Complete and sustained response after peptide receptor radionuclide therapy in a 66-year-old Filipino male with metastatic pancreatic neuroendocrine tumor: A case report

@#The introduction of peptide receptor radionuclide therapy (PRRT) to the Philippines has allowed for novel approaches in the management of neuroendocrine tumors (NETs). This case report details the management of a 66-year-old Filipino man diagnosed with metastatic pancreatic NET after biopsy and staging with Ga-68 DOTATATE PET-CT. After poor response to somatostatin analogue therapy, the patient was advised to undergo PRRT. Upon completing four cycles of PRRT with Lu-177 DOTATATE, the metastatic hepatic lesions showed resolution and the pancreatic tail tumor exhibited regression, allowing the patient to undergo surgical resection of the primary tumor. On follow-up, he was declared to be in remission with good quality of life and no imaging evidence of recurrence. The case underscores the diagnostic and therapeutic utility of radiolabeled somatostatin analogues along with the importance of a multidisciplinary approach in the management of an initially unresectable metastatic pancreatic NET

Comparison of the treatment outcomes: percent change in the sum of longest diameters (RECIST) and percent change of the lesion with the highest SUL (PERCIST) between standard therapy plus Lu-177 PSMA ligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-18 PET-CT as an outcome indicator

Introduction@#Prostate cancer is the third most common cancer among Filipino males. Ga-68 PSMA PET-CT and Lu-177 PRLT have been introduced in the Philippines for the diagnostics and therapy of prostate cancer. @*Objective@#The aim of this study is to compare treatment outcomes of standard therapy plus Lu-177 PSMA radioligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-68 PET-CT as an outcome indicator. @*Methodology@#This is an ambispective cohort study on Ga-68 PSMA PET-CT scans performed between January 1, 2018 and July 31, 2021. Serum PSA data taken within one month of the PET-CT scans were also collected when available. The PET-CT images were reviewed by a radiologist for RECIST response, and by a nuclear medicine physician for PERCIST response . @*Results@#A total of 11 participants were included in the study. Six participants (55.5%) received standard therapy, while five participants (45.5%) received Lu-177 PSMA radioligand therapy plus standard therapy. There was no significant difference in the baseline and follow-up CT as shown by all p values > 0.05. A trend towards higher number of participants with non-complete/non-progressive RECIST response was noted in the control group than the treatment group, as well as higher number of participants with progressive or stable disease using the PERCIST response. @*Conclusion@#There were no significant differences noted in the clinical outcomes of participants who received Lu-177 PRLT and those with standard therapy alone. A trend towards decreasing serum PSA, CT and PET measurements were noted among patients given Lu-177 PRLT than those with standard therapy.

Association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis

Introduction@#Among older populations, osteoarthritis (OA) is one of the most common chronic joint disorders and is a leading cause of disability, while osteoporosis is the most common metabolic bone disease, conferring fragility and significant risk of fracture. The relationship between OA and osteoporosis remains controversial. Although earlier studies reported an inverse association between the two diseases, more recent literature found a complex relationship mediated by various factors. @*Objective@#The investigators sought to determine the association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis.@*Methodology@#A cross-sectional analytical study was conducted involving 256 patients with suspected hip OA who underwent radiography of the hips and central dual energy x-ray absorptiometry (DXA). Radiographs of the hips were evaluated by a radiologist using the Kellgren-Lawrence (KL) grading scale, while central DXA images were processed and evaluated by a nuclear medicine physician using the World Health Organization criteria for the diagnosis of osteoporosis and the 2019 International Society for Clinical Densitometry guidelines. The primary outcome measures were the prevalence of osteoporosis in patients with suspected hip OA, and the association of osteoporosis with radiologic KL grading of the hips. The secondary outcome measure was the association of osteoporosis with sex and BMI. @*Results@#The study found that osteoporosis was present in 136 (53.1%) of the 256 patients who all presented with radiologic evidence of hip OA. There was a positive association between the presence of osteoporosis and the radiologic grade of hip OA (p-value: 0.006 on the right hip and 0.036 on the left). Osteoporosis was more prevalent in women compared to men (p-value: 0.031). Likewise, osteoporosis had a direct relationship with BMI (p-value: <0.001). @*Conclusion@#Osteoporosis was prevalent in a significant proportion of older Filipino patients with clinical and radiologic evidence of hip OA, particularly among women, and was positively associated with increasing severity of OA. The study suggests that obesity may not necessarily protect against osteoporosis in this population, possibly relating to increased adiposity and decreased lean muscle mass.