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Prostate cancer (PCa) seldom metastasizes to the thyroid gland, and only a limited number of cases are documented in the literature. The application of a relatively recent and highly sensitive imaging technique, prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT), has enhanced the identification of metastatic disease. Nevertheless, as PSMA is expressed in various tissue types, the clinical importance of a PSMA-avid thyroid lesion remains largely uncertain. A minor, yet noteworthy, percentage of these lesions are ultimately determined to be malignant. Here we describe the case of a 70-year-old man with a past medical history of Lynch syndrome who presented to an outpatient oncologic clinic for management of very high risk localized PCa. He developed metastatic recurrence and his disease progressed through several lines of therapy, including immunotherapy and targeted treatments. He was found to have a new, intense PSMA uptake in an existing, previously benign thyroid nodule. Sonographic evaluation revealed changing morphology despite grossly stable size. Repeat biopsy confirmed the unusual finding of PCa metastasis to a known thyroid nodule. The shift in PSMA avidity played a pivotal role in discerning this metastatic deposit. There is a potential risk that such lesions may be inadequately acknowledged. The impact of the patient's Lynch syndrome on this presentation remains uncertain.
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PURPOSE: To compare bone marrow biopsy (BMB) with [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (PET/CT) imaging in the demonstration of bone marrow involvement in children with Hodgkin's Lymphoma (HL) and to investigate the effectiveness of PET/CT imaging and thus the necessity for BMB at staging. METHODS: Pediatric patients with HL, who underwent both bilateral iliac BMB and PET/CT imaging at disease staging were retrospectively analyzed. In determining bone marrow involvement (BMinv), BMB and/or first/follow-up PET/CT imaging were eligible for review. RESULTS: Fifty-six patients were included. BMinv was detected by PET/CT imaging in 6/56 (10.7%), whereas the proportion was 3/56 (5.3%) in BMB specimens. Bone marrow biopsies and PET/CT images were concordant in 53/56 (94.6%) patients with BMB specimens missing three cases of BMinv detected by PET/CT. When diagnostic accuracy was calculated, sensitivity, specificity, positive predictive value and negative predictive values for PET/CT were 100%, 100%, 100%, 100%, respectively, and the same values for BMB were 50%, 100%, 100%, 94.3%, respectively. CONCLUSIONS: The results of PET/CT and BMB for staging of pediatric HL patients were compatible, and PET/CT imaging was found to provide high diagnostic performance in determining BMinv. In keeping with earlier research, the current study showed that BMB may not be necessary in every patient at staging, and should be reserved for cases where PET/CT is inconclusive.
Assuntos
Medula Óssea , Doença de Hodgkin , Humanos , Criança , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Estudos Retrospectivos , Fluordesoxiglucose F18 , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , BiópsiaRESUMO
A 40-year-old woman with a palpable mass lesion in her right breast suggested as breast cancer was admitted to 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) unit for the metabolic characterization of the lesion and for the staging of the disease. The patient had no fever and no evidence of weight loss or night sweats. 18F-FDG PET/CT revealed an isolated solid mass lesion with increased 18F-FDG uptake in the upper outer quadrant of the right breast and increased 18F-FDG uptake in the lymph nodes of the right axilla suspected as primary breast cancer and its local lymph node metastasis. There was no other pathological 18F-FDG uptake in the whole body. Excisional biopsy histopathology revealed diffuse large B-cell non-Hodgkin lymphoma.
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ABSTRACT: A 57-year-old man with newly diagnosed with prostate cancer was admitted to our department for 68 Ga-prostate-specific membrane antigen PET/CT imaging. The patient, who was asymptomatic at the time of imaging, had increased diffuse 68 Ga-prostate-specific membrane antigen uptake in the trachea on PET/CT. No ground-glass density suggestive of pneumonia in both lungs was observed. The patient, whose symptoms developed 2 days after PET/CT imaging, was diagnosed with coronavirus disease 2019 by real-time polymerase chain reaction.
