Purpose. We evaluated the use of positron emission tomography (PET) with fluorine- 18- labeled fluoro- 2- deoxy- d- glucose (FDG) in follow- up study after radiation therapy in patients with uterine cervical carcinoma...Purpose. We evaluated the use of positron emission tomography (PET) with fluorine- 18- labeled fluoro- 2- deoxy- d- glucose (FDG) in follow- up study after radiation therapy in patients with uterine cervical carcinoma. Materials and methods. Thirty- two studies in 25 patients were reviewed. Twenty patients were treated with external beam irradiation and intracavitary brachytherapy, and five with irradiation following initial surgery. Time frominitial treatment to FDG- PET was 23.3 (5.2- 88.0) months. Rationale for FDG- PET was the presence of symptoms in 6 patients, abnormal serum tumor marker values in 13, abnormal lesions on other diagnostic imaging modalities in 19, and patient request in 2. On visualization of a lesion, the maximum standardized uptake value (maxSUV) of the lesion was calculated, and values over 2.0 were classified as FDG- positive. Maximum tumor diameter and tumor volume in the corresponding disease were estimated by computed tomography (CT) or magnetic resonance imaging (MRI). Results. Sensitivity and specificity of FDG- PET in the detection of recurrent disease were 91.5% (43/47) and 57.1% (4/7), respectively. Four false negative findings were seen for small lung metastases having a volume less than 1 cm3. Three false- positive cases were a localized pneumonitis, a benign pubic bone fracture,and a fibrosis after interstitial brachytherapy. Sensitivity for extrapelvic lymph node metastases was extremely high (100% ); in contrast, sensitivity and specificity for lung and bone lesions were 75.0% (12/16) and 33.3% (1/3), respectively. Regarding tumor volume measurement, good correlation between maxSUV on FDG- PET and tumor volume was obtained (lung metastases, P = 0.03; extrapelvic nodes, P < 0.0001). Within this study, all corresponding lesions over 1 cm3 showed a maxSUV value greater than 2.0. Conclusion. FDG- PET is a useful tool for the detection of extrapelvic lesions during the follow- up period after radiation therapy for cervical cancer. This study suggests that FDG uptake is associated with tumor volume, and FDG- PET has limitations in the detection of lesions less than 1 cm3 or microscopic disease. Careful diagnostic agreement between PET and CT/MRI for positive but benign lesions, such as inflammation and bone fracture, remains important.展开更多
Goals and Background: There are great differences between treatment methods for early-stage esophageal cancer in institutions. Radiation therapy has been considered to be an effective modality as organ-preserving trea...Goals and Background: There are great differences between treatment methods for early-stage esophageal cancer in institutions. Radiation therapy has been considered to be an effective modality as organ-preserving treatment of the disease. The aim of this study is to assess the effect and limitation of radiation therapy on patients with early esophageal cancer. Study: The subjects were 38 patientswith stage I (T1N0M0) squamous cell carcinoma of the esophagus who had received definitive radiation therapy alone. Eleven tumors were assessed within the mucosal layer, whereas 27 tumors showed submucosal invasion by examination using endoscopic ultrasound. All patients were treated with more than 60 Gy using a conventional daily fractionation dose at 2 Gy. An additional boost with brachytherapy was performed for 20 patients, and the prescribed doses were 10 Gy (5 Gy ×2 times) with low dose rate (8 patients) and 9 Gy (3 Gy ×3 times) with high dose rate (12 patients). Outcomes and prognostic factors, including the efficacy of intraluminal brachytherapy, were investigated. Results: The cause-specific survival rate and the local control rate at 5 yearswere 82.6%and 86.3%, respectively. Recurrences were noted in 8 patients with submucosal cancer, but no recurrence was observed in patients with mucosal cancer. In the present study, tumor length was a statistically significant prognostic factor for cause-specific survival (P = 0.018) and tumor depth tended toward statistical significance (P = 0.073). In 27 patientswith submucosal cancer, the tumor length was also statistically significant for the survival (P = 0.032). The 5-year cause-specific survival rates for the short tumor group and the long tumor groupwere 85.7%and 55.6%, respectively. On the other hand, the use of intraluminal brachytherapy had no significant effect on patient survival. Conclusion: Radiation therapy is very effective for early esophageal squamous cell carcinoma with tumor length less than 5 cm, but other treatment modalities, including chemoradiotherapy especially for inoperable patients, should be considered for submucosal cancer with a tumor length of 5 cm or more.展开更多
