68Ga-PSMA PET/CT in the evaluation of locally advanced and metastatic breast cancer, a single center experience.

Current research indicates that prostate-specific membrane antigen (PSMA) is related to angiogenesis of many solid tumors including breast cancer (BC), our objective is evaluating PSMA expression in primary tumor and metastatic BC by Positron emission tomography/computed tomography (PET/CT). In this retrospective study twenty-one patients with BC included all molecular subtypes, was evaluated with 18F-FDG-PET/CT imaging as stratification and 68Ga-PSMA-PET/CT. Primary sites of BC was identifying in all patients with 18F-FDG-PET/CT. We identified lymph node metastases in 17 patients (81%) and metastatic disease in 15 patients (71%). A total 127 lesions were detected by 18F-FDG-PET/CT, 30 of which were in the breast, 31 axillary lymph-node metastases, 25 mediastinal lymph-node metastases, 15 distant non-bone metastases and 26 bone metastases. 68Ga-PSMA-11-PET/CT showed lower detection-rate (DRs) than did 18F-FDG-PET/CT in all patients with LUM-A and LUM-B HER2. All 18F-FDG PET/CT positive lesions in patients TPN (local, lymph nodes, and metastatic lesions) showed 68Ga-PSMA-PET/CT uptake (P<0.05). Sensitivities and specificities of 99.2% and 93.6% for 18F-FDG-PET/CT and for 68Ga-PSMA-11-PET/CT of 84% and 91.8% (P<0.05). Accuracy measured as AUC was 0.86-0.95 in 18F-FDG-PET/CT and 0.74-0.94 for 68Ga-PSMA-PET/CT (P<0.05). In Patient-Based analysis we found that patients triple-negative subtype (TPN) evaluated with 68Ga-PSMA-PET/CT identified a higher number of positive patients than did LUM A. We conclude that a significate DRs to imaging with 68Ga-PSMA-PET/CT in the staging of locally advanced and metastatic BC with high rates in patients TPN, LUM B HER2+ and HER2 overexpression. We believe that concept of theranostics it may be considered as a potential diagnostic and therapeutic target.

Evaluation of non-small cell lung cancer by PET/CT with 64CuCl2: initial experience in humans.

Human copper transporter 1 (hCtr1) is the main transporter of copper which has been involved as an essential cofactor in biological processes and mechanisms of action for cisplatin and its analogues. Although expression of hCtr1 is present in all tissues that require copper, several studies have showed that levels of expression are highly variable between normal and neoplastic tissues. We evaluated the potential diagnostic of the 64CuCl2-PET/CT in patients with wild type non-small cell lung cancer (NSCLC). Eleven patients were included. Baseline 18F-FDG-PET/CT and 64CuCl2-PET/CT performed before to initiate treatment with platinum-based chemotherapy. 18F-FDG-PET/CT detected a total of 68 lesions in different corporal sites: lung (24), regional lymph node (30), distant non-bone metastases (17) and bone metastases (14). Of total, 73% demonstrated high focal uptake of 64CuCl2-PET/CT: 36% in primary tumor and 27% in lymph-nodes metastases. The detection-rates (DRs) was lower with 64CuCl2 PET/CT compared to 18F-FDG-PET/CT, however, these was not statistically significant (P = 0.108). A complete match was found in 2 patients. All patients were treated with platinum-based chemotherapy. According to RECIST 1.1 and PERCIST 1.0 criteria, most patients with highest uptake 64CuCl2-PET/CT presented partial response (mean 3 cycles) corroborated with 18F-FDG PET/CT. On the other hand, patients with very low uptake or faint uptake have progressive disease (3/16 patients). To our knowledge, this is the first study with 64CuCl2-PET/CT in-human in patients with NSCLC chemo-naïve. Our results may represent that 64CuCl2-PET/CT had a good ability for detect lesions. In addition, the 64CuCl2 uptake is based on the expression of Ctr1 transporters seeking to differentiate between those patients who may benefit from platinum-based therapy. More studies are necessary for confirm these findings.

68Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography-computed tomography in the evaluation of hepatic hemangioendothelioma epithelioid.

Hemangioendothelioma epithelioid is a rare tumor that originates in soft tissues. Imaging evaluation with conventional modalities (tomography and magnetic resonance) is difficult. Novel radiotracers which capably evaluate angiogenesis may have a higher impact on the therapeutic decisions. A 45-year-old man underwent workup for thrombosis and was diagnosed with hemangioendothelioma epithelioid based on the results of liver pathology and immunohistochemistry. The decision of the multidisciplinary board was to begin with thalidomide. After 4 months, progression of disease was documented and right hepatectomy was performed. A 68Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography-computed tomography scan showed residual lesions. After documented angiogenesis by 68Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography-computed tomography, nintedanib was administrated. And 1 year later, progression of the disease was documented by positron emission tomography-computed tomography. Ipilimumab plus nivolumab was started and partial response and excellent clinical response were documented. Molecular imaging with 68Ga-DOTA-E-[c(RGDfK)]2 positron emission tomography-computed tomography is a good biomarker of the response of hemangioendothelioma epithelioid, and ipilimumab plus nivolumab therapy demonstrated a good response.

Head to head comparison performance of 99mTc-EDDA/HYNIC-iPSMA SPECT/CT and 68Ga-PSMA-11 PET/CT a prospective study in biochemical recurrence prostate cancer patients.

Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) has found widespread use for the diagnosis of biochemical recurrence of prostate cancer (PCa). Unfortunately, PET/CT is not as widely available; thus a PSMA-targeting compound for scintigraphy is of special interest. The aim of this study was to compare 99mTc-EDDA/HYNIC-iPSMA and 68Ga-PSMA-11 PET/CT qualitatively and semi-quantitatively. Twenty-three patients with metastatic PCa were underwent 99mTc-EDDA/HYNIC-iPSMA SPECT/CT followed by 68Ga-PSMA-11 PET/CT. Gleason score in all patients was obtained. Maximal standardized uptake value (SUVmax) and counts per organ, including the primary and metastatic tumor, were normalized and compared using Pearson's correlation test. Sites considered as positive have increased SUVmax and tumor-to-background ratio (TBR) in comparison with non-diseased organs/tissues (SUVmax =25.2±4.7, 18.4±1.6, 11.4±1.2 (P=0.037) from prostate, bone and lymph nodes versus TBR =35.9±45.2, 15.4±18.9, 19.1±51.7 (P=0.035) for prostate, bone and lymph nodes. 99mTc-HYNIC-iPSMA and 68Ga-PSMA-11 uptake values in the evaluation of the affected nodes were very similar, although their ranges ranged from 5-21 mm (12±7.6). Correlation coefficient was normalized between SUVmax and TBR, demonstrating r values for prostate of r2=0.731; for bone of r2=0.720; and lymph nodes of r2=0.864 (P<0.05 in all cases). Values and confidence interval at the 95% are supporting the equivalency of both parameters in primary tumor and metastases (prostate 95% CI=4.61, 4.38; bone tissue 95% CI=-2.21, 3.41 and lymph node 95% CI=4.67). We conclude that 68Ga-PSMA-11 PET/CT and 99mTc-EDDA/HYNIC-iPSMA SPECT/CT were comparable, supporting the use of 99mTc-EDDA/HYNIC-iPSMA in patients with progressive metastatic castration-resistant PCa.

Usefulness of positron emission mammography in the evaluation of response to neoadjuvant chemotherapy in patients with breast cancer.

