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Coleman JA, Yip W, Wong NC, Sjoberg DD, Bochner BH, Dalbagni G, Donat SM, Herr HW, Cha EK, Donahue TF, Pietzak EJ, Hakimi AA, Kim K, Al-Ahmadie HA, Vargas HA, Alvim RG, Ghafoor S, Benfante NE, Meraney AM, Shichman SJ, Kamradt JM, Nair SG, Baccala AA, Palyca P, Lash BW, Rizvi MA, Swanson SK, Muina AF, Apolo AB, Iyer G, Rosenberg JE, Teo MY, Bajorin DF. Multicenter Phase II Clinical Trial of Gemcitabine and Cisplatin as Neoadjuvant Chemotherapy for Patients With High-Grade Upper Tract Urothelial Carcinoma. J Clin Oncol 2023; 41:1618-1625. [PMID: 36603175 PMCID: PMC10043554 DOI: 10.1200/jco.22.00763] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) has proven survival benefits for patients with invasive urothelial carcinoma of the bladder, yet its role for upper tract urothelial carcinoma (UTUC) remains undefined. We conducted a multicenter, single-arm, phase II trial of NAC with gemcitabine and split-dose cisplatin (GC) for patients with high-risk UTUC before extirpative surgery to evaluate response, survival, and tolerability. METHODS Eligible patients with defined criteria for high-risk localized UTUC received four cycles of split-dose GC before surgical resection and lymph node dissection. The primary study end point was rate of pathologic response (defined as < ypT2N0). Secondary end points included progression-free survival (PFS), overall survival (OS), and safety and tolerability. RESULTS Among 57 patients evaluated, 36 (63%) demonstrated pathologic response (95% CI, 49 to 76). A complete pathologic response (ypT0N0) was noted in 11 patients (19%). Fifty-one patients (89%) tolerated at least three complete cycles of split-dose GC, 27 patients (47%) tolerated four complete cycles, and all patients proceeded to surgery. With a median follow up of 3.1 years, 2- and 5-year PFS rates were 89% (95% CI, 81 to 98) and 72% (95% CI, 59 to 87), while 2- and 5-year OS rates were 93% (95% CI, 86 to 100) and 79% (95% CI, 67 to 94), respectively. Pathologic complete and partial responses were associated with improved PFS and OS compared with nonresponders (≥ ypT2N any; 2-year PFS 100% and 95% v 76%, P < .001; 2-year OS 100% and 100% v 80%, P < .001). CONCLUSION NAC with split-dose GC for high-risk UTUC is a well-tolerated, effective therapy demonstrating evidence of pathologic response that is associated with favorable survival outcomes. Given that these survival outcomes are superior to historical series, these data support the use of NAC as a standard of care for high-risk UTUC, and split-dose GC is a viable option for NAC.
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Affiliation(s)
| | - Wesley Yip
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Harry W. Herr
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene K. Cha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kwanghee Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Min Y. Teo
- Memorial Sloan Kettering Cancer Center, New York, NY
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El Homsi M, Horvat N, Woodlock DP, Araji A, Vargas HA, Bates DDB. CT Imaging Findings in Patients with Ovarian Cancer and Acute Abdominal Symptoms: Experience at a Tertiary Cancer Center. Emerg Radiol 2022; 29:947-952. [PMID: 35809140 DOI: 10.1007/s10140-022-02075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate computed tomography (CT) findings in patients with ovarian cancer presenting to a comprehensive cancer center's urgent care unit with acute abdominal symptoms. METHODS This retrospective study included consecutive patients with ovarian cancer who underwent abdominal CT at a comprehensive cancer center's urgent care unit between January 1, 2018, and January 14, 2020, due to acute abdominal symptoms. Two abdominal radiologists reviewed the abdominal CT reports, categorizing imaging findings as follows: (a) no new or acute finding, (b) new or increased bowel or gastric obstruction, (c) new or increased ascites, (d) new or increased peritoneal carcinomatosis, (e) new or increased nonperitoneal metastases, (f) new inflammatory or infectious changes, (g) new or increased hydronephrosis, (h) new or increased biliary dilatation, (i) new vascular complications, or (j) new bowel perforation. RESULTS A total of 200 patients (mean age, 59 years; range, 22-87) underwent a total of 259 abdominal CT scans, of which 217/259 (83.8%) scans were found to have new or increased findings. A total of 115/259 (44.4%) scans had only one finding while 102/259 (39.4%) scans had 2 or more findings. Altogether, 382 new or increased findings were detected: findings were most commonly related to bowel or gastric obstruction (92/382, 24.1%) with small bowel obstruction being the most common finding (80/382, 20.9%); ascites (78/382, 20.4%); peritoneal carcinomatosis (62/382, 16.2%); and nonperitoneal metastases (62/382, 16.2%). Inflammatory or infectious findings accounted for 30/382 (7.9%) findings. CONCLUSION Most patients with ovarian cancer presenting with acute abdominal had relevant positive findings on abdominal CT, with small bowel obstruction being the most common finding.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David P Woodlock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Abdallah Araji
