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Chen SH, Miles K, Taylor SA, Ganeshan B, Rodriquez M, Fraioli F, Wan S, Afaq A, Shortman R, Walls D, Hoy L, Endozo R, Bhargava A, Hanson M, Huang J, Raouf S, Francis D, Siddiqi S, Arulampalam T, Sizer B, Machesney M, Reay-Jones N, Dindyal S, Ng T, Groves AM. FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis. Eur J Nucl Med Mol Imaging 2021; 49:371-384. [PMID: 33837843 PMCID: PMC8712298 DOI: 10.1007/s00259-021-05318-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/13/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study assesses the potential for vascular-metabolic imaging with FluoroDeoxyGlucose (FDG)-Positron Emission Tomography/Computed Tomography (PET/CT) perfusion to provide markers of prognosis specific to the site and stage of colorectal cancer. METHODS This prospective observational study comprised of participants with suspected colorectal cancer categorized as either (a) non-metastatic colon cancer (M0colon), (b) non-metastatic rectal cancer (M0rectum), or (c) metastatic colorectal cancer (M+). Combined FDG-PET/CT perfusion imaging was successfully performed in 286 participants (184 males, 102 females, age: 69.60 ± 10 years) deriving vascular and metabolic imaging parameters. Vascular and metabolic imaging parameters alone and in combination were investigated with respect to overall survival. RESULTS A vascular-metabolic signature that was significantly associated with poorer survival was identified for each patient group: M0colon - high Total Lesion Glycolysis (TLG) with increased Permeability Surface Area Product/Blood Flow (PS/BF), Hazard Ratio (HR) 3.472 (95% CI: 1.441-8.333), p = 0.006; M0rectum - high Metabolic Tumour Volume (MTV) with increased PS/BF, HR 4.567 (95% CI: 1.901-10.970), p = 0.001; M+ participants, high MTV with longer Time To Peak (TTP) enhancement, HR 2.421 (95% CI: 1.162-5.045), p = 0.018. In participants with stage 2 colon cancer as well as those with stage 3 rectal cancer, the vascular-metabolic signature could stratify the prognosis of these participants. CONCLUSION Vascular and metabolic imaging using FDG-PET/CT can be used to synergise prognostic markers. The hazard ratios suggest that the technique may have clinical utility.
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Affiliation(s)
- Shih-hsin Chen
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kenneth Miles
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Stuart A. Taylor
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Balaji Ganeshan
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Manuel Rodriquez
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
- Department of Research Pathology, Cancer Institute, UCL, London, UK
| | - Francesco Fraioli
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Simon Wan
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Asim Afaq
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
- University of Iowa, Carver College of Medicine, Iowa City, USA
| | - Robert Shortman
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Darren Walls
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Luke Hoy
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
| | - Raymond Endozo
- University College London Hospitals (UCLH) NHS Foundation Trust, Surgery and Cancer Board, Imaging Division, University College Hospital (UCH), London, UK
| | - Aman Bhargava
- Institute of Health Barts and London Medical School, Queen Mary University of London (QMUL), London, UK
| | - Matthew Hanson
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
| | - Joseph Huang
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
| | - Sherif Raouf
- Barking, Havering and Redbridge University Hospitals NHS Trust, Division of Cancer and Clinical Support, Queens and King George Hospitals, Essex, UK
- Radiotherapy Department, Barts Cancer Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Daren Francis
- Royal Free London NHS Foundation Trust, Department of Colorectal Surgery, Barnet and Chase Farm Hospitals, London, UK
| | - Shahab Siddiqi
- Mid Essex Hospital Services NHS Trust, Department of Lower GI Surgery and Coloproctology, Broomfield Hospital, Essex, UK
| | - Tan Arulampalam
- East Suffolk and North Essex NHS Foundation Trust, Department of Surgery & Department of Clinical Oncology, Colchester General Hospital, Essex, UK
| | - Bruce Sizer
- East Suffolk and North Essex NHS Foundation Trust, Department of Surgery & Department of Clinical Oncology, Colchester General Hospital, Essex, UK
| | - Michael Machesney
- Barts Health NHS Trust, Cancer Clinical Board, Colorectal Surgery, Whipps Cross Hospital, London, UK
| | - Nicholas Reay-Jones
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Queen Elizabeth II Hospital, Hertfordshire, UK
| | - Sanjay Dindyal
- East and North Hertfordshire NHS Trust, Colorectal Surgery, Lister Hospital, Hertfordshire, UK
| | - Tony Ng