Our study examines the association between two Positron Emission Mammography (PEM) semi-quantitative parameters: PUVmax (maximum uptake value) and LTB (lesion to background) baseline and the end of Neoadjuvant chemotherapy (NAC) with pathologic response in each of the following breast cancer subtype: Triple negative breast cancer (TPN), HER2-positive, and ER-positive/HER2-negative cancers. One-hundred and eight patients, 71 with invasive ductal carcinoma and 37 with infiltrating lobular carcinoma were evaluate with 18F-FDG-PEM scans before and after of NAC. We assessed the impact of 2 PEM semi-quantitative parameters for molecular subtype correlated with pathologic response according Miller-Payne grade (MPG). After NAC, an overall reduction of 2 PEM semi-quantitative parameters was found. Neither breast cancer subtypes nor Ki67 modified chemotherapy responses. Compared to PUVmax, an overall increase of LTB was found in baseline condition, independent of the expressed immunophenotype. Post-treatment values of PUVmax revealed a significant reduction compared to baseline values (4.8 ± 0.26 vs. 1.9 ± 0.18; P < 0.001) and LTB exhibited a significant decay after the first course of NAC (15.8 ± 1.36 vs. 5.5 ± 0.49; P < 0.001). Using the Kruskal-Wallis H test which showed no correlation between the different molecular subtypes and the MPG and PUVmax and LTB (P = 0.52). Two PEM semi-quantitative parameters demonstrated a statically significant correlation and equivalence across the different breast cancer subtypes correlated with pathologic response according to MPG. PEM did not allow for prediction of NAC response in terms of breast cancer biomarkers, it is not discarded that this technology might be helpful for individual treatment stratification in breast cancer.

Impacto de la medicina nuclear en el diagnóstico y tratamiento del cáncer diferenciado de tiroides.

Los pacientes afectados por el cáncer diferenciado de tiroides habitualmente presentan un curso clínico favorable, ya que la piedra angular del tratamiento es la cirugía; a pesar de esto, algunos pueden desarrollar un ominoso desenlace, debido a las características clinico-patológicas de esta enfermedad. El tratamiento óptimo aún es controvertido, en especial respecto a la extensión de la cirugía, indicaciones de radioyodo y la supresión de la hormona estimulante de la tiroides. La correcta evaluación de los riesgos, antes y después de la cirugía, facilita un selectivo enfoque del tratamiento; destacando la relevancia de revisar el impacto de la medicina nuclear en la correcta evaluación, tratamiento y seguimiento de los pacientes que padecen esta neoplasia.Patients affected by differentiated thyroid cancer usually have a favorable clinical course, since the cornerstone of treatment is surgery; despite this, some patients may develop an ominous outcome, due to the clinical-pathological features of this disease. Optimal treatment remains controversial, especially regarding the extent of surgery, indications for radioiodine and thyroid-stimulating hormone. The correct evaluation of risks before and after surgery facilitates a selective treatment approach; highlighting the importance of reviewing the impact of nuclear medicine on the correct evaluation, treatment and follow-up of patients suffering from this neoplasm.

Correlación entre el volumen molecular tumoral evaluado con PET/TC con 68Ga-PSMA y los niveles de antígeno prostático específico / Correlation between molecular tumor volume evaluated with 68Ga-PSMA PET/CT and prostatic specific antigen levels

Objetivo: Investigar la asociación entre el nivel del antígeno prostático específico (PSA) en el mismo momento de la realización de PET/TC con 68Ga-PSMA y el volumen tumoral metabólico (MTV) en pacientes con cáncer de próstata en progresión bioquímica. Métodos: En este análisis retrospectivo se estudió a 84 pacientes sometidos a PET/TC con 68Ga-PSMA, a quienes se midieron los niveles de PSA en la misma semana (Trigger-PSA). Se calculó el MTV a partir de la suma de las lesiones metastásicas. Para determinar las relaciones entre el nivel de Trigger-PSA y los hallazgos de PET/TC utilizamos la correlación de Spearman. Resultados: El MTV medio de la enfermedad ósea (mBD) fue significativamente superior al valor encontrado en los ganglios metastásicos (mLN) (139,5 frente a 17,7; p<0,05). La enfermedad se limitó a la próstata en 8 pacientes (9,5%), mLN en 21 pacientes (25%), mBD en 32 pacientes (38,1%) y las 3 localizaciones (próstata, mBD y mLN) en 17 pacientes (20,2%). En 6 pacientes (6,14%), la PET/TC con 68Ga-PSMA no fue capaz de detectar la enfermedad. Los niveles medios de Trigger-PSA en los pacientes con enfermedad limitada a próstata (2,8ng/ml), mLN (6,8ng/ml) y mBD (16,8ng/ml) fueron estadísticamente significativos (p<0,05). Los pacientes positivos tuvieron un Trigger-PSA medio de 4,3ng/ml frente a 1,5ng/ml en los pacientes negativos (p<0,05). Establecimos 3 puntos límite para la tasa de detección del nivel de Trigger-PSA:≤1ng/ml (47,3%), 1-4ng/ml (68,4%) y≥4ng/ml (96,7%). Cuando el Trigger-PSA excedió de 4ng/ml, el MTV fue superior (p<0,001). Conclusión: Los resultados evidencian la correlación de MTV con Trigger-PSA, lo cual puede tener impacto sobre el tratamiento. Sin embargo, los niveles de Trigger-PSA no permitieron distinguir entre la enfermedad localizada o a distancia. La estadificación precisa de la enfermedad podría permitir planificar la mejor estrategia terapéutica