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Das JP, Woo S, Ghafoor S, Andrieu PC, Ulaner GA, Donahue TF, Goh AC, Vargas HA. Value of MRI in evaluating urachal carcinoma: A single center retrospective study. Urol Oncol 2022; 40:345.e9-345.e17. [DOI: 10.1016/j.urolonc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
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Woo S, Ghafoor S, Das JP, Gangai N, Goh AC, Vargas HA. Plasmacytoid urothelial carcinoma of the bladder: MRI features and their association with survival. Urol Oncol 2022; 40:108.e1-108.e10. [PMID: 34750054 PMCID: PMC8885786 DOI: 10.1016/j.urolonc.2021.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/20/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Plasmacytoid urothelial carcinomas (PUC) of the bladder are rare variants known for diffuse and infiltrative spread, however their magnetic resonance imaging (MRI) features are not well established. We aimed to evaluate MRI features of PUC of the bladder and their association with survival. METHODS AND MATERIALS This retrospective single-center study included 41 patients with pathologically-proven bladder PUC of the bladder that underwent pre-treatment MRI between January 2000 and March 2020. Two radiologists reviewed MRIs independently followed by consensus with a third radiologist. On MRI, tumor extent, size, Vesical Imaging-Reporting and Data System (VI-RADS) scores (≥4, muscle-invasive; 5, extravesical extension [EVE]), pelvic peritoneal spread (PPS), hydronephrosis, pelvic adenopathy and clinicopathological factors of age, gender, pathological stage, and treatment type were extracted. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with survival. RESULTS Thirty-two men and 9 women (median age 70 years, IQR 64-76) were included. Most were muscle-invasive (n = 30 [73.2%]). On MRI, most tumors were diffuse (n = 28 [68.3%]), >5 cm (n = 30 [73.2%]), VI-RADS 4 to 5 (n = 36 [87.8%]) with features of EVE and (n = 31 [75.6%]) and PPS (n = 25 [61.0%]). Variables associated with survival were: Larger tumors (>5 cm; hazard ratio [HR] = 5.0; 95% confidence interval [CI] 1.6-15.5; P < 0.01), diffuse extent (HR = 4.0; 95% CI 1.4-11.2; P = 0.01), EVE (HR = 4.5; 95% CI 1.5-13.6; P < 0.01), PPS (HR = 3.0; 95% CI 1.2-7.4; P = 0.01), hydronephrosis (HR = 13.7; 95% CI 3.1-60.9; P < 0.01), pathologic stage (≥pT3 vs. pT1; HR = 5.6; 95% CI 1.3-22.0; P = 0.02), and margin positivity (HR = 4.4 [95% CI 1.2-16.4], P = 0.03). CONCLUSION PUCs of the bladder are commonly large, diffuse VI-RADS score 4 to 5 tumors with MRI features of EVE and PPS. These features and pathological stage were associated with survival.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Alvin C. Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY
| | - H. Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
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Becker AS, Erinjeri JP, Chaim J, Kastango N, Elnajjar P, Hricak H, Vargas HA. Automatic Forecasting of Radiology Examination Volume Trends for Optimal Resource Planning and Allocation. J Digit Imaging 2021; 35:1-8. [PMID: 34755249 PMCID: PMC8577854 DOI: 10.1007/s10278-021-00532-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/12/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022] Open
Abstract
The aim of the study was to evaluate the performance of the Prophet forecasting procedure, part of the Facebook open-source Artificial Intelligence portfolio, for forecasting variations in radiological examination volumes. Daily CT and MRI examination volumes from our institution were extracted from the radiology information system (RIS) database. Data from January 1, 2015, to December 31, 2019, was used for training the Prophet algorithm, and data from January 2020 was used for validation. Algorithm performance was then evaluated prospectively in February and August 2020. Total error and mean error per day were evaluated, and computational time was logged using different Markov chain Monte Carlo (MCMC) samples. Data from 610,570 examinations were used for training; the majority were CTs (82.3%). During retrospective testing, prediction error was reduced from 19 to < 1 per day in CT (total 589 to 17) and from 5 to < 1 per day (total 144 to 27) in MRI by fine-tuning the Prophet procedure. Prospective prediction error in February was 11 per day in CT (9934 predicted, 9667 actual) and 1 per day in MRI (2484 predicted, 2457 actual) and was significantly better than manual weekly predictions (p = 0.001). Inference with MCMC added no substantial improvements while vastly increasing computational time. Prophet accurately models weekly, seasonal, and overall trends paving the way for optimal resource allocation for radiology exam acquisition and interpretation.
