Addition of 18F-FDG-PET scans to radiotherapy planning of thoracic lymphoma.

BACKGROUND AND PURPOSE: FDG-PET possesses greater sensitivity and accuracy than computed tomography (CT) in detecting diseased lymph nodes. Though the FDG-PET scans are acquired for similar diagnostic reasons as CT, they are not used in the radiotherapy (RT) planning process. Successful tumourcidal dose is usually delivered but large volumes of normal and non-malignant tissues are irradiated due to the nature of lymphoma and also to the subjectivity of the field determining process. This study tries to lessen the subjectivity of the field determining process by the addition of currently acquired PET to the conventional thoracic lymphoma RT. The differences between retrospectively delineated volumes from CT and FDG-PET were compared and the effect of this additional information was evaluated. MATERIALS AND METHODS: Seventeen FDG-PET scans were registered to corresponding CT scans using rigid-body registration with negligible intra-observer variability. Comparisons were made between the volumes, lateral extensions and the most inferior point of the delineated gross tumour volumes (GTVs). RESULTS: For 1/17 patient data, no diseased volumes were delineated and in 6/17, no volumes were delineated on PET and yet in CT, masses up to 367.2 cm3 were outlined. From the 10 positive-CT and PET data, the GTV(PET) were smaller than GTV(CT) in six cases. Greater than 3.0 cm lateral disease extension differences were observed in 4/10 cases. Inferior tumour extents were confirmed in 6/10 cases whereas in 2/10 patients GTV(CT) was greater than 12.0 cm inferior compared to GTV(PET). CONCLUSIONS: FDG-PET data can be introduced to current thoracic lymphoma RT planning protocol with minimal intervention and changes. The subjectivity in the RT planning of thoracic lymphoma would be decreased with the addition of currently acquired FDG-PET data.     

Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis

Objective: Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is a new techniquefor identifying different malignant tumors using different uptake values between tumor cells and normal tissues.Here we assessed the diagnostic accuracy of 18F-FDG-PET in patients with testicular cancer by pooling data ofexisting trials in a meta-analysis. Methods: PubMed/MEDLINE, Embase and Cochrane Central Trials databaseswere searched and studies published in English relating to the diagnostic value of FDG-PET for testicularcancer were collected. The summary receiver operating characteristic (SROC) curve was used to examine theFDG-PET accuracy. Results: A total of 16 studies which included 957 examinations in 807 patients (median age,31.1 years) were analyzed. A meta-analysis was performed to combine the sensitivity and specificity and their95% confidence intervals (CIs), from diagnostic odds ratio (DOR), positive likelihood ratios (PLR), negativelikelihood ratio (NLR). SROC were derived to demonstrate the diagnostic accuracy of FDG-PET for testicularcancer. The pooled sensitivity and specificity were 0.75 (95% confidence interval (CI), 0.70-0.80) and 0.87 (95%CI, 0.84-0.89), respectively. The pooled DOR was 35.6 (95% CI, 12.9-98.3). The area under the curve (AUC) was0.88. The pooled PLR and pooled NLR were 7.80 (95% CI, 3.73-16.3) and 0.31 (95% CI, 0.23-0.43), respectively.Conclusion: In patients with testicular cancer, 18F-FDG-PET demonstrated a high SROC area, and could be apotentially useful tool if combined with other imaging methods such as MRI and CT. Nevertheless, the literaturefocusing on the use of 18F-FDG-PET in this setting still remains limited.     

18F-FDG PET和CT对食管癌临床分期的价值

评价18F-FDG PET和CT判定食管癌术前T、N分期的敏感性、特异性及准确性,并探讨SUV值与食管癌预后的相关性。方法:29例食管癌患者术前均行PET和CT扫描,分别进行T、N分期,并与术后病理分期进行对照分析。结果:与术后病理证实的T、N分期结果比较,CT扫描对判断T分期的准确率明显高于PET,PET扫描对判断N分期的准确率虽高于CT,但差异无统计学意义。仅术前PET扫描检测T分期的一致性较差（Kappa<0.4）;术前PET扫描检测N分期、术前CT扫描检测T、N分期一致性均较好（Kappa>0.4）。SUV值与PETsuv2.5显示病变长度及体积呈正相关,SUV值<9.0患者预后好于SUV值≥9.0患者。结论:在判断食管癌临床T分期方面CT较PET具有一定优势,对判断N分期方面,两者准确率均较高。SUV临界值9.0可以作为一项实用的判断预后指标。      