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COVID-19 , Neoplasias da Próstata , Traqueíte , COVID-19/complicações , COVID-19/diagnóstico por imagem , Radioisótopos de Gálio , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Antígeno Prostático Específico , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico por imagemRESUMO
OBJECTIVE: The feasibility of tracer production of 99mtechnetium (Tc)-prostate-specific membrane antigen (PSMA)-I&S sterile cold kit, imaging with single photon emission tomography/computed tomography (SPECT/CT), and 99mTc-PSMA-radioguided robot-assisted laparoscopic radical prostatectomy (99mTc-PSMA-RG-RALRP) technique for lymph node (LN) dissection of primary prostate cancer (PCa) patients were evaluated prospectively. METHODS: Fifteen primary PCa patients with intermediate- or high-risk score according to D'Amico risk stratification who had PSMA receptor affinity with Ga-68 PSMA-11 PET/CT were enrolled. After 99mTc-PSMA-I&S injection and SPECT/CT imaging, 99mTc-PSMA-RG-RALRP with DaVinci XI robotic platform and laparoscopic gamma probe were performed. Radioactive rating of resected tissue was compared with post-operative histopathology. Physiological and pathological uptakes of organs and tissues for both imaging modalities were compared. RESULTS: Physiological radiotracer distribution was similar for both imaging modalities. PCa lesions were much more visible on PET/CT. Metastatic LNs could not be visualized with SPECT/CT. Eighteen of 297 totally dissected LNs were metastatic, which were exactly the same with per-operative probe counts with sensitivity, specificity, accuracy, and negative and positive predictive value of all 100%. The median follow-up was 23.5 ± 4.6 months. tPSA reduction was > 98%. The 2.5 years biochemical recurrence-free survival, PCa-specific treatment-free survival and overall survival rates were 86,7%, 66,7% and 100%, respectively. CONCLUSION: Tc-99 m-PSMA-RG-RALRP is a promising technique for extended pelvic lymph node dissection (ePLND) during robotic surgery, which may shorten the operation time and reduce complication risks. If LN metastases is detected during surgery with PSMA-targeted probe, it may be an early indicator of PCa-spesific treatment planning. Tc-99 m-PSMA-I&S SPECT/CT is not as successful as Ga-68 PSMA-11 PET/CT for diagnosis of primary PCA lesions or LN metastases.
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Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Próstata , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , TecnécioRESUMO
ABSTRACT: The scan demonstrated multiple linear and patchy hypermetabolic lesions in skeletal muscles, mimicking the coat of a tiger, and was referred to as "a tiger man" sign. A 38-year-old man was admitted to our hospital with weakness, shortness of breath, and muscle pain. A CT scan showed a mass in the anterior mediastinum. 18F-FDG PET/CT was performed to evaluate the mass with a preliminary diagnosis of thymoma; heterogeneous 18F-FDG uptake in the mediastinal mass and tiger man findings in skeletal muscles were observed in PET/CT images.
