Publications by authors named "R J D Prestwich"

105 Publications

Radiotherapy for Oropharyngeal Carcinoma With an Uninvolved Contralateral Neck: The Safety of Omission of Contralateral High Level II and Retropharyngeal Lymph Nodes From Elective Target Volumes.

Clin Oncol (R Coll Radiol) 2021 May 23;33(5):331-339. Epub 2020 Dec 23.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aims: To analyse outcomes and patterns of failure in patients with oropharyngeal carcinoma (OPC) treated with definitive volumetric modulated arc therapy with omission of contralateral high level II lymph nodes (HLII) and retropharyngeal lymph nodes (RPLN) in the contralateral uninvolved neck.

Materials And Methods: Patients with OPC treated between January 2016 and July 2019 were retrospectively identified. In the absence of contralateral neck disease, institutional protocols allowed omission of contralateral HLII and contralateral RPLN in the additional absence of ipsilateral RPLN, soft palate/posterior pharyngeal wall primary.

Results: In total, 238 patients with OPC and an uninvolved contralateral neck received definitive (chemo)radiotherapy with bilateral neck treatment. The median follow-up was 30.6 months. Two-year local control, regional control and overall survival were 91.0, 91.6 and 86.5%, respectively. Contralateral HLII were omitted in 159/238 (66.8%) patients; this included 106 patients in whom the primary tumour was at/crossed the midline. The contralateral RPLN region was omitted from elective target volumes for 175/238 (73.5%); this included 114 patients with a primary tumour at/crossed the midline. The mean contralateral parotid dose when contralateral HLII and RPLN were both omitted was 24.4 Gy, compared with 28.3 Gy without HLII/RPLN omission (P < 0.001). Regional progression occurred in 18/238 (7.6%) patients, all involving the ipsilateral neck with one bilateral. There were no recurrences in the contralateral HLII or RPLN regions.

Conclusion: In patients with OPC and an uninvolved contralateral neck receiving bilateral (chemo)radiotherapy, the omission of contralateral RPLN and HLII from elective target volumes was safe and could lead to reduced contralateral parotid doses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2020.12.007DOI Listing
May 2021

Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice.

Front Oncol 2020 12;10:579917. Epub 2020 Nov 12.

Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom.

Purpose And Objective: A proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require treatment re-planning. The aim of this retrospective study is to analyze the patients who required re-planning and to identify factors, which may predict need for re-planning.

Materials And Methods: A single center evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January and December 2016 was undertaken. Patients who underwent re-planning during the treatment were identified in electronic records. Reasons for re-planning were categorized as: weight loss, tumor shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumor site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated.

Results: 31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy required re-planning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for re-planning were tumor shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumor/treatment factors, nasopharyngeal primary site (p = 0.013) and use of concurrent chemotherapy with radiotherapy (p = 0.034) were found to be significantly correlated with the need for re-planning.

Conclusion: Effective on-treatment verification schedules and close follow up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualized triggered approach to ART rather than scheduled strategies as it is likely to be more feasible in terms of utilization of workload and resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2020.579917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690320PMC
November 2020

Machine learning-based FDG PET-CT radiomics for outcome prediction in larynx and hypopharynx squamous cell carcinoma.

Clin Radiol 2021 Jan 6;76(1):78.e9-78.e17. Epub 2020 Oct 6.

Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research, Faculty of Medicine & Health, University of Leeds, Leeds, UK.

Aim: To determine whether machine learning-based radiomic feature analysis of baseline integrated 2-[F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) computed tomography (CT) predicts disease progression in patients with locally advanced larynx and hypopharynx squamous cell carcinoma (SCC) receiving (chemo)radiotherapy.

Materials And Methods: Patients with larynx and hypopharynx SCC treated with definitive (chemo)radiotherapy at a specialist cancer centre undergoing pre-treatment PET-CT between 2008 and 2017 were included. Tumour segmentation and radiomic analysis was performed using LIFEx software (University of Paris-Saclay, France). Data were assigned into training (80%) and validation (20%) cohorts adhering to TRIPOD guidelines. A random forest classifier was created for four predictive models using features determined by recursive feature elimination: (A) PET, (B) CT, (C) clinical, and (D) combined PET-CT parameters. Model performance was assessed using area under the curve (AUC) receiver operating characteristic (ROC) analysis.

Results: Seventy-two patients (40 hypopharynx 32 larynx tumours) were included, mean age 61 (range 41-77) years, 50 (69%) were men. Forty-five (62.5%) had chemoradiotherapy, 27 (37.5%) had radiotherapy alone. Median follow-up 26 months (range 12-105 months). Twenty-seven (37.5%) patients progressed within 12 months. ROC AUC for models A, B, C, and D were 0.91, 0.94, 0.88, and 0.93 in training and 0.82, 0.72, 0.70, and 0.94 in validation cohorts. Parameters in model D were metabolic tumour volume (MTV), maximum CT value, minimum standardized uptake value (SUVmin), grey-level zone length matrix (GLZLM) small-zone low grey-level emphasis (SZLGE) and histogram kurtosis.

Conclusion: FDG PET-CT derived radiomic features are potential predictors of early disease progression in patients with locally advanced larynx and hypopharynx SCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.crad.2020.08.030DOI Listing
January 2021

The Role of Adjuvant Radiotherapy to the Ipsilateral or Bilateral Neck for pN0 Oral Cavity Squamous Cell Carcinoma.

Authors:
R J D Prestwich

Clin Oncol (R Coll Radiol) 2020 Oct 8;32(10):e212. Epub 2020 Jul 8.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2020.05.009DOI Listing
October 2020

Post-treatment FDG PET-CT in head and neck carcinoma: comparative analysis of 4 qualitative interpretative criteria in a large patient cohort.

