Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma

OBJECTIVE

In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison.

MATERIALS AND METHOD

Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically.

RESULTS

68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%.

CONCLUSION

68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.

Roles of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable or metastatic pancreatic cancer

AIM

In this study, we aimed to investigate the roles of volume based 18F-FDG PET/CT parameters, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable and/or metastatic pancreatic ductal adenocarcinoma.

MATERIALS AND METHOD

Fifty-seven pancreatic cancer patients who were followed in University of Health Sciences Gazi Yasargil Training and Research Hospital between January 2017 and June 2020, declined surgical treatment and/or radiation therapy or had medically inoperable, unresectable, or metastatic disease, and received chemotherapy were included in the study. 18F-FDG PET/CT images of patients were evaluated and calculated metabolic tumor volume (MTV) and total lesion glycolysis (TLG) parameters were compared with CA19-9 levels and complete blood count parameters. Patients were assessed in two groups as survivors and non-survivors.

RESULTS

Total MTV and total TLG on 18F-FDG PET/CT were significantly higher among non-survivors than survivors (p: 0.023 and 0.034, respectively). Multivariate Cox regression analysis revealed that TLG higher than 46 g/ml.cm3, MTV higher than 11.02 cm3 (OR 0.987, 95%CI 0.976-0.999, p:0.029 and OR 0.246, 95%CI 0.089- 0.685, p: 0.007, respectively) and elevated MPV (OR:0.785, 95% CI 0,574-0.976, p:0.042) were independent prognostic factors for predicting mortality.

CONCLUSION

TLG >46 g/ml.cm3 and MTV >11.02 cm3 in 18F-FDG PET/CT and elevated MPV in complete blood count are independent prognostic factors for predicting mortality in patients with unresectable or metastatic pancreatic cancer who are treated with chemotherapy.

KEY WORDS

Pancreatic cancer, Metabolic tumor volume, Total lesion glycolysis, Mean platelet volume.

Nivolumab-Related Dry Mouth and Dry Eye: Cross-Sectional Study

To evaluate ICIs related dry eye and dry mouth in nivolumab therapy, 24 patients receiving nivolumab (group 1), 30 patients in remission without treatment for 6 months (group 2), 30 healthy participants (group 3) were cross-sectionally examined. Schirmer's 1, 2, TSH blood tests, serological analysis, salivary flow scintigraphy and minor-salivary gland biopsy were performed. Schirmer's tests were performed with anesthetic (1) and without anesthetic (2). Schirmer's scores were lower in group 1 with more frequent reduced tear production (p < 0.001). TSH levels negatively correlated with Schirmer's scores. Functional insufficiency was detected by salivary flow scintigraphy in 7 out of 10 patients with Schirmer's test positivity. In Schirmer's positive patients, lymphocytic sialadenitis was confirmed in 4 patients (focus score > 1) and CD4 T lymphocyte precipitation was observed in 6 patients. Nivolumab therapy may be associated with ICIs related immune sicca.

The role of inflammatory parameters in predicting disease recurrence in patients with stage IIA colon cancer with no high-risk features

OBJECTIVE

We aimed to investigate the roles of inflammatory parameters, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR), in predicting disease recurrence in patients with stage IIA (T3N0M0) high microsatellite instability and microsatellite-stable colon cancer who had no risk factors associated with relapse.

MATERIALS AND METHODS

We evaluated 155 patients with colon cancer followed in 3 hospitals in Turkey between February 2009 and March 2020. These patients had stage IIA disease and had no risk factors associated with relapse. None of the patients received adjuvant chemotherapy. NLR, PLR, LMR, and CAR parameters were retrospectively obtained from laboratory results at the time of diagnosis, and their associations with disease recurrence were assessed.

RESULTS

Over a median follow-up period of 38 months (range: 4-98 months), 11 of the 155 patients experienced relapse or developed metastases. Multivariate Cox analyses revealed that NLRs of ≥3.12 (hazard ratio [HR]: 0.041, 95% confidence interval [CI]: 0.048-0.826, p = 0.006) and CARs of ≥0.027 (HR: 0.199, 95% CI: 0.004-0.404, p = 0.026) were independent prognostic markers predicting relapse. The median 5-year recurrence-free survival rate of patients with NLRs of ≥3.12 at the time of diagnosis was 88.0%; this rate was 100% in patients with NLRs of <3.12 (p < 0.001). Similarly, the median 5-year recurrence-free survival rate of patients with CARs of ≥0.027 at the time of diagnosis was 84.7%; this rate was 95.7% in patients with CARs of <0.027 (p = 0.016).

CONCLUSION

In this study, NLR and CAR were found to be independent prognostic markers predicting disease recurrence in patients with stage IIA colon cancer who did not receive adjuvant chemotherapy due to low clinical risk.

68Ga-FAPI-04 PET/CT, a new step in breast cancer imaging: a comparative pilot study with the 18F-FDG PET/CT

AIM

We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of primary tumor and metastases in primary and recurrent breast cancer.