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Dermatomiosite , Timoma , Neoplasias do Timo , Adulto , Dermatomiosite/complicações , Dermatomiosite/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Timoma/complicações , Timoma/diagnóstico por imagem , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico por imagemRESUMO
OBJECTIVE: The aims were to evaluate the performance of models that predict Gleason Grade (GG) groups with radiomic data obtained from the prostate gland in dual time 68Ga-Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computerized Tomography (PET/CT) images for prostate cancer (PCa) staging, and to analyze the contribution of late imaging to the radiomic model and to evaluate the relationship of the distance between tumor foci in the body (Dmax) obtained in early PET images with histopathology and prostate specific antigen (PSA) value. METHODS: Between October 2020 and August 2021, 41 patients who underwent 68Ga-PSMA PET/CT for staging of PCa were retrospectively analyzed. Volumetric and radiomics data were obtained from early and late PSMA PET images. The differences between age, metastasis status, PSA, standard uptake value (SUV), volumetric and radiomics parameters between GG groups were analyzed. Early and late PET radiomic models were created, area under curve (AUC), sensitivity, specificity and accuracy values of the models were obtained. In addition, the correlation of Dmax values with total PSMA-tumor volume (TV), Total lesion (TL)-PSMA and PSA values was evaluated. In metastatic patients, the difference in Dmax between GG groups was analyzed. RESULTS: There was a significant difference between patients with GG ≤ 3 and > 3 in 35 of the early PET radiomic features. In the early PET model, multivariate analyses showed that GLRLM_RLNU and PSA were the most meaningful parameters. The AUC, sensitivity, specificity and accuracy values of the early model in detecting patients with GG > 3 were calculated as 0.902, 76.2%, 84% and 78.1%, respectively. In 36 late PET radiomic features, there was a significant difference between patients with GG ≤ 3 and > 3. In multivariate analyses; SHAPE_compacity and PSA were obtained as the most meaningful parameters. The AUC, sensitivity, specificity and accuracy values of the late model in detecting patients with GG > 3 were calculated as 0.924, 85.7%, 85% and 85.4%. There was a strong correlation between Dmax and PSA values (p < 0.001, rho: 0.793). Dmax showed strong correlation with PSMA-TVtotal and TL-PSMAtotal (p < 0.001, rho: 0.797; p < 0.001, rho: 0.763, respectively). In patients with metastasis, median Dmax values of the GG > 3 group were higher than GG ≤ 3 group; A statistically significant difference was obtained between these two groups (p = 0.023). CONCLUSIONS: Model generated from the late PSMA PET radiomic data had better performance in the current study. Without the use of invasive methods, the heterogeneity and aggressiveness of the primary tumor and the prediction of GG groups may be possible with 68Ga-PSMA PET/CT images obtained for diagnostic purposes especially with late PSMA PET/CT imaging.
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Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos RetrospectivosRESUMO
OBJECTIVE: In this study, our aim was to evaluate the relationship of the quantitative data obtained from pretreatment 68Ga prostate-specific membrane antigen (PSMA) PET-computerized tomography (PET/CT) with treatment response of the patients with the diagnosis of metastatic castrationresistant prostate cancer (mCRPC) who received 177Lu-PSMA radioligand therapy (RLT). METHODS: The patients who were given three or four cycles of 177Lu-PSMA RLT between January 2016 and June 2018 were evaluated retrospectively. Volumetric data; PSMA tumor volume (TV) and total lesion (TL) PSMA, were obtained from 68Ga-PSMA PET/CT for whole (PSMA-TVT and TL-PSMAT). The distance between the two furthest lesions (Dmax) was calculated. Posttreatment early prostate-specific antigen (PSA) values on the fourteenth day after treatment were obtained. According to the PSA responses, the patients were divided into two groups as progressed and nonprogressed. In univariate analysis, the relationship of PET quantitative data with biochemical response groups was evaluated with Mann-Whitney U test. Logistic regression was used in multivariate analysis. RESULTS: A total of 38 patients were included in the study. In univariate analysis, Dmax, PSMA-TVT and TL-PSMAT values were obtained at lower levels in the progressed group. In multivariate analysis, only Dmax was found to be a prognostic factor in predicting early biochemical response. CONCLUSION: Dmax is the most prognostic parameter in predicting the early biochemical response in patients with mCRPC; high total tumor volume and burden are also parameters that give us an idea about the response to treatment. The success rate will be higher if 177Lu-PSMA RLT treatment is planned for patients with higher tumor volume and spread.