Objective: To investigate the association between prostatic-specific antigen (PSA) levels and molecular tumor volume (MTV) measured in the 68Ga-PSMA PET/CT, both done in a short period of time, in prostate cancer patients with biochemical failure. Methods: Eighty-four patients who underwent 68Ga-PSMA PET/CT and measurement of PSA levels in the same week (trigger-PSA) were studied in this retrospective analysis. MTV was calculated from the sum of the metastatic lesions. To determine the association between trigger-PSA level and PET/CT findings, Spearman rank correlation was used. Results: The median MTV of metastatic bone disease (mBD) was significantly higher than in metastatic lymph-nodes (mLN) (139.5 versus 17.7; P<.05). Disease was limited to the prostate in 8 patients (9.5%), mLN in 21 patients (25%), mBD in 32 patients (38.1%) and the 3 sites (prostate, mLN, and mBD) in 17 patients (20.2%). In 6 patients (6.14%), 68Ga-PSMA-PET/CT was not capable of detecting disease. The median trigger-PSA levels of patients with disease limited to the prostate (2.8ng/mL), mLN (6.8ng/mL), and for mBD (16.8ng/mL) was statically significant (P<.05). Positive patients had a mean trigger-PSA of 4.3ng/mL vs 1.5ng/mL in negative patients (P<.05). We established 3 threshold-points for trigger-PSA level detection rate:≤1ng/mL (47.3%), 1-4ng/mL (68.4%) and≥4ng/mL (96.7%). When trigger-PSA exceeded 4ng/mL, the MTV was higher (P<.001). Conclusion: The correlation of MTV with trigger-PSA is demonstrated, which may have an impact on management. However, trigger-PSA levels were not capable of distinguishing between localized or distant disease. An accurate detection of disease can lead to a better therapeutic strategy

Evaluation of recurrence of musculoskeletal tumors with thallium-201 scintigraphy plus SPECT/CT in pediatric population. / Evaluación de la recurrencia de tumores musculoesqueléticos mediante gammagrafía complementada con SPECT/CT con talio-201 en población pediátrica

Background: Imaging studies, particularly simple and contrast-enhanced tomography, constitute the first diagnostic approach to detect recurrence of musculoskeletal tumors. The aim of the present retrospective study was to demonstrate the usefulness of scintigraphy plus SPECT/CT (single photon emission computed tomography) with thallium-201 (201Tl) in the evaluation of malignant musculoskeletal tumors with suspicion of recurrence or metastatic disease. Methods: Eight weeks after the last therapy, 72 scintigraphy and SPECT/CT studies were performed to assess regional recurrence and metastatic disease in 42 patients with different types of malignant musculoskeletal tumors, such as osteosarcoma, Ewing's sarcoma, rhabdomyosarcoma, retinoblastoma, synovial sarcoma, and Wilms tumor at the Hospital Infantil de México Federico Gómez. The positive predictive value (PPV) and the confidence interval of the scintigraphy and SPECT/CT were calculated when compared with the results of the histopathological analysis and the clinical and radiological follow-up for the identification of recurrence. Results: Scintigraphy was abnormal in 30 (71.4%) of the 42 patients; 33 lesions (30 patients) were detected by scintigraphy and 25 lesions (21 patients) by chest X-ray and tomography of two regions. The SPECT/CT was performed on 30 patients, where 12 lesions were detected in addition to the planar scintigraphy. Scintigraphy showed a PPV of 82%; SPECT/CT, 100%. Conclusion: 201Tl-scintigraphy can be considered as an adequate study to identify the sites of tumor viability with a high degree of diagnostic certainty combined with the SPECT/CT technique.