18F-FDG标准摄取值对非小细胞肺癌预后的影响

目的:探讨18F-FDG标准摄取值(SUV)在判断非小细胞肺癌预后中的作用。方法:对122例非小细胞肺癌(NSCLC)经PET显像并计算出肺部肿瘤病灶感兴趣区(ROI)的SUV。结果:单变量分析结果显示,临床分期、身体状况及病理学类型间生存曲线有显著性差异(P<0.01);SUV>7的患者与SVU≤7患者间生存曲线差异有显著性(P<0.05),性别对生存期影响无显著性差异(P>0.05);COX多因素分析显示,总生存率与临床分期、身体状况、病理学类型及SUV大小(SUV>7和SVU≤7)密切相关,而性别对总的生存率无影响。结论:SUV值能够预测NSCLC的生物学恶性进程,并为临床治疗方案的选择和预后判断提供参考。     

18F-FDG-PET/CT在小细胞肺癌化疗疗效中的评估价值

摘 要：［目的］ 探讨18氟脱氧葡萄糖—正电子发射计算机断层扫描(18fluorodeoxyglucose positron emission computed tomography,18F-FDG-PET) 在检测小细胞肺癌(small cell lung cancer,SCLC)化疗客观疗效中的临床价值。 ［方法］ 68例小细胞肺癌患者入组（广泛期35例、局限期33例）,所有患者均行全身化疗,化疗2个周期后根据SUV值及RECIST 标准分别评价疗效,比较两者是否具有一致性,Kaplan-Meier生存分析SUVmax值与患者的生存时间的相关性。［结果］ 18F-FDG-PET代谢缓解与RECIST标准评价的疗效具有明显的一致性(P<0.001)。 ROC曲线分析示SUVmax曲线下面积为0.855,SUVmax值下降>30%患者2年生存率为42.05%,高于SUVmax值下降≤30%者的8.83%(P<0.05);代谢缓解者（SUVmax值下降>30%）的中位生存时间为21.86个月,明显长于代谢无缓解者（SUVmax值下降≤30%）的9.35个月（χ2=11.928,P=0.001）。［结论］ 18F-FDG-PET能够预测小细胞肺癌化疗的疗效,在小细胞肺癌化疗反应监测中具有一定的临床价值。     

The effect of cryotherapy on oral mucosa: a study in healthy volunteers

Oral cryotherapy causes local vasoconstriction, which reduces blood flow and reduces the cytotoxic damage to the oral mucosa, has been shown to reduce oral mucositis after intense cytostatic treatment. The main object of this study was to investigate the effect of oral cryotherapy on the temperature in the oral mucosa, the level of proinflammatory cytokine interleukin-6 (IL-6) in saliva and the effect on blood pressure in healthy volunteers, before and after 1?h of cooling the oral cavity with crushed ice. Twelve healthy volunteers [mean age 32.4 (SD 13.2) (20?C56) years] were treated with oral cryotherapy in the form of crushed ice. Temperature measurements were performed in the oral mucosa using infrared thermograph following a flowchart protocol. Blood pressure (BP) was measured with a sphygmomanometer. Saliva was analysed for inflammatory cytokine IL-6, using an enzyme-linked immunosorbent assay (ELISA). All participants fulfilled the cooling session. The temperature in the oral cavity decreased significantly (mean 12.9?°C, p?<?.002). The systolic BP was marginally but significantly higher after cooling (~5?mmHg, p?=?.019). We could not detect any differences in cytokine IL-6 levels before and after oral cooling. We conclude that cryotherapy during 1?h lowers the mucosal temperature as much as ~12.9?°C, which explains the significant protective effect against mucosal damage by cytostatic drugs. The cooling caused no increase in IL-6 levels. Systemic blood pressure was marginally increased.     