MATERIALS AND METHOD

Twenty female patients with histopathologically confirmed primary and recurrent breast cancer were included in the prospective study. All patients underwent FDG and FAPI PET/CT imaging in the same week. The number of primary and metastatic lesions, SUVmax values, and tumor-to-background ratios (TBR) were recorded from both scans. Data obtained were statistically compared.

RESULTS

FAPI PET/CT was superior to FDG in detecting breast lesions, as well as hepatic, bone, lymph node, and cerebral metastases in terms of patient- and lesion-based assessments. The sensitivity and specificity of FAPI in detecting primary breast lesions were 100% and 95.6%, respectively, while the sensitivity and specificity of FDG were 78.2% and 100%, respectively. The SUVmax values of primary breast tumors, lymph nodes, lung metastases, and bone metastases were significantly higher on FAPI imaging than FDG imaging (p < 0.05). However, SUVmax values of hepatic metastases did not exhibit a statistically significant difference between two imaging techniques (p > 0.05). Also, FAPI imaging yielded significantly higher TBR in breast lesions as well as hepatic, bone, brain and lung metastases compared to FDG (p < 0.05).

CONCLUSION

68 Ga-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in detecting the primary tumor in patients with breast cancer with its high sensitivity, high SUVmax, and high TBR. 68 Ga-FAPI-04 PET/CT is also superior to 18F-FDG PET/CT in detecting lymph node, hepatic, bone, and cerebral metastases because it has lower background activity and higher uptake in subcentimetric lesions.

Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays

PURPOSE

Pandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined.

METHODS

BDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays.

RESULTS

The depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038).

CONCLUSION

SARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes

PURPOSE

In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients.

METHODS

This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers.

RESULTS

Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure.

CONCLUSIONS

Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Multimodality treatment for esophageal cancer in Turkey: A single center experience

e15507

Background: Esophagus cancer is an important cause of cancer-related deaths in Turkey as well as in the world. In our study, clinicopathological features and survival results of patients treated for esophageal cancer were presented. Methods: This study retrospectively reviewed esophageal squamous cell carcinoma (SCC) and adenocarcinoma (ADC) patients who were admitted to our center, between 2012 and 2016. Results: A total of 82 patients (56 males) with a median age of 56 years were evaluated. Seventy-one (87%) patients were diagnosed with SCC, 10 (12%) with ADC, 1 with adenosquamous carcinoma. All ADC patients were HER2 negative. The localization of tumors; lower third (55%), middle third (27%) and upper third (18%) of the esophagus. Prior to surgery, neoadjuvant chemoradiotherapy (CRT) was administered in 21 patients (26%); 10 of them receiving carboplatin and paclitaxel (CP), and 11 receiving cisplatin and 5-FU (CF). TNM classification of operated patients were as follows; Stage 1 (n = 5), stage 2 (n = 10), stage 3 (n = 8) and stage 4 (n = 1). Adjuvant chemotherapy (CF) was administered in the other 6 (7%) patients. Definitive CRT was given in 36 patients (44%), with CF being administered in 32 patients, and CP therapy in 4 patients. There were 19 patients (23%) with metastatic diagnosis and 13 of whom were treated with CF, and 4 with docetaxel-cisplatin-5FU combination. With median follow up of 21 months, median overall survival (OS) and time to progression (TTP) were 24 and 17 months, respectively. The median OS and TTP of patients with metastatic disease were 14 and th 9 months, respectively. The median OS and TTP of the patients who underwent surgery were 45 and 34 months, respectively. Conclusions: Our findings in this study regarding the rate of histology, the percentages of patients with metastatic vs. locally advanced disease, and survival rates were similar to the literature.

The effect of iron treatment on adhesion molecules in patients with iron deficiency anemia

The present study was aimed to determine the effect of iron supplementation on levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with iron deficiency anemia (IDA). In this study, 26 female patients diagnosed with iron deficiency were treated approximately 3 months of oral iron supplementation (99 ± 10 days; ferrous glycine sulfate; 100 mg/day of elemental iron). Levels of sICAM-1 and sVCAM-1 were assessed prior to treatment and after approximately 3 months of treatment and compared with 26 healthy female subjects. A significant increase in sVCAM levels was found in the patients with iron deficiency at the end of the treatment relative to pretreatment levels compared to controls, whereas no significant differences were determined in sICAM levels. In the posttreatment period, no significant change was observed in sICAM levels compared to the pretreatment levels, whereas sVCAM levels decreased. However, after the treatment period, the sVCAM, hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels did not return to the normal range compared to the controls. Pretreatment sVCAM-1 levels were inversely correlated with levels of hemoglobin, hemotocrit, MCV, serum iron, and ferritin. After treatment, the sVCAM-1 levels were negatively correlated with ferritin levels. Levels of sVCAM were significantly higher in patients with IDA than controls. After the treatment period, the sVCAM levels were not completely normalized in patients with IDA compared to controls, regardless of the presence of inadequate levels of hemoglobin, MCV, and serum ferritin. Thus, iron supplementation not only ameliorates anemia, but may also reduce the inflammation markers in cases with IDA.