Sci Rep 2020 03 5;10(1):4086. Epub 2020 Mar 5.

Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

There is no consensus regarding optimal interpretative criteria (IC) for Fluorine-18 fluorodeoxyglucose (FDG) Positron Emission Tomography - Computed Tomography (PET-CT) response assessment following (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). The aim was to compare accuracy of IC (NI-RADS, Porceddu, Hopkins, Deauville) for predicting loco-regional control and progression free survival (PFS). All patients with histologically confirmed HNSCC treated at a specialist cancer centre with curative-intent non-surgical treatment who underwent baseline and response assessment FDG PET-CT between August 2008 and May 2017 were included. Metabolic response was assessed using 4 different IC harmonised into 4-point scales (complete response, indeterminate, partial response, progressive disease). IC performance metrics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy) were compared. Kaplan-Meier and Cox proportional hazards regression analyses were performed for survival analysis. 562 patients were included (397 oropharynx, 53 hypopharynx, 48 larynx, 64 other/unknown primary). 420 patients (75%) received CRT and 142 (25%) had radiotherapy alone. Median follow-up was 26 months (range 3-148). 156 patients (28%) progressed during follow-up. All IC were accurate for prediction of primary tumour (mean NPV 85.0% (84.6-85.3), PPV 85.0% (82.5-92.3), accuracy 84.9% (84.2-86.0)) and nodal outcome (mean NPV 85.6% (84.1-86.6), PPV 94.7% (93.8-95.1), accuracy 86.8% (85.6-88.0)). Number of indeterminate scores for NI-RADS, Porceddu, Deauville and Hopkins were 91, 25, 20, 13 and 55, 70, 18 and 3 for primary tumour and nodes respectively. PPV was significantly reduced for indeterminate uptake across all IC (mean PPV primary tumour 36%, nodes 48%). Survival analyses showed significant differences in PFS between response categories classified by each of the four IC (p <0.001). All four IC have similar diagnostic performance characteristics although Porceddu and Deauville scores offered the best trade off of minimising indeterminate outcomes whilst maintaining a high NPV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-60739-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058010PMC
March 2020

Histiocytic sarcoma of the base of tongue treated with radical radiotherapy: A case report and review of the literature.

Clin Transl Radiat Oncol 2020 Mar 22;21:66-68. Epub 2020 Jan 22.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.

Histiocytic sarcoma (HS) is an exceedingly rare and aggressive neoplasm of lymphoid and haematopoietic tissues and expresses histological and phenotypical characteristics of mature histiocytes. There have only been a few cases of documented HS in the head and neck region. Whilst patients with HS often have nodal or disseminated disease, patients can present with localised disease. There are currently no established treatment guidelines, and reported cases of localised disease have been managed with primary surgery and adjuvant radiotherapy and/or chemotherapy. Here we present, the case of a 49 year old man with a HS of the base of tongue treated with radical radiotherapy to a dose of 60 Gy in 30 fractions, achieving disease free survival of greater than 5 years with minimal toxicity. To our knowledge, this is the first reported case of HS treated with radical radiotherapy, and suggests that when the potential morbidity of surgery for localised disease is significant, radiotherapy may represent an alternative treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctro.2020.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995885PMC
March 2020

Retropharyngeal Lymph Node Involvement in Oropharyngeal Carcinoma: Impact upon Risk of Distant Metastases and Survival Outcomes.

Cancers (Basel) 2019 Dec 29;12(1). Epub 2019 Dec 29.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds LS97TF, UK.

The influence of retropharyngeal lymph node (RPLN) involvement on prognosis in oropharyngeal carcinoma remains poorly defined. The aim of this study was to assess the impact of RPLN involvement upon outcomes. A single-centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated nonsurgically between 2010 and 2017 was performed. All had a baseline 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) PET-CT and contrast-enhanced MRI and/or CT. RPLN status was determined by radiology review of cases with reported abnormal RPLN. Multivariate backwards logistic regression was used to examine impact on outcomes of factors. Abnormal RPLNs were identified in 40/402 (10%) of patients. Median follow up was 42.9 months. RPLN involvement was associated with inferior 3 year outcomes for overall survival (OS) (67.1% vs. 79.1%, = 0.006) and distant metastases-free survival (DMFS) (73.9% versus 88.0%, = 0.011), with no significant difference in local control (81.6% vs. 87.7%, = 0.154) or regional control (80.7% vs. 85.4%, = 0.252). On multivariate analysis abnormal RPLN, no concurrent chemotherapy and ongoing smoking were associated with inferior DMFS and OS, while advanced T stage was also associated with inferior OS. In summary, RPLN involvement, present in 10% of patients, was an independent prognostic factor for the development of distant disease failure translating into inferior OS. These findings need confirmation in future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers12010083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016660PMC
December 2019

A Multicentre UK Study of Outcomes of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy ± Chemotherapy.

Clin Oncol (R Coll Radiol) 2020 04 5;32(4):238-249. Epub 2019 Dec 5.

Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Aims: To report the outcomes of nasopharyngeal carcinoma in adults across three large centres in a non-endemic region in the era of intensity-modulated radiotherapy (IMRT).

Materials And Methods: Adult patients with nasopharyngeal carcinoma treated in three large cancer centres with IMRT ± chemotherapy with curative intent between 2009 and 2016 were identified from institutional databases. Radiotherapy was delivered with 70 Gy in 33-35 daily fractions. A univariable analysis was carried out to evaluate the relationship of patient, tumour and treatment factors with progression-free survival (PFS) and overall survival.

