The impact of 18-fluorodeoxyglucose positron emission tomography on the staging, management and outcome of anal cancer

被引：82

作者：

de Winton, E. ^{[2
]}

Heriot, A. G. ^{[1
]}

Ng, M.

Hicks, R. J. ^{[3
,5
]}

Hogg, A. ^{[3
]}

Milner, A. ^{[4
]}

Leong, T. ^{[5
]}

Fay, M.

MacKay, J.

Drummond, E. ^{[3
]}

Ngan, S. Y. ^{[5
]}

机构：

[1] Peter MacCallum Canc Ctr, Dept Surg Oncol, Div Surg Oncol, Melbourne, Vic 8006, Australia

[2] Royal United Hosp, Dept Oncol, Bath BA1 3NG, Avon, England

[3] Peter MacCallum Canc Ctr, Ctr Mol Imaging, Melbourne, Vic 8006, Australia

[4] Peter MacCallum Canc Ctr, Ctr Biostat & Clin Trials, Melbourne, Vic 8006, Australia

[5] Univ Melbourne, Melbourne, Vic, Australia

来源：

BRITISH JOURNAL OF CANCER | 2009年 / 100卷 / 05期

关键词：

anal cancer; PET CT; staging; radiotherapy; HIGH-RISK MELANOMA; CERVICAL-CANCER; FDG-PET; ESOPHAGEAL CANCER; RANDOMIZED-TRIAL; LYMPH-NODES; CARCINOMA; RADIOTHERAPY; THERAPY; CT;

D O I：

10.1038/sj.bjc.6604897

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Accurate inguinal and pelvic nodal staging in anal cancer is important for the prognosis and planning of radiation fields. There is evidence for the role of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the staging and management of cancer, with early reports of an increasing role in outcome prognostication in a number of tumours. We aimed to determine the effect of FDG- PET on the nodal staging, radiotherapy planning and prognostication of patients with primary anal cancer. Sixty-one consecutive patients with anal cancer who were referred to a tertiary centre between August 1997 and November 2005 were staged with conventional imaging (CIm) (including computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound and chest X-ray) and by FDG- PET. The stage determined by CIm and the proposed management plan were prospectively recorded and changes in stage and management as a result of FDG- PET assessed. Patients were treated with a uniform radiotherapy technique and dose. The accuracy of changes and prognostication of FDG- PET were validated by subsequent clinical follow-up. Kaplan-Meier survival analysis was used to estimate survival for the whole cohort and by FDG- PET and CIm stage. The tumour-stage group was changed in 23% (14 out of 61) as a result of FDG- PET (15% up-staged, 8% down-staged). Fourteen percent of T1 patients (3 out of 22), 42% of T2 patients (10 out of 24) and 40% of T3-4 patients (6 out of 15) assessed using CIm, had a change in their nodal or metastatic stage following FDG- PET. Sensitivity for nodal regional disease by FDG- PET and CIm was 89% and 62%, respectively. The staging FDG- PET scan altered management intent in 3% (2 out of 61) and radiotherapy fields in 13% (8 out of 61). The estimated 5-year overall survival (OS) and progression-free survival (PFS) for the cohort were 77.3% (95% confidence interval (CI): 55.3-90.4%) and 72.2% (95% CI: 51.5-86.4%), respectively. The estimated 5-year PFS for FDG- PET and CIm staged N2-3 disease was 70% (95% CI: 42.8-87.9%) and 55.3% (95% CI: 23.3-83.4%), respectively. FDG- PET shows increased sensitivity over CIm for staging nodal disease in anal cancer and changes treatment intent or radiotherapy prescription in a significant proportion of patients.

引用

页码：693 / 700

页数：8