MRI assessment and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer: long-term results from the GEMCAD 0801 trial.

Background: Primary chemotherapy has been tested as a possible approach for patients with high risk features but predicted clear mesorectal margins on preoperative MRI assessment. This study investigates the prognostic relevance of baseline and post-treatment MRI and pathology staging in rectal cancer patients undergoing primary chemotherapy. Patients and methods: Forty-six patients with T3 tumour > =2 mm from the mesorectal fascia were prospectively treated with Neoadjuvant Capecitabine, Oxaliplatin and Bevacizumab prior to surgery between 2009 and 2011. The baseline and post-treatment MRI: T, Nodal and Extra-mural venous invasion (EMVI) status were recorded as well as post-treatment MRI Tumour regression grade (TRG) and modified-RECIST assessment of tumour length. The post-treatment pathology (yp) assessments of T3 substage, N, EMVI and TRG status were also recorded. Three-year disease-free survival (DFS) and cumulative incidence of recurrence were estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging and response on MRI and pathology with survival outcomes. Results: About 46 patients underwent neoadjuvant chemotherapy alone for high risk margin safe primary rectal cancer. The median follow-up was 41 months, 5 patients died and 11 patients experienced relapse (2 local, 8 distant and 1 both). In total 23/46 patients were identified with MRI features of EMVI at baseline. mrEMVI positive status carried independent prognostic significance for DFS (P = 0.0097) with a hazard ratio of 31.33 (95% CI: 2.3-425.4). The histopathologic factor that was of independent prognostic importance was a final ypT downstage of ypT3a or less, hazard ratio: 14.0 (95% CI: 1.5-132.5). Conclusions: mrEMVI is an independent prognostic factor at baseline for poor outcomes in rectal cancer treated with neoadjuvant chemotherapy while ≤ypT3a is associated with an improvement in DFS. Future preoperative therapy evaluation in rectal cancer patients will need to stratify treatment according to baseline EMVI status as a crucial risk factor for recurrence in patients with predicted CRM clear rectal cancer.

[Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation]. / Aportación de la PET en el seguimiento de las metástasis cerebrales del cáncer de pulmón no microcítico. Valoración de un caso clínico.

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer.

Aportación de la PET en el seguimiento de las metástasis cerebrales del cáncer de pulmón no microcítico. Valoración de un caso clínico / Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation

Presentamos el caso clínico de un varón de 44 años diagnosticado de adenocarcinoma pulmonar con metástasis única cerebral tratada con cirugía y radioterapia. Los estudios con PET realizados durante el curso evolutivo de la enfermedad fueron muy útiles y decisivos en la detección primero de radionecrosis, y posteriormente de recidiva de la metástasis cerebral en dos ocasiones que se confirmó por los hallazgos radiológicos (RMN cerebral) y la anatomía patológica tras su extirpación quirúrgica. La PET ofrece una ayuda importante en casos seleccionados de pacientes con metástasis cerebrales de cáncer de pulmón

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer

[Hemangioma, the most frequent hepatic tumor. Diagnosis with dynamic CAT]. / El hemangioma, tumor hepático más frecuente. Diagnóstico con TAC dinámico.

The sensitivity, specificity and predictive values of dynamic CAT with contrast piston-stroke performed at a single cut are described for the diagnosis of hepatic hemangiomas. We analyzed the correlation between the findings obtained through dynamic CAT and those obtained through echography, PAAF, analytic and clinical study of the patients with suspicion of hepatic hemangioma. The following values were obtained: sensitivity 92.3%; specificity 50%; VPP 88.8%; VPN 60%; and global diagnostic affectivity 84.37%. According to these results, we think that dynamic CAT is a highly reliable test for the diagnosis of hepatic hemangiomas.