Šedienė, Severina

Galvos ir kaklo navikai yra heterogeniška navikų grupė, kurių lokalizacija gali būti nuo kaukolės pamato iki raktikaulių. Šiose anatominėse srityse daug kritinių organų, svarbių juslėms, išvaizdai, kvėpavimui, bendravimui ir valgymui. Tiek šalutinės reakcijos, tiek gydomosios dozės paskyrimas į naviką ir patologinius limfmazgius priklauso nuo radioterapijos kokybės. Pastaraisiais dešimtmečiais spindulinės terapijos kokybė, atsižvelgiant į naujas vaizdavimo, planavimo ir paskyrimo galimybes, labai pagerėjo. Norint visapusiškai išnaudoti naujų technologijų privalumus vis svarbesnis darosi tikslus taikinių ir kritinių organų apibrėžimas. Siekiant sumažinti skirtumus tarp gydytojų ir radioterapijos skyrių specialistų sampratos apibrėžiant taikinio tūrį ir kritinius organus buvo sudarytos galvos ir kaklo navikų sritinių limfmazgių lygmenų nustatymo gairės ir kritinių organų apibrėžimo gairės. Įvairiose publikacijose autoriai pateikia skirtingus kritinių organų dozės ir tūrio vertinimo kriterijus. Dėl šių skirtumų, naudojant skirtingus apibrėžimo protokolus, neįmanoma palyginti skirtingų studijų rezultatų tarpusavyje, todėl siūloma, kad tiek kasdienėje klinikinėje praktikoje, tiek daugiainstituciniuose klinikiniuose tyrimuose būtų vadovaujamasi bendromis kritinių organų apibrėžimo bei dozės ir tūrio vertinimo gairėmis. Siekiant užtikrinti aukštą radioterapijos kokybę, būtina vadovautis rekomendacijomis, kurias pateikia pasaulinės radioterapijos organizacijos: AIRO (Italijos onkologų ir radioterapeutų asociacija), CACA (Galvos ir kaklo vėžio komitetas, Nosiaryklės vėžio komitetas, Kinijos kovos su vėžiu asociacija), DAHANCA (Danijos galvos ir kaklo vėžio grupė), EORTC (Europos vėžio tyrimų ir gydymo organizacija), GORTEC (Prancūzijos galvos ir kaklo radioterapinės onkologijos grupė), IAG-KHT (Vokietijos multidisciplininė galvos ir kaklo navikų grupė), RTOG (JAV spindulinio gydymo tyrimus koordinuojančioji grupė), TROG (Tran-Tasmanijos radioterapinės onkologijos grupė) ir kitos. Mokomoji knyga skirta gydytojams onkologams-radioterapeutams, gydytojams onkologams-chemoterapeutams, gydytojams otorinolaringologams, gydytojams veido žandikaulių chirurgams bei šių specialybių gydytojams rezidentams ir medicinos studentams.

Background and Objectives: To our knowledge, this is the first study that investigated the prognostic value of radiomics features extracted from not only staging 18F-fluorodeoxyglucose positron emission tomography (FDG PET/CT) images, but also post-induction chemotherapy (ICT) PET/CT images. This study aimed to construct a training model based on radiomics features obtained from PET/CT in a cohort of patients with locally advanced head and neck squamous cell carcinoma treated with ICT, to predict locoregional recurrence, development of distant metastases, and the overall survival, and to extract the most significant radiomics features, which were included in the final model. Materials and Methods: This retrospective study analyzed data of 55 patients. All patients underwent PET/CT at the initial staging and after ICT. Along the classical set of 13 parameters, the original 52 parameters were extracted from each PET/CT study and an additional 52 parameters were generated as a difference between radiomics parameters before and after the ICT. Five machine learning algorithms were tested. Results: The Random Forest algorithm demonstrated the best performance (R2 0.963–0.998) in the majority of datasets. The strongest correlation in the classical dataset was between the time to disease progression and time to death (r = 0.89). Another strong correlation (r ≥ 0.8) was between higher-order texture indices GLRLM_GLNU, GLRLM_SZLGE, and GLRLM_ZLNU and standard PET parameters MTV, TLG, and SUVmax. Patients with a higher numerical expression of GLCM_ContrastVariance, extracted from the delta dataset, had a longer survival and longer time until progression (p = 0.001). Good correlations were observed between Discretized_SUVstd or Discretized_SUVSkewness and time until progression (p = 0.007). Conclusions: Radiomics features extracted from the delta dataset produced the most robust data. Most of the parameters had a positive impact on the prediction of the overall survival and the time until progression. The strongest single parameter was GLCM_ContrastVariance. Discretized_SUVstd or Discretized_SUVSkewness demonstrated a strong correlation with the time until progression.

