Valor pronóstico del SUVmáx del tumor primario pretratamiento con PET/TC con 18F-FDG en pacientes con cáncer de pulmón no microcítico en estadio II / Prognostic value of primary tumor SUVmax on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer

Objetivos: La quimiorradioterapia concomitante (QRTC) se utiliza de forma amplia para tratar a los pacientes con cáncer de pulmón no microcítico (CPNM) en estadio iii. La identificación precoz de los pacientes con mal pronóstico constituye la premisa del tratamiento personalizado de los pacientes. El objetivo de este estudio fue evaluar el valor pronóstico de los parámetros clínicos y SUVmáx del tumor primario sobre PET/TC con 18F-FDG pretratamiento en los pacientes con CPNM en estadio iii. Material y métodos: Se revisaron retrospectivamente las historias clínicas de 79 pacientes de CPNM en estadio iii con PET/TC con 18F-FDG pretratamiento, tratados con QRTC definitiva. Se correlacionaron los criterios de evaluación clínicos en términos de supervivencia libre de progresión (SLP) y supervivencia global (SG) con el valor SUVmáx medio del tumor primario pretratamiento. También se analizaron otros factores de influencia en el resultado del paciente. Resultados: La edad media de los pacientes fue de 58 años (rango, 45-71), con 72 (91%) varones. El carcinoma de células escamosas (73%) fue el tipo histológico más común. El estatus del desempeño fue muy bueno (ECOG 0) en el 64,5% de los pacientes. Sesenta (79%) pacientes habían fallecido en el momento de este análisis. Los valores medios de SG y SLP fueron de 22,5 y 12 meses, respectivamente. Los pacientes se dicotomizaron con arreglo a SUVmáx del tumor primario pretratamiento≤15 vs.>15. No se encontró ninguna diferencia significativa para SG y SLP entre ambas ramas. El análisis multivariante reflejó que el SUVmáx pretratamiento no constituía un factor predictivo de SG (HR 1,099, p=0,726) ni SLP (HR 1,022, p=0,941). Conclusiones: El índice SUVmáx con un valor límite de 15 con respecto al tumor primario pretratamiento no tiene valor pronóstico en nuestro grupo de pacientes de CPNM en estadio iii, tratados con QRTC definitiva

Objectives: Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. Material and methods: Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. Results: The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). Conclusions: SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT

Prognostic value of primary tumor SUVmax on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer. / Valor pronóstico del SUVmáx del tumor primario pretratamiento con PET/TC con 18F-FDG en pacientes con cáncer de pulmón no microcítico en estadio iii.

OBJECTIVES: Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. MATERIAL AND METHODS: Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. RESULTS: The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). CONCLUSIONS: SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT.

Effect of chemotherapy on pulmonary epithelial permeability in lung cancer.

The aim of this study is to investigate the effect of one-course chemotherapy on the pulmonary epithelial permeability. Eighteen patients (18 male; mean age: 59+/-10 years) with lung cancer (11 non-small cell, 7 small cell) inhaled 40 mCi (1,480 MBq) (99m)Tc-diethylenetriaminepentaacetic acid (DTPA). Thirty images of 1-min duration were acquired from posterior projection. The first 7 min of the decay-corrected time activity curves were used to calculate lung clearance half-time. Clearance half-times of (99m)Tc-DTPA from the peripheral regions of the lungs were 42+/-19 min before and 56+/-34 min after chemotherapy (p=0.009); from the central regions, clearance half-times were 112+/-94 min before and 160+/-125 min after chemotherapy (p=0.005). This decrease in clearance rate might be related to decreasing mucociliary clearance rate due to the toxic effect of the chemotherapy regimen on cilia movement and/or mucus structure. (99m)Tc-DTPA radioaerosol study can be used to monitor the toxic effects of chemotherapy on the pulmonary epithelium and possibly on mucociliary function.

The effect of coronary artery bypass surgery on brain perfusion.

UNLABELLED: Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB. METHODS: Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The 99mTc-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera. Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively. RESULTS: None of the patients had severe neurologic complications. Neuropsychological deficits occurred in eight patients after CABG. Cognitive deterioration and depressive mood occurred in five patients. Disorientation, agitation and confusion periods were present in another two patients. Frontal hypoperfusion was found in these patients by visual and semiquantitative evaluations (p = 0.0277) and left parietal hypoperfusion was also present semiquantitatively (p = 0.0277). Visual hallucinations occurred in one patient. Computed tomography of these patients was normal. No perfusion abnormalities were observed in the patient with visual hallucinations and in patients without symptoms after open-heart surgery nor in the control group. Brain SPECT was repeated in two symptomatic patients 5 mo after CABG. Frontal hypoperfusion became normal, and these patients' symptoms disappeared. CONCLUSION: The results of this study indicate that regional cortical hypoperfusion may occur in patients with neuropsychological complications after CABG. Technetium-99m-HMPAO brain SPECT is a useful method to locate and determine brain perfusion changes after CABG.

Infusion versus bolus injection of Tc-99m tetrofosmin in the identification of viable myocardium.

In this report, a patient with 100% RCA stenosis and prominent collaterals, in which TI-201 rest/redistribution and Tc-99m tetrofosmin infusion imaging findings were compatible with viable myocardium in contrast to Tc-99m tetrofosmin bolus imaging is presented. Viability was confirmed with improvement of wall motion and perfusion 3 months after revascularization. Infusion of Tc-99m tetrofosmin rather than a bolus injection may be a more reliable technique in the identification of severely ischemic but viable myocardium.

Sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium: a comparative study with stress, redistribution, reinjection and late redistribution 201Tl imaging.

To investigate the role of sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium, we selected 25 patients with coronary artery disease who had at least one fixed segmental defect during conventional stress-redistribution (ST-RD) 201Tl single photon emission tomographic (SPET) imaging. Reinjection (RI) and 24 h late redistribution (LRD) imaging were also performed. Within a week of 201Tl imaging, one-day rest-stress (R-ST) 99Tcm-tetrofosmin SPET was performed with the same stress levels. The following day, 99Tcm-tetrofosmin was infused over 1 h immediately after sublingual nitrate administration and SPET images (N + Inf) were acquired. Of 100 fixed defects on R-ST 99Tcm-tetrofosmin imaging, 15 were reversible on N + Inf 99Tcm-tetrofosmin imaging. There was 91% concordance between ST-RD/RI/LRD 201Tl and R-ST/N + Inf 99Tcm-tetrofosmin imaging regarding reversibility. We conclude that N + Inf 99Tcm-tetrofosmin imaging may be clinically useful in the detection of severely ischaemic but viable myocardium.