Presented at the 2017 American Society for Clinical Oncology Gastroenterology in San Francisco - January 21st 2017 Background: ASCC remains rare, but the incidence has been increasing over the last decade, especially in patients with HIV infection (HIV+). A recent meta-analysis demonstrated the usefulness of 18FDG-PET in initial staging and response assessment in ASCC. HIV+ patients may develop opportunistic infections which can cause false positives lymph nodes on Pet scanning and, therefore, our objective was to evaluate performance of 18FDG-PET in HIV+ patients. Patients and Methods: Retrospective analysis of consecutive patients with non-metastatic ASCC, treated in our institution during six years. HIV+ patients were analyzed separately in two groups, group 1 (Gr1): N0, group 2 (Gr2): N1,N2,N3. Results: A total of 87 patients with ASCC were analyzed, including 24 HIV+ patients (21 males, median age was 53 for male and 50 for women). There were 15 patients in Gr1 and 9 in Gr2. All patients performed conventional imaging (MRI and CT-scan). In Gr1, 12/15 patients had FDG-PET, it resulted in upstaging nodal disease in 2 patients. In Gr 2, 6/9 patients had FDG-PET, it resulted in upstaging nodal disease in 1 patient and down staging nodal disease in 2 patients. Both of sensibility and specificity of FDG-PET were 83% in our HIV+ population. All patients underwent Mitomycine C/5FU based chemoradiation or exclusive radiation therapy. Mean radiation dose received was 63.3Gy in G1 and 63.9Gy in G2. 18FDG-PET drive a modification in treatment strategy in only 1 patient in both of groups. Post-treatment PET scan was performed 4 months after treatment completion. Among patients who had post-treatment 18FDG-PET, a metabolic complete response was observed in 6/11 patients in Gr 1 and 3/5 patients in Gr 2. Survival at 5 years was 89% and 75% in Gr1 and Gr2, respectively. Conclusion: Based on our experience, 18FDG-PET nether drives substantial changes in staging nor in therapeutic strategy for ASCC HIV+ patients.

1. Performance
of
18-­‐FDG-­‐PET
in
the
management
of
non-­‐metasta8c
HIV+
anal
squamous
cell
carcinoma
(ASCC)
1 N. Baba Hamed, 2 G. Deplanque, 1 R. Kassis, 1 M. Gatineau, 1 L. Staudacher, 1 I. Chaiba, 1 F. Savinelli, 1 R. Sverdlin, 1 O. Maiga, 3 JL. Marin, 4 V. de Parades, 4 N. Lemarchand, 5O. Marty, 5 D. Levoir, 6 V. Duchatelle, 7 J. Loriau,
8 E. Zerbib, 9 M. Zins, 9 I. Boulay, 1 E. Raymond
1 Department of oncology, Groupe Hospitalier Paris Saint Joseph (GHPSJ), Paris, France; 2 Department of Oncology, Hopital Riviera-Chablais, Vaud-Valais, Switzerland; 3 Department of radiation therapy, Clinique Des Peupliers, Paris, France; 4 Department of proctology, GHPSJ,
Paris, France; 5 Department of Gastro-enterology GHPSJ, Paris, France; 6 Department of Pathology GHPSJ, Paris, France; 7 Department of Surgery, GHPSJ, Paris, France;8 CIMEN, Hopital FOCH, Suresne, France, 9 Department of Radiology, GHPSJ, Paris, France
: nbaba-hamed@hpsj.fr
N
=
87
N
=
24
Gr
2
=
9
Gr
1
=
15
HIV
+
Clinical/MRI
staging
Gr
1
Gr
2
All
pa8ents
N=
87
Sexe
M
F
14
1
7
2
34
53
Mean
age
(yo)
56
53
54(M)/65(F)
Lymph
nodes
staging
Nx
N0
N1
N2
N3
-­‐
15
-­‐
-­‐
-­‐
-­‐
-­‐
5
2
2
1
56
15
10
5
Mean
radia<on
dose
(Gy)
63.3
63.9
63.6
Exclusive
RT
5
0
15
CRT
10
9
72
CT
before
CRT
3
7
21
Gr
2
=
9
Gr
1
=
15
Gr
2
=
6
Gr
1
=
12
Pre
treatment
FDG-­‐PET
performance
2
Downstaging
:
-­‐ Pa8ent
1
:
T3N1
à
T3N0
-­‐ Pa8ent
2
:
T3N3
à
T3N2
Clinical/MRI
staging
N+
N-­‐
FDG-­‐PET
staging
N+
5
2
N-­‐
1
10
FDG-­‐PET
sensibility
=
83%
FDG-­‐PET
specificity
=
83%
Survival proportions: Survival of Two groups
0 1 2 3 4 5 6 7
0
50
100
Years
Percentsurvival
VIH+
VIH-
p-value=0.44 (NS)
1
Upstaging
:
T3N1
à
T3N3
0
Downstaging
2
Upstaging
:
-­‐ Pa8ent
1
:
T2N0
à
T2N2
-­‐ Pa8ent
2
:
T2N0
to
T2N1
R
e
s
t
a
g
i
n
g
No
modifica8on
1
modifica8on
:
Switch
CRT
to
CT
_
1
modifica8on
:
Switch
RT
to
CRT
(Pa8ent
1)
Modifica8on
of
strategy
CT
=
chemotherapy
RT
=
exclusive
Radia<on
therapy
CRT
=
Chemoradia<on
therapy
N+
N-­‐
N-­‐
N+
(1)The
Role
of
FDG-­‐PET
in
the
Ini<al
Staging
and
Response
Assessment
of
Anal
Cancer:
A
Systema<c
Review
and
Meta-­‐analysis.