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Isótopos de Gálio , Radioisótopos de GálioRESUMO
INTRODUCTION AND AIM: Cancer-associated fibroblasts, which are densely found in tumor tissue, express high levels of fibroblast activation protein (FAP), and FAP inhibitors (FAPIs) labeled with radionuclides can be used in the diagnosis and treatment of cancer. In this study, the role of 68Ga-DOTA-FAPI-04 PET/CT in imaging of primary, metastatic, and recurrent cancers was investigated. PATIENTS AND METHODS: A total of 42 patients (16 females, 26 males; mean age, 58.5 years; range, 31-84 years) with 22 different types of malignant diseases were included in the study. 68Ga-DOTA-FAPI-04 PET/CT imaging was performed 1 to 7 days after 18F-FDG PET/CT. Pathological uptake levels in primary tumoral lesions, lymph nodes, skeletal system, liver, peritoneal surfaces, and other body parts were compared between 2 PET/CTs. In addition, physiological uptake levels of 18F-FDG and 68Ga-FAPI were defined measuring the liver, thoracic aorta, gluteal muscle activities, and uterus activity in female patients. RESULTS: Of the 42 patients in the study group, 33 patients were included for staging, 8 patients for restaging, and 1 patient for evaluation of treatment response. 68Ga-DOTA-FAPI-04 PET/CT showed intense uptake in 94.2% of primary tumoral lesions. In patients with multiple myeloma, 18F-FDG uptake in the bone marrow was significantly higher than 68Ga-FAPI uptake, whereas in gastric signet ring cell tumors, 68Ga-FAPI uptake was found to be significantly higher than 18F-FDG uptake. It was observed that 68Ga-DOTA-FAPI-04 PET/CT detected bone, liver, and peritoneum metastases with higher sensitivity and accuracy compared 18F-FDG PET/CT. CONCLUSIONS: The preliminary findings of this study showed that 68Ga-DOTA-FAPI-04 PET/CT can contribute to the diagnostic process in solid tumors. Especially in malignancies with mild uptake on 18F-FDG PET/CT, it stands out in diagnosis, staging, and restaging. It is also predicted that FAPI molecules can be used for radionuclide therapy in patients with metastatic disease and unresponsive to other treatments showing intense uptake on 68Ga-DOTA-FAPI-04 PET/CT.
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Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Feminino , Radioisótopos de Gálio , Compostos Heterocíclicos com 1 Anel , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , QuinolinasRESUMO
ABSTRACT: A 68-year-old woman with a mass lesion in right hepatic lobe had an elevated α-fetoprotein level (>54,000 ng/mL). The lesion showed higher 68Ga-DOTA-FAPI-04 uptake than 18F-FDG uptake in consecutive PET/CT images. The histopathological examination revealed neuroendocrine carcinoma with Ki-67 proliferation index of 80%.
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Carcinoma Neuroendócrino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Idoso , Carcinoma Neuroendócrino/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Compostos Heterocíclicos com 1 Anel , Humanos , Fígado/diagnóstico por imagem , Quinolinas , alfa-FetoproteínasRESUMO
INTRODUCTION: The current study aimed to investigate the diagnostic performance of metabolic parameters of pre-treatment F-18 fluorodeoxyglucose PET/computed tomography for predicting axillary lymph node metastases, distant metastases, and overall survival rates in breast cancer patients. MATERIALS AND METHODS: One hundred thirteen breast cancer patients who underwent pre-treatment F18 [FDG] PET-computed tomography with biopsy-proven axillary lymph node status were included in the current study. In pre-treatment F18 [FDG] PET-computed tomography for primary tumour area maximum standard uptake value, metabolic tumour volume, tumour lesion glycolysis, tumour diameter and for axillary lymph nodes maximum standard uptake value-LN were recorded. Also if distant metastatic sites were observed they were verified. RESULTS: The median follow-up period was 43.8 months. Five-year overall survival was 98% vs. 56% in patients with tumour diameter < vs. ≥22 mm, 93% vs. 50% in patients with maximum standard uptake value-T < vs. ≥6.7, 71% vs. 70% in patients with metabolic tumour volume < vs. ≥8.31cm, 94% vs. 49% in patients with maximum standard uptake value-LN < vs. ≥1.6, 98% vs. 48% in patients with tumour lesion glycolysis < vs. ≥19 084 g/ml × cm, 90% vs. 30% in patients with negative or positive distant metastases in initial PET/computed tomography, respectively. Maximum standard uptake value-LN with a cut-off level of <1.6 and <5.7 had high sensitivity and specificity for predicting axillary lymph node and systemic metastasis, respectively. Additionally, tumour lesion glycolysis was the strongest independent prognostic factor for overall survival. CONCLUSION: Our data shows that the combination of pre-treatment tumour lesion glycolysis and maximum standard uptake value-LN could improve risk stratification among breast cancer patients.
