Value of positron emission tomography/ computed tomography with [18] f-fluoro-2-deoxyglucose [[18]F-FDG PET/CT] in patients with ovarian cancer

This article discusses the current role of [18]F-fluoro-deoxy-glucose [FDG] PET, CT and integrated PET/CT in the management of ovarian cancer patients. 87 PET/CT scans of 64 women with clinically suspected or pathologically proven ovarian cancer were analyzed. The findings of contrast enhanced CT [CE-CT] were interpreted by one experienced radiologist unaware of P ET/CT findings. Two experienced nuclear medicine physicians who were unaware of CE-CT findings examined PET images, evaluating localization and characterization and compared them to co-registered PET/CT images. Diagnostic accuracy was determined on a patient level and a region level. PET has significantly higher Sensitivity, specificity PPV NPV, and overall accuracy [94.7%, 86.7%, 93.1%, 89.7%, and 91.9% respectively] compared to [89.5%, 30%, 70.8%, 60% and 68.9%] for CT on patient level. The diagnostic performance of PET was also better at most anatomical sites when results were analyzed on region level. [18]F FDG PET in addition to conventional imaging modalities should represent an important step in the diagnostic flow chart of ovarian cancer patients. Particularly in patients having a high risk for the presence of extra-abdominal metastatic deposits

Role of TC99M MIBI inevaluation of skeletal malignancy

The aim of our study is to assess the value of 99mTc-hexakis-2-methoxyisobutylisonitrile [MIBI] scintigraphy to detect viable boney tumor in patients with clinical and radiological features of primary or metastatic skeletal tumors. This is a prospective study included thirty six patients with different bone malignancies [17 cases with primary lesions and 19 cases with metastatic boney lesions]. All patients were subjected to Tc99m MDP bone scan [BS] and Tc99m MIBI scans. Planar whole body scintigraphy was performed 2 hours after intravenous injection of 20-30 mCi of Tc99m MDP, and after 1 to 2 weeks a Tc-99m MIBI scan was performed using 15-20 mCi and planar imaging was done 15 min post injection. Thirty of 36 patients represented by bone lesions in BS showed increased MIBI uptake, with sensitivity 83.3%. In cases of primary bone tumors 3 patients out of 17 showed no tracer uptake in MIBI scan and also 3 patients of metastatic bone lesions out of 19 showed no tracer uptake in MIBI scan. The MIBI scan can detect more 41 sites of tracer uptake in these patients not seen in Bs. Tc-99m MDP bone and Tc-99m MIBI scans are complementary to each other. The sensitivity of detection of malignant bone tumor is more for combined BS and MIBI than each one alone

Trade-off between tumor coverage and normal tissue sparing during three-dimensional radiotherapy for breast cancer

To study the different dosimetric data regarding target, lung and heart using 3D planning in patients with breast cancer receiving adjuvant radiotherapy. This study included 30 female breast cancer patients who underwent either conservative breast surgery or modified radical mastectomy [MMR] and received adjuvant systemic chemo-hormonal therapy. Those patients attended the radiotherapy department of South Egypt Cancer Institute, Assiut University, during period from June, 2004 to February, 2006. All patients received loco-regional radiotherapy comprising opposing tangential chest wall fields and supraclavicular field irradiation. Three dimensions planning [3D] and analysis of different target dosimetric data was done. The median age was 49 years age, 87% underwent MRM and all of them received adjuvant systemic chemo-hormonal therapy. The mean value of mean target doses was 4289 cGy. The mean value of maximum doses was 5569 cGy. Mean volume of the target that received more than 110% of dose was 2.5%, while the mean volume of the target that received more than 105% of dose was 15.5%. About 12.6% of target volume received less than 95% of the prescribed dose. The mean value of dose homogeneity index [DHI] was 68.8%. The total irradiated volume of ipsilateral lung was 20% supraclavicular field irradiated half of it. Mean dose of the ipsilateral lung was 1086 cGy. The mean value of CLD of the ipsilateral lung was 1.97 cm NTCP of the ipsilateral lung was 2.05. As regard heart dosimetry, left sided cases: the maximum dose was 4950 cGy; the mean dose was 150cGy. the mean heart volume included by 50% isodose line was 0.9%. From our results we can conclude that 3D planning of the breast provide good dosimetric target coverage with good sparing of normal tissue especially lung and heart. The CLD and MHD are useful parameters to estimate the volumetric dose of lung and heart

Role of IL-6, sIL-6R, IL-1 beta, TNF-alpha, and B2M in pathophysiology and prognosis of multiple myeloma

Cytokines control myeloma cell proliferation, differentiation, apoptosis and tumor-induced bone marrow destruction. The present study was designed to estimate the serum levels of interleukin-6 [IL-6], soluble IL-6 receptor [sIL-6R], IL-1 beta, tumor necrosis factor-alpha [TNF-alpha], and beta-2 microglobulin [beta 2M] in multiple myeloma [MM] in an attempt to elucidate their role in the disease, to study their levels in different immunologic types of MM, and to evaluate the effect of therapy on these levels. The study included 40 patients with MM, 20 newly diagnosed [group I] and 20 patients receiving treatment [group II]. Ten patients received therapy for one year [group IIb]. Patients were subclassified according to beta 2M level into [patients with beta 2M < 6 mg/L and patients with beta 2M >/= 6 mg/L]. Fifteen healthy individuals were included as controls. Samples of all patients and controls were subjected to serum protein electrophoresis, immunofixation, serum cytokines [IL-6, IL-1 beta, TNF-alpha], sIL-6R, and beta 2-microglobulin estimation. Bone marrow aspiration [for patients only] and other laboratory chemical investigations were also performed. Serum immunofixation electrophoresis revealed that out of 40 patients, 25 were IgG myeloma, 12 were IgA myeloma, one case was light chain myeloma and 2 cases had biclonal gammopathy. Serum IL-6, sIL-6R, IL-1 beta, TNF-alpha and beta 2M showed significant increase in patient groups compared to controls, with no significant difference between groups I and II in both [IgG] and [IgA] myeloma. On the other hand, IL-6, sIL-6R, and beta 2M were significantly decreased in group IIb when compared with group I and group IIa. When beta 2M level was used for subgrouping, IL-6, sIL-6R, IL-1 beta, and TNF-alpha were significantly higher in group II patients with beta 2M >/= 6 mg/L than those with beta 2M < 6 mg/L. As IL-6, sIL-6R, IL-1 beta TNF-alpha, and beta 2M were elevated in all the studied myeloma patients, they might be involved in the pathophysiology of the disease irrespective of its immunologic type. IL-6 and sIL-6R could be used in monitoring the effect of therapy in MM especially in patients with impaired renal function. In addition of being known as a good prognostic marker, beta 2M could be used to monitor the response to therapy in MM

Evalution of post operative radiotherapy in bladder cancer after total cystectomy

Fifty patients with carcinoma of the urinary bladder who undergone total cystectomies were reviewed for evaluation of the effect of post-operative radiotherapy. Those patients were classified into two groups, 25 patients each. One group had recievid post-operative radiotherapy and the other not. The age of patients, sex, occupation, history of B infestation, pathological type, histopathological grading, duration of the disease before surgery and duration and type of recurrence after operation were all reviewed. The results showed that the use of post operative radiotherapy has improved the outcome of these cases after surgery