Erin Deeb

Stereotactic Body Radiotherapy for Recurrent Squamous Cell Carcinoma of the Head and Neck: Results of a Phase I Dose-Escalation Trial

PURPOSE To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) in previously irradiated patients with squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS In this Phase I dose-escalation clinical trial, 25 patients were treated in five dose tiers up to 44 Gy, administered in 5 fractions over a 2-week course. Response was assessed according to the Response Evaluation Criteria in Solid Tumors and [(18)F]-fluorodeoxyglucose standardized uptake value change on positron emission tomography-computed tomography (PET-CT). RESULTS No Grade 3/4 or dose-limiting toxicities occurred. Four patients had Grade 1/2 acute toxicities. Four objective responses were observed, for a response rate of 17% (95% confidence interval 2%-33%). The maximum duration of response was 4 months. Twelve patients had stable disease. Median time to disease progression was 4 months, and median overall survival was 6 months. Self-reported quality of life was not significantly affected by treatment. Fluorodeoxyglucose PET was a more sensitive early-measure response to treatment than CT volume changes. CONCLUSION Reirradiation up to 44 Gy using SBRT is well tolerated in the acute setting and warrants further evaluation in combination with conventional and targeted therapies.

Comparison of proton magnetic resonance spectroscopy with fluorine-18 2-fluoro-deoxyglucose positron emission tomography for assessment of brain tumor progression

We investigated the accuracy of high‐field proton magnetic resonance spectroscopy (1H MRS) and fluorine‐18 2‐fluoro‐deoxyglucose positron emission tomography (18F‐FDG‐PET) for diagnosis of glioma progression following tumor resection, stereotactic radiation, and chemotherapy.

INTERPRETABILITY OF PET/CT IMAGING IN HEAD AND NECK CANCER PATIENTS FOLLOWING COMPOSITE MANDIBULAR RESECTION AND OSTEOCUTANEOUS FREE FLAP RECONSTRUCTION

We investigated positron emission tomography (PET)/CT scanning following segmental resections and osteocutaneous free‐flap reconstruction. The interpretability of PET/CT imaging with healing osteotomies and reconstruction hardware was analyzed.

Clinical Value of the First Dedicated, Commercially Available Automatic Injector for Ictal Brain SPECT in Presurgical Evaluation of Pediatric Epilepsy: Comparison with Manual Injection

The most challenging technical problem in ictal brain SPECT for localization of an epileptogenic focus is obtaining a timely injection of a radiopharmaceutical. In our institution, the first dedicated commercially available, remotely controlled automatic injector has been used in the pediatric epilepsy unit in conjunction with 24-h video and electroencephalogram monitoring. The goal of this study was to demonstrate the improved success rate of ictal injection by use of the automatic injector in the pediatric population. Methods: Eighty-four pediatric patients and eighty-four 99mTc-ethylcysteinate dimer (99mTc-ECD) ictal brain SPECT studies were retrospectively analyzed in a masked manner. The group with manual injection consisted of 45 studies performed from 2004 to 2010 before the introduction of the automatic injector. The group with automatic injection consisted of 39 studies performed from 2010 to 2011 after the introduction of the automatic injector. The 2 groups were comparable in the total duration of seizure, injected dose, and time from the injection to the image acquisition. The latency time from the seizure onset to the initiation time of injection, the ratio of latency time to total duration of seizure (L/T), the number of patients with repeated studies, the number of days of additional hospitalization for each study, and the localization rate for identifying a single focus in each study were compared between the groups. Results: The median latency time in the group with automatic injection (8 s) was significantly lower than that of the group with manual injection (18 s) (P < 0.05). Also there was a statistically significant decrease in the number of patients with repeated studies in the group with automatic injection (2/39 [5%]), compared with the group with manual injection (14/45 [31%]) (P < 0.05). The median number of days of additional hospitalization in the group with manual injection (range, 0–7) was statistically significantly different, compared with the group with automatic injection (range, 0–1) (P < 0.05). In the group with automatic injection, 31 of 39 scans demonstrated a single localizing focus, compared to 22 of 45 scans from the manual-injection group, a significant difference (P < 0.05). The radiation exposure rate to nursing staff during the periods with automatic injection was lower than during the periods with manual injection. Conclusion: The automatic injector combined with 24-h video and electroencephalogram monitoring demonstrated significant clinical value by decreasing latency time, the number of patients with repeated studies, and the number of days of additional hospitalization while increasing the number of studies with a single localizing focus.

Early cancer therapy response assessment by quantitative F-18 FDG PET/CT

Purpose: Reliable noninvasive quantitative methods for assessing early response to chemotherapy are vital for development of more personalized cancer therapy management, by allowing earlier decisions regarding therapy changes. The CT RECIST method is widely used; however, CT does not provide information on the physiologic properties of the tumor. In this study, F-18 FDG (FDG) PET is compared to CT in predicting response to chemotherapy using changes in imaging biomarkers of tumor metabolism and size early after initiation of therapy compared to baseline (BL) and follow-up. Materials and Methods: Nine patients with malignant cancer (lung, colorectal, or lymphoma) entered this early therapy response study. All patients received a BL scan before the initiation of chemotherapy, an early therapy assessment (ETA) scan between 2 to 7 weeks after initiation of therapy, and a study end point (FTA) scan between 3 to 9 months. The average length of time between ETA and FTA scans was 4 months. All PET/CT scans were performed on GE ST PET/CT scanner, approximately 60 min after patients received IV injection of approximately 15 mCi of F-18 FDG. All PET/CT images were registered and analyzed on MIMvista workstation to calculate FDG SUV values and CT RECIST measurements. By comparing BL and FTA scans, patients were classified as responders or non-responders based on RECIST. To compare FDG PET and CT data, the largest tumor was identified on CT at BL and its area and SUV were measured at ETA and FTA in each patient. Results: At FTA, responders had an average (FTA CT area)/(BL CT area) of 0.40 and average (FTA SUV)/(BL SUV) of 0.25. For non-responders, these values were 1.55 and 1.27 respectively. At ETA, for responders, (ETA CT area)/(BL CT area) averaged 0.65 and (ETA SUV)/(BL SUV) averaged 0.26. For non-responders, these values were 1.19 and 1.15 respectively. Conclusion: FDG uptake reduction at ETA compared to BL can be used to distinguish responders from non-responders, classified based upon RECIST at FTA. This early change in FDG uptake is more sensitive than early CT changes in predicting response to chemotherapy at FTA. Research Support: This research was supported in part by grant U01 CA140230 from the National Cancer Institute to Dr. Mountz.