Results: In total, 151 patients were identified with a median follow-up of 5.2 years. The median age was 52 years (range 18-85). Seventy-five per cent were of Caucasian origin; 75% had non-keratinising tumours; Epstein Barr virus status was only available in 23% of patients; 74% of patients had stage III or IV disease; 54% of patients received induction chemotherapy; 86% of patients received concurrent chemotherapy. Five-year overall survival, PFS, local disease-free survival, regional disease-free survival and distant disease-free survival were 70%, 65%, 91%, 94% and 82%, respectively. Keratinising squamous cell carcinoma, older age, worse performance status, smoking and alcohol intake were associated with inferior overall survival and PFS.

Conclusions: Local, regional and distant disease control are relatively high following IMRT ± chemotherapy in a non-endemic population. There was considerable heterogeneity in terms of radiotherapy treatment and the use of chemotherapy, encouraging the development of treatment protocols and expert peer review in non-endemic regions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2019.11.009DOI Listing
April 2020

Evaluation of Locoregional Recurrence Patterns Following Adjuvant (Chemo)Radiotherapy for Oral Cavity Carcinoma.

Clin Oncol (R Coll Radiol) 2020 04 23;32(4):228-237. Epub 2019 Oct 23.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aims: To evaluate patterns of locoregional recurrence following adjuvant (chemo)radiotherapy for oral cavity squamous cell carcinomas.

Materials And Methods: One hundred and one patients who received adjuvant radiotherapy ± chemotherapy for oral cavity squamous cell carcinoma between 2013 and 2016 were analysed. For documented locoregional recurrence, recurrence imaging was deformably co-registered to the planning computed tomography scan. The volume of recurrence was delineated (Vrec). Vrec coverage by 95% of the corresponding planning target volume prescription dose was determined and the location compared with planning target volumes. Sites of recurrence were classified using a combined volume and centroid-based method: (A) central high dose, (B) peripheral high dose, (C) central low dose, (D) central peripheral dose, (E) extraneous.

Results: The median follow-up was 36 months. Forty-three per cent and 53% of patients received radiotherapy to the ipsilateral neck only and bilateral neck, respectively. Three-year overall survival, disease-free survival, local control, regional control and distant metastases-free survival were 63.0, 65.6, 88.0, 85.1 and 85.3%, respectively. Of 10 episodes of primary site recurrences, five were type A, four type B and one was type E. Of 14 episodes of regional recurrence, five were type A, two type C, two type D and five type E. Five of 21 (24%) patients with oral tongue carcinoma with an undissected/unirradiated contralateral neck had a type E contralateral neck recurrence, including 2/11 with pN0, 1/4 with pN1 and 2/6 with pN2 disease.

Conclusions: Marginal and out-of-field recurrences remain a significant pattern of failure. We advocate generous target delineation postoperatively and, for oral tongue carcinomas, a comprehensive approach with bilateral neck irradiation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2019.10.002DOI Listing
April 2020

Influencing Factors on Radiotherapy Outcome in Stage I-II Glottic Larynx Cancer-A Multicenter Study.

Front Oncol 2019 20;9:932. Epub 2019 Sep 20.

Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom.

Larynx cancer represents one of the most frequently diagnosed head and neck malignancies, which is most often confined to the glottic area. The aim of this study was to report the oncological outcome and identify prognostic factors in early-stage glottic squamous cell carcinoma treated with radiotherapy. Patients ( = 761) diagnosed and treated in 10 centers between 1990 and 2015 were retrospectively analyzed. Probabilities of loco-regional control (LRC) and overall survival (OS) were calculated and possible prognostic factors were analyzed using Cox proportional hazards models. The median follow-up was 63 months (range: 2-243). Three hundred and sixty-four, 148 and 249 patients had cT1a, cT1b, and cT2 stage I-II disease, respectively. Five and 10-years LRC/OS rates in the whole cohort were 83/82% and 80/68%, respectively. Three patients developed distant recurrences. In univariate analysis, male sex (HR: 3.49; 95% CI: 1.47-11.37; < 0.01), T2 vs. T1a (HR: 1.62; 95% CI: 1.08-2.43; = 0.02) and anterior commissure involvement (ACI) (HR: 1.66; 95% CI: 1.38-2.45; < 0.01) were associated with impaired LRC. In multivariate analysis, male sex (HR: 3.42; 95% CI: 1.44-11.17; < 0.01) and ACI (HR: 1.51; 95% CI: 1.01-2.28; = 0.047) remained poor prognostic factors. No relation of treatment technique and biologically equivalent dose (BED) to oncological outcome was identified except for higher BED(L = 25; T = 1) yielding better LRC in T1a tumors ( = 0.04) in univariate analyses. Our results highlight the negative impact of ACI on tumor control. A less-expected finding was the impact of sex on tumor control. Further research is needed to validate its prognostic value and investigate any related biologic or behavioral factors, which may be modified to improve oncologic outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2019.00932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763757PMC
September 2019

Second-look PET-CT following an initial incomplete PET-CT response to (chemo)radiotherapy for head and neck squamous cell carcinoma.

Eur Radiol 2020 Feb 29;30(2):1212-1220. Epub 2019 Aug 29.

Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK.

Objectives: The limited positive predictive value of an incomplete response on PET-CT following (chemo)radiotherapy for head and neck squamous cell carcinoma (HNSCC) means that the optimal management strategy remains uncertain. The aim of the study is to assess the utility of a 'second-look' interval PET-CT.

Methods: Patients with HNSCC who were treated with (chemo)radiotherapy between 2008 and 2017 and underwent (i) baseline and (ii) response assessment PET-CT and (iii) second-look PET-CT following incomplete (positive or equivocal scan) response were included. Endpoints were conversion rate to complete response (CR) and test characteristics of the second-look PET-CT.

