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Prognostic impact of tumour burden assessed by metabolic tumour volume on FDG PET/CT in anal canal cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to confirm the prognostic value of metabolic tumour volume (MTV) at the primary site on initial work-up FDG PET/CT in patients with squamous cell carcinoma (SCC) of the anal canal.

Methods

Patients with a recent diagnosis of SCC of the anal canal without metastases undergoing PET/CT for initial work-up and treated with (chemo)radiotherapy were retrospectively reviewed. Computer-aided MTV and SUVmax were determined. Survival rates were estimated using the Kaplan-Meier method. Cox regression analysis was used to evaluate prognostic variables of progression-free survival and overall survival (OS).

Results

The study group comprised 75 patients who had an initial work-up PET/CT. Five patients (6.7 %) had stage I disease, 22 (29.3 %) stage II disease, 20 (26.7 %) stage IIIA disease, and 28 (37.3 %) stage IIIB disease. Median follow-up was 51 months (range 10 – 117 months). Global 4-year OS was 82.7 %, ranging from 100 % in patients with stage I disease to 75 % in patients with stage IIIB disease. MTV at the primary site was significantly and independently correlated with OS (p < 0.05), as patients with MTV less than 7 cm3 had a better prognosis. SUVmax was not correlated with survival parameters. Metabolic involvement of the inguinal lymph nodes was also correlated with a poor outcome in the univariate analysis (p < 0.05).

Conclusion

MTV at the primary site is a prognostic biomarker in anal canal cancer. Hypermetabolic inguinal lymph nodes also appear to be correlated with survival.

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References

  1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Anal Cancer. Bethesda, MD: National Cancer Institute. 2016. http://seer.cancer.gov/statfacts/html/anus.html. Accessed 4 Aug 2016

  2. Edge S, Byrd D, Compton CC, Fritz A, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 165–73.

    Google Scholar 

  3. Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson 3rd AB, Thomas Jr CR, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008;299:1914–21.

    Article  CAS  PubMed  Google Scholar 

  4. Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson 3rd AB, Thomas Jr CR, et al. Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98-11). Cancer. 2010;116:4007–13.

  5. Bazan JG, Koong AC, Kapp DS, Quon A, Graves EE, Loo BW, et al. Metabolic tumor volume predicts disease progression and survival in patients with squamous cell carcinoma of the anal canal. J Nucl Med. 2013;54:27–32.

    Article  PubMed  Google Scholar 

  6. Lee P, Weerasuriya DK, Lavori PW, Quon A, Hara W, Maxim PG, et al. Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys. 2007;69:328–33.

    Article  PubMed  Google Scholar 

  7. Dibble EH, Alvarez ACL, Truong M-T, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med. 2012;53:709–15.

    Article  CAS  PubMed  Google Scholar 

  8. Schellenberg D, Quon A, Minn AY, Graves EE, Kunz P, Ford JM, et al. 18Fluorodeoxyglucose PET is prognostic of progression-free and overall survival in locally advanced pancreas cancer treated with stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 2010;77:1420–5.

    Article  PubMed  Google Scholar 

  9. Benson AB 3rd, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS et al. Anal carcinoma. In: NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. 2016. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 4 Aug 2016.

  10. Deutsch E, Brunet R, Peiffert D, Salmon R, Siproudhis L, Touboul E. Cancer du canal anal. In: Thésaurus National de Cancérologie Digestive (TNCD). Société Nationale Française de Gastro-Entérologie. 2010. http://www.tncd.org/. Accessed 4 Aug 2016.

  11. Cotter SE, Grigsby PW, Siegel BA, Dehdashti F, Malyapa RS, Fleshman JW, et al. FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys. 2006;65:720–5.

    Article  PubMed  Google Scholar 

  12. Day FL, Link E, Ngan S, Leong T, Moodie K, Lynch C, et al. FDG-PET metabolic response predicts outcomes in anal cancer managed with chemoradiotherapy. Br J Cancer. 2011;105:498–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ortholan C, Resbeut M, Hannoun-Levi J-M, Teissier E, Gerard J-P, Ronchin P, et al. Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study). Int J Radiat Oncol Biol Phys. 2012;82:1988–95.