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Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Fluordesoxiglucose F18 , Metástase Linfática , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de SobrevidaRESUMO
A 66-year-old man with neuroendocrine tumor originating from midgut was referred to Ga-DOTATATE PET/CT imaging for restaging postoperatively. No suspicious uptake regarding residual primary tumoral involvement was seen. But there was diffuse high uptake in prostate gland suggestive of prostatitis or secondary primary tumoral lesion. Concurrent prostate-specific antigen level was 5.02 ng/mL (range, 0-4 ng/mL), C-reactive protein level was 8.25 mg/L (range, <5 mg/L), and white blood cell count was 6.83 × 10/µL (range, 3.9-10.9 × 10/µL). Diagnosis of active chronic prostatitis was achieved by core biopsy, which is identified as potential cause for false-positive diffuse uptake on Ga-DOTATATE PET/CT.
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Compostos Organometálicos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prostatite/diagnóstico por imagem , Idoso , Doença Crônica , Humanos , Masculino , Estadiamento de Neoplasias , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Prostatite/complicaçõesRESUMO
BACKGROUND: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. MATERIALS AND METHODS: Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. CONCLUSION: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.
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Ácido Edético/análogos & derivados , Radioisótopos de Gálio , Oligopeptídeos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Idoso , Isótopos de Gálio , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Neoplasias da Próstata/patologia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Recent years have seen the start of treatment of metastatic castration-resistant prostate cancer with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PRLT), especially 177Lu-PSMA-617. However, PRLT has side effects on the salivary glands that limit the safety of the treatment. The current study aimed to show the effect of external cooling with ice packs on 177Lu-PSMA-617 uptake by the parotid glands (PGs). Methods: The study included 19 patients (mean age, 72.9 y) with metastatic castration-resistant prostate cancer who had been referred for the first time for 177Lu-PSMA-617 treatment and underwent pretreatment 68Ga-PSMA-11 PET/CT. Before the initiation of PRLT, the SUVmax and SUVmean of the right and left PGs were measured on 68Ga-PSMA PET/CT. Frozen ice packs were then affixed over the right PG of each patient for approximately 5 h; 1 h after they were affixed, PRLT was administered. At 4 h after PRLT, head-and-neck SPECT/CT was performed, and at both 4 and 24 h after PRLT, whole-body planar scintigraphy was performed. Regions and volumes of interest were applied for the right and left PGs, and the counts and volumes were determined. Results: Before PRLT, 68Ga-PSMA-11 PET/CT showed no significant difference in SUVmax or SUVmean between the right and left PGs (P > 0.05). At 4 and 24 h after PRLT, planar imaging showed no significant difference in counts between the cooled and noncooled PGs (P > 0.05). Furthermore, at 4 h after PRLT, SPECT/CT showed no significant difference in counts or volumes between the cooled and noncooled PGs (P > 0.05). Conclusion: External cooling does not reduce uptake of 177Lu-PSMA-617 by the PGs.
