ABSTRACT
OBJECTIVE: Limited data are available concerning long-term results of imatinib therapy in patients with advanced gastrointestinal stromal tumors. We aimed to clarify the long-term outcomes of imatinib therapy in Japanese patients with advanced gastrointestinal stromal tumors. METHODS: A prospective, observational study of imatinib therapy for unresectable and metastatic gastrointestinal stromal tumors was conducted in our institution. Imatinib was initiated at a dose of 400 mg daily and continued until disease progression. Safety, efficacy and long-term tolerability and survival were evaluated in an intent-to-treat population. The median follow-up period in this study was 68 months. RESULTS: Seventy patients were enrolled between December 2001 and December 2009. Treatment-related Grade 3/4 adverse events occurred in 49 patients (70.0%). Although 14 patients required adverse effect management with hospitalization, only 5 patients (7.1%) withdrew from the treatment owing to imatinib intolerance. The tumor response and clinical benefit rates were 61.4 and 85.7%, respectively. Thirty-seven patients (52.9%) maintained the treatment at 400 mg daily imatinib, whereas 33 patients (47.1%) had their dose reduced to 300 mg daily or less. The overall survival rate at 5 years was 60.9% and the median survival time was 70 months. The median progression-free survival time of all the 70 enrolled patients was 30 months. Seven patients (10.0%) suffered from second malignancies, including three patients with genitourinary carcinomas. CONCLUSIONS: Despite the need for dose reduction, the long-term results of imatinib therapy for advanced gastrointestinal stromal tumors were good in Japanese patients. Physicians should pay attention to the occurrence of second malignancies during imatinib therapy for gastrointestinal stromal tumor patients.
Subject(s)
Antineoplastic Agents/therapeutic use , Gastrointestinal Neoplasms/drug therapy , Gastrointestinal Stromal Tumors/drug therapy , Neoplasms, Second Primary/chemically induced , Piperazines/therapeutic use , Pyrimidines/therapeutic use , Adult , Aged , Antineoplastic Agents/administration & dosage , Benzamides , Drug Administration Schedule , Female , Follow-Up Studies , Gastrointestinal Neoplasms/mortality , Gastrointestinal Neoplasms/pathology , Gastrointestinal Stromal Tumors/mortality , Gastrointestinal Stromal Tumors/pathology , Humans , Imatinib Mesylate , Japan/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Piperazines/administration & dosage , Prospective Studies , Protein Kinase Inhibitors/therapeutic use , Pyrimidines/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The diagnosis of peritoneal tuberculosis (TB) is difficult, and the condition is often misdiagnosed as advanced ovarian cancer. The clinical discrimination is important to avoid both unnecessary surgery and a delay in anti-TB treatment. CASE: A 66-year-old woman presented with abdominal distension. Positron emission tomography (PET) with F18-fluorodeoxyglucose showed a diffuse F18-fluorodeoxyglucose accumulation on the entire peritoneum. The presumptive diagnosis was peritoneal TB, and anti-TB treatment was thus started. Follow-up F18-fluorodeoxyglucose-PET revealed the disappearance of the pathologic foci and a decreased peak standardized uptake value. CONCLUSION: F18-fluorodeoxyglucose-PET may be a helpful tool in the diagnosis of peritoneal TB and serial F18-fluorodeoxyglucose-PET plays a potentially important role in monitoring the treatment response. The peak standardized uptake value may also be helpful for making a quantitative assessment of the therapeutic response.
Subject(s)
Antitubercular Agents/therapeutic use , Ascites/diagnostic imaging , Peritonitis, Tuberculous/diagnostic imaging , Positron-Emission Tomography , Aged , Ascites/drug therapy , Female , Fluorodeoxyglucose F18 , Humans , Peritonitis, Tuberculous/drug therapy , RadiopharmaceuticalsABSTRACT
We propose a new method for diagnostic assistance in oncology, [fluorine-18]-2-fluoro-2-deoxy-D: -glucose (FDG)-positron emission tomography (PET). Early and delayed scans were performed on 10 patients with lung cancer by use of an ECAT EXACT 47 PET scanner, and standardized-uptake-value (SUV) images were created. Three segmentation (S1, S2, and S3) maps were created from the early and delayed SUV images according to various thresholds (SUV(threshold) = 2.0, 2.5, and 3.0) based on the early image and the percentage change defined as (SUV(delayed) - SUV(early)) x 100/SUV(early). Voxels that had larger voxel values in their early images than the SUV(threshold) were clustered into three classes: S1 if the percentage change was larger than 10, S2 if the percentage change was between 0 and 10, and S3 if the percentage change was negative. The S1 segments showed malignant lesions clearly; however, the S2 segments showed an SUV that had decreased from the S1 areas due to the partial volume effect or misalignment between the early and delayed scans. The S3 areas showed benignity or physiologic accumulation. The segmented images, S1, S2, and S3, were useful for clinical diagnosis with dual-phase FDG-PET scans and offer an easy way of exploring the longitudinal alteration in the SUV.