PET显像对卵巢癌诊断和监测治疗价值的初步探讨(附3例报告)

目的探讨PET显像诊断卵巢癌和监测治疗的价值.方法用siemensECAT47PET扫描仪对1例可疑卵巢癌患者及2例术后的患者行PET检查.3例患者均经病理证实为卵巢癌.PET检查前禁食6小时,空腹血糖控制在6.7mmol/l以下,并按5.55MBq/kg静脉注入18F-FDG,40分钟后检测.结果PET显示了术前1例B超阴性,肿瘤标志物CA125在正常范围内的透明细胞癌,经PET检查确诊并经病理证实.另2例术后化疗3周期的卵巢癌经PET检查,其中1例局部复发并全身转移,另1例仍无瘤生存.结论PET显像可用于卵巢癌的早期诊断,及术后化疗疗效监测且比B超及肿瘤标志物CA125等更具有敏感性.     

Molecular imaging of pediatric brain tumors: comparison of tumor metabolism using 18F-FDG-PET and MRSI

Magnetic resonance spectroscopic imaging (MRSI) and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) are non-invasive imaging techniques routinely used to evaluate tumor malignancy in adults with brain tumors. We compared the metabolic activity of pediatric brain tumors using FDG-PET and MRSI. Children (n?=?37) diagnosed with a primary brain tumor underwent FDG-PET and MRSI within two weeks of each other. Tumor metabolism was classified as inactive, active or highly active using the maximum choline:N-acetyl-asparate (Cho:NAA) on MRSI and the highest tumor uptake on FDG-PET. A voxel-wise comparison was used to evaluate the area with the greatest abnormal metabolism. Agreement between methods was assessed using the percent agreement and the kappa statistic (κ). Pediatric brain tumors were metabolically heterogeneous on FDG-PET and MRSI studies. Active tumor metabolism was observed more frequently using MRSI compared to FDG-PET, and agreement in tumor classification was weak (κ?=?0.16, p?=?0.12), with 42?% agreement (95?% CI?=?25-61?%). Voxel-wise comparison for identifying the area of greatest metabolic activity showed overlap in the majority (62?%) of studies, though exact agreement between techniques was low (29.4?%, 95?% CI?=?15.1-47.5?%). These results indicate that FDG-PET and MRSI detect similar but not always identical regions of tumor activity, and there is little agreement in the degree of tumor metabolic activity between the two techniques.     

盐酸帕洛诺司琼注射液在健康受试者体内的药代动力学研究

  目的  评价盐酸帕洛诺司琼注射液在健康受试者体内的药动学特征。  方法  31例健康受试者分成3组,单次静脉注射盐酸帕洛诺司琼剂量分别为0.125,0.25和0.5 mg。采用超高效液相-串联质谱法（UPLC-MS/MS）测定人血浆中帕洛诺司琼浓度,采用DAS 2.1药动学软件进行药动学参数的分析和计算。  结果  单剂量静脉注射0.125,0.25和0.5 mg的盐酸帕洛诺司琼注射液后,AUC_0~168h分别为（7.5±2.5）、（15.2±4.0）、（34.8±9.7）μg·h·mL-1;消除半衰期t_1/2分别为（27.2±9.5）、（27.2±6.5）、（31.4±5.6）h。AUC_0~168h与剂量呈正相关,相关系数为0.998。受试者在研究期间未发生重度以上不良事件。  结论  本研究建立的检测方法简单、快速、准确、灵敏度高,适合盐酸帕洛诺司琼人体药代动力学研究。单次静脉注射盐酸帕洛诺司琼后,受试者耐受良好。在0.125~0.5 mg剂量范围内,帕洛诺司琼在健康受试者体内表现为线性药动学特征。      

