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Zaknun JJ, Bodei L, Mueller-Brand J, Pavel ME, Baum RP, Hörsch D, O’Dorisio MS, O’Dorisiol TM, Howe JR, Cremonesi M, Kwekkeboom DJ. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2013; 40:800-16. [PMID: 23389427 PMCID: PMC3622744 DOI: 10.1007/s00259-012-2330-6] [Citation(s) in RCA: 483] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peptide receptor radionuclide therapy (PRRNT) is a molecularly targeted radiation therapy involving the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. PRRNT employing the radiotagged somatostatin receptor agonists (90)Y-DOTATOC ([(90)Y-DOTA(0),Tyr(3)]-octreotide) or (177)Lu-DOTATATE ([(177)Lu-DOTA(0),Tyr(3),Thr(8)]-octreotide or [(177)Lu-DOTA(0),Tyr(3)]-octreotate) have been successfully used for the past 15 years to target metastatic or inoperable neuroendocrine tumours expressing the somatostatin receptor subtype 2. Accumulated evidence from clinical experience indicates that these tumours can be subjected to a high absorbed dose which leads to partial or complete objective responses in up to 30 % of treated patients. Survival analyses indicate that patients presenting with high tumour receptor expression at study entry and receiving (177)Lu-DOTATATE or (90)Y-DOTATOC treatment show significantly higher objective responses, leading to longer survival and improved quality of life. Side effects of PRRNT are typically seen in the kidneys and bone marrow. These, however, are usually mild provided adequate protective measures are undertaken. Despite the large body of evidence regarding efficacy and clinical safety, PRRNT is still considered an investigational treatment and its implementation must comply with national legislation, and ethical guidelines concerning human therapeutic investigations. This guidance was formulated based on recent literature and leading experts' opinions. It covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This document is aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRNT and to deliver the treatment in a safe and effective manner. This document is largely based on the book published through a joint international effort under the auspices of the Nuclear Medicine Section of the International Atomic Energy Agency.
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Affiliation(s)
- John J. Zaknun
- Nuclear Medicine Section, Division of Human Health, International Atomic Energy Agency, IAEA, Vienna, Austria
- Zentralklinik Bad Berka, Center for Molecular Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany
| | - L. Bodei
- Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - J. Mueller-Brand
- Klinik und Institut für Nuklearmedizin, Universitätsspital Basel, Basel, Switzerland
| | - M. E. Pavel
- Campus Virchow Klinikum, Klinik für Gastroenterologie, Hepatologie, Endokrinologie, Diabetes und Stoffwechsel-erkrankungen, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - R. P. Baum
- Zentralklinik Bad Berka, Department of Internal Medicine, Gastroenterology and Endocrinology, ENETS Center of Excellence, Bad Berka, Germany
| | - D. Hörsch
- Zentralklinik Bad Berka, Department of Internal Medicine, Gastroenterology and Endocrinology, ENETS Center of Excellence, Bad Berka, Germany
| | - M. S. O’Dorisio
- RJ and LA Carver College of Medicine, Department of Pediatrics, University of Iowa, Iowa City, IA USA
| | - T. M. O’Dorisiol
- RJ and LA Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA USA
| | - J. R. Howe
- RJ and LA Carver College of Medicine, Department of Surgical Oncology, University of Iowa, Iowa City, IA USA
| | - M. Cremonesi
- Service of Health Physics, European Institute of Oncology, Milan, Italy
| | - D. J. Kwekkeboom
- Department of Nuclear Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Park JS, Choi JY, Moon SH, Ahn YC, Lee J, Kim D, Kim K, Shim YM. Response evaluation after neoadjuvant chemoradiation by positron emission tomography-computed tomography for esophageal squamous cell carcinoma. Cancer Res Treat 2013; 45:22-30. [PMID: 23613667 PMCID: PMC3629360 DOI: 10.4143/crt.2013.45.1.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/06/2013] [Indexed: 12/22/2022] Open
Abstract
Purpose Parameters of positron emission tomography-computed tomography (PET-CT) were compared with the results of histopathologic examination in order to determine which can provide an objective indication of response after neoadjuvant chemoradiation for treatment of thoracic esophageal squamous cell carcinoma (SCC). Materials and Methods Between August 2003 and January 2010, data on 25 patients who underwent neoadjuvant chemoradiation and subsequent resection for treatment of esophageal SCC were retrospectively reviewed. Changes in maximum standardized uptake value (ΔSUVmax), metabolic tumor volume (ΔMTV), and total lesion glycolysis (ΔTLG) were analyzed by comparison with the histopathologic findings. Results Pathologic complete remission (CR) for the main tumor was achieved in 11 patients. Postradiation esophagitis was observed in 10 patients. ΔSUVmax of the main tumor was significantly greater in the CR group than in the partial response (PR) group (p=0.039), while ΔMTV and ΔTLG of the main tumor were not (p=0.141 and p=0.349, respectively). The cut-off ΔSUVmax value for CR was estimated as 72.1%, indicating significantly better accuracy than visual interpretation (p=0.045). Of the 48 involved lymph nodes, ΔSUVmax and ΔMTV of lymph nodes were significantly greater in the CR group than in the PR group (p=0.045 and p=0.014, respectively), while ΔTLG was not (p=0.063). The cut-off value of ΔSUVmax for prediction of CR in lymph nodes was calculated as 50.67%. Conclusion PET-CT could be used for prediction of response to neoadjuvant treatment in thoracic esophageal SCC. ΔSUVmax may be a more significant predictor for CR after neoadjuvant chemoradiation than ΔTLG and ΔMTV.
