B.A. Shah

Evolving role of FDG PET/CT in multiple myeloma imaging and management.

OBJECTIVE Multiple myeloma is the most common cause of primary malignancy in bones. Radiography has been the imaging reference standard for decades. However, the growing use of CT, MRI, and PET technology has led to earlier diagnosis of multiple myeloma, more accurate therapy assessment, and better prediction of patient outcome. This article is focused on the evolving role of (18)F-FDG PET/CT in multiple myeloma diagnosis, therapy assessment, and prognosis. CONCLUSION FDG PET/CT is a valuable imaging modality in diagnosis, therapy assessment, and prognosis of multiple myeloma.

Interreader agreement and variability of FDG PET volumetric parameters in human solid tumors.

OBJECTIVE The purpose of this article is to evaluate the interreader agreement and variability of two (18)F-FDG PET parameters, metabolic tumor volume and total lesion glycolysis, in human solid tumors. MATERIALS AND METHODS One hundred eleven patients (mean [± SD] age, 61.9 ± 12.5 years) with baseline staging FDG PET/CT scans were included. Two readers independently read the scans and segmented metabolic tumor volume and total lesion glycolysis using two fixed thresholds, 40% and 50% of the lesions maximum standardized uptake value (SUVmax). The impact of the lesions FDG avidity and location on reader agreement and variability was established. Intraclass correlation coefficient (ICC), precision, and Bland-Altman analysis were used to evaluate agreement and variability. RESULTS The ICCs for 40% and 50% SUVmax segmentations of metabolic tumor volume between the readers were 0.987 and 0.995, and the corresponding values for 40% and 50% SUVmax segmentations of total lesion glycolysis were 0.987 and 0.986, respectively (p = 0.0001). The corresponding precisions were 0.5%, 0.2%, 0.5%, and 0.5%, respectively. The mean biases between the readers for 40% and 50% SUVmax segmentations of metabolic tumor volume were -1.78 ± 8.42 mL and -0.46 ± 2.1 mL and for 40% and 50% SUVmax segmentations of total lesion glycolysis were -7.3 ± 31.6 g and -2.97 ± 12.86 g, respectively. Subgroup analysis showed better precision and lesser variability for 50% SUVmax segmentations of metabolic tumor volume and total lesion glycolysis in patients with the highest and lowest FDG-avid primary tumors. The precision was highest and variability was lowest for lung tumors. CONCLUSION There is excellent interreader agreement for measurement of metabolic tumor volume and total lesion glycolysis with 40% and 50% SUVmax threshold segmentations in human solid tumors.

Analysis of decision making at a multidisciplinary head and neck tumor board incorporating evidence-based National Cancer Comprehensive Network (NCCN) guidelines.

PURPOSE To evaluate incorporation of National Cancer Comprehensive Network (NCCN) guidelines in decision making at a head and neck cancer (HNC) multidisciplinary tumor board (MDT) at an urban academic medical center. METHODS AND MATERIALS A retrospective study of 176 HNC patients was performed. The extent to which MDT decisions and subsequent patient care incorporate NCCN guidelines was evaluated. RESULTS A total of 173 (98.3%) HNC patients received MDT recommendations according to NCCN guidelines. Of the 159 patients treated, 153 (96.2%) received treatment according to NCCN guidelines. The MDT recommended the highest available evidence-based NCCN category guideline in 78.0%. Subsequent treatment using the same or higher category MDT recommendation occurred in 87.0% of patients. CONCLUSIONS Evaluation of patients at an MDT using NCCN guidelines incorporates the highest level of evidence in approximately 80% of patients and translates well into subsequent care. Incorporation of the highest available NCCN guideline may be improved, although management should be individualized.

Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer.

Randomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown.

Assessing cumulative acute toxicity of chemoradiotherapy in head and neck cancer with or without induction chemotherapy

BACKGROUND To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT). METHODS 77 patients underwent definitive CCRT (30 I/CCRT and 47 CCRT). Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. Using the TAME adverse event reporting system, short-term toxicity (T) scores were generated for IC (TIC), CCRT (TCCRT), total treatment duration (TRx), post-treatment period (TPT) and an overall score (Toverall) from treatment start to post treatment period. RESULTS Acute toxicity other than dysphagia, odynophagia, or dermatitis was reported in 90.0% and 66.0% of I/CCRT and CCRT patients, respectively (P=0.02). Compared to CCRT group, I/CCRT patients reported greater mean TRx (TRx: 2.11 vs. 2.87, P=0.01) and Toverall (Toverall: 2.60 vs. 3.70, P=0.003). CONCLUSION I/CCRT patients reported more cumulative acute toxicity during treatment compared to CCRT patients using the TAME reporting system.