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Affiliation(s)
- Anton S Becker
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Joseph P Erinjeri
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Chaim
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicholas Kastango
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pierre Elnajjar
- Department of Radiology, Informatics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Alberto Vargas
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Becker AS, Perez-Johnston R, Chikarmane SA, Chen MM, El Homsi M, Feigin KN, Gallagher KM, Hanna EY, Hicks M, Ilica AT, Mayer EL, Shinagare AB, Yeh R, Mayerhoefer ME, Hricak H, Vargas HA. Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel. Radiology 2021; 300:E323-E327. [PMID: 33625298 PMCID: PMC7909071 DOI: 10.1148/radiol.2021210436] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (eg, for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information-date(s) administered, injection site(s), laterality, and type of vaccine-should be included in every preimaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams, and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination.
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Affiliation(s)
- Anton S Becker
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Rocio Perez-Johnston
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Sona A Chikarmane
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Melissa M Chen
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Maria El Homsi
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Kimberly N Feigin
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Katherine M Gallagher
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Ehab Y Hanna
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Marshall Hicks
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Ahmet T Ilica
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Erica L Mayer
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Atul B Shinagare
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Randy Yeh
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Marius E Mayerhoefer
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - Hedvig Hricak
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
| | - H Alberto Vargas
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-704, New York, NY 10065 (A.S.B., R.P.J., M.E.H., K.N.F., K.M.G., A.T.I., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (S.A.C., A.B.S.); Departments of Imaging (S.A.C., A.B.S.) and Medical Oncology (E.L.M.), Dana-Farber Cancer Institute, Boston, Mass; and Division of Diagnostic Imaging (M.M.C., M.H.) and Department of Head and Neck Surgery (E.Y.H.), MD Anderson Cancer Center, Houston, Tex
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7
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Affiliation(s)
- Edouard J. Trabulsi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Trabulsi EJ, Rumble RB, Jadvar H, Hope T, Pomper M, Turkbey B, Rosenkrantz AB, Verma S, Margolis DJ, Froemming A, Oto A, Purysko A, Milowsky MI, Schlemmer HP, Eiber M, Morris MJ, Choyke PL, Padhani A, Oldan J, Fanti S, Jain S, Pinto PA, Keegan KA, Porter CR, Coleman JA, Bauman GS, Jani AB, Kamradt JM, Sholes W, Vargas HA. Optimum Imaging Strategies for Advanced Prostate Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1963-1996. [PMID: 31940221 DOI: 10.1200/jco.19.02757] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Provide evidence- and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups. METHODS An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality. RESULTS A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles. RECOMMENDATIONS One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography [CT], bone scan, and/or prostate magnetic resonance imaging [MRI]) and/or next-generation imaging (NGI), positron emission tomography [PET], PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.