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Affiliation(s)
- Joon Suk Park
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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103
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Arrese D, McNally ME, Chokshi R, Feria-Arias E, Schmidt C, Klemanski D, Gregory G, Khabiri H, Shah M, Bloomston M. Extrahepatic Disease Should Not Preclude Transarterial Chemoembolization for Metastatic Neuroendocrine Carcinoma. Ann Surg Oncol 2013; 20:1114-20. [DOI: 10.1245/s10434-012-2786-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Indexed: 11/18/2022]
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104
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Corvò R, Lamanna G, Vagge S, Belgioia L, Bosetti D, Aloi D, Timon G, Bacigalupo A. Once-weekly stereotactic radiotherapy for patients with oligometastases: compliance and preliminary efficacy. TUMORI JOURNAL 2013; 99:159-163. [PMID: 23748808 DOI: 10.1177/030089161309900207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AIMS AND BACKGROUND This retrospective analysis reports the outcomes obtained with an original once-weekly stereotactic radiotherapy fractionation given to patients affected by evolving oligometastases from different solid malignancies. METHODS From 2009 to 2011, patients with symptomatic and/or evolving oligometastases were submitted to a median 5-fraction cycle of stereotactic radiotherapy of one fraction per week in order to exploit a radiobiological rationale designed to increase the therapeutic index. Individual fractionation was mainly planned according to patient performance status, oligometastasis size and site, and record of previous irradiation in the same site. RESULTS Thirty-six patients in stage IV UICC-TNM affected by oligometastases were treated with image-guided intensity-modulated stereotactic tomotherapy with a single weekly radiation. Median age was 70 years (range, 34-89). The median weekly single dose, number of fractions and overall total radiation dose were 7 Gy, 5 fractions and 35 Gy, respectively. Thirty-five (97%) patients completed the treatment schedule. No patient suffered mild or severe radiation-related side effects. Twenty-one (87%) of 24 patients with local pain had complete symptomatic response within 30 days following the end of radiotherapy. Local control assessed at imaging after stereotactic radiotherapy was evidenced in 30 (83%) patients. Median time to response after the end of radiotherapy was 40 days. CONCLUSIONS The original radiotherapy regimen delivering only a single stereotactic dose per week seems to be highly feasible with an interesting high efficacy rate in patients with oligometastases from different solid tumors. Overall, the once-weekly treatment was very compliant in an advanced cancer stage especially for elderly and frail patients.
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Affiliation(s)
- Renzo Corvò
- Department of Radio-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy.
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105
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Sonoda H, Mekata E, Shimizu T, Endo Y, Tani T. Safety and efficacy of panitumumab therapy after metastatic colorectal cancer progression with cetuximab: Experience at a single Japanese institution. Oncol Lett 2013; 5:1331-1334. [PMID: 23599789 PMCID: PMC3628964 DOI: 10.3892/ol.2013.1171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/28/2013] [Indexed: 12/31/2022] Open
Abstract
Panitumumab (Pmab) is generally considered to be ineffective after the failure of cetuximab (Cmab) therapy in metastatic colorectal cancer (mCRC) patients. However, a few studies have demonstrated that Pmab is an effective treatment for disease progression following Cmab-based regimens in the USA. In the present study, we evaluated the safety and efficacy of Pmab therapy following the failure of Cmab therapy in Japanese patients with mCRC. We performed a retrospective review of the treatment of 16 mCRC patients who tolerated Pmab with clinical benefits after the failure of Cmab therapy between August 2010 and September 2011 at Shiga University of Medical Science. Fourteen of the 16 patients were administered standard Pmab monotherapy (6 mg/kg) intravenously every 2 weeks and the remaining two patients received Pmab with mFOLFOX6 intravenously every 2 weeks. All patients received Pmab chemotherapy until the occurrence of disease progression. Partial radiographic responses (PR) were observed in 2 of the 16 patients and stable disease (SD) was observed in 5 patients. Nine patients had evidence of progressive disease (PD). According to the KRAS status, 7 of the 13 (53.8%) patients who had wild-type KRAS achieved a high disease control rate (PR + SD). The median progression-free survival (PFS) and overall survival (OS) in the wild-type KRAS patients was 96 and 245 days, respectively. Pmab may be an alternative treatment strategy for Japanese patients with mCRC who have experienced failure with standard Cmab-based therapeutic regimens.
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Affiliation(s)
- Hiromichi Sonoda
- Department of Surgery, Shiga University of Medical Science, Shiga 520-2192, Japan
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106
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Lam MGEH, Louie JD, Iagaru AH, Goris ML, Sze DY. Safety of repeated yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2013; 36:1320-8. [PMID: 23354961 DOI: 10.1007/s00270-013-0547-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/28/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Repeated radioembolization (RE) treatments carry theoretically higher risk of radiation-induced hepatic injury because of the liver's cumulative memory of previous exposure. We performed a retrospective safety analysis on patients who underwent repeated RE. METHODS From 2004 to 2011, a total of 247 patients were treated by RE. Eight patients (5 men, 3 women, age range 51-71 years) underwent repeated treatment of a targeted territory, all with resin microspheres (SIR-Spheres; Sirtex, Lane Cove, Australia). Adverse events were graded during a standardized follow-up. In addition, the correlation between the occurrence of RE-induced liver disease (REILD) and multiple variables was investigated in univariate and multivariate analyses in all 247 patients who received RE. RESULTS Two patients died shortly after the second treatment (at 84 and 107 days) with signs and symptoms of REILD. Both patients underwent whole liver treatment twice (cumulative doses 3.08 and 2.66 GBq). The other 6 patients demonstrated only minor toxicities after receiving cumulative doses ranging from 2.41 to 3.88 GBq. All patients experienced objective tumor responses. In the whole population, multifactorial analysis identified three risk factors associated with REILD: repeated RE (p = 0.036), baseline serum total bilirubin (p = 0.048), and baseline serum aspartate aminotransferase (p = 0.043). Repeated RE proved to be the only independent risk factor for REILD in multivariate analysis (odds ratio 9.6; p = 0.002). Additionally, the administered activity per target volume (in GBq/L) was found to be an independent risk factor for REILD, but only in whole liver treatments (p = 0.033). CONCLUSION The risk of REILD appears to be elevated for repeated RE. Objective tumor responses were observed, but establishment of safety limits will require improvement in dosimetric measurement and prediction.
