Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer.

AIM: To prospectively validate 3 T magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for preoperative lymph node (LN) staging in a clinical setting, in intermediate- and high-risk prostate cancer (PCa) patients using laparoscopic extended LN dissection (ePLND) as the reference standard. MATERIALS AND METHODS: Between August 2011 and May 2013, 40 newly diagnosed intermediate and high-risk PCa patients underwent preoperative LN staging with 3 T MRI DWI using histopathology of ePLND as the reference standard. The sensitivity, specificity, and accuracy of MRI DWI were calculated. A subgroup analysis of proven LN-positive patients was made to investigate differences in PSA, Gleason score, number, and size of LN metastases, estimated risk of LN involvement, and if curative treatment was indicated, between the true-positive and the false-negative groups. RESULTS: A total of 728 LN were harvested from six anatomical regions per patient (external, obturator, internal) with a mean number of 18 LNs per patient (range 11-40). Twenty patients had histologically proven LN-positive disease. MRI DWI was true positive in 11 patients, false negative in nine patients, false positive in two patients, and true negative in 18 patients, resulting in 90% specificity, 55% sensitivity, and 72.5% accuracy. The true-positive patients had significantly more involved LNs (mean 6.9 versus 2.7, p=0.017), with larger diameter (mean 12.3 versus 5.2 mm, p=0.048) and fewer were treated with curative intent (six versus nine, p=0.03), compared with the false-negative group. CONCLUSION: MRI DWI LN staging has a low sensitivity but high specificity. The true-positive patients have a considerably higher burden of LN metastases compared to false-negative patients.

Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial.

OBJECTIVE: A prospective phase II study was performed to determine the feasibility and efficacy in terms of response rate, resectability, and morbidity in patients with locally advanced rectal cancer who received preoperative regional hyperthermia combined with radiochemotherapy (HRCT). SUMMARY BACKGROUND DATA: Recent studies suggest that preoperative radiochemotherapy in locally advanced rectal cancer can induce downstaging, but after resection the incidence of local recurrences remains high. Hyperthermia (HT) may add tumoricidal effects and improve the efficacy of radiochemotherapy in a trimodal approach. PATIENTS AND METHODS: Thirty-seven patients with histologically proven rectal cancer and T3 or T4 lesions, as determined by endorectal ultrasound and computed tomography, entered the trial. 5-Fluorouracil (300-350 mg/m2) and leucovorin (50 mg) were administered on days 1 to 5 and 22 to 26. Regional HT using the SIGMA 60 applicator (BSD-2000) was given once a week before radiotherapy (45 Gy with 1.8-Gy fractions for 5 weeks). Surgery followed 4 to 6 weeks after completion of HRCT. RESULTS: Preoperative treatment was generally well tolerated, with 16% of patients developing grade III toxicity. No grade IV complications were observed. The overall resectability rate was 32 of 36 patients (89%), and 31 resection specimens had negative margins (R0). One patient refused surgery. In 5 patients (14%), the histopathologic report confirmed no evidence of residual tumor (pCR). A partial remission (PR) was observed in 17 patients (46%). The survival rate after 38 months was 86%. In none of the patients was local recurrence detected after R0(L), but five patients developed distant metastases. CONCLUSION: Preoperative HRCT is feasible and effective and may contribute to locoregional tumor control of advanced rectal cancer, which is to be proven in an ongoing phase III trial.

Video-assisted thoracic surgery. Staging and management of thoracic tumors.

BACKGROUND: This prospective study was conducted to investigate the value of video-assisted thoracic surgery (VATS) for staging and therapy of thoracic tumors. METHODS: VATS was performed in 86 patients presenting peripheral pulmonary nodules. Indications for thoracoscopy included diagnosis of indeterminated pulmonary lesions (n = 55), staging of disseminated disease (n = 24), and therapeutic interventions (n = 7). Previous or simultaneous tumors belonged to gastrointestinal tract (n = 27), sarcoma (n = 19), breast (n = 12), and miscellaneous. VATS was carried out under general anesthesia using double lumen intubation. RESULTS: VATS was successfully performed in 78% of patients. It was converted in 19 patients (22%) because of adhesions (n = 12), technical problems (n = 3), and lesions not to be found (n = 4). VATS revealed malignancy in 81% and benign lesions in 19%. Additional information compared to conventional staging was obtained in 48%, resulting in therapeutic consequences in 34% of the patients. Postoperative complications related to VATS were observed in nine patients. CONCLUSIONS: In this study, VATS proved to be a sensitive technique for staging of pulmonary lesions. Thoracoscopic wedge resection may have significant impact on the operative management of carefully selected patients with peripheral pulmonary lesions.

