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Radiation Oncology (London, England) Feb 2024Xerostomia is one of the most common side effects in nasopharyngeal carcinoma (NPC) patients after chemoradiotherapy. To establish a Delta radiomics model for predicting...
BACKGROUND
Xerostomia is one of the most common side effects in nasopharyngeal carcinoma (NPC) patients after chemoradiotherapy. To establish a Delta radiomics model for predicting xerostomia secondary to chemoradiotherapy for NPC based on magnetic resonance T1-weighted imaging (T1WI) sequence and evaluate its diagnostic efficacy.
METHODS
Clinical data and Magnetic resonance imaging (MRI) data before treatment and after induction chemotherapy (IC) of 255 NPC patients with stage III-IV were collected retrospectively. Within one week after CCRT, the patients were divided into mild (92 cases) and severe (163 cases) according to the grade of xerostomia. Parotid glands in T1WI sequence images before and after IC were delineated as regions of interest for radiomics feature extraction, and Delta radiomics feature values were calculated. Univariate logistic analysis, correlation, and Gradient Boosting Decision Tree (GBDT) methods were applied to reduce the dimension, select the best radiomics features, and establish pretreatment, post-IC, and Delta radiomics xerostomia grading predictive models. The receiver operating characteristic (ROC) curve and decision curve were drawn to evaluate the predictive efficacy of different models.
RESULTS
Finally, 15, 10, and 12 optimal features were selected from pretreatment, post-IC, and Delta radiomics features, respectively, and a xerostomia prediction model was constructed with AUC values of 0.738, 0.751, and 0.843 in the training set, respectively. Only age was statistically significant in the clinical data of both groups (P < 0.05).
CONCLUSION
Delta radiomics can predict the degree of xerostomia after chemoradiotherapy for NPC patients and it has certain guiding significance for clinical early intervention measures.
Topics: Humans; Nasopharyngeal Carcinoma; Retrospective Studies; Radiomics; Xerostomia; Magnetic Resonance Imaging; Nasopharyngeal Neoplasms; Chemoradiotherapy
PubMed: 38418994
DOI: 10.1186/s13014-024-02417-6 -
Journal of Medical Imaging and... Jun 2024In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated...
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
Topics: Humans; Carcinoma, Squamous Cell; Subarachnoid Hemorrhage; Parotid Neoplasms; Male; Radiation Injuries; Middle Aged; Female; Tomography, X-Ray Computed; Aged
PubMed: 38418293
DOI: 10.1016/j.jmir.2024.02.006 -
International Journal of Clinical... 2024Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the...
Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (=0.013). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.
Topics: Humans; Carcinoma, Squamous Cell; Parotid Gland; Skin Neoplasms; Retrospective Studies; Parotid Neoplasms; Neoplasm Staging
PubMed: 38410673
DOI: 10.1155/2024/5525741 -
Current Oncology (Toronto, Ont.) Feb 2024This study aims to compare whether the use of a salivary substitute including an enzymatic system clinically reduces the intensity of xerostomia, as well as exploring... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aims to compare whether the use of a salivary substitute including an enzymatic system clinically reduces the intensity of xerostomia, as well as exploring the impact that this has on the quality of life, in patients who had received radiotherapy in the head and neck (HNC) region. Forty patients who had completed radiotherapy treatment within 6 months to 1 year previously were allocated into an Enzymatic Spray group ( = 21) or a Placebo arm ( = 19). It should be noted that two patients in the Placebo arm declined to participate during phase 2 of the study. All patients were randomized and used both products three times a day for 30 days. For analysis, xerostomia grade, unstimulated (UWS) and stimulated (SWS) salivary flow rate, and quality of life through the University of Washington Quality of Life Questionnaire validated in Portuguese (UW-QoL) were assessed in two phases: Phase 1 (before the use of the products) and Phase 2 (after 30 days of using the products). All clinical data were collected from medical records. Analyzing the salivary substitute with the enzymatic system, an improvement in xerostomia complaints was observed 30 days after using the product; however, this difference was not statistically significant ( > 0.05). Regarding quality of life, no significant differences were observed in relation to the UW-QoL and saliva domain between the groups in the two phases of the study ( > 0.05). The salivary substitute with the enzymatic system may be effective in reducing radio-induced xerostomia symptoms; however, further research is necessary to evaluate the efficacy of this salivary substitute on oral health.