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Affiliation(s)
- Marnix G E H Lam
- Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5642, USA
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107
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Jeh SK, Kim SH, Kang BJ. Comparison of the diagnostic performance of response evaluation criteria in solid tumor 1.0 with response evaluation criteria in solid tumor 1.1 on MRI in advanced breast cancer response evaluation to neoadjuvant chemotherapy. Korean J Radiol 2012; 14:13-20. [PMID: 23323026 PMCID: PMC3542297 DOI: 10.3348/kjr.2013.14.1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/21/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance in evaluating the response of neoadjuvant chemotherapy (NAC), between the response evaluation criteria in solid tumor (RECIST) 1.0 and RECIST 1.1, on magnetic resonance imaging (MRI) for advance breast cancer patients. MATERIALS AND METHODS Breast cancer patients, who underwent NAC between 2005 and 2010, were included. Both prechemotherapy and post-chemotherapy MRIs were performed within 1-4 weeks before and after NAC. Only the patients with subsequent surgery were included. The response to NAC was assessed by using RECIST 1.0 and RECIST 1.1. Patients with a complete or partial response on MRI were considered as responders, and those with stable or progressive disease were considered as non-responders. Tumor necrosis > 50% on pathology was defined as responders and necrosis < 50% was defined as non-responders. The diagnostic accuracy of both RECIST 1.0 and RECIST 1.1 was analyzed and compared by receiver operating characteristic curve analysis. RESULTS Seventy-nine females (mean age 51.0 ± 9.3 years) were included. Pathology showed 45 responders and 34 non-responders. There were 49 responders and 30 non-responders on RECIST 1.0, and in 55 patients, RECIST 1.0 results agreed with pathologic results (69.6%). RECIST 1.1 showed 52 responders and 27 non-responders. In 60 patients, RECIST 1.1 results were in accordance with pathology results (75.9%). The area under the ROC curve was 0.809 for RECIST 1.0 and 0.853 for RECIST 1.1. CONCLUSION RECIST 1.1 showed better diagnostic performance than RECIST 1.0, although there was no statistically significant difference between the two.
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Affiliation(s)
- Su Kyung Jeh
- Department of Radiology, Hallym University College of Medicine, Seoul 150-950, Korea
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108
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Vohra NA, Turaga KK, Gonzalez RJ, Conley A, Reed D, Bui MM, Cheong D, Letson DG, Zager JS. The use of isolated limb infusion in limb threatening extremity sarcomas. Int J Hyperthermia 2012. [PMID: 23205633 DOI: 10.3109/02656736.2012.740548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This paper reports a single-institution experience with the use of isolated limb infusion for limb salvage in locally advanced, unresectable, recurrent limb threatening soft tissue sarcomas. BACKGROUND Locally advanced, limb threatening soft tissue sarcomas (STS) pose a significant treatment challenge. We report our experience using isolated limb infusion (ILI) in patients with unresectable extremity STS. METHODS A total of 22 patients with extremity STS underwent 26 ILIs with melphalan and dactinomycin. Patient characteristics, intra-operative parameters and toxicity were recorded. Outcome measures included limb-salvage and in-field response rates. RESULTS Of the 19 lower and 7 upper extremity ILIs, Wieberdink grade III toxicity or less was observed in all. Median followup was 11 months. A total of 17 patients were evaluable at 3 months post-ILI with an overall response rate of 42%. Four (24%) had complete response (CR), three (18%) partial response (PR), three (18%) stable disease (SD) and seven (41%) progressive disease (PD). Twelve of 17 (71%) underwent successful limb preservation at a median of 9 months post-ILI. Two (12%) were downstaged to resectable disease and remain showing no evidence of disease (NED) after surgery at 30 and 22 months post-ILI. CONCLUSIONS ILI is an attractive modality that provides regional disease control and limb preservation in patients with limb threatening sarcoma. Although short-term results appear encouraging, long-term follow-up is needed to fully assess the role of ILI in unresectable extremity STS.
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Affiliation(s)
- Nasreen A Vohra
- Department of Sarcoma Oncology, Moffitt Cancer Center, Tampa, Florida 33612, USA
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109
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Response evaluation in patients with colorectal liver metastases: RECIST version 1.1 versus modified CT criteria. AJR Am J Roentgenol 2012; 199:809-15. [PMID: 22997372 DOI: 10.2214/ajr.11.7910] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our retrospective study compared Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 with modified CT criteria to determine their respective utilities as a prognostic indicator. Using both sets of criteria, we compared treatment responses of patients with colorectal liver metastases treated with bevacizumab-containing chemotherapy with those of patients treated with chemotherapy alone. MATERIALS AND METHODS Fifty-nine patients who received bevacizumab-containing chemotherapy (n=30, group 1) or chemotherapy alone (n=29, group 2) for the treatment of colorectal carcinoma underwent contrast-enhanced CT before treatment and 2 months after treatment. Two radiologists determined changes in tumor size and density between the pretreatment and 2-month follow-up CT images. RECIST 1.1 assesses responses on the basis of changes in tumor size, and the modified CT criteria assesses responses on the basis of changes in tumor density and size. Responses were correlated with time to tumor progression by log rank test. RESULTS According to RECIST 1.1, nine of 30 patients (30%) in group 1 and 12 of 29 patients (41%) in group 2 were good responders. According to the modified CT criteria, 23 of 30 patients in group 1 (77%) and 23 of 29 patients in group 2 (79%) were good responders. As assessed by the modified CT criteria, good responders in both groups had significantly longer time to tumor progression than poor responders (p<0.05). As assessed by RECIST 1.1, good responders in group 1 had significantly longer time to tumor progression than poor responders (p=0.0154), but there was no difference in group 2. CONCLUSION Evaluating treatment response with tumor size and density changes on CT was a better predictor of time to tumor progression than changes in tumor size alone in both groups.
