A growing number of neuropsychological studies reported that chemotherapy may impair brain functions, inducing persistent cognitive changes in a subset of cancer survivors. The aim of this paper was ...to investigate the neural basis of the chemotherapy induced neurobehavioral changes by means of metabolic imaging and neuropsychological testing.
We studied the resting brain ¹⁸FFDG-PET/CT images of 50 adult cancer patients with diagnosis of lymphoma: 18 patients were studied prior and 32 after to chemotherapy. All patients underwent to a neuropsychological examination assessing cognitive impairment (tests for shifting attention, verbal memory, phonemic fluency), depression, anxiety and distress.
Compared to no chemotherapy patients, the treated group showed significant bilateral lower rate of glucose metabolism in prefrontal cortices, cerebellum, medial cortices and limbic brain areas. The metabolism of these regions negatively correlated with number of cycles and positively with post-chemotherapy time. The treated group showed a poorer performance in many frontal functions, but similar level of depression, anxiety and distress.
Chemotherapy induced significant long-term changes in metabolism of multiple regions with a prevailing involvement of the prefrontal cortex. The observed cognitive dysfunctions could be explained by these changes. The recovery from chemotherapy is probably affected by treatment duration and by the time elapsed after its end. We speculated that the mechanism could be an accelerating ageing / oxidative stress that, in some patients at risk, could result in an early and persistent cognitive impairment.
Purpose
Pathological complete response (pCR) following neoadjuvant chemoradiotherapy or radiotherapy in locally advanced rectal cancer (LARC) is reached in approximately 15–30% of cases, therefore it ...would be useful to assess if pretreatment of
18
F-FDG PET/CT and/or MRI texture features can reliably predict response to neoadjuvant therapy in LARC.
Methods
Fifty-two patients were dichotomized as responder (pR+) or non-responder (pR-) according to their pathological tumor regression grade (TRG) as follows: 22 as pR+ (nine with TRG = 1, 13 with TRG = 2) and 30 as pR- (16 with TRG = 3, 13 with TRG = 4 and 1 with TRG = 5). First-order parameters and 21 second-order texture parameters derived from the Gray-Level Co-Occurrence matrix were extracted from semi-automatically segmented tumors on T2w MRI, ADC maps, and PET/CT acquisitions. The role of each texture feature in predicting pR+ was assessed with monoparametric and multiparametric models.
Results
In the mono-parametric approach, PET homogeneity reached the maximum AUC (0.77; sensitivity = 72.7% and specificity = 76.7%), while PET glycolytic volume and ADC dissimilarity reached the highest sensitivity (both 90.9%). In the multiparametric analysis, a logistic regression model containing six second-order texture features (five from PET and one from T2w MRI) yields the highest predictivity in distinguish between pR+ and pR- patients (AUC = 0.86; sensitivity = 86%, and specificity = 83% at the Youden index).
Conclusions
If preliminary results of this study are confirmed, pretreatment PET and MRI could be useful to personalize patient treatment, e.g., avoiding toxicity of neoadjuvant therapy in patients predicted pR-.
Purpose
Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of
18
F-fluorodeoxyglucose (FDG) positron emission ...tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale (“Cuneo score”).
Methods
We performed a retrospective, multicenter study on HNSCC patients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients’ information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome.
Results
Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18;
p
= 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46;
p
= 0.024) and overall survival (OR for death, 4.81; 1.07-21.53;
p
= 0.04).
Conclusions
In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy.
We hypothesized that the IL-1β-511 C>T polymorphism could be associated with the development of neurotoxicity and that it could be a possible biomarker to rate the risk of occurrence of neurotoxicity ...in cancer patients. Genomic DNA was extracted from 85 cancer patients: 49 received systemic chemotherapeutic treatment (CHT) and 36 patients did not receive it (No-CHT). All subjects were genotyped for the functionally active polymorphisms of IL-1β-511 C>T. We estimated neurotoxicity with the evaluation of neurological deficits. CHT patients showed erythrocytopenia, neurological deficit and a slight lowering of cognitive performance. The subgroup of patients carrying the CC genotype of the IL-1β-511 C>T gene showed lesser neurological deficits. In the context of cancer treatment, we suggested the potential value of IL-1β-511 C>T as genetic biomarkers to identify patients with higher risk to develop neurological deficits.
To predict pathological response to neoadjuvant chemo-radiotherapy (CRT) in locally advanced rectal carcinoma (LARC), using a classifier based on texture features derived from MRI and PET ...acquisitions.
