«PET IN ONCOLOGY. MOLECULAR IMAGING IN HEAD AND NECK CANCER»

February 15, 2017, «BLOKHIN RUASSIAN CANCER RESEARCH CENTER», Москва.

The fourth annual conference “PET in Oncology. Molecular Imaging in Head and Neck Cancer” was held at Blokhin Russian Cancer Research Center on February 17, 2016 . Traditionally, it was organized by N.N. Blokhin RCRC, Russian Association of Oncologists (RAO) and Oncological Society of Molecular Imaging (OSMI).

This year the conference was devoted to the topical issues of primary and differential diagnostics, therapy response and detection of distant recurrent tumors of head and neck cancer using the modern methods of conventional radiology and radionuclide diagnostics. Whole range of problems of molecular imaging of head and neck cancer (from CT-perfusion and additional MR-protocols to SPECT/CT, PET/CT and PET/MRI with radiopharmaceuticals of current interest) was captured during three sessions of one-day event.

The Conference was attended by approximately 300 participants from different cities of Russian Federation and сountries of the Commonwealth of Independent States . There were performed reports of the top specialists from Russia, Brazil, UK, Israel, Italy, Finland and Switzerland.

participants registration

Traditionally, the conference was accompanied by a satellite medical exhibition.

satellite medical exhibition

Director of research institute of clinical and experimental radiology RCRC, professor, academician of Russian Academy of Sciences (RAS) Boris Dolgushin gave a welcome speech and declared the conference “PET in oncology 2017” opened. Also Boris Dolgushin outlined the main idea of the conference and thanked the speakers for their support.

chair: A. Mudunov, I. Pronin, B. Dolgushin

The first session (chair: A. Mudunov, I. Pronin, B. Dolgushin) was opened by the head of head and neck tumors department of research institute of clinical oncology, “N.N. Blokhin Russian Cancer Research Center” Ali Mudunov. His report was devoted to specificies of head and neck cancer anatomy and to its surgical treatment approaches depending of cancer stage, its localization and histology. Ali Mudunov reviewed clinical observations of surgical interventions cases of different localization and histological types of neoplasms.

Ali Mudunov

The second report was performed by MD from radiodiagnosis department in research institute of clinical and experimental radiology in “N.N. Blokhin Russian Cancer Research Center” Ekaterina Dronova. Her report was devoted to capacities of CT and MRI methods in diagnosis of epipharynx, oropharynx and hypopharynx cancer. In the report, attention was focused to the defining of tumorous process to the adjacent soft tissue structures as well using the modern contrast agents. It was illustrated by by many clinical observations. Also, the capacities of standard mode of CT and MRI methods in therapy response were identified.

Ekaterina Dronova

The third report was performed by MD of radiology unit in department of radiological methods of cancer diagnostics and therapy in research institute of pediatric oncology and hematology in “N.N. Blokhin Russian Cancer Research Center” Dmitry Sevryukov. The report was concerned to role of MRI with dynamic contrast enchasement for head and neck tumors in pediatric oncology.Report was focused to issues of data acquisition, its quantitative and qualitative analysis in primary differential diagnostics, therapy response and detecting of recurrent head and neck cancer.

Dmitry Sevryukov

Forth report was performed by academician of RAS, head of radiology and nuclear diagnostics department, deputy director of science in “NSPC of neurosurgery by N.N. Burdenko” Igor Pronin. The report was devoted to CT-perfusion technology in head and neck cancer diagnostics. Professor Pronin cited the examples of tumor blood-flow in primary differential cancer diagnostics as well as in therapy response and in continued dynamic monitoring of the patients. This method has a high value in diagnosis of haemangioblastomas, chordomas and other growths of this localization.

Igor Pronin

The next review report about PET/CT in head and neck cancer was performed by professor, director of nuclear medicine and PET/CT department in Rambam Health Care Campus Ora Israel. The issues of cancer staging, therapy response and PET with ¹⁸F-FDG capacity in prognosis of patients’ survival were discussed. Ora Israel told about application of PET/CT in diagnostics of secondary tumors with different localization. Sensitivity and specifity of this method is 88% and 95% accordantly. In addition, PET/CT has a high diagnostics value in radiotherapy planning. According to author's data, PET/CT with 18F-FDG diagnostic accuracy in head and neck cancer reaches 81%, opposed to CT and MRI, which diagnosis accuracy does not exceed 45%. In addition, there were performed examples of PET/MRI application in head and neck cancer diagnosis and radiotherapy planning - better diagnosis accuracy in detection of T-stage (87% oppose to 67% for PET/CT) and similar is for N-stage detection was shown. In the end of the report, Ora Israel gave some recommendations about reasonability of using PET/CT with ¹⁸F-FDG in head and neck cancer.