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110
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De Cecco CN, Darnell A, Rengo M, Muscogiuri G, Bellini D, Ayuso C, Laghi A. Dual-Energy CT: Oncologic Applications. AJR Am J Roentgenol 2012; 199:S98-S105. [DOI: 10.2214/ajr.12.9207] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Carlo Nicola De Cecco
- Departments of Radiological Sciences, Oncology, and Pathology, University of Rome Sapienza–Polo Pontino, Via Franco Faggiana, 34, 04100 Latina, Italy
| | - Anna Darnell
- Department of Radiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marco Rengo
- Departments of Radiological Sciences, Oncology, and Pathology, University of Rome Sapienza–Polo Pontino, Via Franco Faggiana, 34, 04100 Latina, Italy
| | - Giuseppe Muscogiuri
- Departments of Radiological Sciences, Oncology, and Pathology, University of Rome Sapienza–Polo Pontino, Via Franco Faggiana, 34, 04100 Latina, Italy
| | - Davide Bellini
- Departments of Radiological Sciences, Oncology, and Pathology, University of Rome Sapienza–Polo Pontino, Via Franco Faggiana, 34, 04100 Latina, Italy
| | - Carmen Ayuso
- Department of Radiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Andrea Laghi
- Departments of Radiological Sciences, Oncology, and Pathology, University of Rome Sapienza–Polo Pontino, Via Franco Faggiana, 34, 04100 Latina, Italy
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111
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Santini D, Vincenzi B, Addeo R, Garufi C, Masi G, Scartozzi M, Mancuso A, Frezza AM, Venditti O, Imperatori M, Schiavon G, Bronte G, Cicero G, Recine F, Maiello E, Cascinu S, Russo A, Falcone A, Tonini G. Cetuximab rechallenge in metastatic colorectal cancer patients: how to come away from acquired resistance? Ann Oncol 2012; 23:2313-2318. [PMID: 22396447 DOI: 10.1093/annonc/mdr623] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Scientific data provide the evidence that secondary K-RAS mutations do not occur during anti-epidermal growth factor receptor therapy in colorectal cancer patients. This multicenter phase II prospective study aims to investigate the activity of a retreatment with a cetuximab-based therapy. PATIENTS AND METHODS We enrolled 39 irinotecan-refractory patients who had a clinical benefit after a line of cetuximab- plus irinotecan-based therapy and then a progression of disease for which underwent a new line chemotherapy and finally, after a clear new progression of disease, were retreated with the same cetuximab- plus irinotecan-based therapy. RESULTS Median number of therapeutic lines before accrual was 4. Median interval time between last cycle of first cetuximab-based therapy and first cycle of the retreatment was 6 months. Overall response rate was 53.8% with 19 partial responses (48.7%) and 2 complete responses (5.1%). Disease stabilization was obtained in 35.9% of patients and progression in four patients (10.2%). Median progression-free survival was 6.6 months. The correlation between skin toxicity during first cetuximab therapy and during cetuximab rechallenge was significant (P = 0.01). CONCLUSION Rechallenge with the same cetuximab-based therapy may achieve a new important clinical benefit further delaying the progression of disease and improving the therapeutic options.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
| | - B Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
| | - R Addeo
- Department of Oncology, S Giovanni di Dio Hospital, Frattaminore, Naples
| | - C Garufi
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome
| | - G Masi
- Medical Oncology Unit-Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - M Scartozzi
- Department of Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona
| | - A Mancuso
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - A M Frezza
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
| | - O Venditti
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
| | - M Imperatori
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
| | - G Schiavon
- Department of Medical Oncology, Erasmus University Medical Center - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - G Bronte
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - G Cicero
- Department of Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - F Recine
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - E Maiello
- Department of Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - S Cascinu
- Department of Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona
| | - A Russo
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy.
| | - A Falcone
- Medical Oncology Unit-Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - G Tonini
- Department of Medical Oncology, Università Campus Bio-Medico, Rome
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112
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Kim YJ, Kim JY, Yoo SH, Min BJ, Chung KZ, Seo SS, Kang SB, Lim MC, Hwang JH, Yoo HJ, Park SY. High control rate for lymph nodes in cervical cancer treated with high-dose radiotherapy using helical tomotherapy. Technol Cancer Res Treat 2012; 12:45-51. [PMID: 22905806 DOI: 10.7785/tcrt.2012.500252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate whether bulky lymphadenopathy located in the abdominopelvic cavity in cervical cancer can be controlled without severe toxicity by increasing radiation dose using helical tomotherapy. From January 2007 to December 2010, 26 patients with cervical cancer with metastatic lymph nodes (LNs) having at least one short diameter > 1.5 cm were treated with helical tomotherapy. A total of 58 LN sites were treated and the largest LN of each site was evaluated for response. Median follow-up time was 28 months (4-50 months). Median short diameter of the LNs was 1.7 cm (0.7-4.2 cm) with median radiation dose of 62.6 Gy(10) in 2 Gy equivalent dose (53.3-77.9 Gy(10)). Initial LN response was evaluated on imaging obtained within 4 months after radiotherapy. Initial complete response (CR), partial response (PR), and stable disease (SD) were observed in 54, 2 and 2 lesions, respectively. Recurrence occurred in two with CR and progression in one with PR. Therefore, final CR, PR, SD, and progression of disease were observed in 52, 1, 2, and 3, respectively. Actuarial 3-year LN progression-free survival and overall survival (OS) were 63% and 65%, respectively. Multivariate analysis revealed final LN response (CR vs. non-CR) as a strong prognostic factor for OS (p = 0.016). Radiation Therapy Oncology Group grade 2 or more acute and late toxicity was observed in 8 and 1 patients, respectively. The treatment of bulky lymphadenopathy using helical tomotherapy in advanced cervical cancer is highly effective and has acceptable toxicity.