Introducción: Los estudios de imagen, como la tomografía simple y contrastada, son la primera aproximación diagnóstica para detectar la recurrencia de tumores musculoesqueléticos. El objetivo de este estudio retrospectivo fue demostrar la utilidad de la gammagrafía acoplada a tomografía computarizada por emisión de fotón único (SPECT/CT) con talio-201(201Tl) en la valoración de tumores musculoesqueléticos malignos con sospecha de recurrencia o enfermedad metastásica. Métodos: Se realizaron 72 estudios gammagráficos y de SPECT/CT para la valoración de la recurrencia locorregional y a distancia, al menos 8 semanas tras la última terapia, en 42 pacientes con diferentes tipos de tumores musculoesqueléticos malignos, como osteosarcoma, sarcoma de Ewing, rabdomiosarcoma, retinoblastoma, sarcoma sinovial y tumor de Wilms en el Hospital Infantil de México. Se calcularon el valor predictivo positivo (VPP) y el intervalo de confianza del gammagrama y de la SPECT/CT en comparación con el resultado del análisis histopatológico y el seguimiento clínico y radiológico para identificar la recurrencia. Resultados: La gammagrafía fue anormal en 30 (71.4%) de los 42 pacientes. Se detectaron 33 lesiones (30 pacientes) por gammagrafía y 25 (21 pacientes) por telerradiografía de tórax y tomografía de dos regiones. La SPECT/CT se realizó en 30 pacientes y se detectaron 2 lesiones adicionales al rastreo planar. El VPP con la gammagrafía fue del 82%, y con la SPECT/CT, del 100%. Conclusión: La gammagrafía con 201Tl puede considerarse un estudio adecuado para identificar los sitios de viabilidad tumoral, con alto grado de certeza diagnóstica al complementar con SPECT/CT.

Correlation between molecular tumor volume evaluated with 68Ga-PSMA PET/CT and prostatic specific antigen levels. / Correlación entre el volumen molecular tumoral evaluado con PET/TC con 68Ga-PSMA y los niveles de antígeno prostático específico.

OBJECTIVE: To investigate the association between prostatic-specific antigen (PSA) levels and molecular tumor volume (MTV) measured in the 68Ga-PSMA PET/CT, both done in a short period of time, in prostate cancer patients with biochemical failure. METHODS: Eighty-four patients who underwent 68Ga-PSMA PET/CT and measurement of PSA levels in the same week (trigger-PSA) were studied in this retrospective analysis. MTV was calculated from the sum of the metastatic lesions. To determine the association between trigger-PSA level and PET/CT findings, Spearman rank correlation was used. RESULTS: The median MTV of metastatic bone disease (mBD) was significantly higher than in metastatic lymph-nodes (mLN) (139.5 versus 17.7; P<.05). Disease was limited to the prostate in 8 patients (9.5%), mLN in 21 patients (25%), mBD in 32 patients (38.1%) and the 3 sites (prostate, mLN, and mBD) in 17 patients (20.2%). In 6 patients (6.14%), 68Ga-PSMA-PET/CT was not capable of detecting disease. The median trigger-PSA levels of patients with disease limited to the prostate (2.8ng/mL), mLN (6.8ng/mL), and for mBD (16.8ng/mL) was statically significant (P<.05). Positive patients had a mean trigger-PSA of 4.3ng/mL vs 1.5ng/mL in negative patients (P<.05). We established 3 threshold-points for trigger-PSA level detection rate:≤1ng/mL (47.3%), 1-4ng/mL (68.4%) and≥4ng/mL (96.7%). When trigger-PSA exceeded 4ng/mL, the MTV was higher (P<.001). CONCLUSION: The correlation of MTV with trigger-PSA is demonstrated, which may have an impact on management. However, trigger-PSA levels were not capable of distinguishing between localized or distant disease. An accurate detection of disease can lead to a better therapeutic strategy.