A phase I study of monohydroxyethylrutoside in healthy volunteers

The flavonol monohydroxyethylrutoside (monoHER) has demonstrated protection against doxorubicin-induced cardiotoxicity in in vitro and in vivo studies without affecting the antitumor effect. In the present phase I study, the possible side effects and the pharmacokinetics of monoHER were evaluated in healthy volunteers with the aim to develop a safe and feasible dose to be evaluated in cancer patients treated with doxorubicin. The study was performed as a single blind, randomized trial in healthy volunteers (age between 19 and 56 years). At each dose level, six subjects received monoHER and three placebo. MonoHER was solubilized in 100 ml dextrose 5% and administered as an i.v. infusion in 10 min. The placebo consisted of 100 ml dextrose 5%. The starting dose of monoHER was 100 mg/m². Dose escalation by 100% of the preceding dose took place after finishing each dose level until the protecting pharmacokinetic values for C _max and AUC^∞ (as observed in mice after 500 mg/kg monoHER i.p.) were reached and/or serious side effects were observed. The dose was escalated up to 1,500 mg/m². The mean values of C _max and AUC^∞ were 360±69.3 μM and 6.8±2.1 μmol min/ml, respectively. These values were comparable to the C _max and AUC^∞ observed under the protecting conditions in mice. No serious side effects occurred during the entire study. Thus, 1,500 mg/m² is a feasible and safe dose to be evaluated in a phase II study to investigate the protective properties of monoHER against doxorubicin-induced cardiotoxicity in cancer patients. Preliminary results of this study have been presented as a poster at AACR (Proc. AACR 43 (2002) 2751).     

Biological response of nasopharyngeal carcinoma to radiation therapy: a pilot study using serial 18F-FDG PET/CT scans

We used serial (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to evaluate tumors' maximum standardized uptake value (SUV(max)) before, during, and after radiotherapy to explore the biological behavior of and response to radiation therapy in various subtypes of nasopharyngeal carcinoma (NPC). Sixty-one patients with pathologically diagnosed NPC were prospectively enrolled into the study. WHO type II(B) disease had a higher initial SUV(max) and more significant biological response at the primary site as compared with type II(A) subtype. The two subtypes of WHO type II NPC may significantly differ in their biological behavior and response to radiotherapy.     

63例肺内孤立性结节18F-FDG符合线路正电子显像临床分析

目的评估符合线路正电子显像在肺内孤立性结节中的诊断价值。方法对63例肺内结节行18F-FDG符合线路正电子显像检查,阳性显像者手术切除,阴性显像临床可疑者,行手术或肺内穿刺。结合术后或肺内穿刺病理,判定符合线路正电子显像检查的灵敏性,特异性和正确性。结果63例患者中阳性显像36例,其中病理证实阳性者31例,假阳性5例。阴性显像27例,其中病理证实真阴性24例,假阴性3例。灵敏性为91.2%(31/34),特异性为88.9%(24/27),正确性为87.3%(55/63),真阳性率为86.1%(31/36),假阳性率13.9%(5/36),真阴性率88.9%(24/27),假阴性率11.1%(3/27)。结论符合线路正电子显像作为一种安全、非创伤性的显像方法在鉴别肺内孤立性结节(SPN)性质时具有高敏感性,高特异性,极大地减少了不必要的诊断性开胸手术,因而有十分广阔的应用前景。     

Performance of 18F-FET versus 18F-FDG-PET for the diagnosis and grading of brain tumors: systematic review and meta-analysis

Background

For the past decade ¹⁸F-fluoro-ethyl-l-tyrosine (FET) and ¹⁸F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) have been used for the assessment of patients with brain tumor. However, direct comparison studies reported only limited numbers of patients. Our purpose was to compare the diagnostic performance of FET and FDG-PET.

Methods

We examined studies published between January 1995 and January 2015 in the PubMed database. To be included the study should: (i) use FET and FDG-PET for the assessment of patients with isolated brain lesion and (ii) use histology as the gold standard. Analysis was performed on a per patient basis. Study quality was assessed with STARD and QUADAS criteria.

Results

Five studies (119 patients) were included. For the diagnosis of brain tumor, FET-PET demonstrated a pooled sensitivity of 0.94 (95% CI: 0.79–0.98) and pooled specificity of 0.88 (95% CI: 0.37–0.99), with an area under the curve of 0.96 (95% CI: 0.94–0.97), a positive likelihood ratio (LR+) of 8.1 (95% CI: 0.8–80.6), and a negative likelihood ratio (LR−) of 0.07 (95% CI: 0.02–0.30), while FDG-PET demonstrated a sensitivity of 0.38 (95% CI: 0.27–0.50) and specificity of 0.86 (95% CI: 0.31–0.99), with an area under the curve of 0.40 (95% CI: 0.36–0.44), an LR+ of 2.7 (95% CI: 0.3–27.8), and an LR– of 0.72 (95% CI: 0.47–1.11). Target-to-background ratios of either FDG or FET, however, allow distinction between low- and high-grade gliomas (P > .11).