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Affiliation(s)
- Y J Kim
- Research Institute and Hospital, _National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
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113
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Cervera Deval J. [RECIST and the radiologist]. RADIOLOGIA 2012; 56:193-205. [PMID: 22902252 DOI: 10.1016/j.rx.2012.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 11/19/2022]
Abstract
Biomedical imaging makes it possible not only to diagnose and stage cancer, but also to follow up patients and evaluate the response to treatment. RECIST (Response Evaluation Criteria In Solid Tumors) provides a method to monitor the response to treatment based on one dimensional measurements of tumors obtained with reproducible imaging techniques like CT, MRI, and PET. The metabolic changes induced by new treatments modify the biology and behavior of the tumor; occasionally, there is a discrepancy between the patient's clinical condition and the response measured by RECIST, which indicates that functional tests need to be included in the evaluation of the response to treatment. The objective is to review the RECIST criteria to include the contribution of functional imaging to enable the efficacy and effects of the treatment in patients with solid tumors.
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Affiliation(s)
- J Cervera Deval
- Servicio de Radiología, Fundación Instituto Valenciano de Oncología, Valencia, España.
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Halle C, Andersen E, Lando M, Aarnes EK, Hasvold G, Holden M, Syljuåsen RG, Sundfør K, Kristensen GB, Holm R, Malinen E, Lyng H. Hypoxia-Induced Gene Expression in Chemoradioresistant Cervical Cancer Revealed by Dynamic Contrast-Enhanced MRI. Cancer Res 2012; 72:5285-95. [DOI: 10.1158/0008-5472.can-12-1085] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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115
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Nikolaou K, Cyran CC, Lauber K, Reiser MF, Clevert DA. [Preclinical imaging in animal models of radiation therapy]. Radiologe 2012; 52:252-62. [PMID: 22382437 DOI: 10.1007/s00117-011-2194-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CLINICAL/METHODICAL ISSUE Modern radiotherapy benefits from precise and targeted diagnostic and pretherapeutic imaging. STANDARD RADIOLOGICAL METHODS Standard imaging modalities, such as computed tomography (CT) offer high morphological detail but only limited functional information on tumors. METHODICAL INNOVATIONS Novel functional and molecular imaging modalities provide biological information about tumors in addition to detailed morphological information. PERFORMANCE Perfusion magnetic resonance imaging (MRI) CT or ultrasound-based perfusion imaging as well as hybrid modalities, such as positron emission tomography (PET) CT or MRI-PET have the potential to identify and precisely delineate viable and/or perfused tumor areas, enabling optimization of targeted radiotherapy. Functional information on tissue microcirculation and/or glucose metabolism allow a more precise definition and treatment of tumors while reducing the radiation dose and sparing the surrounding healthy tissue. ACHIEVEMENTS In the development of new imaging methods for planning individualized radiotherapy, preclinical imaging and research plays a pivotal role, as the value of multimodality imaging can only be assessed, tested and adequately developed in a preclinical setting, i.e. in animal tumor models. PRACTICAL RECOMMENDATIONS New functional imaging modalities will play an increasing role for the surveillance of early treatment response during radiation therapy and in the assessment of the potential value of new combination therapies (e.g. combining anti-angiogenic drugs with radiotherapy).
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Affiliation(s)
- K Nikolaou
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377 München.
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116
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Abajian AC, Levy M, Rubin DL. Informatics in radiology: improving clinical work flow through an AIM database: a sample web-based lesion tracking application. Radiographics 2012; 32:1543-52. [PMID: 22745220 DOI: 10.1148/rg.325115752] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quantitative assessments on images are crucial to clinical decision making, especially in cancer patients, in whom measurements of lesions are tracked over time. However, the potential value of quantitative approaches to imaging is impeded by the difficulty and time-intensive nature of compiling this information from prior studies and reporting corresponding information on current studies. The authors believe that the quantitative imaging work flow can be automated by making temporal data computationally accessible. In this article, they demonstrate the utility of the Annotation and Image Markup standard in a World Wide Web-based application that was developed to automatically summarize prior and current quantitative imaging measurements. The system calculates the Response Evaluation Criteria in Solid Tumors metric, along with several alternative indicators of cancer treatment response, by using the data stored in the annotation files. The application also allows the user to overlay the recorded metrics on the original images for visual inspection. Clinical evaluation of the system demonstrates its potential utility in accelerating the standard radiology work flow and in providing a means to evaluate alternative response metrics that are difficult to compute by hand. The system, which illustrates the utility of capturing quantitative information in a standard format and linking it to the image from which it was derived, could enhance quantitative imaging in clinical practice without adversely affecting the current work flow.
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Affiliation(s)
- Aaron C Abajian
- Departments of Radiology and Medicine, Stanford University School of Medicine, Richard M. Lucas Center, Stanford University, Stanford, CA 94305, USA
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117
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Kang H, Lee HY, Lee KS, Kim JH. Imaging-based tumor treatment response evaluation: review of conventional, new, and emerging concepts. Korean J Radiol 2012; 13:371-90. [PMID: 22778559 PMCID: PMC3384819 DOI: 10.3348/kjr.2012.13.4.371] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/14/2012] [Indexed: 01/07/2023] Open
Abstract
Tumor response may be assessed readily by the use of Response Evaluation Criteria in Solid Tumor version 1.1. However, the criteria mainly depend on tumor size changes. These criteria do not reflect other morphologic (tumor necrosis, hemorrhage, and cavitation), functional, or metabolic changes that may occur with targeted chemotherapy or even with conventional chemotherapy. The state-of-the-art multidetector CT is still playing an important role, by showing high-quality, high-resolution images that are appropriate enough to measure tumor size and its changes. Additional imaging biomarker devices such as dual energy CT, positron emission tomography, MRI including diffusion-weighted MRI shall be more frequently used for tumor response evaluation, because they provide detailed anatomic, and functional or metabolic change information during tumor treatment, particularly during targeted chemotherapy. This review elucidates morphologic and functional or metabolic approaches, and new concepts in the evaluation of tumor response in the era of personalized medicine (targeted chemotherapy).
