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Master Thesis

Apport du tep-scanner au 18F-FDG dans l'évaluation post-thérapeutique du carcinome épidermoïde du canal anal : à propos d'une série de 87 patients

Abstract : Aim of the study: evaluate the response to therapy for anal carcinoma using imaging with [18F]-fluorodeoxyglucose Positron Emission Tomography Computed Tomography (FDG-PET/CT) and compare metabolic response with patient outcome. Materials & Methods: 87 patients with positive biopsy for anal carcinoma were involved in a retrospective multicenter study. Staging was established on clinical examination and CT or MR imaging. All patients underwent a post-treatment FDG PET/CT (between march 2008 and january 2014) and 56 had a pretreatment PET/CT. The treatment was concurrent radiochemotherapy. After treatment, a clinical examination was performed routinely for all patients. The correlation between PET/CT qualitative metabolic response and progression-free survival and cause-specific survival was calculated using the Kaplan-Meier method. Results: patient staging: 40 patients with T1 or T2 (46%), 43 patients with T3 or T4 (49%), 38 patients with N0 (44%), 49 patients with N+ (56%), 5 patients with M1 (6%). Median follow-up was 25 months (range, 2-76 months). Overall, 25 patients (29%) presented a recurrence: locally for 9 of them (10%), at distance or 12 (14%), and for 4 locally and distant recurrence (4,6%). Among patients with recurrence, 12 are currently alive. FDG-PET was performed between 2-8 months (mean 4 months) after therapy completion and detected 23 of 25 (92%) cases of clinical progression (local and distant). Thirteen patients (15%) died during our study: 1 with a local recurrence, 12 with metastatic anal carcinoma. FDG-PET/CT did not show abnormal FDG uptake (=complete metabolic response) in 55 patients (63%). Persistant abnormal FDG uptake (partial metabolic response) was observed in 32 patients (37%): 15 in the initial anal tumor site (17%), 14 at distance (nodes or metastases) (16%) and 3 locally and distant abnormal uptake (3%). The 2-year cause specific survival rate was 100% for patients with a complete response (CR) versus 59% for patients with a post-treatment FDG-PET/CT with abnormal uptake (P<0,0001). The 2-year progression-free survival for patients with CR versus non-CR was 96% and 28% respectively (p<0,0001). Conclusion: This is the first consequent french mulicentric study to date demonstrating that complete metabolic response on post-treatment FDG-PET/CT is highly predictive of increased progression-free and cause-specific survival. Moreover, those results agree with previous studies.
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Submitted on : Friday, January 30, 2015 - 10:21:33 AM
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Clémence Houard. Apport du tep-scanner au 18F-FDG dans l'évaluation post-thérapeutique du carcinome épidermoïde du canal anal : à propos d'une série de 87 patients. Médecine humaine et pathologie. 2014. ⟨dumas-01111312⟩

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