Prognostic value of 18F-FDG PET/CT in patients with malignant pleural mesothelioma.

PURPOSE: To evaluate prognostic value of integrated 2-deoxy-2-[F-18]fluoro-D: -glucose-positron emission tomography/computed tomography (FDG-PET/CT) and correlate histopathological subtype with maximum standardized uptake value (SUV(max)) and survival in patients with malignant mesothelioma (MM). PROCEDURES: Retrospective review of FDG-PET/CT scans, with derivation of SUV(max) of FDG-avid lesions, was performed in patients with biopsy-proven MM. Clinical follow-up and Kaplan-Meier survival analysis was performed. RESULTS: Forty-six patients (37 M:9 F; mean age 61 years) with MM had a FDG-PET/CT scan in a 30-month period. Follow-up was available on 44/46 (96%) patients. Metastatic disease was detected in 9/46 (20%) patients on FDG-PET/CT, where 8/9 were previously undetected. Better survival was found in patients without metastases (p value < 0.05). Mean SUV(max) of primary pleural lesions in patients with metastatic disease was significantly higher than in patients without metastatic disease (p value < 0.05). Progression-free survival was significantly better in the epithelioid histology group compared to the biphasic group (p value 0.015). CONCLUSIONS: Detection of extrathoracic metastases on FDG-PET/CT and nonepithelioid histopathology are poor prognostic indicators in patients with MM.

Leiomyosarcoma of the rectum: what role does adjuvant therapy play?

Leiomyosarcoma of the rectum is an exceedingly rare malignancy and for this reason the literature fails to provide definitive management guidelines with regard to the place of adjuvant therapies. The role of radiotherapy (RT) is often downplayed on the basis of articles written at a time when state-of-the art RT equipment was unavailable. A case of leiomyosarcoma of the rectum is presented and the literature is reviewed. Because the rarity of this tumour type virtually precludes a prospective randomized trial of adjuvant therapies, the authors recommend (in otherwise fit patients) postoperative pelvic RT because its morbidity is minimal. Smaller tumours may benefit to a greater extent than those lesions that are large at presentation and thereby run a worse clinical course.

Internal mammary node relapse following breast conservation: a case for reirradiation.

Internal mammary node involvement in early breast cancer is a prognostic factor of uncertain significance. This paper addresses isolated regional recurrence at this site following breast conservation radiotherapy. A case is presented of a woman who developed an internal mammary recurrence after lumpectomy and breast irradiation. This recurrence was diagnosed as a bone metastasis, a common mistake which may lead to suboptimal management. The true incidence of regional recurrences in the internal mammary nodes has been underestimated and their clinical significance has not been appreciated. Salvage procedures for local control and long-term cure are likely to be successful if the diagnosis is made before distant metastases have occurred and a lengthy period has elapsed since initial treatment was given. The role of reirradiation should be considered as the tissues at this site will generally tolerate a second course of radical radiotherapy given more than 10 years after the first.

The contribution of 18F-fluoro-2-deoxy-glucose positron emission tomographic imaging to radiotherapy planning in lung cancer.

A retrospective analysis was performed to determine whether coronal thoracic [18F]fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) scans, if viewed at the time of radiotherapy (RT) planning, would have influenced the anterior-posterior (AP) RT volumes that were administered to a group of unoperated lung cancer patients. Viewing of PET and diagnostic images enabled a qualitative assessment of whether abnormal thoracic PET activity was present in areas regarded as normal by diagnostic imaging; this would, therefore, have influenced the RT volume if done prospectively. Additionally a method of graphical co-registration was devised to quantitate the adequacy of coverage of each patient's abnormal PET activity by his/her actual RT field. Of 15 patients analyzed, 26.7% (four patients) would have had their RT volume influenced by PET findings, highlighting the potential value of PET in treatment planning.

Should cancer survivors fear radiation-induced sarcomas?

Purpose/Results. Ionizing radiation is carcinogenic and the induction of a second malignancy is a serious potential long-term complication of radiotherapy. The incidence of radiation-induced sarcomas was evaluated from many large epidemiological surveys of long-term cancer survivors reported in the literature over the past 30 years and only one case was found for every 1000 patients irradiated.Discussion. Although greater numbers of cancer patients are receiving radical radiotherapy and surviving free of disease for longer intervals, cases of radiation-induced sarcomas are rare and should not deter patients from accepting radiotherapy as treatment for curable cancers. With improvements in the administration of radiotherapy over the past two decades which are resulting in less damage to bone and soft tissues, it is likely that fewer cases of this condition will be seen in the future. If these sarcomas are diagnosed early, long-term survival can be achieved with surgical excision and possibly re-irradiation, as occurs in other types of sarcomas.

Endodontists in a period of improving dental economics and changing realities of practice.

The distribution and increasing number of endodontists are considered in terms of the increasing demand for dental services, improvements in dental economics, and the increase in the size of dental practices. The future for the practice of endodontics seems favorable.

Low dose postoperative adjuvant radiation therapy for rectal cancer is ineffective.