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Temperatura Baixa , Glândula Parótida/diagnóstico por imagem , Neoplasias de Próstata Resistentes à Castração/diagnóstico por imagem , Neoplasias de Próstata Resistentes à Castração/radioterapia , Glândulas Salivares/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Dipeptídeos/farmacocinética , Compostos Heterocíclicos com 1 Anel/farmacocinética , Humanos , Pacientes Internados , Lutécio , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Prospectivos , Antígeno Prostático Específico , Cintilografia , Compostos Radiofarmacêuticos/farmacocinética , Reprodutibilidade dos Testes , Imagem Corporal TotalRESUMO
PURPOSE: To evaluate the effect of metabolic parameters of pretreatment primary tumor and regional lymph nodes with F-18-FDG PET/CT compared with MRI findings for the prognostic value and disease-free survival (DFS) in locally advanced cervical cancer. MATERIAL AND METHODS: From 2011 to 2016, 112 patients with a diagnosis of cervical cancer stages IB2-IVA treated with concomitant chemoradiation therapy with 3D intracavitary brachytherapy were analyzed. From this group, 50 patients who underwent pretreatment and posttreatment FDG PET/CT and MRI were enrolled. LRFFS, DFS, and overall survival were analyzed in comparison with FDG PET/CT and MRI data. Relationship between SUVmax data and DFS was also assessed. RESULTS: The median followup was 21 months, and median age was 54 years. The estimated 5-year locoregional failure-free survival, DFS, and overall survival rates were 87.4%, 70%, and 81%, respectively. DFS was 59.5% in patients with nodal metastases in FDG PET/CT and 100% in node negative patients (p:0,017). DFS was 50% and 79.4% in MRI node-positive and in node-negative patients, respectively (p:0,260). In addition, the nodal SUVmax (p: 0.005) and posttreatment response in FDG PET-CT (p < 0.001) were significant prognostic factors for DFS. Furthermore, primary tumor volume in MRI (p:0,982), node positivity in MRI (p:0,301), and response in posttreatment MRI (p:0,26) are not significant prognostic factors for DFS. CONCLUSION: As a result, FDG PET/CT has higher accuracy than MRI in detecting lymph node metastasis, and tumor volume reduction on FDG PET/CT images was greater than that on MRI images after CCRT.
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Linfonodos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia , Quimiorradioterapia , Intervalo Livre de Doença , Feminino , Fluordesoxiglucose F18 , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Compostos Radiofarmacêuticos , Taxa de Sobrevida , Carga Tumoral , Neoplasias do Colo do Útero/patologiaRESUMO
OBJECTIVES: Cervical cancer is one of the main causes of cancer death worldwide. Fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT) has been playing an increasingly important role in staging and monitoring treatment response in the disease. In the current study, we investigated metabolic F-FDG PET/CT parameters among patients with locally advanced squamous cell cervical cancer treated with concurrent chemoradiotherapy for predicting disease-free survival (DFS). PATIENTS AND METHODS: Forty-four patients with biopsy-proven locally advanced squamous cell cervical cancer were included in the study. Pretreatment and after treatment F-FDG PET/CT metabolic parameters [metabolic tumor volume, tumor lesion glycolysis, maximum standard uptake value (SUVmax)] for the primary tumor area and/or pelvic/para-aortic lymph nodes and also accompanying distant metastases were analyzed. Treatment response was divided into four groups according to a post-treatment F-FDG PET/CT scan. RESULTS: For all patients, the 3-year DFS was 79%. Pretreatment primary tumor SUVmax and tumor lesion glycolysis, pelvic lymph node SUVmax, and pretreatment para-aortic lymph node SUVmax were significant prognostic factors for DFS with different cut-off values. In contrast, for metabolic tumor volume-T1, there was no statistical significance for DFS. CONCLUSION: F-FDG PET/CT cut-off values may help clinicians with their treatment planning and follow-up in locally advanced squamous cell cervical cancer patients.
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Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/patologiaRESUMO
The aim of this study was to describe the influence of HIV infection on the staging of gastric cancer by using positron emission tomography/computed tomography (PET/CT) imaging. We treated a patient with local advanced gastric cancer. PET/CT showed an unusual hypermetabolic activity of lymph nodes, and the patient was later found to be HIV-positive. PET/CT scans in cancer staging of patients with chronic HIV infection may show advanced stage disease. Spread of primary tumor to unusual sites should be a warning sign for the possible concurrent diseases.