    Article  PubMed  Google Scholar 

  14. Tomaszewski JM, Link E, Leong T, Heriot A, Vazquez M, Chander S, et al. Twenty-five-year experience with radical chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys. 2012;83:552–8.

    Article  PubMed  Google Scholar 

  15. Zilli T, Betz M, Bieri S, Ris F, Roche B, Roth AD, et al. Elective inguinal node irradiation in early-stage T2N0 anal cancer: prognostic impact on locoregional control. Int J Radiat Oncol. 2013;87:60–6.

    Article  Google Scholar 

  16. Gunderson LL, Winter KA, Ajani JA, Pedersen JE, Moughan J, Benson AB, et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol. 2012;30:4344–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14:2527–39.

    CAS  PubMed  Google Scholar 

  18. James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol. 2013;14:516–24.

    Article  CAS  PubMed  Google Scholar 

  19. Peiffert D, Giovannini M, Ducreux M, Michel P, François E, Lemanski C, et al. High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2001;12:397–404.

  20. Peiffert D, Tournier-Rangeard L, Gérard J-P, Lemanski C, François E, Giovannini M, et al. Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol. 2012;30:1941–8.

    Article  CAS  PubMed  Google Scholar 

  21. Saboo SS, Zukotynski K, Shinagare AB, Krajewski KM, Ramaiya N. Anal carcinoma: FDG PET/CT in staging, response evaluation, and follow-up. Abdom Imaging. 2012;38:728–35.

    Article  Google Scholar 

  22. Vercellino L, Montravers F, de Parades V, Huchet V, Kerrou K, Bauer P, et al. Impact of FDG PET/CT in the staging and the follow-up of anal carcinoma. Int J Colorectal Dis. 2010;26:201–10.

    Article  Google Scholar 

  23. Schwarz JK, Siegel BA, Dehdashti F, Myerson RJ, Fleshman JW, Grigsby PW. Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys. 2008;71:180–6.

    Article  PubMed  Google Scholar 

  24. Kidd EA, Dehdashti F, Siegel BA, Grigsby PW. Anal cancer maximum F-18 fluorodeoxyglucose uptake on positron emission tomography is correlated with prognosis. Radiother Oncol. 2010;95:288–91.

    Article  PubMed  Google Scholar 

  25. Mistrangelo M, Pelosi E, Bellò M, Ricardi U, Milanesi E, Cassoni P, et al. Role of positron emission tomography-computed tomography in the management of anal cancer. Int J Radiat Oncol. 2012;84:66–72.

    Article  Google Scholar 

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Authors and Affiliations

  1. Médecine Nucléaire, Institut Curie, Saint-Cloud, France

    Mathieu Gauthé & Jean-Louis Alberini

  2. Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

    Mathieu Gauthé

  3. Radiothérapie, Institut Curie, Saint-Cloud, France

    Marion Richard-Molard

  4. Oncologie Médicale, Institut Curie, Saint-Cloud, France

    Juliette Fayard, Wulfran Cacheux & Astrid Lièvre

  5. Service des Maladies de l’Appareil Digestif, CHU Pontchaillou, Rennes, France

    Astrid Lièvre

  6. Université Rennes 1, Rennes, France

    Astrid Lièvre

Authors
  1. Mathieu Gauthé
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  2. Marion Richard-Molard
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  3. Juliette Fayard
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  4. Jean-Louis Alberini
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Correspondence to Mathieu Gauthé.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

Research involving human participants and/or animals

For this type of study formal consent is not required.

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This study was approved by the institutional review board; the need for written informed consent was waived.

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Gauthé, M., Richard-Molard, M., Fayard, J. et al. Prognostic impact of tumour burden assessed by metabolic tumour volume on FDG PET/CT in anal canal cancer. Eur J Nucl Med Mol Imaging 44, 63–70 (2017). https://doi.org/10.1007/s00259-016-3475-5

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  • DOI: https://doi.org/10.1007/s00259-016-3475-5

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