Evaluación de la recurrencia de tumores musculoesqueléticos mediante gammagrafía complementada con SPECT/CT con talio-201 en población pediátrica / Evaluation of recurrence of musculoskeletal tumors with thallium-201 scintigraphy plus SPECT/CT in pediatric population

Resumen Introducción: Los estudios de imagen, como la tomografía simple y contrastada, son la primera aproximación diagnóstica para detectar la recurrencia de tumores musculoesqueléticos. El objetivo de este estudio retrospectivo fue demostrar la utilidad de la gammagrafía acoplada a tomografía computarizada por emisión de fotón único (SPECT/CT) con talio-201(201Tl) en la valoración de tumores musculoesqueléticos malignos con sospecha de recurrencia o enfermedad metastásica. Métodos: Se realizaron 72 estudios gammagráficos y de SPECT/CT para la valoración de la recurrencia locorregional y a distancia, al menos 8 semanas tras la última terapia, en 42 pacientes con diferentes tipos de tumores musculoesqueléticos malignos, como osteosarcoma, sarcoma de Ewing, rabdomiosarcoma, retinoblastoma, sarcoma sinovial y tumor de Wilms en el Hospital Infantil de México. Se calcularon el valor predictivo positivo (VPP) y el intervalo de confianza del gammagrama y de la SPECT/CT en comparación con el resultado del análisis histopatológico y el seguimiento clínico y radiológico para identificar la recurrencia. Resultados: La gammagrafía fue anormal en 30 (71.4%) de los 42 pacientes. Se detectaron 33 lesiones (30 pacientes) por gammagrafía y 25 (21 pacientes) por telerradiografía de tórax y tomografía de dos regiones. La SPECT/CT se realizó en 30 pacientes y se detectaron 12 lesiones adicionales al rastreo planar. El VPP con la gammagrafía fue del 82%, y con la SPECT/CT, del 100%. Conclusión: La gammagrafía con 201Tl puede considerarse un estudio adecuado para identificar los sitios de viabilidad tumoral, con alto grado de certeza diagnóstica al complementar con SPECT/CT.

Abstract Background: Imaging studies, particularly simple and contrast-enhanced tomography, constitute the first diagnostic approach to detect recurrence of musculoskeletal tumors. The aim of the present retrospective study was to demonstrate the usefulness of scintigraphy plus SPECT/CT (single photon emission computed tomography) with thallium-201 (201Tl) in the evaluation of malignant musculoskeletal tumors with suspicion of recurrence or metastatic disease. Methods: Eight weeks after the last therapy, 72 scintigraphy and SPECT/CT studies were performed to assess regional recurrence and metastatic disease in 42 patients with different types of malignant musculoskeletal tumors, such as osteosarcoma, Ewing's sarcoma, rhabdomyosarcoma, retinoblastoma, synovial sarcoma, and Wilms tumor at the Hospital Infantil de México Federico Gómez. The positive predictive value (PPV) and the confidence interval of the scintigraphy and SPECT/CT were calculated when compared with the results of the histopathological analysis and the clinical and radiological follow-up for the identification of recurrence. Results: Scintigraphy was abnormal in 30 (71.4%) of the 42 patients; 33 lesions (30 patients) were detected by scintigraphy and 25 lesions (21 patients) by chest X-ray and tomography of two regions. The SPECT/CT was performed on 30 patients, where 12 lesions were detected in addition to the planar scintigraphy. Scintigraphy showed a PPV of 82%; SPECT/CT, 100%. Conclusion: 201Tl-scintigraphy can be considered as an adequate study to identify the sites of tumor viability with a high degree of diagnostic certainty combined with the SPECT/CT technique.

