Brain metastases from lung cancer responding to erlotinib: the importance of EGFR mutation.

Median survival of patients with brain metastases from nonsmall cell lung cancer (NSCLC) is poor and more effective treatments are urgently needed. We have evaluated the efficacy of erlotinib in this setting and its association with activating mutations in the epidermal growth factor receptor (EGFR) gene. We retrospectively identified patients with NSCLC and brain metastases treated with erlotinib. EGFR mutations in exons 19 and 21 were analysed by direct sequencing. Efficacy and tolerability were compared according to EGFR mutational status. 69 NSCLC patients with brain metastases were identified, 17 of whom harboured EGFR mutations. Objective response rate in patients with EGFR mutations was 82.4%; no responses were observed in unselected patients (p<0.001). Median (95% CI) time to progression within the brain for patients harbouring EGFR mutations was 11.7 (7.9-15.5) months, compared to 5.8 (5.2-6.4) months for control patients whose EGFR mutational status had not been assessed (p<0.05). Overall survival was 12.9 (6.2-19.7) months and 3.1 (2.5-3.9) months (p<0.001), respectively. The toxicity of erlotinib was as expected and no differences between cohorts were observed. Erlotinib is active in brain metastases from NSCLC; this clinical benefit is related to the presence of activating mutations in exons 19 or 21 of the EGFR gene.

La cardiología nuclear, una subespecialidad basada en la evidencia / Nuclear cardiology, an evidence based sub-speciality

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[Usefulness of pilocarpine in the prevention of xerostomia in patients with head and neck cancer treated with radiotherapy. Assessment with gammagraphy and salivary flow]. / Utilidad de la pilocarpina como profiláctico de xerostomía en pacientes con cáncer de cabeza y cuello tratados con radioterapia. Valoración mediante gammagrafía y flujo salivar.

AIM: To assess the utility of salivary gland scintigraphy and salivary flow to quantify salivary function and to evaluate the usefulness of pilocarpine in the treatment of radiation-induced xerestomia in head and neck cancer patients. METHOD: Thirty two patients with head and neck tumor treated with radiotherapy (RDT) were studied. Patients were classified into two groups: pilocarpine group (P), that received prophylactic pilocarpine before RDT and during the first year after treatment. No pilocarpine group (NP) that received RDT without pilocarpine. Salivary gland scintigraphy and salivary flow were performed before RDT and during one year after treatment. Parotid and submaxillary uptake and excretion were calculated. Salivary flow after stimulation during five minutes was also obtained. RESULTS: Uptake and excretion in both salivary glands decreased after RDT. There were no statistical differences comparing P and NP groups (p < 0.001). However, in group P a trend to recovery was observed in parotid uptake values at 12 months after treatment, but it was not statistically significant. In both groups the salivary flow decreased after RDT and a good correlation (r = 0.8) between salivary flow and submaxillary excretion and parotid excretion was found. CONCLUSIONS: Salivary gland scintigraphy and salivary flow could be useful to evaluate salivary gland function in patients with head and neck irradiated tumors. Although better results on the salivary uptake at 12 months were noted, pilocarpine did not significantly improve salivary gland function.

Corrección de movimientos en estudios de SPECT cardíaco / Correction of movements in cardiac SPECT studies

Objetivos: El movimiento del paciente durante la adquisición de imágenes es causa frecuente de artefactos en estudios de SPECT miocárdica de perfusión. En este trabajo se propone un algoritmo para la corrección de movimientos longitudinales. Material y métodos: El método está basado en el cálculo de la correlación entre funciones unidimensionales obtenidas de proyecciones sucesivas, utilizando una ventana obtenida de forma automática para eliminar datos espúreos antes de calcular la correlación. El algoritmo fue evaluado sobre estudios obtenidos a partir de un maniquí cardíaco y sobre estudios correspondientes a diez pacientes, 7 de los cuales presentaban movimientos apreciables y 3 en los que no se apreciaba movimiento que se utilizaron como control. Resultados: En los estudios obtenidos con el maniquí, el error medio en el desplazamiento calculado utilizando la ventana propuesta fue inferior a 0,5 píxeles. Cuando se utilizaron ventanas de mayor tamaño los errores medios aumentaron hasta 2,8 píxeles. En los estudios de pacientes, el método consiguió reducir los movimientos observados en siete casos y mantuvo inalterados los tres controles. Cuando no se utilizó una ventana para restringir la correlación, 3 de los 7 casos que presentaban movimiento no mejoraron, e incluso uno de los controles, empeoró. Conclusiones: Los resultados obtenidos indican la utilidad del algoritmo y ponen de relieve la necesidad de utilizar una ventana para eliminar datos antes de calcular la correlación (AU)

Objectives: Patient movement during SPECT acquisition of images is a frequent cause of artefacts in myocardial perfusion SPECT studies. In this paper we propose an algorithm for the correction of longitudinal movements. Materials and methods: The method is based on the calculation of the correlation between unidimensional functions obtained from successive projections with a window obtained automatically to eliminate unwanted data points before calculating the correlation. The algorithm was assessed on studies obtained from a cardiac phantom and from those corresponding to ten patients. Seven of these patients had significant movement during SPECT acquisition and those corresponding to the other three studies, in which no movement was observed, were used as a control. Results: In the phantom studies obtained, the mean error of the calculated displacements was less than 0.5 pixels when the window proposed was employed. The error reached 2.8 pixels when the length of the window increased. In patient studies, the method succeeded in reducing the patient motion in all cases and the three control studies remained unchanged. When no window was used to limit the correlation, three out of the seven studies that originally presented movements did not improve and one control study got worse. Conclusion: The results obtained indicate the utility of the algorithm and demonstrate the need to window the data before calculating the correlation (AU)