文摘Purpose. We evaluated the use of positron emission tomography (PET) with fluorine- 18- labeled fluoro- 2- deoxy- d- glucose (FDG) in follow- up study after radiation therapy in patients with uterine cervical carcinoma. Materials and methods. Thirty- two studies in 25 patients were reviewed. Twenty patients were treated with external beam irradiation and intracavitary brachytherapy, and five with irradiation following initial surgery. Time frominitial treatment to FDG- PET was 23.3 (5.2- 88.0) months. Rationale for FDG- PET was the presence of symptoms in 6 patients, abnormal serum tumor marker values in 13, abnormal lesions on other diagnostic imaging modalities in 19, and patient request in 2. On visualization of a lesion, the maximum standardized uptake value (maxSUV) of the lesion was calculated, and values over 2.0 were classified as FDG- positive. Maximum tumor diameter and tumor volume in the corresponding disease were estimated by computed tomography (CT) or magnetic resonance imaging (MRI). Results. Sensitivity and specificity of FDG- PET in the detection of recurrent disease were 91.5% (43/47) and 57.1% (4/7), respectively. Four false negative findings were seen for small lung metastases having a volume less than 1 cm3. Three false- positive cases were a localized pneumonitis, a benign pubic bone fracture,and a fibrosis after interstitial brachytherapy. Sensitivity for extrapelvic lymph node metastases was extremely high (100% ); in contrast, sensitivity and specificity for lung and bone lesions were 75.0% (12/16) and 33.3% (1/3), respectively. Regarding tumor volume measurement, good correlation between maxSUV on FDG- PET and tumor volume was obtained (lung metastases, P = 0.03; extrapelvic nodes, P < 0.0001). Within this study, all corresponding lesions over 1 cm3 showed a maxSUV value greater than 2.0. Conclusion. FDG- PET is a useful tool for the detection of extrapelvic lesions during the follow- up period after radiation therapy for cervical cancer. This study suggests that FDG uptake is associated with tumor volume, and FDG- PET has limitations in the detection of lesions less than 1 cm3 or microscopic disease. Careful diagnostic agreement between PET and CT/MRI for positive but benign lesions, such as inflammation and bone fracture, remains important.
文摘Goals and Background: There are great differences between treatment methods for early-stage esophageal cancer in institutions. Radiation therapy has been considered to be an effective modality as organ-preserving treatment of the disease. The aim of this study is to assess the effect and limitation of radiation therapy on patients with early esophageal cancer. Study: The subjects were 38 patientswith stage I (T1N0M0) squamous cell carcinoma of the esophagus who had received definitive radiation therapy alone. Eleven tumors were assessed within the mucosal layer, whereas 27 tumors showed submucosal invasion by examination using endoscopic ultrasound. All patients were treated with more than 60 Gy using a conventional daily fractionation dose at 2 Gy. An additional boost with brachytherapy was performed for 20 patients, and the prescribed doses were 10 Gy (5 Gy ×2 times) with low dose rate (8 patients) and 9 Gy (3 Gy ×3 times) with high dose rate (12 patients). Outcomes and prognostic factors, including the efficacy of intraluminal brachytherapy, were investigated. Results: The cause-specific survival rate and the local control rate at 5 yearswere 82.6%and 86.3%, respectively. Recurrences were noted in 8 patients with submucosal cancer, but no recurrence was observed in patients with mucosal cancer. In the present study, tumor length was a statistically significant prognostic factor for cause-specific survival (P = 0.018) and tumor depth tended toward statistical significance (P = 0.073). In 27 patientswith submucosal cancer, the tumor length was also statistically significant for the survival (P = 0.032). The 5-year cause-specific survival rates for the short tumor group and the long tumor groupwere 85.7%and 55.6%, respectively. On the other hand, the use of intraluminal brachytherapy had no significant effect on patient survival. Conclusion: Radiation therapy is very effective for early esophageal squamous cell carcinoma with tumor length less than 5 cm, but other treatment modalities, including chemoradiotherapy especially for inoperable patients, should be considered for submucosal cancer with a tumor length of 5 cm or more.