Results: Five hundred sixty-two patients with HNSCC underwent response assessment PET-CT at a median of 17 weeks post-radiotherapy. Following an incomplete response on PET-CT, 40 patients underwent a second-look PET-CT at a median of 13 weeks (range 6-25) from the first response PET-CT. Thirty-four out of 40 (85%) patients had oropharyngeal carcinoma. Twenty-four out of 40 (60%) second-look PET-CT scans converted to a complete locoregional response. The primary tumour conversion rate was 15/27 (56%) and the lymph node conversion rate was 14/19 (74%). The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the second-look PET-CT were 75%, 75%, 25% and 96% for the primary tumour and 100%, 92%, 40% and 100% for lymph nodes. There were no cases of progression following conversion to CR in the primary site or lymph nodes.

Conclusions: The majority of patients who undergo a second-look PET-CT convert to a CR. The NPV of a second-look PET-CT is high, suggesting the potential to avoid surgical intervention.

Key Points: • PET-CT is a useful tool for response assessment following (chemo)radiotherapy for head and neck squamous cell carcinoma. • An incomplete response on PET-CT has a limited positive predictive value and optimal management is uncertain. • These data show that with a 'second-look' interval PET-CT, the majority of patients convert to a complete metabolic response. When there is doubt about clinical and radiological response, a 'second-look' PET-CT can be used to spare patients unnecessary surgical intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-019-06401-7DOI Listing
February 2020

Incidence and patterns of retropharyngeal lymph node involvement in oropharyngeal carcinoma.

Radiother Oncol 2020 01 17;142:92-99. Epub 2019 Aug 17.

Department of Clinical Oncology, Leeds Cancer Centre, UK. Electronic address:

Introduction: The aim was to evaluate in oropharyngeal carcinoma the: (1) incidence and predictors of retropharyngeal (RP) lymph node (LN) involvement, (2) pattern of ipsilateral/bilateral/contralateral-only RP LNs (3) location of RP LNs in relation to contouring guidelines.

Methods: Single centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated non-surgically between 2010 and 2017. All patients had a baseline FDG PET-CT and contrast-enhanced MRI and/or CT. All cases with reported abnormal RP LNs underwent radiology review.

Results: Abnormal RP LNs were identified in 40/402 (10%) of patients. On multivariate analysis, RP LN involvement was associated with posterior pharyngeal wall/soft palate primaries (OR 10.13 (95% CI 2.29-19.08), p = 0.002) and contralateral cervical LN involvement (OR 2.26 (95% CI 1.05-4.86), p = 0.036). T stage, largest LN size, levels of ipsilateral LN level involvement, HPV and smoking status did not predict risk. 5/402 (1.2%) patients had bilateral RP involvement. 3/402 patients (0.7%) had contralateral-only RP LNs. All patients with contralateral RP LNs had contralateral neck nodes or primary cancers extending across midline. In 5/40 (12.5%) cases with involved RP LNs, the RP LNs were superior to hard palate/upper edge of body of C1 vertebra.

Conclusions: RP LNs were identified in 10% of oropharyngeal carcinoma patients, and were associated with contralateral neck disease and/or posterior pharyngeal wall/soft palate primary. Contralateral RP LN involvement was rare and associated with contralateral neck disease and/or primary crossing midline, suggesting potential for omission from target volumes for selected patients. Involvement of RP LNs close to the skull base highlights the need for generous elective outlining.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radonc.2019.07.021DOI Listing
January 2020

Quality Assurance Peer Review for Radiotherapy for Haematological Malignancies.

Clin Oncol (R Coll Radiol) 2019 10 8;31(10):e1-e8. Epub 2019 Jul 8.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aims: To assess the impact of weekly scheduled peer review of radiotherapy planning contours for definitive treatment of haematological malignancies based on rates of recommended changes.

Materials And Methods: Analysis of a prospective database of contour-based peer review at weekly scheduled meetings for patients undergoing definitive radiotherapy for haematological malignancies at a single large cancer centre between January and December 2018. Recommended changes were prospectively classified as involving the gross tumour volume (GTV), clinical target volume (CTV), planning target volume (PTV), organs at risk or dose fractionation. A univariate analysis was carried out to explore the associations between recommended changes and disease, treatment characteristics and consultant experience.

Results: In total, 158/171 (92%) of all cases of haematological malignancy undergoing definitive radiotherapy were prospectively peer reviewed over a 12-month period. Overall, 26/158 (16.5%) changes were recommended within the peer review meetings. This included a total of 27 contour changes (GTV, CTV or PTV) in 25 patients. An increase in CTV was the most common change, occurring in 20/158 (12.7%) cases. One dose-fractionation change was recommended. Additional advice regarding planning technique/set-up was documented in 5/158 (3.2%) patients. There were no significant associations between rates of recommended change and disease type, stage, prior chemotherapy, first line versus refractory/relapse, anatomical site, radiotherapy technique or consultant experience.

Conclusions: Weekly contour-based peer review meetings resulted in a high rate of recommended changes. Compliance was high. Peer review was potentially beneficial for all disease and treatment characteristics and for any degree of clinician experience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2019.06.010DOI Listing
October 2019

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma.

Acta Oncol 2019 Aug 29;58(8):1187-1196. Epub 2019 Apr 29.

a Department of Clinical Oncology , Leeds Cancer Centre , Leeds , UK.

Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 disease-free patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%,  < .001), lower median percentage weight loss (7.0% vs. 9.4%,  < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months,  < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/0284186X.2019.1609698DOI Listing
August 2019

Quality Assurance Peer Review of Head and Neck Contours in a Large Cancer Centre via a Weekly Meeting Approach.