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Affiliation(s)
- Hee Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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118
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Abstract
It has been 40 years since Folkman hypothesized the use of anti-angiogenic therapy as a strategy in the treatment of cancer. Since then, vascular endothelial growth factor (VEGF) has been identified as the most potent cytokine to induce angiogenesis and drugs targeting VEGF, principally the humanized monoclonal antibody bevacizumab and the tyrosine kinase inhibitors sunitinib and sorafenib, have proven therapeutic benefit. The initial high expectations of tumor vascular targeting agents, however, have yet to be fulfilled. In unselected patient populations, the benefits of these agents is often marginal, they cause harmful side effects, and drug resistance is quickly established. Biomarkers to identify patients suitable for anti-angiogenic therapy will be key to the future development of these drugs.
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Affiliation(s)
- Robin J Young
- Academic Unit of Surgical Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
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119
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Spatially resolved regression analysis of pre-treatment FDG, FLT and Cu-ATSM PET from post-treatment FDG PET: an exploratory study. Radiother Oncol 2012; 105:41-8. [PMID: 22682748 DOI: 10.1016/j.radonc.2012.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 05/08/2012] [Accepted: 05/18/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To quantify associations between pre-radiotherapy and post-radiotherapy PET parameters via spatially resolved regression. MATERIALS AND METHODS Ten canine sinonasal cancer patients underwent PET/CT scans of [(18)F]FDG (FDG(pre)), [(18)F]FLT (FLT(pre)), and [(61)Cu]Cu-ATSM (Cu-ATSM(pre)). Following radiotherapy regimens of 50 Gy in 10 fractions, veterinary patients underwent FDG PET/CT scans at 3 months (FDG(post)). Regression of standardized uptake values in baseline FDG(pre), FLT(pre) and Cu-ATSM(pre) tumour voxels to those in FDG(post) images was performed for linear, log-linear, generalized-linear and mixed-fit linear models. Goodness-of-fit in regression coefficients was assessed by R(2). Hypothesis testing of coefficients over the patient population was performed. RESULTS Multivariate linear model fits of FDG(pre) to FDG(post) were significantly positive over the population (FDG(post) ~ 0.17 · FDG(pre), p = 0.03), and classified slopes of RECIST non-responders and responders to be different (0.37 vs. 0.07, p = 0.01). Generalized-linear model fits related FDG(pre) to FDG(post) by a linear power law (FDG(post) ~ FDG(pre)(0.93),p<0.001). Univariate mixture model fits of FDG(pre) improved R(2) from 0.17 to 0.52. Neither baseline FLT PET nor Cu-ATSM PET uptake contributed statistically significant multivariate regression coefficients. CONCLUSIONS Spatially resolved regression analysis indicates that pre-treatment FDG PET uptake is most strongly associated with three-month post-treatment FDG PET uptake in this patient population, though associations are histopathology-dependent.
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Abstract
Magnetic resonance imaging, MRI has more advantages than ultrasound, computed tomography, CT, positron emission tomography, PET, or any other imaging modality in diagnosing focal hepatic masses. With a combination of basic T1 and T2 weighted sequences, diffusion weighted imaging, DWI, and hepatobiliary gadolinium contrast agents, that is gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB), most liver lesions can be adequately diagnosed. Benign lesions, as cyst, hemangioma, focal nodular hyperplasia, FNH or adenoma, can be distinguished from malignant lesions. In a non-cirrhotic liver, the most common malignant lesions are metastases which may be hypovascular or hypervascular. In the cirrhotic liver hepatocellular carcinoma, HCC, is of considerable importance. Besides, intrahepatic cholangiocarcinoma and other less common malignancies has to be assessed. In this review, the techniques and typical MRI features are presented as well as the new algorithm issued by American Association for the Study of the Liver Diseases (AASLD).
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Affiliation(s)
- Nils Albiin
- Division of Radiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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121
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Chalian H, Töre HG, Horowitz JM, Salem R, Miller FH, Yaghmai V. Radiologic assessment of response to therapy: comparison of RECIST Versions 1.1 and 1.0. Radiographics 2012; 31:2093-105. [PMID: 22084190 DOI: 10.1148/rg.317115050] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improvements in radiologic imaging technology and therapeutic options available for management of tumors have necessitated the revision of guidelines for the imaging-based assessment of tumor response to therapy. The purpose of this article is to familiarize radiologists with the modifications to the Response Evaluation Criteria in Solid Tumors (RECIST) that have been incorporated in the latest version of the guidelines, RECIST 1.1. The most important differences between this version and the previous one, RECIST 1.0, include reductions in the maximum number of lesions per patient and per organ that may be targeted for measurement, augmentation of the criteria defining progressive disease, additional guidelines for reporting findings of lesions that are too small to measure and for measuring lesions that appear to have fragmented or coalesced at follow-up imaging, new criteria for characterizing lymphadenopathy, new criteria for selecting bone lesions and cystic lesions as targets for measurement, and the inclusion of findings at positron emission tomography among the indicators of disease response.