Ninety-seven patients with rectal cancer which had either penetrated through the rectal wall or involved regional lymph nodes received postoperative adjuvant radiation therapy of 24 Gy in 12 fractions or 25 Gy in 10 fractions in 2 weeks. The crude pelvic recurrence rate was 48/97 (49%) and the actuarial local relapse-free rate at 5 years was 41%. The radiation doses used produced no late morbidity, but had no discernible effect on the risk of local recurrence, and may have compromised the subsequent use of radiation for symptomatic pelvic recurrence.

Management of oesophageal cancer at Westmead Hospital from 1979-1985.

The aim of this study was to evaluate the various treatment options, including radiotherapy, surgery and chemotherapy, when all patients with carcinoma of the oesophagus were assessed and managed by the same team. From December 1, 1979 to December 31, 1985, 144 patients with carcinoma of the oesophagus were referred to Westmead Hospital. Eighty-five patients were men, 59 patients were women and the median age was 63 years. Twenty-five patients were at stage I, 75 patients were at stage II, 24 patients were at stage III and 20 patients were at stage IV of oesophageal cancer. Forty-two patients underwent surgical resection. Fifty patients underwent radical radiotherapy, 30 patients underwent palliative radiotherapy and 22 patients underwent palliative intubation. The operative mortality of those patients who underwent surgery was zero. The treatment mortality of those who underwent radical radiotherapy was 6%, and for those who underwent palliative radiotherapy, was 16.7%. The mortality after intubation was 12.5%. The prevalence of benign strictures was 7.5% after surgery, 33% after radical radiotherapy and 8% after palliative radiotherapy. The prevalence of malignant strictures (recurrent disease) was 2.5% after surgery, 21% after radical radiotherapy and 20% after palliative radiotherapy. The median survival after surgery was 12 months; that after radical radiotherapy, 12 months; that after palliative radiotherapy, six months; and that after intubation, 3.5 months. Where all patients with carcinoma of the oesophagus were managed by a team approach the treatment mortality was low but the long-term survival remained poor.

The value of lymphoscintigraphy, lymphangiography and computer tomography scanning in the preoperative assessment of lymph nodes involved by pelvic malignant conditions.

In a preoperative study to identify accurately metastases to the lymph nodes within the pelvis and retroperitoneum, the three imaging techniques of pelvic interstitial lymphoscintigraphy, bipedal lymphangiography and computer tomography (CT) scanning were compared in 69 patients with carcinoma of the cervix uteri or rectum. Results were correlated with histologic node examination in all patients and each technique was assessed for sensitivity, specificity and over-all accuracy. Lymphoscintigraphy is too unreliable for routine use in the diagnosis or staging of pelvic malignant conditions. Lymphangiography detects involved lateral pelvic and para-aortic nodes but is unable to visualize the internal iliac or other medial pelvic nodes. CT scanning is only accurate if metastatic nodes are enlarged but may reveal other pathways of spread which will alter the surgical approach.

Fatal veno-occlusive disease of the liver associated with herbal tea consumption and radiation.

A case is presented of fatal veno-occlusive disease of the liver in a patient undergoing treatment by whole abdomen irradiation for carcinoma of the ovary. She had also been exposed to herbal tea and chemotherapy, each of which may cause veno-occlusive disease in its own right. Interaction of these agents is postulated and should be considered before submitting patients to combination treatment.

Radiation hepatitis following moving strip radiotherapy.

A 71 year-old woman developed acute veno-occlusive disease of the liver after receiving moving strip radiotherapy to the whole abdomen according to the Toronto technique for carcinoma of the ovary. The dose of 22.5 Gy in 10 fractions to the liver is compared with other regimens which have produced this complication, and factors which may have sensitized the liver to irradiation are considered.

Purification and characterization of acid phosphatase-1 from Drosophila melanogaster.

Acid phosphatase-1 (orthophosphoric monoester phosphohydrolase, acid optimum, EC 3.1.3.2), the major phosphatase in adult Drosophila melanogaster, has been purified to apparent homogeneity. The final product is a glycoprotein homodimer with a subunit molecular weight of about 50,000, as measured by its electrophoretic mobility in denaturing conditions on polyacrylamide gels containing sodium dodecyl sulfate. It has a turnover number of 1720 1-naphthyl phosphate molecules hydrolyzed/s by each acid phosphatase-1 molecule at 37 degrees C, pH 5.0. An average fly contains about 5 ng of enzyme. Pure acid phosphatase-1 displays heterogeneity in isoelectric focusing, with a major band at pH 5.3. The enzyme hydrolyzes a wide variety of phosphate monoesters, including AMP, glucose 6-phosphate, ATP, choline phosphate, or phosphoproteins. The maximum reaction rates are different for all substrates, and some substrates appear to inhibit the reaction at high substrate concentrations. The Michaelis constants for 1-naphthyl phosphate and p-nitrophenyl phosphate are 79 microM and 68 microM, respectively, at pH 5.0 and 37 degrees C. The optimum pH level for 1-naphthyl phosphate is 4.5. Acid phosphatase-1 is inhibited by L(+)-tartrate (but not D(-)-tartrate), phosphate, and fluoride. The reaction rate increases 2.1-fold for every 10 degrees C rise in temperature. Above 48 degrees C, the rate of thermal denaturation is greater than the rate of the enzyme reaction.