Ora Israel

Concluding in the first session report was performed by MD from Istituto Clinico Humanitas (Milan, Italy) Maria Kirienko. Maria told about radiomics and radiogenomics in head and neck cancer. Actual data about capacities of ultrasound, CT, MRI, PET and PET/CT in differential diagnostics of benign and malignant tumors by data analysis were discussed . There were considered clinical examples of chemoradiotherapy of dermoid cancer effectiveness monitoring with achievement of homogenous tumor structure – the predictor of positive therapy response. Maria Kirienko noticed that more accurate choosing of radiation exposure zone is possible on base of PET/CT texture data analysis using manual as well as automatic outlining target volumes for radiation planning. This methodic can improve evaluation of therapy response as well as prognosis of patients survival.

Margarita Kirienko

The second session (Chair: Chiti A., Dolgushin M.) was started with a report about ability of PET/CT in detection of primary tumor in cases of metastatic cervical and supraclavicular lymph nodes by MD from Center of Positron Emission Tomography in Chelyabinsk Regional Oncological Hospital Aleksey Subbotin. Aleksey Subbotin performed his own diagnostics data of 51 patients and statistical data of metastasis histology in 36 of them. It was noticed that dermoid cancer and adenocarcinoma (15 and 12 cases) prevail over melanoma and carcinoma simplex (5 and 4 cases). In addition author gave data that in most of cases (58%) PET/CT allowed to determine primary site, just as other diagnostics methods didn’t give any result.

Aleksey Subbotin

The next report was performed by professor Ora Israel. This time it was devoted to difficulties of interpretation and artefacts in PET/CT with ¹⁸F-FDG. The report was extensive with a number of clinical examples. Author told about rules of preparation of patients to PET/CT investigation and some limitations of this method. There were discussed alternatives of radiopharmaceutical physiological uptake in different anatomical structures, image distortion around metal frame structures, difficulties in identification of satellite inflammation changes as well as changes after radio- and drug therapy. The report informativeness and сomprehensive review of the whole issue were great.

Visiting professor in Department of Nuclear Medicine in University of Texas Kalevi Kairemo performed the third report about hypoxia imaging in head and neck cancer and PET in evaluation of treatment response of head and neck cancer . Professor Kairemo told about specifies of ¹⁸F-FMISO, ¹⁸F-FAZA, ¹⁸F-EF5 и ⁶⁴Cu-ATSM radiopharmaceuticals application. It was noticed, that ¹⁸F-FMISO is the most usable radiopharmaceutical in head and neck cancer, which allows to adjust local radiation doze up to 105 Gy to the hypoxia zone. In addition, author raised a question about changing of practical application of therapy response criteria, such as RECIST and PERCIST. Also the reasonability of repeated PET/CT investigation in head and neck cancer was discussed: it is necessary to investigate patients before and after radiotherapy without intermediate investigation.

Kalevi Kairemo

Professor, the head of positron emission tomography department in research institute ofclinical and experimental radiology in «N.N.Blokhin Russian Cancer Research Center» Mikhail Dolgushin performed the fourth report about first experience of application ¹⁸F-FET in head and neck cancer Russia. The comparison of ¹⁸F-FET and ¹⁸F-FDG capacities in differentiation of tumor tissue and satellite inflammation changes for this localization was performed in the report. Particular attention required questions about estimation of tumor boundaries in intracranial extension and sensitivity of metastatic lesion in lymph nodes detection methodic. It was noticed that ¹⁸F-FET uptake in inflammation zone is much less. That’s make possible to define real tumor boundaries. However, PET/CT with ¹⁸F-FDG has better diagnostics accuracy in detection of lymph nodes lesion.

Mikhail Dolgushin

The third session (chair: R. Dedivitis, O. Israel, S. Shiryaev) was opened by professor of department of head and neck surgery in the hospital of Medical Faculty in San-Paulo University Rogério Dedivitis. His report was devoted to the role of PET/CT after organ preservation surgery in head and neck cancer. Professor Dedivitis shared a data about treatment, variability of head and neck cancer patients’ survival. Special attention was devoted to capacities of PET/CT method in detection of recurrences and to the continued treatment tactics in those patients. Author showed that using of PET/CT reduces necessity of laryngoscopy in 50% of cases as well as total cost of treatment.

