Biomarcadores pronósticos en el uso del radio-223 en pacientes con cáncer de próstata metastásico resistente a la castración / Prognostic biomarkers in the use of radium-223 in patients with metastatic castration-resistant prostate cancer

Objetivos Establecer biomarcadores basales en pacientes con cáncer de próstata metastásico resistente a la castración (CPMRC) tratados con Ra-223 que predigan una mejor supervivencia global (SG), así como valorar la toxicidad hematológica y la respuesta. Materiales y métodos Estudio retrospectivo multicéntrico en 151 pacientes con CPMRC tratados con Ra-223 entre 2013 y 2020. Se valoró la SG de acuerdo a: los niveles basales de hemoglobina (Hb), el antígeno prostático específico (PSA), la fosfatasa alcalina (FA), la escala de dolor de la OMS, el Eastern Cooperative Oncology Group (ECOG), el número de lesiones en gammagrafía ósea (GO), el uso de agentes de protección ósea y las dosis recibidas. Se determinó el grado de toxicidad hematológica y la respuesta basada en los cambios de la FA y el dolor pre y postratamiento. Resultados Mediana de SG de 24meses (IC95%: 16,5-31). En el 70% que recibieron tratamiento completo (5-6dosis) la mediana de SG fue de 34,9meses, versus 5,8 en el tratamiento incompleto (1-4dosis). La SG fue mayor en los pacientes con menor PSA, FA, Hb>13g/dl, menor número de metástasis óseas y ECOG 0-1. 52/151pacientes (34%) fallecieron durante el seguimiento. Cerca del 70% de los pacientes presentaron disminución del dolor, y el 66%, reducción de la FA. La mitad de los pacientes presentaron eventos adversos hematológicos leves, y solo el 5%, severos. Conclusiones Los pacientes con CPMRC tratados con Ra-223 que presentan biomarcadores basales como Hb>13g/ml, ECOG 0-1, PSA<20ng/ml y menor número de lesiones en GO muestran mejor SG, con un adecuado perfil de seguridad (AU)

Objectives Establish basal biomarkers in patients with bone metastatic castration-resistant prostate cancer (mCRPC) treated with Ra-223 that predicted a better overall survival (OS), assess hematology toxicity and treatment response. Materials and methods Retrospective multicenter study in 151 patients with mCRPC between 2013 and 2020. OS was assessed according to basal hemoglobin (Hb), PSA, alkaline phosphatase (AP), WHO pain scale, Eastern Cooperative Oncology Group (ECOG), number of metastatic lesions on bone scan (BS), use of protective bone agents and received. Hematological toxicities were evaluated. Treatment response was based on changes in FA and pain. Results Median OS was 24months (95%CI: 16.5-31). OS in 70% of patients who received complete Ra-223 treatment (5-6 doses) was 34.9m vs. 5.8m in patients with incomplete treatment (1-4 doses). OS was longer in patients with lower PSA and AP, Hb>13g/dL, lesser bone metastasis on GO and ECOG 0-1. 52/151 patients (34%) died during follow-up. Nearly 70% of patients experienced decrease in pain and 66% reduction on AP. Half of patients had mild hematological adverse effects and only 5% had severe. Conclusions mCRPC patients treated with Ra-223 who had Hb>13g/mL, ECOG 0-1, low AP, PSA<20ng/ml and lesser bone metastasis on BS shown a better OS with adequate safety profile (AU)

Prognostic biomarkers in the use of radium-223 in patients with metastatic castration-resistent prostate cancer.

OBJECTIVES: This study aimed to establish basal biomarkers in patients with bone metastatic castration-resistant prostate cancer (mCRPC) treated with 223Ra to predict better overall survival (OS), and assess hematologic toxicity and treatment response. MATERIALS AND METHODS: This was a retrospective multicenter study including 151 patients with mCRPC between 2013 and 2020. OS was assessed according to basal hemoglobin (Hb), prostate-specific antigen (PSA), and alkaline phosphatase (AP) values, the World Health Organization pain scale, the Eastern Cooperative Oncology Group (ECOG) performance status scale, the number of metastatic lesions on bone scintigraphy (BS), and the use of protective bone agents and the dose received. The grade of hematological toxicities was evaluated as well as treatment response based on changes in AP and pre- and post-treatment pain. RESULTS: The median OS was 24 months (95% confidence interval 16.5-31). The OS in 70% of patients who received complete (5-6 doses) versus incomplete (1-4 doses) 223Ra treatment was 34.9 vs. 5.8 months, respectively, being longer in patients with lower PSA and AP values, Hb >13 g/dl, lesser bone metastasis on bone scan and with an ECOG 0-1. 52/151 patients (34%) died during follow-up. Pain reduced in nearly 70% of patients and 66% presented a reduction in AP values. Half of the patients presented mild and 5 % severe hematological adverse effects. CONCLUSIONS: mCRPC patients treated with 223Ra with Hb values >13 g/mL, an ECOG 0-1, low AP values, PSA < 20 ng/mL and lesser bone metastasis on BS presented a better OS with an adequate safety profile.

