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Role of 18F-FDG PET/CT in Posttreatment Evaluation of Anal Carcinoma
The Journal of Nuclear Medicine ( IF 9.3 ) Pub Date : 2017-09-01 , DOI: 10.2967/jnumed.116.185280
Clémence Houard , Jean-Baptiste Pinaquy , Charles Mesguich , Bénédicte Henriques de Figueiredo , Anne-Laure Cazeau , Jean-Baptiste Allard , Hortense Laharie , Laurence Bordenave , Philippe Fernandez , Véronique Vendrely

The aim of this study was to evaluate the relevance of PET/CT and 18F-FDG as a strategy for response evaluation after chemoradiotherapy for anal cancer. For this, the performance of posttreatment 18F-FDG PET/CT, the impact on patient care, and the predictive value of metabolic response were assessed. Methods: This was a retrospective and multicenter analysis of 87 patients treated by chemoradiotherapy for anal squamous cell carcinoma between October 2007 and October 2013. All patients underwent systematic posttreatment 18F-FDG PET/CT and were followed with at least a clinical examination every 4 mo for 2 y and every 6 mo thereafter. Disease progression was confirmed by biopsy for all patients in the case of local recurrence before surgery. Kaplan–Meier and Cox regression models were used to test for associations between metabolic or clinical endpoints and progression-free survival (PFS) or cause-specific survival (CSS). Results: The median follow-up was 25 mo. 18F-FDG PET/CT was performed 1–8 mo (median, 4 mo) after completion of chemoradiotherapy. Overall, 25 patients relapsed and 13 died. The posttherapy 18F-FDG PET/CT did not show any abnormal 18F-FDG uptake (complete metabolic response [CMR]) in 55 patients whereas 32 displayed incomplete response (non-CMR): 15 patients with partial response and 17 with disease progression. The sensitivity of 18F-FDG PET/CT to detect residual tumor tissue was 92% (95% confidence interval [CI], 75%–97%), specificity was 85% (95% CI, 75%–92%), positive predictive value was 72% (95% CI, 61%–90%), and negative predictive value was 96.4% (95% CI, 90%–98.7%). The 2-y PFS was 96% (95% CI, 90–100) for patients with CMR and 28% (95% CI, 14–47) for non-CMR patients (P < 0.0001). The 2-y CSS was 100% for patients with CMR and 59% (95% CI, 42–84) for those without CMR (P < 0.0001). 18F-FDG PET/CT changed patient management in 14 cases (16%), with relevant modifications in 12 (14%). A Cox proportional hazards model of survival outcome indicated that a CMR was the only significant predictor of PFS and CSS (P < 0.0001). Conclusion: 18F-FDG PET/CT shows good accuracy in posttreatment evaluation of anal cancer and has a relevant impact on patient management. Moreover, CMR is associated with good survival outcome. Thus, 18F-FDG PET/CT may play a significant role during posttreatment follow-up of anal cancer.



中文翻译:

的角色18在肛门癌的治疗后评价F-FDG PET / CT

这项研究的目的是评估PET / CT和18 F-FDG的相关性,作为对放化疗治疗肛门癌后反应进行评估的一种策略。为此,评估了18 F-FDG PET / CT后处理的性能,对患者护理的影响以及代谢反应的预测价值。方法:这是一项回顾性和多中心分析,分析了2007年10月至2013年10月间经化学放射疗法治疗肛门鳞状细胞癌的87例患者。所有患者均接受了系统的后处理18F-FDG PET / CT,每4个月进行至少2个月的临床检查,此后每6个月进行一次临床检查。对于所有患者,在手术前局部复发的情况下,通过活检可以确认疾病的进展。Kaplan–Meier和Cox回归模型用于测试代谢或临床终点与无进展生存期(PFS)或因因生存(CSS)之间的关联。结果:中位随访时间为25 mo。放化疗完成后1–8 mo(中位数,4 mo)进行18 F-FDG PET / CT。总体而言,有25例患者复发,其中13例死亡。术后18 F-FDG PET / CT未显示任何异常1855位患者的F-FDG摄取(完全代谢反应[CMR]),而32位显示不完全反应(非CMR):15位患者部分缓解,17位疾病进展。18 F-FDG PET / CT检测残留肿瘤组织的敏感性为92%(95%置信区间[CI],75%–97%),特异性为85%(95%CI,75%–92%),阳性预测值为72%(95%CI,61%–90%),阴性预测值为96.4%(95%CI,90%–98.7%)。CMR患者的2-y PFS为96%(95%CI,90–100),非CMR患者为28%(95%CI,14–47)(P <0.0001)。有CMR的患者的2-y CSS为100%,无CMR的患者为59%(95%CI,42–84)(P <0.0001)。18岁F-FDG PET / CT改变了14例患者的治疗(16%),其中12例(14%)进行了相关修改。生存结果的Cox比例风险模型表明,CMR是PFS和CSS的唯一重要预测因子(P <0.0001)。结论: 18 F-FDG PET / CT在肛门癌的治疗后评估中显示出良好的准确性,并且对患者管理产生了相关影响。此外,CMR与良好的生存结果相关。因此,18 F-FDG PET / CT可能在肛门癌的治疗后随访中发挥重要作用。

更新日期:2017-09-05
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