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Affiliation(s)
- Hamid Chalian
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611, USA
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122
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Abengózar M, Fernández-Aceñero M, Chaves S, Celdrán A. Prognostic utility of tumor thickness at the tumor-normal interface in chemotherapy-treated hepatic colorectal metastasis. Pathol Res Pract 2012; 208:235-9. [DOI: 10.1016/j.prp.2012.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 01/06/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
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Paprottka PM, Zengel P, Ingrisch M, Cyran CC, Eichhorn M, Reiser MF, Nikolaou K, Clevert DA. [Contrast-enhanced ultrasound in animal models]. Radiologe 2012; 51:506-13. [PMID: 21626179 DOI: 10.1007/s00117-010-2105-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past the detection of tumor perfusion was achieved solely via invasive procedures, such as intravital microscopy or with the help of costly modalities, such as multidetector computed tomography (MDCT), magnetic resonance tomography (MRT) or the combined use of positron emission tomography and computed tomography (PET/CT). Ultrasound offers the non-invasive display of organs without usage of ionizing radiation and it is widely available. However, colour-coded ultrasound and power Doppler do not allow the detection of tumor microcirculation. The introduction of contrast-enhanced ultrasound (CEUS) as well as new high-frequency ultrasound probes made it possible to detect and quantify tumor microcirculation with high resolution. CEUS has been used clinically on human beings for more than 10 years. During the last years different tumor models in experimental animals were used for the establishment of this new technique, e.g. in rats, hamsters and mice. CEUS allows the detection of functional parameters, such as the angiogenetic metabolic status of tissue pretreatment and posttreatment. Further research is required to solve the problems of absolute quantification of these perfusion parameters to allow the comparison of CEUS with other modalities (e.g. MRT and CT).
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Affiliation(s)
- P M Paprottka
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377 München.
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Afaq A, Akin O. Imaging assessment of tumor response: past, present and future. Future Oncol 2011; 7:669-77. [PMID: 21568682 DOI: 10.2217/fon.11.38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.
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Affiliation(s)
- Asim Afaq
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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125
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Tessler FN, Loop MS, Fineberg N, McNamara MM, McArthur TA. Effect of display magnification on perceived growth of liver lesions on computed tomography. J Digit Imaging 2011; 25:266-70. [PMID: 21779947 DOI: 10.1007/s10278-011-9403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Our goal was to investigate the effect of displayed image magnification on perception of the size of hepatic lesions on abdominal computed tomography (CT) scans. Institutional review board approval and informed observer consent were obtained. Three experienced radiologists reviewed 90 CT image pairs in one session. Each image pair demonstrated a solitary, well-defined hypodense hepatic lesion measuring greater than 1 cm obtained at two points in time. The image pairs were presented three times in random order, once with the left image magnified, once with the right image magnified, and once with neither image magnified. The radiologists were asked to determine on which image the lesion was smaller or if there was no difference. The responses were analyzed statistically. The proportion of correct responses increased significantly as the difference in lesion size increased (p < 0.001). The percent of correct responses was higher when neither CT image was magnified. Magnification of one image decreased the accuracy of the readers' performance, especially at smaller differences, both of which were statistically significant (p < 0.001). Thus, accuracy of detecting lesion size differences was degraded when the images were presented at differing magnification. This should be kept in mind when evaluating serial CT scans for growth or regression of tumors and other lesions.
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126
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Halle C, Lando M, Svendsrud DH, Clancy T, Holden M, Sundfør K, Kristensen GB, Holm R, Lyng H. Membranous expression of ectodomain isoforms of the epidermal growth factor receptor predicts outcome after chemoradiotherapy of lymph node-negative cervical cancer. Clin Cancer Res 2011; 17:5501-12. [PMID: 21737508 DOI: 10.1158/1078-0432.ccr-11-0297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We compared the prognostic significance of ectodomain isoforms of the epidermal growth factor receptor (EGFR), which lack the tyrosine kinase (TK) domain, with that of the full-length receptor and its autophosphorylation status in cervical cancers treated with conventional chemoradiotherapy. EXPERIMENTAL DESIGN Expression of EGFR isoforms was assessed by immunohistochemistry in a prospectively collected cohort of 178 patients with squamous cell cervical carcinoma, and their detection was confirmed with Western blotting and reverse transcriptase PCR. A proximity ligation immunohistochemistry assay was used to assess EGFR-specific autophosphorylation. Pathways associated with the expression of ectodomain isoforms were studied by gene expression analysis with Illumina beadarrays in 110 patients and validated in an independent cohort of 41 patients. RESULTS Membranous expression of ectodomain isoforms alone, without the coexpression of the full-length receptor, showed correlations to poor clinical outcome that were highly significant for lymph node-negative patients (locoregional control, P = 0.0002; progression-free survival, P < 0.0001; disease-specific survival, P = 0.005 in the log-rank test) and independent of clinical variables. The ectodomain isoforms were primarily 60-kD products of alternative EGFR transcripts. Their membranous expression correlated with transcriptional regulation of oncogenic pathways including activation of MYC and MAX, which was significantly associated with poor outcome. This aggressive phenotype of ectodomain EGFR expressing tumors was confirmed in the independent cohort. Neither total nor full-length EGFR protein level, or autophosphorylation status, showed prognostic significance. CONCLUSION Membranous expression of ectodomain EGFR isoforms, and not TK activation, predicts poor outcome after chemoradiotherapy for patients with lymph node-negative cervical cancer.
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Affiliation(s)
- Cathinka Halle
- Department of Radiation Biology, The Norwegian Radium Hospital, Oslo, Norway
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127
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Nicolini A, Crespi S, Martinetti L. Drug delivery embolization systems: a physician's perspective. Expert Opin Drug Deliv 2011; 8:1071-84. [PMID: 21692688 DOI: 10.1517/17425247.2011.590472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The number of patients suffering from primary and secondary liver tumoral diseases is on the increase worldwide. The development of new technologies and drugs requires an increasingly multidisciplinary approach in the management of these diseases. Therapies should be based on scientifically supported guidelines and at the same time should be designed to suit the individual patient. In this decision-making process, an understanding of the advantages and disadvantages of every treatment is very important. The efficacy of transarterial chemoembolization (TACE) in improving survival and its role in the management of hepatocellular carcinoma (HCC) have been demonstrated in several clinical trials. The introduction of drug-eluting beads seems to have overcome some of the limitations of conventional TACE. AREAS COVERED This review provides an overview of the spread of primary and secondary liver cancers, then it explains the basis for the use of conventional TACE and its potential benefits and, finally, outlines its clinical application and possible future uses. EXPERT OPINION The management of the treatment of focal liver lesions is a difficult process, which must involve various specialists such as the interventional radiologist. The use of drug-eluting microspheres seems to improve the results of TACE both in HCC and in colorectal liver metastases.