Plasmocitoma ovárico bilateral detectado por 18F-FDG PET/TC / Bilateral ovarian plasmacytoma detected on 18F-FDG PET/CT

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Comparison of four methods for quantitative assessment of 99mTc-MDP SPECT in patients with suspected condylar hyperplasia. / Comparación de cuatro métodos de valoración cuantitativa de la SPECT con 99mTc-MDP en pacientes con sospecha clínica de hiperplasia condilar.

OBJECTIVE: To compare variability, reproducibility and repeatability of four quantitative evaluation methods to interpret the 99mTc-MDP SPECT reports in patients with clinically suspected unilateral condylar hyperplasia. METHOD: This was a descriptive observational study carried out with SPECT images of 38 patients with clinical and radiographic signs of unilateral condylar hyperplasia, and interpreted using four quantitative methods: 1) one image, variable-size region of interest (ROI); 2) one image, fixed-size ROI (1.76cm2), 3) five image variable-size ROI; 4) five image, fixed-size ROI (1.76cm2). Each of the images was reported simultaneously (but in an independent way) by two nuclear medicine experts, in both total radioactive counts as well as normalized counts to evaluate the reproducibility (inter-operator variability) and the repeatability (intra-operator variability). RESULTS: Higher reproducibility and repeatability were obtained in 5-image fixed-size ROI method (intra-class correlation coefficient: 0.979 [0.959; 0.989]). A high grade of diagnostic agreement (97.4%) was also attained in fixed methods (Kappa 0.940, p value: .000) from either total or normalized counts. There was no difference between fixed-size 1 vs 5 image methods. The methods based on variable-size ROI had a low grade of agreement (Kappa<0.20). More positive cases were identified using one image, ROI variable total counts (27 cases), but when the counts were normalized, they presented a lower number (5 cases). CONCLUSION: Five-image fixed-size ROI provides the best intra-operator and inter-operator reliability for the diagnosis of unilateral condylar hyperplasia. In the four methods using normalized counts fewer positive cases were detected (≥10%), unlike with total counts when more positive cases were found.

Unilateral breast metastasis from alveolar rhabdomyosarcoma in adult detected by 18F-FDG PET/CT / Metástasis mamaria unilateral de rabdomiosarcoma alveolar en un adulto, detectada por 18F-FDG PET/TAC

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18F-FDG PET-CT usefulness in extra-pancreatic involvement in IgG4 related diseases / Utilidad de la 18F-FDG PET-TC en las manifestaciones extrapancreáticas de las enfermedades relacionadas con IgG4

IgG4-related diseases are a group of recently identified entities that include disorders that were previously known by other names, such as Mikulicz disease, Küttner's tumor, Riedel thyroiditis, among others, as well as some new ones described in the last years. These pathologies are a challenge for the medical community in terms of diagnosis and characterization due to their wide spectrum of clinical presentation. Functional imaging can provide a new approach to the comprehension of physiopathology, staging and targeting site of biopsy of IgG4-related diseases. In this clinical note, we describe five patients who underwent 18F-FDG PET-CT and correlate their findings with previous reports (AU)

Las enfermedades relacionadas con IgG4 son un grupo de entidades recientemente identificadas; que engloban a patologías anteriormente conocidas como la enfermedad de Mikulicz, el tumor de Küttner y la tiroiditis de Riedel entre otras, las cuales se creían que eran entidades diferentes, y otras descritas en los últimos años. Estas patologías plantean un reto diagnóstico para el clínico y el médico nuclear, dado su amplio espectro de presentación clínica. La imagen funcional puede brindar un nuevo abordaje con respecto a la fisiopatología, estudio de extensión y optimización de los sitios de biopsia, en las enfermedades relacionadas con IgG4. En esta nota clínica presentamos cinco 5 casos clínicos, valorados mediante 18F-FDG PET-TC y correlacionamos hallazgos con la literatura médica reciente (AU)

¹8F-FDG PET-CT usefulness in extra-pancreatic involvement in IgG4 related diseases.

IgG4-related diseases are a group of recently identified entities that include disorders that were previously known by other names, such as Mikulicz disease, Küttner's tumor, Riedel thyroiditis, among others, as well as some new ones described in the last years. These pathologies are a challenge for the medical community in terms of diagnosis and characterization due to their wide spectrum of clinical presentation. Functional imaging can provide a new approach to the comprehension of physiopathology, staging and targeting site of biopsy of IgG4-related diseases. In this clinical note, we describe five patients who underwent ¹8F-FDG PET-CT and correlate their findings with previous reports.