Clin Oncol (R Coll Radiol) 2019 06 16;31(6):344-351. Epub 2019 Mar 16.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aims: To assess the impact of weekly scheduled peer review of head and neck contours for definitive and adjuvant radiotherapy cases based on rates of recommended changes.

Materials And Methods: Retrospective analysis of a prospective database. Recommended changes were prospectively classified as 'major' (change in gross tumour volume and/or high-dose clinical target volume, dose/fractionation) or 'minor' (change in intermediate or elective dose clinical target volumes or organs at risk). Univariate analysis to explore associations between recommended changes and tumour site/stage and radical/adjuvant indication.

Results: In total, 307/375 (82%) head and neck cases treated with volumetric-modulated arc therapy were prospectively peer reviewed over a 12-month period; 195 (64%) cases received definitive and 112 (36%) received adjuvant radiotherapy. Overall, 43/307 (14.0%) changes were recommended within the peer review meetings. This comprised 27/307 (8.8%) major changes and 16/307 (5.2%) minor changes; 33/43 (77%) changes were in the clinical target volume. Rates of recommended changes were significantly higher for adjuvant versus definitive radiotherapy (odds ratio 2.26, P = 0.014) and for larynx compared with oropharynx (odds ratio 3.02, P = 0.02). There was no overall correlation between clinician experience and rates of change (P = 0.62).

Conclusion: Routine weekly meeting contour-based peer review resulted in a number of major and minor changes to treatment. Compliance was high. Peer review was potentially beneficial for all tumour sites/stages/indications and any degree of clinician experience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2019.03.001DOI Listing
June 2019

Accuracy of Response Assessment Positron Emission Tomography-Computed Tomography Following Definitive Radiotherapy Without Chemotherapy for Head and Neck Squamous Cell Carcinoma.

Clin Oncol (R Coll Radiol) 2019 04 13;31(4):212-218. Epub 2018 Dec 13.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aim: There are few data to inform on the use of response assessment 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography-computed tomography (PET-CT) following radical radiotherapy without chemotherapy for head and neck squamous cell carcinoma (HNSCC). This retrospective study evaluated the accuracy of PET-CT in HNSCC following radical radiotherapy.

Materials And Methods: In total, 138 patients with HNSCC treated with radical radiotherapy without chemotherapy who underwent a baseline and response assessment FDG PET-CT were identified. FDG PET-CT outcomes were analysed with reference to clinicopathological outcomes.

Results: The median follow-up was 26 months. FDG-avid disease at baseline was present for the primary site and lymph nodes in 118 and 86 patients, respectively. With regard to the primary tumour, the negative predictive value (NPV) of a complete metabolic response (CMR) was 95%; the positive predictive value (PPV) of equivocal uptake and a positive scan were 6% and 82%, respectively. The likelihood ratios for a CMR, equivocal and positive scans of the primary site were 0.19, 0.22, 14.8, respectively. With regard to lymph node disease, the NPV of a CMR was 91%, the PPV of equivocal uptake and a positive scan were 33% and 88%, respectively. Likelihood ratios for lymph node disease for CMR, equivocal and positive scans were 0.19, 0.97 and 15.1, respectively.

Conclusion: Compared with the accuracy reported in the literature following chemoradiotherapy, response assessment FDG PET-CT following radical radiotherapy without chemotherapy had a similarly high NPV, whereas the PPV following a positive scan was higher.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2018.11.036DOI Listing
April 2019

Assessment of the Impact of Deformable Registration of Diagnostic MRI to Planning CT on GTV Delineation for Radiotherapy for Oropharyngeal Carcinoma in Routine Clinical Practice.

Healthcare (Basel) 2018 Nov 24;6(4). Epub 2018 Nov 24.

Department of Clinical Oncology, St. James's University Hospital, Leeds Cancer Centre, Beckett Street, Leeds LS9 7TF, UK.

Background: Aim of study was to assess impact of deformable registration of diagnostic MRI to planning CT upon gross tumour volume (GTV) delineation of oropharyngeal carcinoma in routine practice.

Methods: 22 consecutive patients with oropharyngeal squamous cell carcinoma treated with definitive (chemo)radiotherapy between 2015 and 2016, for whom primary GTV delineation had been performed by a single radiation oncologist using deformable registration of diagnostic MRI to planning CT, were identified. Separate GTVs were delineated as part of routine clinical practice (all diagnostic imaging available side-by-side for each delineation) using: CT (GTV), MRI (GTV), and CT and MRI (GTV). Volumetric and positional metric analyses were undertaken using contour comparison metrics (Dice conformity index, centre of gravity distance, mean distance to conformity).

Results: Median GTV volumes were 13.7 cm³ (range 3.5⁻41.7), 15.9 cm³ (range 1.6⁻38.3), 19.9 cm³ (range 5.5⁻44.5) for GTV, GTV and GTV respectively. There was no significant difference in GTV and GTV volumes; GTV was found to be significantly larger than both GTV and GTV. Based on positional metrics, GTV and GTV were the least similar (mean Dice similarity coefficient (DSC) 0.71, 0.84, 0.82 for GTV⁻GTV, GTV⁻GTV and GTV⁻GTV respectively).

Conclusions: These data suggest a complementary role of MRI to CT to reduce the risk of geographical misses, although they highlight the potential for larger target volumes and hence toxicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/healthcare6040135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316469PMC
November 2018

Results of a multicentre randomised controlled trial of cochlear-sparing intensity-modulated radiotherapy versus conventional radiotherapy in patients with parotid cancer (COSTAR; CRUK/08/004).