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Affiliation(s)
- Antonio Nicolini
- IRCCS-Fondazione Ca' Granda Ospedale Maggiore Policlinico Milano, Interventional radiology, Via Francesco Sforza 35, Milano 20100, Italy.
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Mediastinal atlas creation from 3-D chest computed tomography images: application to automated detection and station mapping of lymph nodes. Med Image Anal 2011; 16:63-74. [PMID: 21641269 DOI: 10.1016/j.media.2011.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 11/23/2022]
Abstract
One important aspect of lung cancer staging is the assessment of mediastinal lymph nodes in 3-D chest computed tomography (CT) images. In the current clinical routine this is done manually by analyzing the 3-D CT image slice by slice to find nodes, evaluate them quantitatively, and assign labels to them for describing the clinical and pathologic extent of metastases. In this paper we present a method to automate the process of lymph node detection and labeling by creation of a mediastinal average image and a novel lymph node atlas containing probability maps for mediastinal, aortic, and N1 nodes. Utilizing a fast deformable registration approach to match the atlas with CT images of new patients, our method can maintain an acceptable runtime. In comparison to previously published methods for mediastinal lymph node detection and labeling it also shows a good sensitivity and positive predictive value.
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129
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Wang L. Morphological and functional MDCT: problem-solving tool and surrogate biomarker for hepatic disease clinical care and drug discovery in the era of personalized medicine. Hepat Med 2010; 2:111-24. [PMID: 24367211 PMCID: PMC3846718 DOI: 10.2147/hmer.s9052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This article explains the significant role of morphological and functional multidetector computer tomography (MDCT) in combination with imaging postprocessing algorithms served as a problem-solving tool and noninvasive surrogate biomarker to effectively improve hepatic diseases characterization, detection, tumor staging and prognosis, therapy response assessment, and novel drug discovery programs, partial liver resection and transplantation, and MDCT-guided interventions in the era of personalized medicine. State-of-the-art MDCT depicts and quantifies hepatic disease over conventional CT for not only depicting lesion location, size, and extent but also detecting changes in tumor biologic behavior caused by therapy or tumor progression before morphologic changes. Color-encoded parameter display provides important functional information on blood flow, permeability, leakage space, and blood volume. Together with other relevant biomarkers and genomics, the imaging modality is being developed and validated as a biomarker to early response to novel, targeted anti-VEGF(R)/PDGFR or antivascular/angiogenesis agents as its parameters correlate with immunohistochemical surrogates of tumor angiogenesis and molecular features of malignancies. MDCT holds incremental value to World Health Organization response criteria and Response Evaluation Criteria in Solid Tumors in liver disease management. MDCT volumetric measurement of future remnant liver is the most important factor influencing the outcome of patients who underwent partial liver resection and transplantation. MDCT-guided interventional methods deliver personalized therapies locally in the human body. MDCT will hold more scientific impact when it is fused with other imaging probes to yield comprehensive information regarding changes in liver disease at different levels (anatomic, metabolic, molecular, histologic, and other levels).
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Affiliation(s)
- Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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130
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Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol 2010; 20:2690-8. [DOI: 10.1007/s00330-010-1842-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 12/21/2022]
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131
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Katopodis O, Polyzos A, Kentepozidis N, Giassas S, Rovithi M, Bozionelou V, Kalbakis K, Vamvakas L, Mavroudis D, Georgoulias V. Second-line chemotherapy with capecitabine (Xeloda) and docetaxel (Taxotere) in previously treated, unresectable adenocarcinoma of pancreas: the final results of a phase II trial. Cancer Chemother Pharmacol 2010; 67:361-8. [PMID: 20428874 DOI: 10.1007/s00280-010-1329-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/09/2010] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the efficacy and toxicity of the docetaxel and capecitabine combination in patients with previously treated, unresectable adenocarcinoma of the pancreas. PATIENTS AND METHODS Patients with pancreatic adenocarcinoma, pre-treated with gemcitabine-based chemotherapy, were treated with capecitabine (800 mg/m(2) orally, twice a day for 14 days) and docetaxel (75 mg/m(2) i.v, on day 1), every 3 weeks. The primary end-point was overall response rate (RR). RESULTS Thirty-one patients were enrolled in the study; 93.6% of them had a performance status (PS) of 0-1 and 96.8% had stage IV disease. Patients received a median of 4 cycles/patient, and the main reason for treatment discontinuation was disease progression. Partial response was observed in three (9.7%) patients, stable disease in seven (22.6%) (disease control rate: 32.3%, 95% CI: 15.80-48.71%) and disease progression in 21 (67.6%). The median progression-free survival (PFS) was 2.4 months (95% CI: 1.6-3.13) and the median overall survival (OS) was 6.3 months (95% CI: 3.38-9.23); the estimated 1-year survival rate was 14.7%. Grade III/IV neutropenia occurred in 10 (32.2%) patients and febrile neutropenia in one patient. Other severe non-hematologic toxicities were mild and manageable. After 2 chemotherapy cycles, pain control occurred in 20% of patients and stabilization of body weight in 40%. CONCLUSION The combination of docetaxel/capecitabine may confer good disease control associated with improvement of quality of life as second-line chemotherapy in patients with metastatic pancreatic cancer.
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Affiliation(s)
- Ourania Katopodis
- Hellenic Oncology Research Group (HORG), 55 Lombardou str., 11470 Athens, Greece
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