47 patients with: (a) histologically diagnosis of LARC, (b) pre-treatment MRI and PET/CT, (c) neoadjuvant treatment consisting of 46–55 Gy in 23–30 RT fractions alone or in association with either infusional 5-FU or oral Capecitabine, and (d) total mesorectal excision were included in this study. Patients with complete (tumour regression grade, TRG = 1) or near complete (TRG = 2) regression were defined as responders (pR+), while patients with moderate (TRG = 3) to no regression (TRG = 5) were considered as non-responders (pR-) 1,2. Before implementing texture analysis, tumours were semi-automatically segmented on T2-w MRI, ADC maps and PET/CT acquisitions. From the segmented tumours, the following quantitative features were extracted from T2-w, ADC and PET images: (a) first-order parameters: median, mean, percentiles (10th, 25th, and 75th), (b) SUV, metabolic volume and glycolytic volume only for PET images, and (c) 22 s-order texture parameters, derived from Haralick analysis 3. Multivariate logistic regression was performed to identify features most correlated with TRG.
Overall, 26 patients were classified as pR−, and 21 as pR+ after total mesorectal excision. Parameters included in the multivariate regression were “10th percentile PET”, “10th percentile T2-w”, “Homogeneity ADC”, “Homogeneity PET”, “Information measure of correlation T2-w” (p = 0.002). The area under the ROC curve was 0.83 (95% confidence interval = 0.69–0.93), sensitivity and specificity were 75% and 76%, respectively, in detecting responders.
Texture analysis could provide useful information in assessing response to neoadjuvant treatment in LARC patients. These preliminary results, if confirmed on larger dataset, could be useful to personalize the oncological pathway for patients, delaying or advancing surgery, according to the prediction of treatment response.
To predict pathological response to neoadjuvant chemo-radiotherapy (CRT) in locally advanced rectal carcinoma (LARC), using a classifier based on texture features derived from MRI and PET ...acquisitions.
47 patients with: (a) histologically diagnosis of LARC, (b) pre-treatment MRI and PET/CT, (c) neoadjuvant treatment consisting of 46–55 Gy in 23–30 RT fractions alone or in association with either infusional 5-FU or oral Capecitabine, and (d) total mesorectal excision were included in this study. Patients with complete (tumour regression grade, TRG = 1) or near complete (TRG = 2) regression were defined as responders (pR+), while patients with moderate (TRG = 3) to no regression (TRG = 5) were considered as non-responders (pR−) 1,2. Before implementing texture analysis, tumours were semi-automatically segmented on T2-w MRI, ADC maps and PET/CT acquisitions. From the segmented tumours, the following quantitative features were extracted from T2-w, ADC and PET images: (a) first-order parameters: median, mean, percentiles (10th, 25th, and 75th), (b) SUV, metabolic volume and glycolytic volume only for PET images, and (c) 22 s-order texture parameters, derived from Haralick analysis 3. Multivariate logistic regression was performed to identify features most correlated with TRG.
Overall, 26 patients were classified as pR−, and 21 as pR+ after total mesorectal excision. Parameters included in the multivariate regression were “10th percentile PET”, “10th percentile T2-w”, “Homogeneity ADC”, “Homogeneity PET”, “Information measure of correlation T2-w” (p = 0.002). The area under the ROC curve was 0.83 (95% confidence interval = 0.69–0.93), sensitivity and specificity were 75% and 76%, respectively, in detecting responders.
Texture analysis could provide useful information in assessing response to neoadjuvant treatment in LARC patients. These preliminary results, if confirmed on larger dataset, could be useful to personalize the oncological pathway for patients, delaying or advancing surgery, according to the prediction of treatment response.
Pathological complete response (pCR) following neoadjuvant chemoradiotherapy or radiotherapy in locally advanced rectal cancer (LARC) is reached in approximately 15-30% of cases, therefore it would ...be useful to assess if pretreatment of
F-FDG PET/CT and/or MRI texture features can reliably predict response to neoadjuvant therapy in LARC.
Fifty-two patients were dichotomized as responder (pR+) or non-responder (pR-) according to their pathological tumor regression grade (TRG) as follows: 22 as pR+ (nine with TRG = 1, 13 with TRG = 2) and 30 as pR- (16 with TRG = 3, 13 with TRG = 4 and 1 with TRG = 5). First-order parameters and 21 second-order texture parameters derived from the Gray-Level Co-Occurrence matrix were extracted from semi-automatically segmented tumors on T2w MRI, ADC maps, and PET/CT acquisitions. The role of each texture feature in predicting pR+ was assessed with monoparametric and multiparametric models.
In the mono-parametric approach, PET homogeneity reached the maximum AUC (0.77; sensitivity = 72.7% and specificity = 76.7%), while PET glycolytic volume and ADC dissimilarity reached the highest sensitivity (both 90.9%). In the multiparametric analysis, a logistic regression model containing six second-order texture features (five from PET and one from T2w MRI) yields the highest predictivity in distinguish between pR+ and pR- patients (AUC = 0.86; sensitivity = 86%, and specificity = 83% at the Youden index).
If preliminary results of this study are confirmed, pretreatment PET and MRI could be useful to personalize patient treatment, e.g., avoiding toxicity of neoadjuvant therapy in patients predicted pR-.
PDF