Rogério Dedivitis

Then the president of European Association of Nuclear Medicine (EANM), Director of Nuclear Medicine department at Istituto Clinico Humanitas Arturo Chiti performed his report “Advanced use of imaging in radiation treatment planning for head and neck tumors”. Chiti cited clinical examples of volume selection and doze calculation for radiotherapy, detection of tumor hypoxia, estimation of treatment effectivity using PET/CT and PET/MRI with different radiopharmaceuticals: ¹⁸F-FDG, ¹⁸F-FLT, ¹¹С-MET, ⁶⁴Cu-ATSM. Author noticed that PET/CT method has high sensitivity (88-100%), high specifity (75-100%) and high diagnostics accuracy in detection of distant metastasis, compared with routine MRI and CT methods.

Arturo Chiti

The third report was performed by director in Institute of Head and Neck Studies and Education (InHANSE), chair of Head and Neck Surgery in University of Birmgingham Hisham Mihanna. In his report Mihanna told, that negative PET/CT result after 8 and more months after radiotherapy means remission in 97% of the cases. Also author noticed to high possibilities of PET/CT method in diagnostics of remission compared with CT method (diagnostics accuracy 90% and 46% accordantly). Professor Mihanna could not to visit the conference, but his report was recorded and shown to visitors. Then Mihanna answered questions by videoconference.

Hisham Mihanna

The fourth report about using of 18F-FDG PET/CT in diagnosis of head and neck cancer recurrence was performed by MD from Center of Positron Emission Tomography in Chelyabinsk Regional Oncological Hospital Kirill Bogatenkov. As well as previous speakers, Kirill Bogatenkov noticed high diagnostics accuracy of the method and referred to the literature. Sensitivity of PET/CT method is 86-95%, specifity is 75-93%, compared with CT (sensitivity is 38-75%, specifity is 43-89%). Author demonstrated his own data of 125 patients with epipharynx, oropharynx and hypopharynx cancer. The sensitivity, specifity and diagnostics accuracy of PET/CT method compared with CT method are 98%, 50%, 79% against 67%, 28% and 69%. In addition, it was noticed that radiotherapy could influence to the increase false-positive results of PET/CT.

Kirill Bogatenkov

The fifth report “PET/MR: fiction and facts with special reference to imaging of head and neck cancer “ was performed by professor, chairman and director emeritus of Department of Medical Radiology and Nuclear Medicine in Zurich University Hospital Gustav von Schulthess. The report included practical examples of data acquisition and possible artefacts in PET/MRI images. Clinical data of estimation of cancer prevalence and ability of PET/MRI method to detect it were performed too. Author noticed higher diagnostics accuracy of PET/MRI with contrast agent administration in diagnostics of perineural cancer spread in neck level. Therefore, in determining of process tumour spread (T, N and M stages) PET/MRI has higher diagnostics accuracy than PET/CT method.

Gustav von Schulthess

Final report “Single photon emission computed tomography in evaluation of viability of the jaw autografts in patients with head and neck cancer” was performed by senior researcher of laboratory of radioisotope diagnostics in research institute of clinical and experimental radiology in «N.N.Blokhin Russian Cancer Research Center» Aleksey Ryzhkov. Author told about general algorithms in diagnostics and “viability” estimation of autografts (panorex radiograph, CT, bone scan, SPECT/CT), about its advances and limitations. There were cited own clinical examples of 22 patients management, approved high capacity of SPECT/CT method and reached by this method specifity 100%, compared with bone scan specifity 60%.

Aleksey Ryzhkov

Then the president of the OSMI, head of laboratory of radioisotope diagnostics in research institute of clinical and experimental radiology in “N.N.Blokhin Russian Cancer Research Center” Sergey Shiryaev made the closing speech. He thanked speakers and visitors of the conference, noticed high informative and scientific level of performed reports covered major issues of diagnostics, management and treatment of patients with head and neck cancer using modern methods of radiology and nuclear medicine. Proffessor Shiryaev drewed an attention to the impotence of following to the process of molecular imaging technology development, wide and intensive implementation of different radiopharmaceuticals into routine clinical practice.

Chair: R. Dedivitis, O. Israel, S. Shiryaev (from the right)