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Nicolau UR, de Jesus VHF, Lima ENP, Alves MS, de Oliveira TB, Andrade LDB, Silva VS, Bes PC, de Paiva TF, Calsavara VF, Guimarães APG, Cezana L, Barbosa PNVP, Porto GCLM, Pellizzon ACA, de Carvalho GB, Kowalski LP. Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study. PLoS One 2018; 13:e0200823. [PMID: 30114190 PMCID: PMC6095513 DOI: 10.1371/journal.pone.0200823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/30/2018] [Indexed: 12/12/2022] Open
Abstract
Objective The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN). Methods and findings A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA–B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056–0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040–0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062–0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013–0.96; p = 0.046) survival. Conclusions These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.
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Affiliation(s)
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- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, A.C. Camargo Cancer Center, São Paulo, Brazil
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de Paiva TF, de Barros e Silva MJ, Rinck JA, Fanelli MF, Gimenes DL. Tuberculosis in a patient on temozolomide: a case report. J Neurooncol 2008; 92:33-5. [PMID: 18974931 DOI: 10.1007/s11060-008-9724-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
Abstract
Temozolomide (TMZ) is a cytotoxic agent of the imidazotetrazine class, chemically related to dacarbazine. Its use poses higher risks of lymphopenia and opportunistic infections. Prophylaxis for Pneumocystis jiroveci must be considered up to 12 months after treatment discontinuation. The due literature (MEDLINE) makes no mention of a possible connection between the use of TMZ and tuberculosis (TB). A female patient, aged 59, featuring glioblastoma multiforme and having undergone solely a brain biopsy, was submitted to TMZ along with radiotherapy. After the first TMZ maintenance cycle, the referred patient was admitted displaying a background of a 40-day afternoon fever and productive coughing. She was thus submitted to a bronchoscopy and LBA, which resulted BAAR 1+/4+. TMZ was then suspended, and rifampicin, isoniazid, and pyrazinamide introduced. Considerations on prophylaxis with isoniazide in cancer patients are long-lived and scarce. Some subgroups are likely to benefit from the prophylactic administration of isoniazide during TMZ treatment, such as those patients under high doses of corticoids, patients with past medical history of TB, the malnourished, patients from endemic regions, and patients with highly reactive tuberculinic tests. That, nevertheless, must not restrict the administration of TMZ, but, rather, stand for a warning about its possible toxicity, and thus mitigate complications.
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Affiliation(s)
- Tadeu Ferreira de Paiva
- Department of Oncology, Treatment and Research Center, Hospital A. C. Camargo, Rua Prof. Antônio Prudente, 211, CEP 01509-900, Liberdade, SP, Brazil
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Ribeiro HB, Paiva TFD, Mamprin GPR, Gorzoni ML, Rocha AJD, Lancellotti CLP. Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report. Arq Neuropsiquiatr 2008; 65:841-4. [PMID: 17952293 DOI: 10.1590/s0004-282x2007000500022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 06/02/2007] [Indexed: 11/22/2022]
Abstract
Carcinomatous encephalitis is a rare entity, originally described by Madow and Alpers in 1951, which is characterized by tumoral spreading perivascular, without mass effect. Clinical manifestations such as hemiparesis, seizures, ataxia, speech difficulties, cerebrospinal fluid findings as well as computed tomography are nonspecific. This leads the physician to pursue more frequent diseases that could explain those manifestations--toxic, metabolic, and/or infectious encephalopathy. A magnetic resonance imaging (MRI) with gadolinium, the method of choice, presumes the diagnosis. Previous reports of this unusual form of metastatic disease have described patients with prior diagnosis of pulmonary adenocarcinoma. We present the case of carcinomatous encephalitis in a 76-year-old woman as the primary manifestation of occult pulmonary adenocarcinoma with its clinical, imaging, and anatomopathological findings.
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Affiliation(s)
- Henrique Barbosa Ribeiro
- Department of Medicine, Faculty of Medical Sciences, Santa Casa de São Paulo, Rua de Cesário Mota Jr. 112, 01221-900 São Paulo, SP, Brazil
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de Paiva TF, Ribeiro HB, Campanholo CB, Gonçalves CR, Terigoe DY, de Souza BDB. Behçet’s disease associated with superior vena cava syndrome without thrombosis. Clin Rheumatol 2006; 26:804-6. [PMID: 16538386 DOI: 10.1007/s10067-006-0241-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 09/04/2005] [Accepted: 09/09/2005] [Indexed: 10/24/2022]
Abstract
Behçet's disease is a multisystemic vasculitis of unknown etiology, which is characterized by recurrent urogenital ulceration, cutaneous eruptions, ocular manifestations, arthritis and vasculitis, and its diagnosis is based on clinical criteria. Superior vena cava (SVC) thrombosis is a rare but well-recognized manifestation of Behçet's disease, whereas SVC syndrome due to vasculopathy, without evidence of thrombosis, has not yet been described in the literature. The authors report the case of a patient with Behçet's disease, who presented SVC syndrome with reduction in the lumen of the SVC due to thickening of the vessel wall, without evidence of thrombosis upon computed tomography and magnetic angioresonance. The patient received early anticoagulant therapy, corticosteroid and monthly cyclophosphamide pulse therapy. Clinical control without recurrence was observed after 6 months of follow-up. Behçet's disease should be suspected in young patients presenting with SVC syndrome, in the absence of thrombosis or of a hypercoagulable state.
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