Predictive significance of pretreatment 18F-FDG PET volumetric parameters on survival outcomes in pediatric patients with locally advanced undifferentiated nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare pediatric cancer. Most children are first diagnosed with advanced locoregional disease. Identification of patients at higher risk of treatment failure is crucial as they may benefit from more aggressive initial treatment approaches. 18Fluorine-labeled fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) has shown promise as a prognostic tool for predicting outcomes. METHODS: Retrospective study of pediatric patients with locally advanced undifferentiated NPC who underwent 18F-FDG PET/CT prior to intial treatment. Predictive significance of metabolic PET parameters on survival outcomes were estimated. RESULTS: Thirty-two children were included, age range was 7.1-18 years at the time of diagnosis. The median follow-up duration was 46.1 months. Three patients (9.4%) were classified as AJCC stage IIb, 13 patients (40.6%) as stage IIIa, eight patients (25%) as stage IIIb, and eight patients (25%) as stage IVa. Our findings revealed that high whole-body metabolic tumor volume at the threshold of hepatic reference SUVmean (WB-MTV-HR) (>135 mL) was associated with significantly lower event-free survival (EFS) compared to the low WB-MTV-HR group (≤135 mL) (3-year EFS: 50% ± 18% vs. 82% ± 8%; p = .015). Additionally, the 3-year overall survival (OS) rates differed significantly between the high whole-body metabolic tumor volume at the threshold of an SUV of 2.5 isocontour (WB-MTV-2.5) group (MTV >74 mL) and the low WB-MTV-2.5 group (MTV ≤74 mL) (63% ± 18% vs. 100%; p = .021). CONCLUSION: Our study suggests that WB-MTV parameters could serve as significant prognostic factors for disease progression in pediatric patients with locally advanced undifferentiated NPC. However, further prospective studies with larger sample sizes are needed to validate these findings.

Resective epilepsy surgery in a limited-resource settings: A cohort from a multi-disciplinary epilepsy team in a developing country.

Background: Multidisciplinary pre-surgical evaluation is vital for epilepsy surgery decision and outcomes. Resective epilepsy surgery with assisted monitoring is currently a standard treatment for focal drug resistant epilepsy (DRE). In resource-limited countries, lack of epilepsy surgery center is a huge challenge. We presented and illustrated how to create a multidisciplinary protocol with resource-limited settings in a developing country and epilepsy surgery outcome using brain mapping and monitoring techniques for ensuring satisfactory resection. Methods: We created multicentric incomplete but complementary units covering all epilepsy-related sub-specialties and covering a wide geographical area in our country. Then, we conducted a prospective and multicentric study with low resource settings on patients with focal DRE, who underwent resective epilepsy surgery and were followed up for at least 12 months and were evaluated for postoperative seizure outcome and complications if present. Preoperative comprehensive clinical, neurophysiological, neuropsychological, and radiological evaluations were performed by multidisciplinary epilepsy team. Intraoperative brain mapping including awake craniotomy and direct stimulation techniques, neurophysiological monitoring, and electrocorticography was carried out during surgical resection. Results: The study included 47 patients (18 females and 29 males) with mean age 20.4 ± 10.02 years. Twenty-two (46.8%) patients were temporal epilepsy while 25 (53.2%) were extra-temporal epilepsy. The epilepsy surgery outcome at the last follow up was Engel Class I (seizure free) in 35 (74.5%), Class II (almost seizure free) in 8 (17%), Class III (worthwhile improvement) in 3 (6.4%), and Class IV (no worthwhile improvement) in 1 patient (2.1%). Conclusion: With low resource settings and lack of single fully equipped epilepsy center, favorable outcomes after resective surgery in patients with focal DRE could be achieved using careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques.

Prognostic value of detection of CD99+ , CD45- cells in peripheral blood by flow cytometry in children with Ewing sarcoma.