Topics: Humans; Head and Neck Neoplasms; Quality of Life; Saliva; Surveys and Questionnaires; Xerostomia
PubMed: 38392076
DOI: 10.3390/curroncol31020082 -
Asian Journal of Surgery May 2024
Extended resection followed by anterolateral thigh flap repair for a patient with recurrent epithelial-myoepithelial carcinoma of the parotid gland undergoing radiotherapy after the primary surgery.
Topics: Humans; Male; Myoepithelioma; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Thigh; Treatment Outcome; Aged
PubMed: 38383180
DOI: 10.1016/j.asjsur.2024.01.146 -
Molecular Imaging and Biology Apr 2024To assess the prognostic value of pre-treatment [Ga]Ga-PSMA-11 PET/CT and other baseline clinical characteristics in predicting prostate cancer (PCa) patients response...
PURPOSE
To assess the prognostic value of pre-treatment [Ga]Ga-PSMA-11 PET/CT and other baseline clinical characteristics in predicting prostate cancer (PCa) patients response to [Lu]Lu-PSMA (PSMA-I&T), as well as patient survival.
PROCEDURES
In this retrospective study, 81 patients who received [Lu]Lu-PSMA-I&T between October 2018 and January 2023 were reviewed. Eligible patients had metastatic castration-resistant PCa, underwent pre-treatment [Ga]Ga-PSMA-11 PET/CT, and had serum prostate-specific antigen (PSA) levels available. On PET/CT images, SUVmax, SULmax, SUVpeak, and SULpeak of the most-avid tumoral lesion, as well as SUVmean of the parotid gland (P-SUVmean) and liver (L-SUVmean), were measured. Also, whole-body PSMA tumour volume (PSMA-TV) and total lesion PSMA (TL-PSMA) were calculated. To interpret treatment response after [Lu]Lu-PSMA-I&T, a composite of PSA values and [Ga]Ga-PSMA-11 PET/CT findings were considered. The outcomes were dichotomised into progressive versus controlled (stable disease or partial response) disease. Then, the association of baseline parameters with patient response was evaluated. Also, survival analyses were performed to assess baseline parameters in predicting overall survival.
RESULTS
Sixty patients (age:73 ± 8, PSA:185 ± 371) were included. Patients received at least one cycle of [Lu]Lu-PSMA therapy (median = 4). Overall, half of the patients showed disease progression. In the progressive versus controlled disease evaluation, the highest SULmax, as well as SUVmax and SULmax to both backgrounds (L-SUVmean and P-SUVmean), were significantly correlated with the outcome (p-values < 0.05). In the multivariate analysis, only SULmax to the L-SUVmean remained significant (p-value = 0.038). The best cut-off was 8 (AUC = 0.71). With a median follow-up of 360 days, 11 mortal events were documented. In the multivariate survival analysis, only SULmax to P-SUVmean (cut-off = 2.4; p-value = 0.043) retained significance (hazard ratio = 4.0).
CONCLUSIONS
A greater level of PSMA uptake, specifically higher tumour-to-background uptake in the hottest lesion, may hold substantial prognostic significance, considering both [Lu]Lu-PSMA-I&T response and patient survival. These ratios may have the potential to be used for PCa patient selection for radioligand therapy.
Topics: Male; Humans; Aged; Aged, 80 and over; Positron Emission Tomography Computed Tomography; Gallium Radioisotopes; Prognosis; Prostate-Specific Antigen; Retrospective Studies; Treatment Outcome; Prostatic Neoplasms, Castration-Resistant; Heterocyclic Compounds, 1-Ring; Dipeptides
PubMed: 38360991
DOI: 10.1007/s11307-024-01900-6 -
Polish Archives of Internal Medicine Mar 2024
Topics: Humans; Adenolymphoma; Parotid Gland; Parotid Neoplasms; Lymphoma, Large B-Cell, Diffuse
PubMed: 38345433
DOI: 10.20452/pamw.16679 -
Radiotherapy and Oncology : Journal of... Apr 2024We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland...
BACKGROUND AND PURPOSE
We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT.
MATERIALS AND METHODS
We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed.
