Current status of PET/CT in the diagnosis and follow up of lymphomas

Lymphomas are a heterogeneous group of malignancies that have a distinct biological behavior according to the subtype and degree of differentiation. Adequate staging, which has a direct impact on prognosis, is essential to properly plan therapy. Structural cross-sectional imaging, such as computed tomography, has been the standard imaging tool to stage and monitor patients with lymphoma. However, molecular imaging such as positron emission tomography has shown complementary diagnostic and prognostic values. This review discusses the current value of positron emission tomography imaging using 2-[fluorine-18]fluoro-2-deoxy-d-glucose in staging, restaging, monitoring and detecting relapse in Hodgkin's and non-Hodgkin lymphoma.

Irradiación lumboaórtica en el cáncer cérvico uterino: análisis de la literatura / Radiotherapy of aortic-lumbar lymph nodes in the cervical cancer: literature review

Antecedentes: El cáncer de cuello uterino es una enfermedad prevalente en Chile y es una de las localizaciones tumorales más frecuentes tratadas en el Instituto Nacional del Cáncer. Es habitual recibir pacientes jóvenes con tumores avanzados, en etapas IIB y IIIB, con riesgo elevado de compromiso ganglionar, tanto pelviano como lumboaórtico y donde el tratamiento estándar es la radio-quimioterapia. Objetivos: Determinar si la irradiación lumboaórtica reduce el riesgo de recidiva y/o mejora la sobrevida en pacientes con compromiso ganglionar evidente y en aquellos con alto riesgo de compromiso a dicho nivel. Método: Revisión exhaustiva de la literatura publicada sobre la indicación de radioterapia lumboaórtica en el cáncer cérvico uterino, en pacientes con enfermedad evidente en los ganglios lumboaórticos y en aquellas en que la indicación es en casos de alto riesgo de compromiso en dicho nivel. Resultados: En pacientes con tumores cervicales de pequeño tamaño y con ganglios pelvianos positivos, sería beneficioso el tratamiento ganglionar lumboaórtico. Sin embargo, en aquellas pacientes con enfermedad pelviana masiva (IIIB)o en aquellas en que existe evidencia de enfermedad lumboaórtica, dicho beneficio no sería tan importante. Conclusión: Son las pacientes con enfermedad pelviana controlable y con elevado riesgo de tener compromiso ganglionar lumboaórtico (etapa IA-B, IIA-B con ganglios positivos en la pelvis), las que más se benefician de la radioterapia lumboaórtica.

Background: Uterine cancer is a prevalent disease in Chile and it is one of the most frequent cancer locations treated in the National Chilean Cancer Institute. It is also common to receive young patients that have advanced tumors in stages IIB and IIIB with high risks of compromises of lymphatic nodes of pelvis and aortic-lumbar zones. The treatment for these kinds of cancers is radio-chemotherapy. Aims: Determinate if the radiotherapy of aortic-lumbar lymph nodes lowers the chance of relapsing or increase the survival rate in patients with evident compromise of aortic-lumbar lymph nodes and in those with high risk of compromise in that level. Method: Exhaustive analysis of the literature about the indication of radiotherapy of aortic-lumbar lymph nodes in cervix cancer which is classified in those where the radiotherapy treatment is done in patients with evident compromise of aortic-lumbar lymph-nodes, and those where de radiotherapy is done in patients with high risk of compromise in that level. Results: In patients with small cervix tumors and positive lymphoid nodes the LA lymphatic nodes treatment would be beneficial. However, patients that suffer massive pelvic disease (IIIB) or that have evidence of the disease, the benefit would not be so important. Conclusion: Patients with controllable pelvic disease and with high risk of having aortic-lumbar lymph nodes compromise are the most benefit of radiotherapy in aortic-lumbar lymph nodes (stages IA-B, IIA-B with positive lymph nodes).

