Imaging and treatment with 68Gallium and 177Lutetium-DOTATATE in a rare SSTR2 and ESWR1-CREM fusion positive undifferentiated round cell tumour of the lung.

The authors present a 45-year-old lady with a rare undifferentiated round cell tumour of the lung with a ESWR1-CREM fusion gene that progressed despite multiple lines of therapy. The tumour was Somatostatin Receptors Type 2 (SSTR2) positive and avid on 68Gallium-DOTATATE imaging. This allowed for novel treatment with Peptide Receptor Radionuclide Therapy (PRRT) using 177Lutetium-DOTATATE after all other standard of care options were exhausted.

Optimization of Bayesian penalized likelihood reconstruction for 68 Ga-prostate-specific membrane antigen-11 PET/computed tomography.

OBJECTIVE: The objective of this study is to determine the optimal ß value for clinical use in digital 68 Ga-prostate-specific membrane antigen (PSMA-11) PET/computed tomography (CT) imaging. METHODS: 68 Ga PSMA PET/CT of 21 patients with prostate cancer were reconstructed using block-sequential regularized expectation maximization ( ß value of 400-1600) and ordered subsets expectation maximization. Nine independent blinded readers evaluated each reconstruction for overall image quality, noise level and lesion detectability. Maximum standardized uptake value (SUVmax) of the most intense lesion, liver SUVmean and liver SUV SD were recorded. Lesions were then subdivided according to uptake and size; the SUVmax of these lesions were analyzed. RESULTS: There is a statistically significant correlation between improvement in image quality and ß value, with the best being ß 1400. This trend was also seen in image noise ( P  < 0.001), with the least image noise reported with ß 1400. Lesion detectability was not significantly different between the different ß values ( P  =  0.6452). There was no statistically significant difference in SUVmax of the most intense lesion ( P  = 0.9966) and SUVmean of liver background between the different ß values ( P  = 0.9999); however, the SUV SD of the liver background showed a clear trend, with the lowest with ß 1400 ( P  = 0.0008). There was a decreasing trend observed in SUVmax when ß values increased from 800 to 1400 for all four subgroups, and this decrease was greatest in small and low uptake lesions. CONCLUSION: Bayesian penalized likelihood reconstruction algorithms improve image quality without affecting lesion detectability. A ß value of 1400 is optimal.

Incidence, risk factors and outcomes of malignancies after kidney transplantation in Singapore: a 12-year experience.

INTRODUCTION: Data on malignancy after kidney transplantation (KTX) is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients. METHODS: A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Diseases Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX. RESULTS: 31 patients (61.3% male) developed malignancy during this period, and their median age at diagnosis was 50 (range 18-65) years. Median time to malignancy diagnosis was 2.6 (range 0.3-7.9) years, with cumulative incidence of 1%, 4% and 10% at one, five and ten years, respectively. The commonest malignancy type was lymphoma, followed by kidney cancer, colorectal cancer and malignancy of the male genital organs. Multivariate analysis identified cyclosporine use as an independent risk factor for malignancy. Compared to the general population, KTX recipients had higher malignancy and mortality rates after malignancy diagnosis (SIR 3.36; SMR 9.45). Survival rates for KTX recipients with malignancy versus those without malignancy were 100%, 93% and 64% versus 97%, 93% and 83% at one, five and ten years, respectively. CONCLUSION: KTX was associated with higher mortality and incidence of malignancy. Newer immunosuppressive agents and induction therapies were not found to be risk factors for malignancy, possibly due to our relatively small sample size.

Genetic predisposition resulting in sinusoidal obstruction syndrome in a patient with resected sigmoid cancer on adjuvant oxaliplatin.

A Chinese man who had undergone a curative high anterior resection for sigmoid cancer was administrated XELOX (capecitabine and oxaliplatin) as postoperative adjuvant chemotherapy. He subsequently developed sinusoidal obstruction syndrome (SOS) that resolved on discontinuation of XELOX treatment. Genetic evaluation determined that he had the GSTT1-null and GSTM1-null genotype, known to be an independent risk factor for developing oxaliplatin-induced SOS.