- School of Cancer & Pharmaceutical Sciences, Kings College London (KCL), London, UK
| | - Ashley M Groves
- Division of Medicine, Research Department of Imaging, University College London (UCL), London, UK
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Zarogoulidis P, Kosmidis C, Kougkas N, Lallas A, Petridis D, Hohenforst-Schmidt W, Huang H, Freitag L, Sardeli C. Modification of Apremilast from Pills to Aerosol a Future Concept. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11590. [PMID: 34770103 PMCID: PMC8582726 DOI: 10.3390/ijerph182111590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inhaled drugs have been available in the market for several years and for several diseases. Drugs for chronic obstructive pulmonary disease, cystic fibrosis, and diabetes have been used for several years. In the field of drug modification, these drugs range from tablets to aerosol. METHODS Milling as used to break down the tablets to powder and nebulisers are used to produce aerosol droplets. A mastersizer was used to measure the mass median aerodynamic diameter of the aerosol droplets. RESULTS Apremilast produced mmad diameters (2.43 μm) without any statistical difference between the different jet-nebulizers. The residual cup B contributed to greater mmad diameters as the 95% interval of mean values, based on those the ANOVA mean square clearly indicated, followed by cups C and F. The previous interval plot is much better clarified when the interaction means between drug and residual cap are plotted. The residual cups B, C and F produce mmad between (2.0-3.2). CONCLUSION In the current research study we demonstrated our methodology to create apremilast powder and produce apremilast aerosol droplets with different nebulisers and residual cups.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, General Clinic, Euromedica Private Hospital, 546 45 Thessaloniki, Greece
- 3rd Surgery Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Christoforos Kosmidis
- 3rd Surgery Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Nikolaos Kougkas
- Rheumatology Department, IPPOKRATEIO University General Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Aimilios Lallas
- 1st Dermatology Department, Aristotle University of Thessaloniki, 540 06 Thessaloniki, Greece;
| | - Dimitris Petridis
- Department of Food Science and Technology, International Hellenic University, 507 01 Thessaloniki, Greece;
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology, Pulmonology, Intensive Care, Nephrology, Hof Clinics, University of Erlangen, 91054 Hof, Germany;
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Naval Medical University (Changhai Hospital, Second Military Medical University), Shanghai 200433, China;
| | - Lutz Freitag
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Chrisanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 45 Thessaloniki, Greece;
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Lung metastasectomy after colorectal cancer: prognostic impact of resection margin on long term survival, a retrospective cohort study. Int J Colorectal Dis 2020; 35:9-18. [PMID: 31686201 DOI: 10.1007/s00384-019-03386-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pulmonary metastasectomy is considered a potentially curative treatment for selected patients with metastatic colorectal cancer (CRC). Several prognostic factors have been analysed, but to date, it is still not well defined which is the optimal resection margin during lung metastasectomy (LM). This study analyses the long-term results and prognostic factors after LM in CRC patients with particular attention to the resection margins. Primary endpoint of this study is to assess the correlation between resection margins and long-term outcomes. METHODS Observational cohort study on all proven cases of CRC lung metastases (2000-2016) resected with curative intent in a single centre. RESULTS The series included 210 consecutive patients (M/F 133/77) with a mean age of 65.4 (± 9.96) years, 75% (159/210) of them with a solitary metastasis. Mean size of metastasis was 2.57 cm (± 1.45). One hundred sixty-eight patients underwent wedge resections (80%) and lymphadenectomy was carried out in 90 cases (42.9%). With a mean follow-up of 56 months (range 5-192), we observed a 1-, 3- and 5-year overall survival (OS) of 95%, 74% and 54%, respectively. The patients were divided into three groups according to the resection margin distance from the tumour: (a) ≥ 2 cm (145 cases); (b) < 2, ≥ 1 cm (37 cases); and (c) < 1 cm (12 cases). The OS was significantly different between the three groups (p = 0,020); univariate and multivariate analyses showed that a narrow resection margin was an independent prognostic factor of worse survival (p = 0.006 and HR 3.4 p = 0.009). CONCLUSIONS Long-term survival of patients after LM is strongly associated with a greater distance between the lesion and the resection margin.