[Value of endosonography in tumors of the upper GI tract in comparison with different scanners (Radial 360 degrees and Sector Scanner 120 degrees]. / Stellenwert der Endosonographie bei Tumoren des oberen GI-Traktes bei Vergleich unterschiedlicher Scanner (Radial 360 degrees und Sektor-Scanner 120 degrees).

This comparative study was performed to determine the value of two endosonography devices, i.e, the radial and the longitudinal transducer, for staging upper GI tract cancer. The accuracy of both methods was comparable in esophageal cancer, whereas radial scanning was superior in gastric cancer. Generally radial scanning provided better spatial orientation and was easier to assess. An advantage of the longitudinal curved array scanner is the feasibility of EUS-guided biopsy.

Three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer.

PURPOSE: Preoperative staging of advanced carcinoma of the rectum by conventional endorectal ultrasonography is often impossible because of the presence of obstruction, which does not allow passage of the endoprobe. In a prospective study, we investigated the value of three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer. This technique permits examination of obstructing rectal tumors because scan planes can be chosen deliberately within a scanned volume. METHODS: Overall obstructing tumors not accessible for conventional endoprobes were found in 26 of 94 patients who were subjected to endorectal ultrasonography for staging of rectal cancer. Three-dimensional volume scanning was performed using a three-dimensional frontfire transducer or a three-dimensional bifocal multiplane transducer (7.5/10 MHz). Data of the three-dimensional scans were stored on a hard disk for subsequent evaluation with a combison 530 processor. RESULTS: Three-dimensional transrectal endosonography enabled visualization of local tumor spread in all 26 patients. In 18 patients, obstruction was caused by advanced primary rectal carcinoma. Endosonography accurately determined the tumor infiltration depth in three T2 tumors, eight T3 tumors, and three T4 tumors. Overall accuracy for assessment of infiltration depth was 78 percent. Accuracy for assessment of perirectal lymph node involvement was 75 percent. In eight patients, the obstruction was attributable to extramural regrowth of rectal cancer after surgery. Diameter of the lesions ranged between 3 and 6 cm. Although all lesions were clearly depicted by three-dimensional endosonography, only five lesions (62 percent) were detected by computed tomography. CONCLUSIONS: Three-dimensional endorectal ultrasonography provides previously unattainable scan planes and enables accurate staging of obstructing rectal tumors. This technique may improve therapy planning in advanced rectal cancer by selecting patients who require preoperative adjuvant therapy.

[Significance of serum beta-hCG as a tumor marker for stomach carcinoma]. / Zur Bedeutung von beta-hCG im Serum als Tumormarker für das Magenkarzinom.

INTRODUCTION: Recent investigations indicate that in 50% of patients with gastric cancer, beta-hCG-positive cells can be found in the tumour by immunohistochemical investigations. The objective of this study was to investigate how often beta-hCG-immunoreactive gastric carcinomas were accompanied by an elevation in serum beta-hCG, that could have been used as a course control variable. METHODS: In 54 patients with gastric carcinoma a monoclonal antibody directed against beta-hCG was used for immunohistochemical marking in the APAAP system. The evaluation was graded positive or negative. In parallel, serum beta-hCG was determined preoperatively using an enzyme immunoassay (MEIA). Tumour stage, grading and tumour localization were determinants in the evaluation. RESULTS: We found that 41% (22 of 54) of the carcinomas induced a positive immunohistochemical response to beta-hCG, regardless of their location in the stomach. In relation to tumour stage, a positive beta-hCG immunoreactivity was apparent in 27% (6/22) of tumours without lymph node or distant metastases (T1-4N0M0), in 54% (7/13) of tumours with lymph node and without distant metastases (T1-4N > or = 1M0) and in 47% (9/35) of tumours with distant metastases. Poorly differentiated tumours (G3-4) were positive in 42% (15/36) and well-differentiated tumors (G1-2) in 39% (7/18) of cases. In only 1 patient was the beta-hCG level in serum elevated, however. CONCLUSIONS: beta-hCG-Positive gastric carcinomas are found more frequently in advanced tumour stages and poorly differentiated carcinomas. These carcinomas, however, seem not to excrete beta-hCG in sufficient amounts to produce measurable serum values. Therefore, beta-hCG cannot be used a prognostic factor or for course control. The relevance of beta-hCG expression of tumour cells to the patients' prognosis remains obscure.