Positron emission mammography in the evaluation of interim response to neoadjuvant chemotherapy in patients with locally advanced breast cancer.

Neoadjuvant chemotherapy (NAC) has an important role in patients with locally advanced cancers, treating distant micrometastases, downstaging tumors, improving operability, and sometimes allowing breast-conserving surgery to take place. We studied the association between two Positron Emission Mammography with 18F-FDG (18F-FDG-PEM) semi-quantitative parameters in 108 patients and correlated with pathologic response in each of the following breast cancer subtype: Triple negative breast cancer (TPN), HER2-positive, and ER-positive/HER2-negative cancers. AIM: Examine the association between two Positron Emission Mammography (PEM) semi-quantitative parameters: PUVmax (maximum uptake value) and LTB (lesion to background) baseline and the end of NAC with pathologic response in each breast cancer subtype. METHODS: 108 patients, 71 with invasive ductal carcinoma and 37 with infiltrating lobular carcinoma were evaluate with 18F-FDG-PEM scans baseline and after end of NAC. We assessed the impact of 2 PEM semi-quantitative parameters for molecular subtype correlated with pathologic response according Miller-Payne grade (MPG). RESULTS: After NAC, an overall reduction of 2 PEM semi-quantitative parameters was found. Neither breast cancer subtypes nor Ki67 modified chemotherapy responses. Compared to PUVmax, an overall increase of LTB was found in baseline condition, independent of the expressed immunophenotype. Post-treatment values of PUVmax revealed a significant reduction compared to baseline values (4.8 ±â€¯0.26 vs. 1.9 ±â€¯0.18; p < 0.001) and LTB exhibited a significant decay after the first course of NACT (15.8 ±â€¯1.36 vs. 5.5 ±â€¯0.49; p < 0.001). Using the Kruskal-Wallis H test which showed no correlation between the different molecular subtypes and the MPG and PUVmax and LTB (p = 0.52), but if a correlation was found between the response rate by MPG and both semiquantitative parameters (p = 0.05). CONCLUSION: 2 PEM semi-quantitative parameters demonstrated a statically significant correlation and equivalence across the different breast cancer subtypes correlated with pathologic response according to MPG. PEM did not allow for prediction of NAC response in terms of breast cancer biomarkers, it is not discarded that this technology might be helpful for individual treatment stratification in breast cancer.

Radium-223 IN metastatic hormone-sensitive high-grade prostate cancer: initial experience.

Our study evaluates the feasibility of compassionate exemption of Radium-223 (223Ra) treatment in metastatic hormone-sensitive high-grade prostate cancer (mHSHGPC) patients with concomitant androgen deprivation-therapy (ADT). Seven patients with mHSHGPC, were treated with six cycles of 223Ra plus ADT. All patients had undergone to 18F-NaF-PET/CT. A qualitative analyses of the 18F-NaF-PET/CT was performed in conjunction with Alkaline Phosphatase (ALP), Lactate-dehydrogenase (LDH) and Prostatic-Specific Antigen (PSA) values. The mean of SUVmax values were used as a quantitative measure of tumoral burden. Changes in PSA, ALP, LDH from baseline were evaluated, and were defined as increase or decrease of at least 30%. Clinical response was achieved if there was pain reduction using visual analogic scale. Four patients showed a significant reduction in mean SUVmax after 3 cycles of 223Ra, and one after 6 cycles. Patients who showed reductions in mean SUVmax after Ra-223 also showed reductions in PSA, ALP and LDH. Four weeks after the last cycle of 223Ra all patients had decreased total PSA, ALP and LDH values ≥ 30% also significant improvement on pain. No progress disease was documented after 14 ± 4 weeks. We found slight to moderate decreases in neutrophils and hemoglobin in two patients. We concluded that 223Ra plus ADT can be useful in mHSHGPC; the semi-quantitative 18F-NaF-PET/CT as a method effective to monitor the treatment response. Due to concomitant administration of ADT, 18F-NaF-PET/CT cannot differentiate whether the findings were due to androgen blockade or the 223Ra; nevertheless, data supporting the efficacy of 223Ra is the significant improvement on pain.