Contribuição ao estudo da influência da radiação ionizante pré-operatória sobre a marcação do linfonodo sentinela do reto com azul patente: estudo experimental em ratos / Contribution to the study of the influence of preoperative ionizing radiation on the identification of the sentinel lymph node with patent blue: an experimental in rats

A radiação ionizante prévia promove alterações actínicas em tecidos peritumorais,o que poderia influenciar a demarcação do linfonodo sentinela.O presente estudo desenvolveu modelo experimental para demarcação do linfonodo sentinela do reto do rato e para definição da dose de radiação (curva de calibração).O objetivo foi avaliar a influência da radiação ionizante pré-operatória sobre a marcação, com corante azul patente, do linfonodo sentinela do reto de ratos.A amostra foi constituída por 40 ratos machos Wistar e dividida em 2 grupos:Grupo 1(controle não irradiado;n=20) e Grupo 2(irradiado com 1200cGy e demarcado 2 dias após;n=20).Foi observado aumento linear do tempo de coloração do linfonodo no Grupo 2.Concluindo,a irradiação pré-operatória não influiu na demarcação do linfonodo sentinela do reto do rato / Previous ionizing radiation induces actinic alterations in peritumoral tissues and thus might influence the localization of the sentinel lymph node.The present study developed an experimental model for the localization of the sentinel lymph node of the rectum of the rat and for the definition of the dose of radiation (calibration curve).The objective was to evaluate the influence of preoperative ionizing radiation on the staining of a patent blue dye in the sentinel lymph node of the rectum in rats.The sample was composed of 40 male Wistar rats and was divided in two groups: Group 1( non-irradiated control; n = 20 ) and Group 2( irradiated with 1200cGy and stained 2 days afterwards; n = 20).It was observed a linear increase in the time for the staining of the lymph in Group 2.In conclusion, preoperative irradiation did not influence the staining of the sentinel lymph node of the rectum in rats...

The Effect of Supraclavicular Lymph Node Irradiation upon the Thyroid Gland in the Post-operative Breast Carcinoma Patients

To identify the effect of post-operative irradiation to the thyroid gland in patients with breast carcinoma. Seventy seven patients with partial or total mastectomized breast carcinoma who received routine irradiation therapy (Hockey stick method: supraclavicular, internal mammary lymph nodes, and chest wall irradiation with 5, 040 rads, divided into 30 treatments) were reviewed in terms of their ipsilateral thyroid gland response. All patients had the bilateral thyroid sizes measured annually by ultrasonography before and after radiation therapy. In the one-year follow-up group (n=77), 32 patients (41.5%) demonstrated decreased ipsilateral thyroid gland size after Hockey Stick irradiation therapy (p=0.428), in the two-year follow-up group (n=37), 26 patients (70.3%) demonstrated decreased gland size after Hockey Stick irradiation (p=0.001), and in the three-year follow-up group (n=21), 15 patients (71.4%) showed a decreased thyroid gland size (p=0.005). Most the patients with breast carcinoma (32/77 at the one-year follow-up, 26/37 at the two-year follow-up, and 15/21 at the three-year follow-up) after post-operative Hockey Stick irradiation therapy showed reduced ipsilateral thyroid gland size. Routine en face treatment of the supraclavicular lymph nodes, using the Hockey Stick method, should be reconsidered.

Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

Objective: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. Design: A retrospective analysis of prognostic factors. Location: Hospital A.C.Camargo, Sao Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. Patients: A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were: confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C.Camargo itself). At the end of the follow-up period, 410 patients (65 per cent) had no evidence of disease and 219 (34.8 per cent) had died because of the tumor. Intervention: The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. Main outcomes measures: Multivariate analysis of the different variables was performed according to the Cox regression method. Results: The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). Conclusion: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.

Supraclavicular lymph nodes: 2- Is their routine irradiation in radiotherapy for breast carcinoma really necessary?

34 consecutive cases of female breast carcinoma presenting to NEMROCK were studied. 38 had an infiltrating duct carcinoma [82.4%], four had a lobular carcinoma [11.8%], one an anaplastic carcinoma [2.9%] and in one [2.9%], the type of carcinoma was not recorded. 17 were stage II, 12 stage III and 5 stage IV. All consented to ipsilateral lymph node biopsy by "mini-block" dissection. Histopathological examination confirmed the efficiency of clinical palpation of the supraclavicular lymph nodes. This accuracy is explained on the purely anatomical characteristics of the supraclavicular fossa. Because of this and because life-table analyses have failed to reveal any significant difference in survival between patients with micrometastases and those without nodal metastases, it is suggested that the supraclavicular radiotherapy portals for breast carcinoma be limited to patients with palpable malignant supraclavicular lymph nodes. Until major trials confirm this statement, cases with massive axillary nodal involvement [tumor-bearing nodes 80% or more], and those clinically Menia, should be kept on the present routine