RESULTS
Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were €41,564 (SD 23,624) and €33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was €162,444 per xerostomia avoided. At 24 months, ICER was €194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT.
CONCLUSION
The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer.
Topics: Humans; Cost-Effectiveness Analysis; Radiotherapy, Intensity-Modulated; Cost-Benefit Analysis; Head and Neck Neoplasms; Xerostomia; Parotid Gland; Radiotherapy Dosage
PubMed: 38316193
DOI: 10.1016/j.radonc.2024.110116 -
European Journal of Nuclear Medicine... Jun 2024In addition to significant improvements in sensitivity and image quality, the recent introduction of long axial field-of-view (LAFOV) PET/CT scanners has enabled dynamic...
AIM
In addition to significant improvements in sensitivity and image quality, the recent introduction of long axial field-of-view (LAFOV) PET/CT scanners has enabled dynamic whole-body imaging for the first time. We aim herein to determine an appropriate acquisition time range for static low-dose [F]PSMA-1007 PET imaging and to investigate the whole-body pharmacokinetics of [F]PSMA-1007 by dynamic PET with the LAFOV Biograph Vision Quadra PET/CT in a group of prostate cancer patients.
METHODOLOGY
In total, 38 prostate cancer patients were enrolled in the analysis for staging or re-staging purposes. Thirty-four patients underwent dynamic whole-body PET/CT (60 min) followed by static whole-body PET/CT and four patients underwent static whole-body PET/CT only. The activity applied was 2 MBq/kg [F]PSMA-1007. The static PET images of 10-min duration (PET-10) were reconstructed and further split into 8-min (PET-8), 6-min (PET-6), 5-min (PET-5), 4-min (PET-4), and 2-min (PET-2) duration groups. Comparisons were made between the different reconstructed scan times in terms of lesion detection rate and image quality based on SUV calculations of tumor lesions and the spleen, which served as background. Analysis of the dynamic PET/CT data was based on a two-tissue compartment model using an image-derived input function obtained from the descending aorta.
RESULTS
Analysis of lesion detection rate showed no significant differences when reducing PET acquisitions from 10 up to 5 min. In particular, a total of 169 lesions were counted with PET-10, and the corresponding lesion detection rates (95% CI for the 90% quantile of the differences in tumor lesions) for shorter acquisitions were 100% (169/169) for PET-8 (95% CI: 0-0), 98.8% (167/169) for PET-6 (95% CI: 0-1), 95.9% (162/169) for PET-5 (95% CI: 0-3), 91.7% (155/169) for PET-4 (95% CI: 1-2), and 85.2% (144/169) for PET-2 (95% CI: 1-6). With the exception of PET-2, the differences observed between PET-10 and the other shorter acquisition protocols would have no impact on any patient in terms of clinical management. Objective evaluation of PET/CT image quality showed no significant decrease in tumor-to-background ratio (TBR) with shorter acquisition times, despite a gradual decrease in signal-to-noise ratio (SNR) in the spleen. Whole-body quantitative [F]PSMA-1007 pharmacokinetic analysis acquired with full dynamic PET scanning was feasible in all patients. Two-tissue compartment modeling revealed significantly higher values for the parameter k in tumor lesions and parotid gland compared to liver and spleen, reflecting a higher specific tracer binding to the PSMA molecule and internalization rate in these tissues, a finding also supported by the respective time-activity curves. Furthermore, correlation analysis demonstrated a significantly strong positive correlation (r = 0.72) between SUV and k in tumor lesions.
CONCLUSIONS
In prostate cancer, low-dose (2 MBq/kg) [F]PSMA-1007 LAFOV PET/CT can reduce static scan time by 50% without significantly compromising lesion detection rate and objective image quality. In addition, dynamic PET can elucidate molecular pathways related to the physiology of [F]PSMA-1007 in both tumor lesions and normal organs at the whole-body level. These findings unfold many of the potentials of the new LAFOV PET/CT technology in the field of PSMA-based diagnosis and theranostics of prostate cancer.
Topics: Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Aged; Whole Body Imaging; Middle Aged; Niacinamide; Oligopeptides; Fluorine Radioisotopes; Aged, 80 and over; Radiation Dosage; Radiopharmaceuticals
PubMed: 38286936
DOI: 10.1007/s00259-024-06620-1