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The application of functional imaging techniques to personalise chemoradiotherapy in upper gastrointestinal malignancies.

Wilson JM, Partridge M, Hawkins M - Clin Oncol (R Coll Radiol) (2014)

Bottom Line: The sensitivity and specificity of FDG-PET to predict treatment response and survival are not currently high enough to inform treatment decisions.FDG-PET improves target volume definition in oesophageal cancer by improving the accuracy of tumour length definition and by improving the nodal staging of patients.The current limitations of published studies prevent integrating imaging-derived parameters into decision making on an individual patient basis.

View Article: PubMed Central - PubMed

Affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK. Electronic address: james.wilson@oncology.ox.ac.uk.

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Axial images from 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in a patient with locally advanced pancreatic cancer. Although FDG avidity can be used to inform target volume definition, the process cannot be fully automated. FDG-uptake can be seen to correspond with a mass within the pancreatic head (A). This area of avidity runs the length of the stent within the common bile duct, including areas beyond that of the tumour mass (B). FDG avidity is also associated with inflammatory cell glucose metabolism.
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fig3: Axial images from 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in a patient with locally advanced pancreatic cancer. Although FDG avidity can be used to inform target volume definition, the process cannot be fully automated. FDG-uptake can be seen to correspond with a mass within the pancreatic head (A). This area of avidity runs the length of the stent within the common bile duct, including areas beyond that of the tumour mass (B). FDG avidity is also associated with inflammatory cell glucose metabolism.

Mentions: Only one series has looked at the effect of functional imaging on GTV definition in pancreatic cancer. In a cohort of patients with LAPC, a computed tomography-defined GTV was used as the reference volume for comparison with a GTV that was delineated after fusion of the FDG-PET with the planning computed tomography. An SUV ≥42% of SUVmax was used when viewing the FDG-PET. The PET-derived GTV was larger by 29.7%, due to extension of primary tumours and additional nodes. Figures 1 and 2 show the potential benefit of including FDG-PET in radiotherapy planning for LAPC. Figure 3 illustrates one of the potential limitations of FDG-PET in LAPC, namely the failure of FDG uptake to differentiate between tumour glucose metabolism and uptake in inflammatory cells. No published data on the correlation of functional imaging with histopathology have been reported.


The application of functional imaging techniques to personalise chemoradiotherapy in upper gastrointestinal malignancies.

Wilson JM, Partridge M, Hawkins M - Clin Oncol (R Coll Radiol) (2014)

Axial images from 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in a patient with locally advanced pancreatic cancer. Although FDG avidity can be used to inform target volume definition, the process cannot be fully automated. FDG-uptake can be seen to correspond with a mass within the pancreatic head (A). This area of avidity runs the length of the stent within the common bile duct, including areas beyond that of the tumour mass (B). FDG avidity is also associated with inflammatory cell glucose metabolism.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150923&req=5

fig3: Axial images from 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in a patient with locally advanced pancreatic cancer. Although FDG avidity can be used to inform target volume definition, the process cannot be fully automated. FDG-uptake can be seen to correspond with a mass within the pancreatic head (A). This area of avidity runs the length of the stent within the common bile duct, including areas beyond that of the tumour mass (B). FDG avidity is also associated with inflammatory cell glucose metabolism.
Mentions: Only one series has looked at the effect of functional imaging on GTV definition in pancreatic cancer. In a cohort of patients with LAPC, a computed tomography-defined GTV was used as the reference volume for comparison with a GTV that was delineated after fusion of the FDG-PET with the planning computed tomography. An SUV ≥42% of SUVmax was used when viewing the FDG-PET. The PET-derived GTV was larger by 29.7%, due to extension of primary tumours and additional nodes. Figures 1 and 2 show the potential benefit of including FDG-PET in radiotherapy planning for LAPC. Figure 3 illustrates one of the potential limitations of FDG-PET in LAPC, namely the failure of FDG uptake to differentiate between tumour glucose metabolism and uptake in inflammatory cells. No published data on the correlation of functional imaging with histopathology have been reported.

Bottom Line: The sensitivity and specificity of FDG-PET to predict treatment response and survival are not currently high enough to inform treatment decisions.FDG-PET improves target volume definition in oesophageal cancer by improving the accuracy of tumour length definition and by improving the nodal staging of patients.The current limitations of published studies prevent integrating imaging-derived parameters into decision making on an individual patient basis.

View Article: PubMed Central - PubMed

Affiliation: CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK. Electronic address: james.wilson@oncology.ox.ac.uk.

Show MeSH
Related in: MedlinePlus