Eur J Cancer 2018 11 1;103:249-258. Epub 2018 Oct 1.

The Institute of Cancer Research Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom.

Purpose: About 40-60% of patients treated with post-operative radiotherapy for parotid cancer experience ipsilateral sensorineural hearing loss. Intensity-modulated radiotherapy (IMRT) can reduce radiation dose to the cochlea. COSTAR, a phase III trial, investigated the role of cochlear-sparing IMRT (CS-IMRT) in reducing hearing loss.

Methods: Patients (pT1-4 N0-3 M0) were randomly assigned (1:1) to 3-dimensional conformal radiotherapy (3DCRT) or CS-IMRT by minimisation, balancing for centre and radiation dose of 60Gy or 65Gy in 30 daily fractions. The primary end-point was proportion of patients with sensorineural hearing loss in the ipsilateral cochlea of ≥10 dB bone conduction at 4000 Hz 12 months after radiotherapy compared using Fisher's exact test. Secondary end-points included hearing loss at 6 and 24 months, balance assessment, acute and late toxicity, patient-reported quality of life, time to recurrence and survival.

Results: From Aug 2008 to Feb 2013, 110 patients (54 3DCRT; 56 CS-IMRT) were enrolled from 22 UK centres. Median doses to the ipsilateral cochlea were 3DCRT: 56.2Gy and CS-IMRT: 35.7Gy (p < 0.0001). 67/110 (61%) patients were evaluable for the primary end-point; main reasons for non-evaluability were non-attendance at follow-up or incomplete audiology assessment. At 12 months, 14/36 (39%) 3DCRT and 11/31 (36%) CS-IMRT patients had ≥10 dB loss (p = 0.81). No statistically significant differences were observed in hearing loss at 6 or 24 months or in other secondary end-points including patient-reported hearing outcomes.

Conclusion: CS-IMRT reduced the radiation dose below the accepted tolerance of the cochlea, but this did not lead to a reduction in the proportion of patients with clinically relevant hearing loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejca.2018.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202674PMC
November 2018

Axillary radiotherapy for nodal lymphoma: What CTV expansion is required to account for absence of pre-chemotherapy treatment position FDG PET-CT?

Clin Transl Radiat Oncol 2018 Nov 6;13:14-18. Epub 2018 Sep 6.

Medical Physics and Engineering, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK.

Involved site lymphoma radiotherapy clinical target volumes (CTV) require expansion in the absence of treatment-position pre-chemotherapy PET-CT. This prospective imaging study evaluates CTV contouring for axillary lymphoma using diagnostic imaging compared with co-registered treatment-position PET-CT. Generous expansion axially and cranio-caudally is required to encompass pre-chemotherapy disease without treatment-position pre-chemotherapy PET-CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctro.2018.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146559PMC
November 2018

Changes in Patient-reported Swallow Function in the Long Term After Chemoradiotherapy for Oropharyngeal Carcinoma.

Clin Oncol (R Coll Radiol) 2018 12 17;30(12):756-763. Epub 2018 Jul 17.

Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK. Electronic address:

Aims: To assess long-term patient-reported swallow function after chemoradiotherapy for oropharyngeal carcinoma and to evaluate the frequency of deterioration/improvement over years.

Materials And Methods: Fifty-nine patients with oropharyngeal carcinoma treated with parotid-sparing intensity-modulated radiotherapy and concurrent chemotherapy between 2010 and 2012 had previously completed the MD Anderson Dysphagia Inventory (MDADI) at a median of 34 months (range 24-59) after treatment. An MDADI was posted to 55 alive and disease-free patients after a 30 month interval; 52/55 replies were received, a median of 64 months (range 52-88) after treatment; 27/52 (52%) had been managed with a prophylactic gastrostomy. A 10 point or greater change in the MDADI scores was defined as clinically significant.

Results: Overall, in the whole cohort, patient-reported swallow function showed a small absolute improvement in MDADI composite score on the second MDADI questionnaire (>5 years after treatment) compared with the first MDADI (>2 years after treatment); mean 68.0 (standard deviation 19.3) versus 64.0 (standard deviation 16.3), P = 0.021. Using the composite score, swallow function was stable over time in 29/52 (56%) patients; a clinically significant improvement in swallow function over time was noted in 17/52 (33%) patients; conversely 6/52 (12%) patients experienced a clinically significant deterioration with time. Abnormality of pre-treatment diet and a prophylactic gastrostomy correlated with an inferior MDADI composite score on the later questionnaire (P = 0.029 and P = 0.044, respectively).

Conclusions: Long-term dysphagia is prevalent >5 years after treatment. Although long-term swallow function is stable in most patients, it is not static in a minority. On MDADI composite summary scores, 33% of patients experienced an improvement, whereas 12% deteriorated with time. Further investigation is needed to determine underlying mechanisms behind these divergent outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2018.06.013DOI Listing
December 2018

Patients' experience of enteral feeding following (chemo) radiotherapy for head and neck cancer: A qualitative study.

Clin Nutr 2019 06 21;38(3):1382-1389. Epub 2018 Jun 21.

Department of Clinical Oncology, Leeds Cancer Centre, St James's Institute of Oncology, Leeds, UK. Electronic address:

Background & Aims: Enteral feeding is commonly required during radiotherapy treatment for head and neck cancer. Only limited qualitative research into head and neck cancer patients' experiences of enteral tube feeding has been undertaken. The aim of this qualitative study was to evaluate patients' experiences of EF and the surrounding decision making process.

Methods: Semi-structured, face-to face interviews were conducted with ten patients who had completed (chemo)radiotherapy/radiotherapy for head and neck cancer at a cancer centre in the North of England. Interviews were recorded, transcribed verbatim and analysed qualitatively using Thematic Analysis.

