Accelerated BRAF mutation analysis using a fully automated PCR platform improves the management of patients with metastatic melanoma.

BACKGROUND: Determination of BRAF status is important for the therapeutic management of patients with metastatic melanoma. OBJECTIVES: We evaluated the impact of a faster determination of BRAF mutational status on the delay between initial consultation and initiation of treatment. RESULTS: For the FA-PCR group a median delay of 16 days [11;18] was observed between initial consultation and the implementation of treatment, which was significantly lower than that observed for the SOP group (26 days [20;46], p = 0.035). CONCLUSIONS: In comparison to using conventional SOP, using an FA-PCR platform for BRAF mutation analysis of patients with metastatic melanoma significantly reduced the delay in initiation of personalized therapy by 10 days. MATERIALS AND METHODS: Analysis of the BRAF mutation status of eight formalin-fixed paraffin-embedded (FFPE) tissue samples was performed using a CE-IVD fully-automated (FA) PCR-based platform. The delay between initial consultation and the implementation of treatment was compared between these samples (FA-PCR group) and a retrospective group of 29 FFPE samples analysed by standard operating procedures (SOP group) using conventional PCR.

Options for treating different soft tissue sarcoma subtypes.

Management of soft tissue sarcoma is increasingly subtype-dependent. Surgery is recommended for uterine leiomyosarcoma, with trabectedin being the preferred option for advanced disease when the treatment goal is long-term tumor stabilization. Liposarcoma subgroups are characterized by distinctive morphologies and genetics, different patterns of disease progression and clinical behavior, and variable responses to treatment. Genetic analysis of sarcomas has provided insights into pathogenesis with potential for developing new molecular targets. At the cytogenetic level, soft tissue sarcomas are categorized into specific, balanced translocations and those due to massive chromosomal rearrangements. For subtypes such as undifferentiated sarcomas, angiosarcomas, alveolar soft part sarcomas and clear cell sarcomas, evidence is especially limited, although it is known that these tumors display markedly different sensitivities to chemotherapeutic and targeted agents.

Improved image contrast with mangafodipir trisodium (MnDPDP) during MR-guided percutaneous cryosurgery of the liver.

The present study was undertaken to measure the gain observed in the liver-to-tumor contrast of perioperative images when using mangafodipir trisodium, a liver-specific contrast agent, during percutaneous cryosurgery of the liver performed under the guidance of magnetic resonance images. Retrospective quantitative analyses of MR images were performed on eleven patients having a total of 30 liver tumors treated by MR-guided percutaneous cryosurgery. An initial group of four patients were treated with no contrast agent, and was compared with a second group of 7 patients who received an intravenous injection of 5 microM/kg of mangafodipir for their cryosurgery. The percutaneous cryosurgery was monitored under the near-real-time-imaging mode of a 0.5T open-configuration MRI system using a T(1)-weighted Gradient-recalled echo pulse sequence. A significant improvement in the liver-to-tumor contrast-to-noise ratio was observed with mangafodipir (p < 0.05, paired t test) in 0.5T preoperative images. Along with the stability of the mangafodipir contrast enhancement during the entire cryosurgical procedure, the resulting gain in contrast allowed for better visualizing the presence of residual untreated tumor margins at the periphery of the cryosurgery iceball directly from perioperative images acquired with patients under narcosis. Consequently, it not only became easier for the interventionalist to determine the need for an additional cryoprobe to increase the size of the iceball during the procedure, but also to decide on the appropriate end point of the cryosurgery.