2967/jnumed.108.053249] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED In most types of peptide receptor radionuclide therapy, the maximum activity dose that can be administered is limited by high and persistent renal retention of the radiolabeled peptides, which is, at least partly, mediated by the megalin receptor. Several agents that interfere with renal reabsorption of radiolabeled peptides have been identified (e.g., lysine, arginine, succinylated gelatin solution), but none of these inhibit renal reabsorption completely. Albumin, a naturally abundant megalin ligand, might be a safe and potent alternative. In this study, we analyzed the effects of albumin and fragments of albumin (FRALB) on the renal reabsorption of (111)In-diethylenetriaminepentaacetic acid (DTPA)-d-Phe(1)-octreotide ((111)In-octreotide), [Lys(40)(aminohexoic acid-DTPA-(111)In)NH(2)]-exendin-4 ((111)In-exendin), and (111)In-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-Glu(1)-minigastrin ((111)In-minigastrin). METHODS The effects of albumin and FRALB on megalin-associated binding of (111)In-octreotide, (111)In-exendin, and (111)In-minigastrin were assessed in vitro using rat yolk sac epithelial (BN16) cells. In vivo, uptake and localization of (111)In-albumin and (111)In-FRALB in the kidneys of Wistar rats were determined, as well as the effect of lysine, succinylated gelatin solution, albumin, and FRALB on the kidney uptake of (111)In-octreotide, (111)In-exendin, and (111)In-minigastrin. RESULTS FRALB significantly reduced binding and uptake of (111)In-octreotide, (111)In-exendin, and (111)In-minigastrin by BN16 cells. In rats, renal uptake of (111)In-labeled FRALB was significantly higher than that of (111)In-labeled intact albumin (P<0.001). FRALB administration effectively reduced renal uptake of (111)In-octreotide, (111)In-exendin, and (111)In-minigastrin. Administration of 1-2 mg of FRALB reduced renal uptake of (111)In-octreotide as efficiently as 80 mg of lysine. CONCLUSION Renal uptake of (111)In-octreotide and other radiolabeled peptides in rats can be effectively reduced by administration of albumin fragments. Additional studies to identify the albumin fragments responsible for inhibition of renal peptide uptake are warranted.
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Affiliation(s)
- Erik Vegt
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Vegt E, Wetzels JFM, Russel FGM, Masereeuw R, Boerman OC, van Eerd JE, Corstens FHM, Oyen WJG. Renal uptake of radiolabeled octreotide in human subjects is efficiently inhibited by succinylated gelatin. J Nucl Med 2006; 47:432-6. [PMID: 16513612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
UNLABELLED Peptide receptor-mediated radiotherapy of neuroendocrine and other somatostatin receptor-positive tumors with radiolabeled somatostatin analogs has been applied in several experimental settings. The kidneys are the organs responsible for dose-limiting toxicity attributable to the retention of radiolabeled octreotide in the renal cortex, leading to a relatively high radiation dose that may result in irreversible loss of kidney function. The administration of basic amino acids reduces renal uptake but does have significant side effects. We observed that gelatin-based plasma expanders induced tubular low-molecular-weight proteinuria in healthy volunteers, suggesting that components in these solutions can interfere with the tubular reabsorption of proteins and peptides. Here, we studied the effects of infusion of low doses of the plasma expander succinylated gelatin (GELO) on the renal uptake of 111In-labeled octreotide (111In-OCT). METHODS Five healthy volunteers were given 111In-OCT, first in combination with normal saline and 2 wk later in combination with GELO. Scintigraphic images of the kidneys as well as blood and urine samples were analyzed. To exclude a nonspecific hemodynamic effect of the plasma expander, the procedure was repeated with 5 other volunteers who received the carbohydrate-based plasma expander hydroxyethyl starch (HES). RESULTS Low doses of GELO were able to effectively reduce the kidney retention of 111In-OCT. The renal radiation dose was significantly reduced by 45% +/- 10% (mean +/- SD) (P = 0.006), whereas HES showed no significant effect (0% +/- 12%). The infusion of GELO did not cause any side effects. CONCLUSION GELO effectively reduces the renal uptake of 111In-OCT. In contrast to currently used mixtures of amino acids, GELO does not cause any side effects.
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Affiliation(s)
- Erik Vegt
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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van Eerd JEM, Vegt E, Wetzels JFM, Russel FGM, Masereeuw R, Corstens FHM, Oyen WJG, Boerman OC. Gelatin-based plasma expander effectively reduces renal uptake of 111In-octreotide in mice and rats. J Nucl Med 2006; 47:528-33. [PMID: 16513623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
UNLABELLED 111In-Diethylenetriaminepentaacetic acid-octreotide generally is used for the scintigraphic imaging of neuroendocrine and other somatostatin receptor-positive tumors. On the basis of the successful targeting of octreotide, radiolabeled somatostatin analogs, such as 90Y-(1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid [DOTA])0-Tyr3-octreotide and 177Lu-DOTA0-Tyr3-octreotate, were developed for peptide receptor radionuclide therapy. However, the maximum tolerated doses of these analogs are limited because of the high and persistent renal uptake that leads to relatively high radiation doses in the kidneys. Renal uptake can be reduced by coinfusion of basic amino acids or polypeptides. However, high doses of basic amino acids can induce severe side effects. It was reported that the infusion of gelatin-based plasma expanders resulted in increased low-molecular-weight proteinuria, suggesting that these plasma expanders interfere with the tubular reabsorption of peptides and proteins. In the present study, we analyzed the effects of several plasma expanders on the renal uptake of 111In-octreotide in rats and mice. METHODS Wistar rats and BALB/c mice were injected with 0.5 or 0.1 mL of plasma expander, respectively. Thereafter, the animals received 111In-octreotide intravenously. Animals were killed at 20 h after the injection of the radiopharmaceutical. Organs were dissected, and the amount of radioactivity in the organs and tissues was measured. RESULTS The administration of 20 mg of Gelofusine in rats or 4 mg in mice was as effective in reducing the renal uptake of 111In-octreotide as the administration of 80 or 20 mg of lysine in rats or mice, respectively, without reducing 111In-octreotide uptake in receptor-positive organs. Plasma expanders based on starch or dextran had no effect on the renal uptake of 111In-octreotide. CONCLUSION The gelatin-based plasma expander Gelofusine significantly reduced the kidney uptake of 111In-octreotide as effectively as did lysine. Because Gelofusine is a well-known and generally used blood volume substitute that can be applied safely without the induction of toxicity, evaluation of this compound for its potential to reduce the kidney uptake of radiolabeled peptides in patients is warranted.
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Affiliation(s)
- Julliëtte E M van Eerd
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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