BACKGROUND: Early detection of metastasis and recurrence of Ewing sarcoma (ES) is important for early management. This work aimed to detect CD99+ , CD45- cells in peripheral blood by flow cytometry (FC) before and during chemotherapy and evaluate their prognostic significance. PROCEDURE: This prospective cohort study was carried out on 60 children newly diagnosed with ES at Children Cancer Hospital-Egypt 57357 and 40 healthy children control group. Detection of CD99+ , CD45- cells in peripheral blood was accomplished by FC at baseline before treatment and after five cycles of chemotherapy. Samples were classified as positive if they had more than the upper limit of cells observed in the control cases. Correlation between FC results and relapse and overall survival (OS) after one year was performed. RESULTS: Median percentage of CD99+ , CD45- cells was significantly increased in patients compared with controls (0.002% vs 0%, respectively, P < 0.001). Post-cycle 5 CD99+ , CD45- cells were increased in 12 patients, of them 11 patients' disease had either relapsed or progressed. Post-cycle 5 CD99+ ; CD45- cells had a 73.3% sensitivity and 97.8% specificity for predicting relapse or progression, whereas baseline only had 6.7% sensitivity and 77.8% specificity. The hazard ratio for mortality in the post-cycle 5 positive group was 18.4 [95% confidence interval (1.86 to 181.46)] times that of the negative group. One year OS was 91.67%. CONCLUSION: Post-cycle 5 CD99+ , CD45- cells in peripheral blood by FC is a strong predictor for relapse, progression, and mortality whereas baseline is a poor predictor in newly diagnosed patients with ES.

Comparison of Glomerular Filtration Rate Measurement Methods between Radionuclide in vivo Scintigraphic Gates' and Plasma Sampling.

AIM: To correlate between the radionuclide in vitro plasma sampling method (using single and dual blood samples) and Gates' GFR measurement using Tc-99m diethylene triamine penta-acetic acid (Tc-99m DTPA) renal scintigraphy (in vivo method). METHODS: This study included 40 renal donors (group 1) and 40 patients with obstructive uropathy (group 2). Group 1 included 22 males and 18 females with an age range from 22 to 65 years, while group 2 included 24 males and 16 females with age range 27 to 64 years. Both groups subjected to renal Scintigraphy after administration of 5 mCi 99m-Tc DTPA, GFR was calculated using Gates' method (in vivo method), then plasma sampling was acquired at 60 mins and 180 mins post-injection of the tracer, samples were counted in well counter and GFR was calculated using in vitro technique either using single plasma sample (SPSM 60 mins) or dual sample (DPSM 60 & 180 min). Additionally, GFR was measured by estimated equations based on serum creatinine. RESULTS: In group 1, the mean GFR using in vivo Gates' method was 115.7 ± 29 ml/min, while using the SPSM was 100.1 ± 16.1 ml/min, and the DPSM was 100.3 ± 20.1 ml/min. In group 2, mean GFR using in vivo method was 74.1 ± 14.5 ml/min, while using in vitro SPSM it was 77.5 ± 24.9 ml/min and DPSM was 76.8 ± 24.8 ml/min. There was no significant difference between mean GFR values using in vivo and in vitro methods (single or dual samples) in group 1 and 2 (p > 0.05). There is high significant correlation between SPSM and DPSM in groups 1 and 2 (r = 0.90, r = 0.91 respectively), moderate significant correlation was found between in vivo Gates' method and in vitro SPSM in group 1 and 2 (r = 0.46 and 0.57 respectively) and moderate correlation was evident between in vivo and in vitro DPSM in both groups (r = 0.42 and 0.68 respectively). By using the DPSM as the reference standard significant high correlation was found with SPSM and significant-high moderate correlation with in vivo Gates' scintigraphic method. Conclusion: In vitro plasma sampling considered as a reliable, accurate |method for GFR calculation yet it considered relatively complex, both single and dual sample in vitro techniques showed a very high correlation, and hence SPSM can replace DPSM. CONCLUSION: Renal scintigraphy and GFR estimation using Gates' in vivo method is considered inaccurate, yet given its simplicity in performance it can still be used if corrected GFR is standardised for Egyptian population-based on studies with large numbers of patients from multiple centres.