Michael
Jones;
Ann
Surg
Oncol
(2015)
FDG-­‐PET
response
Gr
1
Gr
2
Post
treatment
PET-­‐FDG
(4
months
aZer
comple8on
of
treatment)
11
5
Complete
metabolic
response
6
3
CT
=
chemotherapy
RT
=
Radia<on
therapy
CRT
:
Chemoradia<on
therapy
(5FU
+
Mitomycine
C)
Anal
squamous
cell
carcinoma
(ASCC)
is
rare
although
the
incidence
of
ASCC
has
been
increasing
over
the
last
few
years,
especially
in
the
HIV+
populaPon.
This
is
largely
due
to
the
greater
prevalence
of
human
papilloma
virus
(HPV).
A
recent
meta
analysis
demonstrates
the
usefulness
of
18
FDG-­‐PET
in
the
staging
and
the
management
of
ASCC,
showing
an
upstaging
in
15%
and
a
downstaging
in
15%
of
nodal
diseases
(1).
Further,
HIV+
paPents
may
develop
opportunisPc
infecPons
which
can
cause
false
posiPves
lymph
nodes
on
18
FDG-­‐PET
scanning.
The
aim
of
our
retrospecPve
study
is
to
asses
the
effect
of
18FDG-­‐PET
on
staging
and
treatment
of
HIV+
paPents
with
non
metastaPc
ASCC
Overall
survival
es8mates:
ABSTRACT
Background
:
ASCC
remains
rare,
but
the
incidence
has
been
increasing
over
the
last
decade,
especially
in
paPents
with
HIV
infecPon
(HIV+).
A
recent
meta-­‐analysis
demonstrated
the
usefulness
of
18FDG-­‐PET
in
iniPal
staging
and
response
assessment
in
ASCC.
HIV+
paPents
may
develop
opportunisPc
infecPons
which
can
cause
false
posiPves
lymph
nodes
on
PET
scanning
and,
therefore,
our
objecPve
was
to
evaluate
performance
of
18FDG-­‐PET
in
HIV+
paPents.
Methods
:
RetrospecPve
analysis
of
consecuPve
paPents
with
non-­‐
metastaPc
ASCC,
treated
in
our
insPtuPon
during
six
years.
HIV+
paPents
were
analyzed
separately
in
two
groups
according
to
their
lymph
nodes
status,
group
1
(Gr
1):
N0,
group
2
(Gr
2):
N1,
N2,
N3.
Results
:
A
total
of
87
paPents
with
ASCC
were
analyzed,
including
24
HIV+
paPents
(21
males,
median
age
was
53
for
male
and
50
for
women).
There
were
15
paPents
in
Gr
1
and
9
in
Gr
2.
All
paPents
performed
convenPonal
imaging
(MRI
and
CT-­‐scan).
In
Gr
1,
12/15
paPents
had
18FDG-­‐PET,
it
resulted
in
upstaging
nodal
disease
in
2
paPents.
In
Gr
2,
6/9
paPents
had
18FDG-­‐PET,
it
resulted
in
upstaging
nodal
disease
in
1
paPent
and
downstaging
nodal
disease
in
2
paPents.
Both
of
sensibility
and
specificity
of
FDG-­‐PET
were
83%
in
our
HIV+
populaPon.
All
paPents
underwent
Mitomycine
C
and
5FU
based
chemoradiaPon
or
exclusive
radiaPon
therapy.
Mean
radiaPon
dose
received
was
63.3Gy
in
G1
and
63.9Gy
in
G2.
18FDG-­‐PET
drives
a
modificaPon
in
treatment
strategy
in
only
1
paPent
in
both
of
groups.
Post-­‐treatment
18FDG-­‐PET
was
performed
4
months
aber
treatment
complePon.
Among
paPents
who
had
post-­‐treatment
18FDG-­‐PET,
a
metabolic
complete
response
was
observed
in
6/11
paPents
in
Gr
1
and
3/5
paPents
in
Gr
2.
Survival
at
5
years
was
89%
and
75%
in
Gr
1
and
Gr
2,
respecPvely.
Conclusion
:
Based
on
our
experience,
18FDG-­‐PET
drives
substanPal
changes
neither
in
staging
nor
in
therapeuPc
strategy
for
ASCC
HIV+
paPents,
however,
it
may
be
useful
for
radiaPon
therapy
planning.
RESULTS
PATIENTS
&
METHODS
REFERENCES
CONCLUSION
According
to
our
experience,
in
HIV+
pa8ents
with
non
metasta8c
ASCC,
18FDG-­‐PET
:
Ø Do
not
drive
substan8al
changes
in
staging
Ø Do
not
drive
consequent
changes
in
therapeu8c
strategy
Ø Can
be
useful
for
therapeu8c
response
assessments
Ø Can
be
useful
for
radia8on
therapy
planning
OBJECTIVES