Monitoring tumour response during chemo-radiotherapy: a parametric method using FDG-PET/CT images in patients with oesophageal cancer View Full Text


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Article Info

DATE

2014-03-07

AUTHORS

Pierre Vera, Bernard Dubray, Odré Palie, Irène Buvat, Sébastien Hapdey, Romain Modzelewski, Ahmed Benyoucef, Caroline Rousseau, Marc-Etienne Meyer, Stéphane Bardet, Isabelle Gardin, Frederic Di Fiore, Pierre Michel

ABSTRACT

BackgroundThe objective of this study is to investigate the feasibility and the additional interest of a parametric imaging (PI) method to monitor the early tumour metabolic response in a prospective series of oesophageal cancer patients who underwent positron emission tomography with fluoro-2-deoxy-d-glucose (FDG-PET/CT) before and during curative-intent chemo-radiotherapy.MethodsFifty-seven patients with squamous cell carcinoma (SCC) of the oesophagus prospectively underwent FDG-PET/CT before chemo-radiotherapy (CRT) (PET1) and at 21 ± 3 days after the beginning of CRT (PET2). The outcome was assessed at 3 months and 1 year after the completion of CRT (clinical examination, CT scan or FDG-PET/CT, biopsy). For each patient, PET1 and PET2 were registered using CT images. The 2 PET image sets were subtracted, so the voxels with significant changes in FDG uptake were identified. A model-based analysis of this graph was used to identify the tumour voxels in which significant changes occurred between the two scans and yielded indices characterising these changes (green and red clusters). Quantitative parameters were compared with clinical outcome at 3 months and at 1 year.ResultsThe baseline tumour FDG uptake decreased significantly at PET2 (p < 0.0001). The tumour volume significantly decreased between PET1 and PET2 (p < 0.02). The initial functional volume of the lesion (TV1) was significantly lower (p < 0.02) in patients in clinical response (CR) at 3 months and 1 year. The volume of the lesion during the treatment (TV2) was significantly lower in patients identified as in CR at 3 months (p < 0.03), but did not predict the outcome at 1 year. Multivariate analyses of outcome at 3 months showed that the risk of failure/death increased with younger age (p = 0.001), larger metabolic volume on PET1 (p = 0.009) and larger volume with decreased FDG uptake (p = 0.047). As for outcome at 1 year, the risk of failure/death increased with younger age (p = 0.006), nodal involvement (p = 0.08) and larger volumes with increased uptake (p = 0.03).ConclusionA parametric method to assess tumour response on serial FDG-PET performed during chemo-radiotherapy was evaluated. Early metabolic changes, i.e. variations in FDG uptake, provided additional prognostic information in multivariate analyses ClinicalTrials.gov NCT 00934505.Trial registrationCurrent Controlled Trials ISRCTN7824458 More... »

PAGES

12

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/2191-219x-4-12

DOI

http://dx.doi.org/10.1186/2191-219x-4-12

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050140418

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24602385


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13 schema:description BackgroundThe objective of this study is to investigate the feasibility and the additional interest of a parametric imaging (PI) method to monitor the early tumour metabolic response in a prospective series of oesophageal cancer patients who underwent positron emission tomography with fluoro-2-deoxy-d-glucose (FDG-PET/CT) before and during curative-intent chemo-radiotherapy.MethodsFifty-seven patients with squamous cell carcinoma (SCC) of the oesophagus prospectively underwent FDG-PET/CT before chemo-radiotherapy (CRT) (PET1) and at 21 ± 3 days after the beginning of CRT (PET2). The outcome was assessed at 3 months and 1 year after the completion of CRT (clinical examination, CT scan or FDG-PET/CT, biopsy). For each patient, PET1 and PET2 were registered using CT images. The 2 PET image sets were subtracted, so the voxels with significant changes in FDG uptake were identified. A model-based analysis of this graph was used to identify the tumour voxels in which significant changes occurred between the two scans and yielded indices characterising these changes (green and red clusters). Quantitative parameters were compared with clinical outcome at 3 months and at 1 year.ResultsThe baseline tumour FDG uptake decreased significantly at PET2 (p < 0.0001). The tumour volume significantly decreased between PET1 and PET2 (p < 0.02). The initial functional volume of the lesion (TV1) was significantly lower (p < 0.02) in patients in clinical response (CR) at 3 months and 1 year. The volume of the lesion during the treatment (TV2) was significantly lower in patients identified as in CR at 3 months (p < 0.03), but did not predict the outcome at 1 year. Multivariate analyses of outcome at 3 months showed that the risk of failure/death increased with younger age (p = 0.001), larger metabolic volume on PET1 (p = 0.009) and larger volume with decreased FDG uptake (p = 0.047). As for outcome at 1 year, the risk of failure/death increased with younger age (p = 0.006), nodal involvement (p = 0.08) and larger volumes with increased uptake (p = 0.03).ConclusionA parametric method to assess tumour response on serial FDG-PET performed during chemo-radiotherapy was evaluated. Early metabolic changes, i.e. variations in FDG uptake, provided additional prognostic information in multivariate analyses ClinicalTrials.gov NCT 00934505.Trial registrationCurrent Controlled Trials ISRCTN7824458
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19 schema:keywords BackgroundThe objective
20 CRT
21 CT
22 CT images
23 Controlled Trials
24 D-glucose
25 FDG PET/CT
26 FDG PET/CT images
27 FDG uptake
28 FDG-PET
29 MethodsFifty-seven patients
30 PET image sets
31 PET1
32 PET2
33 additional interest
34 additional prognostic information
35 age
36 analysis
37 beginning
38 cancer
39 cancer patients
40 carcinoma
41 cell carcinoma
42 changes
43 clinical outcomes
44 clinical response
45 completion
46 completion of CRT
47 days
48 death
49 early metabolic changes
50 emission tomography
51 esophagus
52 failure/death
53 feasibility
54 functional volume
55 graph
56 image sets
57 images
58 imaging method
59 index
60 information
61 interest
62 involvement
63 large volumes
64 lesions
65 metabolic changes
66 metabolic response
67 metabolic volume
68 method
69 model-based analysis
70 months
71 multivariate analysis
72 nodal involvement
73 objective
74 oesophageal cancer
75 oesophageal cancer patients
76 outcomes
77 parameters
78 parametric imaging method
79 parametric methods
80 patients
81 positron emission tomography
82 prognostic information
83 prospective series
84 quantitative parameters
85 response
86 risk
87 scans
88 serial FDG-PET
89 series
90 set
91 significant changes
92 squamous cell carcinoma
93 study
94 tomography
95 treatment
96 trials
97 tumor FDG uptake
98 tumor metabolic response
99 tumor response
100 tumor volume
101 tumor voxels
102 uptake
103 variation
104 volume
105 voxels
106 years
107 younger age
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