Results: Participants described the restrictions on daily living caused by enteral feeding tubes and enteral feeding. Despite these restrictions, participants recognised the value of the enteral feeding tube including its role in their survival and the importance of their involvement in decision making. Participants described coping mechanisms used to deal with the difficulties associated with enteral feeding.

Conclusions: The results of this study provide a unique qualitative insight into the lived experiences of H&N cancer patients managed with enteral feeding and the impact of the decision making process. The results have relevance for professionals supporting this patient group with enteral feeding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clnu.2018.06.958DOI Listing
June 2019

Long term patient reported swallowing function following chemoradiotherapy for oropharyngeal carcinoma.

Radiother Oncol 2018 09 21;128(3):452-458. Epub 2018 Jun 21.

Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK. Electronic address:

Background And Purpose: Limited data are available to inform on long term swallowing outcomes following concurrent chemoradiotherapy for oropharyngeal carcinoma. The aims of this study are to determine long term patient-reported swallowing outcomes across two large UK centres in routine clinical practice and identify associated factors.

Material And Methods: All patients treated for oropharyngeal squamous cell carcinoma with concurrent chemoradiotherapy, and irradiation of the bilateral neck, between 2011 and 2013 were identified. Those requiring therapeutic enteral feeding prior to treatment, or having subsequent disease relapse, were excluded from the study. Patients were sent postal invitations to complete the MD Anderson Dysphagia Inventory (MDADI), at least two years following completion of treatment.

Results: Completed MDADI were received from 201/242 eligible patients (83%) at a median of 3.4 years (range 2-5) post treatment. Median composite MDADI score was 68.4. 64 (32%) had composite MDADI <60 classed as 'poor' function, 76 (38%) scores ≥60-<80 classed as adequate function, and 61 (31%) had scores ≥80 classed as optimal function. Patients with normal and abnormal pre-treatment diet had median composite MDADI scores of 70.5 versus 47.4 respectively. Patients who did not require enteral feeding during treatment and those who did had median composite MDADI scores of 76.3 versus 65.3 respectively. On multivariate analysis poorer performance status, abnormal pre-treatment diet, and use of enteral feeding during radiotherapy were all significantly associated with lower composite, global and subscale MDADI scores.

Conclusions: Patient reported swallowing dysfunction remains common in the long term post-chemoradiotherapy. Impaired pre-treatment diet and use of enteral feeding during treatment are key factors associated with poorer swallowing outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radonc.2018.06.014DOI Listing
September 2018

Can MR textural analysis improve the prediction of extracapsular nodal spread in patients with oral cavity cancer?

Eur Radiol 2018 Dec 5;28(12):5010-5018. Epub 2018 Jun 5.

Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Objective: To explore the utility of MR texture analysis (MRTA) for detection of nodal extracapsular spread (ECS) in oral cavity squamous cell carcinoma (SCC).

Methods: 115 patients with oral cavity SCC treated with surgery and adjuvant (chemo)radiotherapy were identified retrospectively. First-order texture parameters (entropy, skewness and kurtosis) were extracted from tumour and nodal regions of interest (ROIs) using proprietary software (TexRAD). Nodal MR features associated with ECS (flare sign, irregular capsular contour; local infiltration; nodal necrosis) were reviewed and agreed in consensus by two experienced radiologists. Diagnostic performance characteristics of MR features of ECS were compared with primary tumour and nodal MRTA prediction using histology as the gold standard. Receiver operating characteristic (ROC) and regression analyses were also performed.

Results: Nodal entropy derived from contrast-enhanced T1-weighted images was significant in predicting ECS (p = 0.018). MR features had varying accuracy: flare sign (70%); irregular contour (71%); local infiltration (66%); and nodal necrosis (64%). Nodal entropy combined with irregular contour was the best predictor of ECS (p = 0.004, accuracy 79%).

Conclusion: First-order nodal MRTA combined with imaging features may improve ECS prediction in oral cavity SCC.

Key Points: • Nodal MR textural analysis can aid in predicting extracapsular spread (ECS). • Medium filter contrast-enhanced T1 nodal entropy was strongly significant in predicting ECS. • Combining nodal entropy with irregular nodal contour improves predictive accuracy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-018-5524-xDOI Listing
December 2018

Effectiveness of Respiratory-gated Positron Emission Tomography/Computed Tomography for Radiotherapy Planning in Patients with Lung Carcinoma - A Systematic Review.

Clin Oncol (R Coll Radiol) 2018 04 1;30(4):225-232. Epub 2018 Feb 1.

Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.

Aims: A systematic review of the literature evaluating the clinical use of respiratory-gated (four-dimensional; 4D) fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) compared with non-gated (three-dimensional; 3D) PET/CT for radiotherapy planning in lung cancer.

Materials And Methods: A search of MEDLINE, Cochrane, Web of Science, SCOPUS and clinicaltrials.gov databases was undertaken for articles comparing 3D and 4D PET/CT tumour volume or 4D PET/CT for radiotherapy planning. PRISMA guidelines were followed.

Results: Thirteen studies compared tumour volumes at 3D and 4D PET/CT; eight reported significantly smaller volumes (6.9-44.5%), three reported significantly larger volumes at 4D PET/CT (16-50%), one reported no significant difference and one reported mixed findings. Six studies, including two that reported differences in tumour volumes, compared target volumes or studied geographic misses. 4D PET/CT target volumes were significantly larger (19-40%) when compared with 3D PET/CT in all but one study, where they were smaller (3.8%). One study reported no significance in 4D PET/CT target volumes when compared with 4D CT, whereas another study reported significantly larger volumes (38.7%).

