ABSTRACT
Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (PSMA-RLT) with lutetium-177 (177Lu-PSMA) has been used in metastatic castrate-resistant prostate cancer (mCRPC), and retrospective data have shown this therapy to be favourably safe with attractive clinical responses. Re-challenge 177Lu-PSMA therapy in early responders has been shown to be safe and effective. We report the use of low-dose Taxol-based chemotherapy (modified dose 25 mg/m2 weekly × 6 weeks) as a radiosensitizer with re-challenge 177Lu-PSMA therapy (4 cycles). In a period of 3 years, the patient underwent a total of 8 cycles of 177Lu-PSMA with a cumulative dose of 51.8 GBq. All therapies were uneventful and well tolerated. There was a good response to re-challenge 177Lu-PSMA therapy and low-dose docetaxel (Taxol-177Lu-PSMA) with no recorded tumour resistance.
ABSTRACT
BACKGROUND: Pulmonary and pleural involvement is fairly common in patients with lymphoma, especially in the setting of progressive or recurrent disease. Pleuropulmonary involvement in lymphoma may occur as a single pattern or as a combination of multiple patterns which can often mimic unrelated pathologies. METHODS: Review of our institutional database from 01 Jan 2015 to 04 Oct 2017 revealed 90 patients with pulmonary and/or pleural lesions attributable to lymphoma. These lesions were classified into various categories, and the pattern of involvement was evaluated. RESULTS: Pulmonary involvement was seen in 17.6% of patients with Hodgkin lymphoma (HL) and in 10.5% of patients with non-Hodgkin lymphoma (NHL), whereas pleural involvement was seen in 6.5% of patients with NHL. Almost all the patients in our study had findings belonging to multiple categories. Pulmonary involvement in patients with HL was seen in the form of nodules (51.6%), masses (51.6%), and direct extension from a mediastinal/hilar mass (45.2%). Patients with NHL had pulmonary involvement in the form of nodules (42.4%), direct extension from a mediastinal/hilar mass (25.4%), pulmonary masses (18.6%), and interstitial pattern (2.4%). Pleural thickening (61.5%), masses (30.8%), and effusion (15.4%) were the three patterns of pleural involvement. CONCLUSION: Nodules and masses were the two commonest patterns of pulmonary involvement in patients with HL, whereas nodules were the commonest pattern noted in patients with NHL. Pulmonary masses were seen more commonly in patients with HL than in those with NHL. Pleural involvement was seen exclusively in patients with NHL.
ABSTRACT
Breast metastases are a relatively rare condition and account for approximately 0.5-2% of all breast tumors. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. Breast metastases from medullary thyroid cancer (MTC) are very rare with only 21 reported cases in the literature. Some MTCs mimic primary invasive lobular carcinoma of the breast histopathologically and radiologically, making the distinction between the two diagnostically challenging. We present the case of a 45-year-old female presenting with a lump breast, which was later found out to be metastasis from medullary carcinoma thyroid.
ABSTRACT
PURPOSE: The fusion imaging modality of positron-emission tomography-computed tomography (PET-CT) has emerged as an important modality in the management of recurrent head and neck tumors. The aims of this study were to assess the role of PET-CT in the detection of recurrence in treated head and neck squamous cell carcinoma (HNSCC) and compare neck PET-CT and contrast-enhanced computed tomography (CECT) in the detection of locoregional recurrence with histopathologic correlation. MATERIALS AND METHODS: The study design was prospective and the study consisted of patients with treated HNSCC referred to the Department of Radiology at Rajiv Gandhi Cancer Institute and Research Center for follow-up or for clinical suspicion of recurrence. PET-CT and CECT neck images were obtained to detect recurrence based on clinical suspicion or as routine follow-up. Comparison of CECT and PET-CT results was performed using receiver operating characteristics (ROC) curves for the detection of locoregional recurrence with histopathologic correlation. RESULTS: Fifty-eight patients with treated HNSCC underwent neck PET-CT and CECT to detect recurrence based on clinical suspicion or as routine follow-up. The sensitivity and specificity of PET-CT for the detection of locoregional recurrence were 100% and 97.37%, which were considerably higher than 85% and 71.05% when using CECT. The ROC curve and its analysis showed that regional PET-CT is superior to neck CECT in the detection of locoregional recurrence (P = .02). When considering recurrence at the metastatic site, the sensitivity and specificity of PET-CT were 100% and 97.06%. PET-CT also detected second primary tumors in 2 patients. CONCLUSION: PET-CT not only is superior to conventional CECT in the detection of recurrence at locoregional and lymph node sites, but also plays a role in the restaging of recurrent tumors and the detection of distant metastases and second primary tumors. PET-CT, if included in routine post-treatment HNSCC follow-up or in a protocol for suspected recurrence, may have a major impact on the management of patients after treatment of HNSCC.
Subject(s)
Head and Neck Neoplasms/pathology , Multimodal Imaging/methods , Head and Neck Neoplasms/diagnostic imaging , Humans , Neoplasm Metastasis , Neoplasm Recurrence, Local , Positron-Emission Tomography , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
To evaluate the presence of peripheral neuropathy (PN) in newly diagnosed treatment-naive patients with multiple myeloma (MM), 29 patients and 25 age and sex matched controls underwent electrophysiological studies. Patients with associated diabetes, alcoholism, peripheral vascular disease and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M component and skin changes) were excluded from the study. The median age of patients was 56 years (range 28-82) and the sex ratio was 2.6:1. Eighteen (62.1%) patients were found to have evidence of PN by history and clinical examination alone (two patients), both clinical and electrophysiological evidence (five patients) and only electrophysiological evidence (11 patients). Out of 25 healthy controls, only two patients had evidence of PN by electrophysiological studies (cases vs. controls, p < 0.002). The commonest nerve involvement was in the form of sensory-motor axonal neuropathy followed by sensory-motor demyelinating neuropathy. This information may impact therapeutic and prognostic decision-making in newly diagnosed patients with MM.
