Diagnostic Radiation Oncology:¶Malignant Cystosarcoma Phylloides

BACKGROUND: Cystosarcoma phylloides is a rare, mostly benign tumor of the breast. In most cases curative treatment is possible with complete surgical excision of the lesions. However, there is a high local recurrence rate up to 46%. There are only few reported successful treatments with radiotherapy in cystosarcoma phylloides. Radiotherapy is indicated in patients with locoregional recurrent disease and those with symptomatic metastases. PATIENT: We present a case of a 54-year-old woman with a painless mass in the right breast. Clinical examination showed a large, firm tumor and axillary lymph node metastases. The patient underwent mastectomy and axillary lymph node dissection. Histopathology showed a cystosarcoma phylloides measuring 30 x 25 x 19 cm as well as lymph node metastases measuring 9.5 cm. Despite a R0 resection the patient developed 4 thoracic wall recurrences within 2 years. At 18 months there were additional multiple pulmonary and pleural lesions with a maximum diameter of 6.5 cm. Subsequently the patient received polychemotherapy. There was a significant response of the thoracic wall disease as well as of the pulmonary and pleural lesions. Six months later there was further progress of the thoracic wall disease and the pulmonary lesions. Following this the patient underwent radiation therapy of her right thoracic wall with 50 Gy which lead clinically to a quick response. For the past 5 months there has been no evidence of thoracic wall disease recurrence. CONCLUSION: This is an unusual case of cystosarcoma phylloides and response to different therapeutic modalities. Cystosarcoma phylloides showed to be a radiosensitive tumor. Thus postopertive radiation therapy is indicated to prevent local recurrences.     

Oncology service correspondence: do we communicate?

The aim of this study is to assess the content of letters sent from a hospital oncology service regarding the initial assessment of new referrals and the requirements of hospital specialists and General Practitioners (GPs) regarding oncology service correspondence. The content of letters regarding the initial consultation of 204 consecutive new oncology patients was analysed. General Practitioners and referring specialists were sent a 13-point survey to gauge their preferences for the information contained in oncology correspondence pertaining to the initial assessment of an oncology patient. Seventy-two percent of the patients had a letter written following their initial oncology assessment. The GP received a copy of 81% of the letters (58% of the study sample). The diagnosis was recorded in all our letters, and the proposed treatment plan was addressed in 84% of our letters. Both GPs and specialists required information on examination and investigation findings, diagnosis, treatment options, proposed management plan, and what the patient was told. The GPs required further information on current medication, likely side-effects of the proposed management, and clarification of when to contact the oncologist. The majority of the respondents were in favour of a structured letter.     

Diagnostic neuroradiology: Ready for the neuro-interventional age?

Acute cerebral ischemia or stroke is currently considered an emergency for which therapeutic options are available if the therapeutic window of 4.5 h is respected.Imaging modalities have progressed greatly over the last few decades,rendering ischemia detectable in the first hours after the event.However,in order for treatment to be efficacious it is necessary to speed up all the processes before the start of therapy.Thus,one must decrease the time to arrival at the hospital and to the radiological method that is to be employed(be it computed tomography or magnetic resonance imaging);only then will the medical or interventional techniques available fulfill their potential.     

Circulating Tumor Cells: Personalized Medicine in Interventional Oncology?

Innovative technologic advancements have expanded the ability of interventional radiologists to capture and visualize directly tumor cells that have intravasated into the circulation. The detection of these circulating tumor cells (CTCs) is revolutionizing the understanding of the pathogenesis of metastasis and is paving the way for exquisitely sensitive techniques to detect malignancy, monitor recurrence, and prognosticate outcomes. In this review, the prevailing theories on the pathobiology of metastasis and the tools that have been developed to investigate CTCs are summarized. The tremendous impact CTCs are likely to have in oncology is discussed, with particular emphasis on their relevance to interventional oncology.     

Radiation Reduction: How Low Can YOU go?

JOURNAL OF NUCLEAR CARDIOLOGY NEWS UPDATE

Radiation Reduction: How Low Can YOU go?     

What Do We Measure in Oncology PET?

Positron emission tomography (PET) has come to the practice of oncology. It is known that ¹⁸F-fluorodeoxyglucose (FDG) PET is more sensitive for the assessment of treatment response than conventional imaging. In addition, PET has an advantage in the use of quantitative analysis of the study. Nowadays, various PET parameters are adopted in clinical settings. In addition, a wide range of factors has been known to be associated with FDG uptake. Therefore, there has been a need for standardization and harmonization of protocols and PET parameters. We will introduce PET parameters and discuss major issues in this review.