Conclusion: The use of 4D PET/CT leads to differences in target volume delineation compared with 3D PET/CT. These differences vary depending upon technique and the clinical impact currently remains uncertain. Correlation of pretreatment target volumes generated at 3D and 4D PET/CT with postsurgical histology would be ideal but technically challenging. Evaluation of patient outcomes based on 3D versus 4D PET/CT derived treatment volumes warrants further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clon.2018.01.005DOI Listing
April 2018

Accuracy of FDG PET-CT response assessment following radiotherapy alone for head and neck squamous cell carcinoma: Retrospective analysis of 45 patients.

Clin Otolaryngol 2018 06 14;43(3):931-934. Epub 2018 Feb 14.

Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/coa.13063DOI Listing
June 2018

Automated, reference-free local error assessment of multimodal deformable image registration for radiotherapy in the head and neck.

Radiother Oncol 2017 12 31;125(3):478-484. Epub 2017 Oct 31.

Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, UK.

Background: Head and neck MR-CT deformable image registration (DIR) for radiotherapy planning is hindered by the lack of both ground-truth and per-patient accuracy assessment methods. This study assesses novel post-registration reference-free error assessment algorithms, based on local rigid re-registration of native and pseudomodality images.

Methods: Head and neck MR obtained in and out of the treatment position underwent DIR to planning CT. Block-wise mutual information (b-MI) and pseudomodality mutual information (b-pmMI) algorithms were validated against applied rotations and translations. Inherent registration error detection was compared across 14 patient datasets.

Results: Using radiotherapy position MR-CT DIR, quantitative comparison of applied rotations and translations revealed that errors between 1 and 4 mm were accurately determined by both algorithms. Using diagnostic position MR-CT DIR, translations of up to 5 mm were accurately detected within the gross tumour volume by both methods. In 14 patient datasets, b-MI and b-pmMI detected similar errors with improved stability in regions of low contrast or CT artefact and a 10-fold speedup for b-pmMI.

Conclusions: b-MI and b-pmMI algorithms have been validated as providing accurate reference-free quantitative assessment of DIR accuracy on a per-patient basis. b-pmMI is faster and more robust in the presence of modality-specific information.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radonc.2017.10.004DOI Listing
December 2017

Respiratory-gated (4D) contrast-enhanced FDG PET-CT for radiotherapy planning of lower oesophageal carcinoma: feasibility and impact on planning target volume.

BMC Cancer 2017 Oct 4;17(1):671. Epub 2017 Oct 4.

The Christie Hospital, Wilmslow Road, Manchester, M20 4 BX, UK.

Background: To assess the feasibility and potential impact on target delineation of respiratory-gated (4D) contrast-enhanced Fluorine fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT), in the treatment planning position, for a prospective cohort of patients with lower third oesophageal cancer.

Methods: Fifteen patients were recruited into the study. Imaging included 4D PET-CT, 3D PET-CT, endoscopic ultrasound and planning 4D CT. Target volume delineation was performed on 4D CT, 4D CT with co-registered 3D PET and 4D PET-CT. Planning target volumes (PTV) generated with 4D CT (PTV 4D CT co-registered with 3D PET-CT (PTV and 4D PET-CT (PTV) were compared with multiple positional metrics.

Results: Mean PTV, PTV and PTV were 582.4 ± 275.1 cm, 472.5 ± 193.1 cm and 480.6 ± 236.9 cm respectively (no significant difference). Median DICE similarity coefficients comparing PTV with PTV PTV with PTV and PTV with PTV were 0.85 (range 0.65-0.9), 0.85 (range 0.69-0.9) and 0.88 (range 0.79-0.9) respectively. The median sensitivity index for overlap comparing PTV with PTV PTV with PTV and PTV with PTV were 0.78 (range 0.65-0.9), 0.79 (range 0.65-0.9) and 0.89 (range 0.68-0.94) respectively.

Conclusions: Planning 4D PET-CT is feasible with careful patient selection. PTV generated using 4D CT, 3D PET-CT and 4D PET-CT were of similar volume, however, overlap analysis demonstrated that approximately 20% of PTV and PTV are not included in PTV, leading to under-coverage of target volume and a potential geometric miss. Additionally, differences between PTV and PTV suggest a potential benefit for 4D PET-CT.

Trial Registration: ClinicalTrials.gov Identifier - NCT02285660 (Registered 21/10/2014).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-017-3659-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628433PMC
October 2017

Accuracy of [Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma.

Clin Med Insights Oncol 2017 14;11:1179554917713005. Epub 2017 Jun 14.

Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK.

Introduction: The accuracy of response assessment positron emission tomography (PET)-computed tomography (CT) following radiotherapy with or without chemotherapy for laryngeal/hypopharyngeal squamous cell carcinoma is uncertain.

Methods: In all, 35 patients with laryngeal or hypopharyngeal squamous cell carcinoma who were treated between 2009 and 2014 with (chemo)radiotherapy were identified. The accuracy of response assessment PET-CT was made by correlation with clinical follow-up and pathological findings.

Results: Of the 35 patients, 20 (57%) had an overall complete metabolic response. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for response assessment [18Fluorine]-fluoro-2-deoxy-d-glucose (FDG) PET-CT for primary and nodal sites, respectively, were 100%, 73%, 46%, and 100% and 83%, 95%, 83%, and 95%.

Conclusions: Response assessment FDG PET-CT following (chemo)radiotherapy for laryngeal and hypopharyngeal carcinomas has a high NPV for both primary site and lymph nodes and can be used to guide treatment decisions. The PPV of residual FDG uptake at the primary tumour site is limited and requires examination and biopsy confirmation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1179554917713005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476423PMC
June 2017