Background and Objectives This is the first study to explore the prognostic value of radiomics features extracted from both pre- and post-induction chemotherapy (ICT) PET/CT imaging for patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). The study aimed to identify the most significant prognostic radiomics biomarkers for locoregional recurrence free survival (LRFS), based on a machine learning model. [...].

Synopsis: In this lecture the main challenges to report the value of interim treatment 18F-FDG PET radiomics for modeling of local tumor control. Data from HNSCC patients (n=10) treated with induction chemotherapy were used for model training. Radiomic features were extracted from 18F-FDG PET images in the primary tumor region and date were compared with other studies CT values. Compared using the correlation coefficient (CC) and survival, cox regression plots.

Aim/Introduction: Gynecological malignancies are a group of debilitating oncologic ailments frequently affecting women in Europe and Worldwide. Currently, a wide array of structural and molecular imaging modalities are available for evaluating disease spread. 18F-FGD PET/CT being one of them, has one of the highest rates of sensitivity and specificity. Nevertheless, physiological activity in pelvic structures and lesions that are smaller than designated resolution of the PET scanner, hinder primary tumour extent and pathological lymph node evaluation. The purpose of this study was to evaluate if an additional delayed pelvic scan improves lesion characterization, detection rates compared to whole body PET/CT images and can it help differentiating malignant lesions from physiological surrounding tissue activity. Materials and Methods: All patients were provided with written consent form approved by regional ethics committee. A total of 155 patients (age median 56), histologically proven gynecological malignancies (uterine, cervical and ovarian cancer, FIGO stages I-IV), were investigated between November 2018 and November 2020. Two PET/CT scans were completed: whole body (approx. 60 min after FDG injection; low dose CT, 3 min/per bed position) and delayed pelvic (approx. 120 min after injection, diagnostic non-enhanced CT, 5 min/per bed position). Three independent readers of varying experience in nuclear medicine (two with at least 5 year of experience and one less than one year) evaluated images, surveyed and classified lesions by assigning a Likert type scoring (5-point scale: ranging from 1-benign to 5-malignant) and looked for possible new lesions in delayed pelvic scan. Descriptive statistics, interobserver weighted kappa values were calculated. Results: A total of 465-589 lesions were evaluated on whole body PET/CT images. On delayed pelvic scan 26.5 and 14.5 percent of lesions had their scores changed by one point when evaluated by experienced [...].

Since the beginning of the year 2020, the coronavirus-19 dis ease (COVID-19) pandemic has undoubtedly posed signif cant challenges to healthcare systems worldwide [1]. It has also afected, in a way previously unimaginable, our lifestyle and the way we relate to each other, not only at work, but also in the community and in the family setting. Healthcare systems worldwide have been forced to make huge alterations to be able to handle the diferent stages of the pandemic. Specifcally in nuclear medicine departments, several adjust ments have had to be made to face this unprecedented world wide cross-sectional disease. Refecting the need for swift and continuous adaptation, the number of publications on this phe nomenon, which continues to impact upon our routines, has increased considerably in recent months/the past year [...].

