ABSTRACT
PURPOSE: To develop a model that predicts survival in patients irradiated for metastatic spinal cord compression (MSCC), hence assisting in the decision between a short and a long-course radiotherapy (RT) regimen. METHODS: 138 patients diagnosed with MSCC and treated with RT alone were included. Based on a multivariate analysis, a scoring system was developed. It included four prognostic variables: age, number of vertebrae, ECOG and histology. Total scores ranged between 14 and 24 points and patients were divided into two groups. RESULTS: The 6-month survival rate was 22% for patients with a score of 14-18 points; and 69% for patients with a score of 19-24 points (P < 0.001). The system exhibits a high specificity and positive predictive value and an appropriate discriminative ability. CONCLUSIONS: Patients with scores between 19 and 24 points were found to survive longer, thus a long-course RT appears to be more appropriate.
Subject(s)
Spinal Cord Compression/mortality , Spinal Cord Compression/radiotherapy , Spinal Neoplasms/mortality , Spinal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Prognosis , Retrospective Studies , Sensitivity and Specificity , Spinal Cord Compression/pathology , Spinal Neoplasms/secondary , Survival RateABSTRACT
PURPOSE: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.
Subject(s)
Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/radiotherapy , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Adult , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Neoplasm Staging , Positron Emission Tomography Computed Tomography/methodsABSTRACT
The true entity of Seckel's (bird headed dwarfism) has been hardly questioned due to the variety of malformations reported in these patients. However all cases reported have in common: dwarfism, bird head, microcephaly, mental retardation and malformations of different kinds. All these features must be present for the correct diagnosis. In two cases of Seckel's syndrome, full diagnostic features and post-mortem findings are reported. Special emphasis is made on the neuropathologic lesions. For the first time in the literature, changes in the epiphyseal tibial cartilage (with histochemical and EM studies) are described and correlated to dwarfism. Based on morphological data the authors propose Seckel syndrome as a condrodysplasia.
Subject(s)
Abnormalities, Multiple/pathology , Dwarfism/pathology , Osteochondrodysplasias/pathology , Bone and Bones/abnormalities , Brain/pathology , Cartilage/pathology , Epiphyses/pathology , Female , Humans , Immunologic Deficiency Syndromes/complications , Infant , Male , Microcephaly/pathology , Syndrome , Thymus Gland/abnormalitiesABSTRACT
Report of a bronchial mucoepidermoid tumour, in a eight years old boy. This is the first report of this kind of tumour in the pediatric age in the Spanish literature. The clinical and radiological features are considered as well as the usefulness of endoscopy in the diagnosis of bronchial tumours in children. The pathologic findings, differential diagnosis and the surgical treatment performed are discussed. These tumours are of low grade malignancy with an excellent prognosis as is confirmed by the follow-up of the present case without recurrences or metastasis after nine years.
