Can dual-headed 18F-FDG SPET imaging reliably supersede PET in clinical oncology? A comparative study in lung and gastrointestinal tract cancer.

In this study, we prospectively compared the sensitivity of PET and planar SPET (collimated gamma camera) 18F-FDG imaging in patients with lung and gastrointestinal tract cancer and analysed their respective impact on patient management. Twenty-eight patients with lung cancer and 14 with gastro-intestinal tract tumours were scanned on the same day with a PET and a collimated planar SPET gamma camera. The planar SPET procedure consisted of whole-body planar views and a tomographic acquisition centred over the torso or the abdomen, with the total imaging time within the same range as the whole-body PET procedure. The staging of lung cancer patients was accurate in 86% with PET and 64% with planar SPET. Planar SPET would have led to inappropriate therapeutic decisions in 8 of 28 patients, mainly due to undetected distant metastases. In patients with suspected gastrointestinal tract cancer, planar SPET identified 7 of 15 (47%) proven tumour sites, whereas PET identified 14 of 15 (93%). Our results suggest that collimated planar SPET cameras are not a substitute for dedicated PET scanners. The sensitivity for the detection of tumours is unacceptably low and can impair patient management. The use of multiple tomographic acquisitions could improve the sensitivity but would require a longer scanning time.

[A case of pulmonary mycobacteriosis due to Mycobacterium intracellulare (author's transl)]. / Un cas de mycobactériose pulmonaire humaine par Mycobacterium intracellulare.

An M. intracellulare, rough strain (serotype 7) has been isolated from sputum of a sixty-year old patients. This patient was a political prisoner in Germany between 1942-1945 and had contracted pulmonary tuberculosis with the cavity in the upper lobe of the right lung. A strain of mycobacterium susceptible to antituberculous drugs was isolated from his sputum in 1973. Since 1979, the isolation of M. Intracellulare has been accompanied by clinical signs of pulmonary mycobacteriosis, i.e. persistence of the cavity in spite of antituberculous treatments reapparition of cough with sputum, general weakness. Intradermo-reaction with specific sensitin gives a strong positive reaction, contrasting with a weak reaction with PPD tuberculin. As the antibiogram of the strain shows a susceptibility to cotrimoxazole and erythromycin, the patient underwent a therapy with the combination sulfamethaxozale-trimethoprime and erythromycin, for 4 months. At the end of this treatment, he seems to have recovered completely. The radiological aspect of the lungs remains unchanged. Although the source of contamination remains unknown, one thinks on the basis of bibliographica data, that it can be found in human beings, or seldom in animals (a pig, a bird) or in nature (a pond).

[Multidisciplinary treatment of primary cancer of the breast]. / Le traitement pluridisciplinaire du cancer du sein primitif

The prognosis of surgery for carcinoma of the breast is directly and closely related with the number of homolateral axillary lymph nodes involved. When node involvement is present, recurrences are numerous and early, this tendency being increased in accordance with the number involved. When 4 or more nodes are involved, 35 to 52% of recurrences are seen during the first 18 months, according to the differend statistics available. Such recurrences are distant in 85% of cases. This is due to the fact that carcinoma of the breast, even in its early stages, is most often a generalised disease with disseminated lesions in the form of distant micrometastases. In these cases with a poor prognosis, some form of treatment to complement surgery is necessary. Radiotherapy has proved a failure, useless and often harmful as a result of prolonged reduction in cellular immune defences. Prolonged polychemotherapy, by contrast, has shown its great, not to say astonishing, effectiveness. Continued study is thus essential.

[Chemotherapy in primary and metastatic intrathoracic cancer]. / La chimiothérapie dans les cancers intrathoraciques primitifs et métastatiques

Chemotherapy has procured results which are still modest surely valid in the treatment of inoperable primary bronchial cancer: - prolongation of the mean survival time from 3 1/2 months for the nontreated cases to 8 1/2 months for those patients treated with complex combinations; - more than 15% of very good results with return to normal professional activity for 6 to 18 months; - approximately 30% of considerable subjective improvement with a definite sense of "well being"; - considerable reduction in the use of pain-killers. These results amply justify the pursuit of research. 2) The results for the combination hormone-chemotherapy, in the case of thoracic metastases of breast cancer, are definitely better. After leukemia in children, and Hodgking and non-Hodgkin lymphoma, metastases from breast cancer constitute a third group of chemosensitive tumors: - for 64 cases, the percentage of complete or partial remission is 84.3%; - there were 34 complete remissions: mean survival 27 months, at present 11 patients still remain alive: 1 to 16, 1 to 17, 2 to 19, 1 to 23, 31, 35, 38, 43, 68 and 70 months; - 20 partial remissions, mean survival 10 1/2 months, one patient still alive; - 10 failures, mean survival 6 months; - mean duration of complete remission 18 months; - mean duration of partial remission 6 months.

Multidisciplinary curative treatment for disseminated carcinoma of the breast.

Eighty-four patients with disseminated breast carcinoma were treated with the combination of hormonal therapy and combination chemotherapy from the time of diagnosis. Hormonal treatment included castration for women still menstruating, estrogens for women menopausal for greater than 5 years, and androgens or progesterone for women menopausal for less than 5 years. Combination chemotherapy consisted of monthly 5-day courses of 5-fluorouracil (500 mg/day, Days 1-5), cyclophosphamide (300 mg/day, Days 1 and 4), vincristine (1 mg/day, Days 2 and 5), and methotrexate (100 mg, Day 1) followed by citrovorum factor (12 mg/day, Days 2 and 3). The overall response rate was 83.3%: 43 CRs (51%) and 27 PRs. The median survival time was 17 months: 6 months for the failures, 12 months for the 27 PRs, and 27 months for the 43 CRs. Fifteen patients with CR are still alive: one after 16 months, one after 17 months, two after 19 months, and one each after 23, 24, 25, 31, 35, 37, 38, 43, 48, 68 and 70 months.