Conclusions

For brain tumor diagnosis, FET-PET performed much better than FDG and should be preferred when assessing a new isolated brain tumor. For glioma grading, however, both tracers showed similar performances.     

Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project

BACKGROUND: The goal of the Carolinas Cancer Education and Screening (CARES) Project was to improve colorectal cancer (CRC) screening among low-income women in subsidized housing communities in 11 cities in North and South Carolina who were traditionally underserved by cancer control efforts. METHODS: Cross-sectional samples were randomly selected from housing authority lists at 5 timepoints in this nonrandomized community-based intervention study. Face-to-face interviews focused on CRC knowledge, beliefs, barriers to screening, and screening behaviors. The intervention components were based on a previous evidence-based program. RESULTS: A total of 2098 surveys were completed. Seventy-eight percent of the respondents were African American, 62% were 65+ years, and 4% were married. At baseline, the rate of CRC screening within guidelines was 49.3% and physician recommendation was the strongest predictor (odds ratio [OR] = 21.9) of being within guidelines. There was an increase in positive beliefs about CRC screening (P = .010) and in the intention to complete CRC screening in the next 12 months (P = .053) after the intervention. The odds of being within CRC screening guidelines for women living in a city that had received the intervention were not significantly different from women living in a city that had not received the intervention (P = .496). CONCLUSIONS: Although CRC screening rates were not significantly better after the intervention, there was a positive change in beliefs about screening and intention to be screened. The results suggest that the dissemination of an evidence-based behavioral intervention may require a longer duration to engage hard-to-reach populations and change behaviors.     

The role of 18F-FDG-PET in the local/regional evaluation of women with breast cancer

Purpose. In women with breast cancer, knowledge of the local/regional extent of the tumor is essential for staging, treatment planning, monitoring response to therapy, and follow-up. Positron emission tomography (PET) is an important imaging test which can detect tumor at multiple sites in women with breast cancer. We compared the ability of PET to provide a comprehensive view of the local/regional extent of tumor in women with stage I, II and stage III, IV breast cancer. Materials and methods. Forty-six women with breast cancer underwent PET using ¹⁸F-FDG. ¹⁸FDG uptake in the breast primary tumor, associated skin, axillary and internal mammary lymph nodes, and the contralateral breast was determined qualitatively, and correlated with histologic, clinical and radiographic findings. Results. Twenty-four patients were premenopausal and 22 were postmenopausal, with the following distribution according to clinical stage: stage I – 2 patients, stage II – 16, stage III – 16, stage IV – 12 patients. Among stage I, II patients, the sensitivity for detection of the primary tumor was 83.3%, and for detection of axillary lymph node metastases was 42.9%. ¹⁸FDG-PET was negative for the breast skin, contralateral breast, and internal mammary lymph nodes in all stage I, II patients, in agreement with clinical and radiographic findings. Among 28 stage III, IV patients, the sensitivity of ¹⁸FDG-PET for detection of the primary tumor was 90.5%, and for detection of axillary lymph node metastases 83.3%. Fourteen patients had clinically advanced changes in the skin, and the sensitivity of PET for detection of skin changes was 76.9%. ¹⁸FDG-PET was positive in the internal mammary lymph nodes in 25.0%, and negative in the contralateral breast in all patients with stage III, IV breast cancer. ¹⁸FDG-PET was studied in 10 patients following neoadjuvant chemotherapy, and showed a strong correlation with clinical response, and with clinical and pathological findings post-treatment at multiple local/regional sites. Conclusion. ¹⁸FDG-PET can provide a comprehensive image of local/regional tumor in women with breast cancer. ¹⁸FDG-PET may play a greater role in women with stage III, IV breast cancer because of increased sensitivity and the increased involvement of multiple local/regional sites with tumor.