[...]. Darbo tikslas ir uždaviniai. Darbo tikslas Atsitiktinės atrankos prospektyviniame klinikiniame tyrime įvertinti ir palyginti 18F-FDG PET/KT tyrimo metu išmatuotų metabolinių parametrų reikšmę prognozuojant galvos ir kaklo vėžiu sergančių pacientų gydymo atsaką prieš numatomą gydymą ir vertinti gydymo atsaką po taikyto ICT gydymo bei prognozuoti tolimesnes ligos išeitis. Darbo uždaviniai 1. Įvertinti ir palyginti metabolinių parametrų galimybes prognozuoti galvos ir kaklo plokščialąsteliniu vėžiu sergančių pacientų gydymo atsaką dar prieš numatomą gydymą, apskaičiuojant 2-jų metų išgyvenimą be ligos (IBL) ir bendrąjį išgyvenimą (BI). 2. Įvertinti ir palyginti metabolinių parametrų apskaičiuotų slenkstinių reikšmių galimybes prognozuoti galvos ir kaklo plokščialąsteliniu vėžiu sergančių pacientų gydymo atsaką prieš numatytą indukcinės chemoterapijos gydymą, apskaičiuojant 2-jų metų išgyvenimą be ligos ir bendrąjį išgyvenimą. 3. Įvertinti ir palyginti metabolinių parametrų, atliktų prieš ir po gydymo, apskaičiuotų delta slenkstinių reikšmių galimybes prognozuoti galvos ir kaklo plokščialąsteliniu vėžiu sergančių pacientų gydymo atsaką, vertinant 2-jų metų išgyvenimą be ligos ir bendrą išgyvenimą. 4. Įvertinti ir palyginti metabolinių parametrų galimybes prognozuoti galvos ir kaklo plokščialąsteliniu vėžiu sergančių pacientų gydymo atsaką po indukcinės chemoterapijos gydymo, apskaičiuojant 2-jų metų išgyvenimą be ligos ir bendrąjį išgyvenimą. 5. Įvertinti ir palyginti metabolinių parametrų apskaičiuotų slenkstinių reikšmių galimybes prognozuoti galvos ir kaklo plokščialąsteliniu vėžiu sergančių pacientų gydymo atsaką po indukcinės chemoterapijos gydymo, apskaičiuojant 2-jų metų išgyvenimą be ligos ir bendrąjį išgyvenimą.[...].

Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60–70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax 74% (p=0.04), MTV 68% (p=0.03), TLG 76% (p=0.03) in primary tumor, and LN TLG decrease 74% (p=0.03) were associated with PFS. Decrease of primary tumor SUVmax 74% (p=0.04), MTV 69% (p=0.03), TLG 74% (p=0.02) and LN TLG 73% (p=0.02) were prognostic factors for OS. [...].

The role of 18F-fluorodeoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET/CT) imaging in head and neck carcinoma (HNC) during pre-treatment staging, treatment response assessment after induction chemotherapy, radiotherapy planning and after entire therapy, follow-up is analyzed with attention on contemporary evidence. The 18F-FDG PET/CT is properly established in staging for distinction of cervical nodal involvement or rejection of distant metastases. Recently, many papers on the assessment of treatment response of 18F-FDG PET/CT have been published. 18F-FDG PET/CT performed in 2 weeks after the completion of induction chemotherapy (ICT) prevents from irrelevant invasive procedures, such as full neck dissection, with a significant impact on clinical outcome. 18F-FDG PET/CT completed in 8 weeks after the radio-chemotherapy treatment also has a high negative predictive value. From another point of view, the low positive predictive value due to feasible post-ICT and radiation therapy inflammation findings needs adequate attention to make a clinical decision. Recently, 18F-FDG PET/CT imaging in head and neck carcinoma has emerged, especially in radiotherapy planning for tumour volume delineation. In the near future, there are some expectations that new PET radiopharmaceuticals would present significant information on specific tumour characteristics, and all possible limitations of 18F-FDG may be avoided.

Background and objectives: The importance of induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) has been re-established in recent years aiming at fewer metastatic sites and better control of the disease. We prospectively studied the possibility of early prediction of overall survival (OS) and progression-free survival (PFS) after 3 cycles of chemotherapy with doxetacel, cisplatin and 5-fluorouracil using 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (18F-FDG PET/CT) in patients with head and neck squamous cell cancer. To our knowledge, this is the first such study. Materials and Methods: Thirty-five patients were studied. They underwent an 18F-FDG PET/CT examination twice: a day before ICT and 10–14 days after the last cycle of ICT. Tumor-standardized uptake value (SUVmax) and hypermetabolic tumor volume were measured on both scans. The mean age of patients was 56.5 years. Complete responses to CCRT PFS and OS were calculated. Results: Our results showed that a decrease of 30% in the SUVmax value after ICT was a prognostic factor of tumor response to PFS and OS (p = 0.026 and p = 0.021). The groups of patients with a SUVmax between 10 and 14.5 in the primary tumor on a pre-ICT 18F-FDG PET/CT scan had statistically shorter PFS and OS (p = 0.001, p = 0.006) when compared with other groups of patients with SUVmax less than 10 or SUVmax more than 14.5. A decrease of less than 55% of hypermetabolic tumor volume of the primary tumor was significantly related to poor prognosis in PFS and OS (p = 0.033, p = 0.017). Conclusions: SUVmax and hypermetabolic tumor volume measured on 18F-FDG PET/CT after ICT might be valuable prognostic tools for predicting OS and PFS and, thus, for the selection of patients with head and neck cancer who will benefit from CCRT.