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Adenocarcinoma/diagnóstico por imagem , Fluordesoxiglucose F18 , Infecções por HIV/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Alcinos , Antirretrovirais/uso terapêutico , Benzoxazinas/uso terapêutico , Ciclopropanos , Emtricitabina/uso terapêutico , Gastrectomia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Tenofovir/uso terapêutico , Resultado do TratamentoRESUMO
Rectal hemorrhage should be evaluated within a wide spectrum ranging from benign diseases to a malignant process. Especially, the melanomas of rectum are detected at an advanced stage when diagnosed since the present symptoms of rectal melanomas are similar. The question of what will be the surgical approach with MR, CT, and PET-CT imaging methods performed after histopathological diagnosis still conserves its topicality. PET-CT is a good imaging method for determination of distant metastasis and lymphatic involvement. In the present case, a patient with early-stage rectal melanoma was treated with APR. No relapse/metastasis was detected during the 18-month follow-up. The aggressive course of the disease and its low response rates to medical treatments may cause the surgical approaches to be more extensive.
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INTRODUCTION: In Turkey, the gene expression profile test is not standard, so adjuvant treatment is planned according to clinicopathological factors. Therefore, we retrospectively analyzed important parameters that affect the decision on adjuvant chemotherapy, and also factors related to survival in stage IA breast cancer patients in Turkey. METHODS: We retrospectively evaluated 347 stage IA patients. The relationship between the clinicopathological parameters and adjuvant chemotherapy was analyzed. RESULTS: The median age and follow-up time were 52 years (range: 25-86) and 22.6 months (range: 1-113), respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 87.9% and 98.7%, respectively, but the median DFS was not reached. Age, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, and the presence of triple-negative breast tumor (TNBC) were related to DFS, and lymphovascular invasion (LVI), perineural invasion (PNI), HER2 status, the presence of TNBC, and recurrence were related to OS (p > 0.05). Furthermore, age, menopausal status, multicentricity, grade, tumor size, necrosis, ER, the presence of TNBC, and HER2 were found to be related to adjuvant therapy decision (p > 0.05). All these parameters, in addition to LVI and PNI, were independent factors for chemotherapy by logistic regression analysis. CONCLUSIONS: In decisions about adjuvant therapy in stage IA breast cancer patients, clinicopathological factors should be kept in mind.
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Lapatinib is the first dual tyrosine kinase inhibitor of human epidermal growth factor receptor type 2 (HER2/neu) and epidermal growth factor receptor (EGFR). The present study evaluated the efficacy and tolerability of the combination of lapatinib and capecitabine in patients with metastatic breast cancer (MBC) who progressed after therapy with trastuzumab, a taxane and/or anthracycline. A total of 203 patients with a median age of 48 years (range: 25-82 years) were evaluated retrospectively in 11 centres between September 2007 and May 2011. All the patients had HER2-positive MBC progressing after trastuzumab and chemotherapy including an anthracycline and/or taxane. All patients were treated with the combination of lapatinib (1250 mg/day, continuously) and capecitabine (2000 mg/m(2) on days 1 through 14 of a 21-day cycle). Data on demographics, clinical outcome, and toxicity were collected for descriptive analyses. The median follow-up was 10·7 months (range: 1-40 months). An overall response rate (ORR) of 33·4% was achieved including 7 complete responses (CR, 3·4%), 61 partial responses (PR, 30·0%), and 44 stable disease (37·9%). Clinical benefit rate of 71·3% was achieved. Median progression-free survival (PFS) was 7 months (95% CI: 6-10 months), with a median overall survival (OS) of 15 months (95% CI: 12-18 months). The most common side effects were hand-foot syndrome (46·8%), nausea (42·3%), fatigue (42·2%), anorexia (38·5%), diarrhea (31·5%), and rash (29·6%). Grade 3-4 toxicities were identified as hand foot syndrome (7·9%), diarrhea (6·9%), fatigue (5·9%), and rash (5·4%). There were no symptomatic cardiac events. Lapatinib and capecitabine combination therapy is effective and well tolerated in patients with MBC who had progressive disease after trastuzumab, taxane, and/or anthracycline therapy, as evidenced by this retrospective evaluation. Toxicity was mild to moderate with low grade 3-4 toxicity.