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Pędziwiatr M, Mizera M, Witowski J, Major P, Torbicz G, Gajewska N, Budzyński A. Primary tumor resection in stage IV unresectable colorectal cancer: what has changed? Med Oncol 2017; 34:188. [PMID: 29086041 PMCID: PMC5662673 DOI: 10.1007/s12032-017-1047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
Abstract
Most current guidelines do not recommend primary tumor resection in stage IV unresectable colorectal cancer. Rapid chemotherapy development over the last decade has substantially changed the decision making. However, results of recently published trials and meta-analyses suggest that primary tumor resection may in fact be beneficial, principally in terms of prolonged survival. Additional factors, such as use of minimally invasive approach or protocols of enhanced recovery after surgery, affect clinical outcomes as well, but are often neglected when discussing the state of the art in this area. There are still no randomized studies determining the legitimacy of upfront surgery in asymptomatic patients. Also, quality of life also plays an important role in choosing appropriate treatment. Having said that, there is no data that would prove whether primary tumor resection has an advantage on that issue. With all the uncertainty, currently decision making in unresectable stage IV colorectal cancer is primarily up to clinicians' knowledge, common sense and patients' preferences.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland. .,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland.
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
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Hou Z, Zhang H, Gui L, Wang W, Zhao S. Video-assisted thoracoscopic surgery versus open resection of lung metastases from colorectal cancer. Int J Clin Exp Med 2015; 8:13571-13577. [PMID: 26550296 PMCID: PMC4612981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/21/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to compare the short and long-term survival outcomes between video-assisted thoracoscopic surgery (VATS) and open resection of lung metastases from colorectal cancer. Between January 2006 and January 2013, 57 patients underwent VATS of lung metastases from colorectal cancer. These patients were compared with a consecutive matched group of 57 patients who underwent open resection within the same period. The two groups were similar in terms of age, gender, tumor size, number of tumors, tumor laterality and type of pulmonary resections. The operative time was longer in the VATS group, but the estimated blood loss was less in the VATS group than in the open group. Postoperative 30-day mortality, 30-day complications were similar between the groups. More complications were classified as major in patients underwent open resection, though the difference was not significant (P = 0.297). The 5-year overall survival rate was 50% for VATS and 46% for open resection (P = 0.251). The 5-year overall disease-free survival time was similar in two groups (P = 0.457). The findings suggest that VATS is associated with less blood loss than open resection for lung metastases of colorectal cancer. According to our results, VATS for lung metastases from colorectal cancer is equivalent to open resection in terms of long-term survival outcomes.
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Affiliation(s)
- Zhiliang Hou
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450008, China
| | - Haoliang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450008, China
| | - Linyan Gui
- Maternal and Child Health Care Hospital of ZhengzhouZhengzhou 450012, China
| | - Wenbo Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450008, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052, China
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Mineo TC, Tacconi F. Role of systemic inflammation scores in pulmonary metastasectomy for colorectal cancer. Thorac Cancer 2014; 5:431-7. [PMID: 26767035 DOI: 10.1111/1759-7714.12114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/19/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patients with pulmonary metastases from colorectal cancer can benefit from surgical removal. However, the biological determinants of postsurgical outcome are not completely elucidated. We evaluated the role of host systemic inflammation status in this setting. METHODS The modified Glasgow prognostic score (based on serum C-reactive protein and albumin levels) and the neutrophil-to-lymphocyte (NTL) ratio were obtained from 44 patients who received curative-intent metastasectomy, and were used as indicators of systemic inflammation status. We tested the impact of both of these parameters on overall survival (OS) and progression-free survival (PFS), as well as their correlation with other well-known prognosticators. RESULTS Five-year PFS and OS rates were 18% and 49%, respectively. At univariate analysis, multiple metastases, disease-free interval <36 months, and a Glasgow score of 2 (P = 0.031) were significantly associated to a worse PFS rate. A NTL ratio >3 predicted disease progression in the short-term (P = 0.036), but the effect on late events was weaker (P = 0.079). Factors associated with worse OS were multiple metastasis (P = 0.002), elevated carcinoembryonic antigen (P = 0.009), a Glasgow score of 2 (P = 0.029), and a faster metastasis growth (P = 0.008). At Cox regression analysis, neither a Glasgow score of 2, nor elevated NTL ratio showed an independent effect on survival rates. CONCLUSIONS Systemic inflammation scores did not perform well as independent survival prognosticators in patients undergoing curative-intent pulmonary metastasectomy. Further investigation is warranted to evaluate whether these measurements could still be useful when restricting the analysis to specific patient subcategories or to diverse postoperative phases.
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Affiliation(s)
- Tommaso Claudio Mineo
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Rome, Italy
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