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Affiliation(s)
- Edouard J Trabulsi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | | | - Thomas Hope
- University of California, San Francisco, San Francisco, CA
| | | | | | | | - Sadhna Verma
- University of Cincinnati Medical Center, Cincinnati, OH
| | | | | | | | | | | | | | | | | | | | - Anwar Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jorge Oldan
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Suneil Jain
- Queen's University Belfast, Belfast, Northern Ireland
| | | | | | | | | | | | | | | | - Westley Sholes
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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9
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Nougaret S, Castan F, de Forges H, Vargas HA, Gallix B, Gourgou S, Rouanet P. Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial. Br J Surg 2019; 106:1530-1541. [PMID: 31436325 DOI: 10.1002/bjs.11233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC. METHODS All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated. RESULTS A total of 133 randomized patients were analysed. Median follow-up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty-one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse. CONCLUSION Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.
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Affiliation(s)
- S Nougaret
- Department of Radiology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, Institut National de la Santé et de la Recherche Médicale, U1194, Montpellier, France
| | - F Castan
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Gallix
- Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Gourgou
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
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10
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Bodo S, Campagne C, Thin TH, Higginson DS, Vargas HA, Hua G, Fuller JD, Ackerstaff E, Russell J, Zhang Z, Klingler S, Cho H, Kaag MG, Mazaheri Y, Rimner A, Manova-Todorova K, Epel B, Zatcky J, Cleary CR, Rao SS, Yamada Y, Zelefsky MJ, Halpern HJ, Koutcher JA, Cordon-Cardo C, Greco C, Haimovitz-Friedman A, Sala E, Powell SN, Kolesnick R, Fuks Z. Single-dose radiotherapy disables tumor cell homologous recombination via ischemia/reperfusion injury. J Clin Invest 2019; 129:786-801. [PMID: 30480549 DOI: 10.1172/jci97631] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
Abstract
Tumor cure with conventional fractionated radiotherapy is 65%, dependent on tumor cell-autonomous gradual buildup of DNA double-strand break (DSB) misrepair. Here we report that single-dose radiotherapy (SDRT), a disruptive technique that ablates more than 90% of human cancers, operates a distinct dual-target mechanism, linking acid sphingomyelinase-mediated (ASMase-mediated) microvascular perfusion defects to DNA unrepair in tumor cells to confer tumor cell lethality. ASMase-mediated microcirculatory vasoconstriction after SDRT conferred an ischemic stress response within parenchymal tumor cells, with ROS triggering the evolutionarily conserved SUMO stress response, specifically depleting chromatin-associated free SUMO3. Whereas SUMO3, but not SUMO2, was indispensable for homology-directed repair (HDR) of DSBs, HDR loss of function after SDRT yielded DSB unrepair, chromosomal aberrations, and tumor clonogen demise. Vasoconstriction blockade with the endothelin-1 inhibitor BQ-123, or ROS scavenging after SDRT using peroxiredoxin-6 overexpression or the SOD mimetic tempol, prevented chromatin SUMO3 depletion, HDR loss of function, and SDRT tumor ablation. We also provide evidence of mouse-to-human translation of this biology in a randomized clinical trial, showing that 24 Gy SDRT, but not 3×9 Gy fractionation, coupled early tumor ischemia/reperfusion to human cancer ablation. The SDRT biology provides opportunities for mechanism-based selective tumor radiosensitization via accessing of SDRT/ASMase signaling, as current studies indicate that this pathway is tractable to pharmacologic intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Katia Manova-Todorova
- Laboratory of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Boris Epel
- Department of Radiation and Cellular Oncology, Center for EPR Imaging In Vivo Physiology, The University of Chicago, Chicago, Illinois, USA
| | | | | | | | | | | | - Howard J Halpern
- Department of Radiation and Cellular Oncology, Center for EPR Imaging In Vivo Physiology, The University of Chicago, Chicago, Illinois, USA
| | | | - Carlos Cordon-Cardo
- Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | | | | | | | - Zvi Fuks
- Department of Radiation Oncology.,Champalimaud Centre, Lisbon, Portugal
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11
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van Beek EJR, Kuhl C, Anzai Y, Desmond P, Ehman RL, Gong Q, Gold G, Gulani V, Hall-Craggs M, Leiner T, Lim CCT, Pipe JG, Reeder S, Reinhold C, Smits M, Sodickson DK, Tempany C, Vargas HA, Wang M. Value of MRI in medicine: More than just another test? J Magn Reson Imaging 2018; 49:e14-e25. [PMID: 30145852 DOI: 10.1002/jmri.26211] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023] Open
Abstract
There is increasing scrutiny from healthcare organizations towards the utility and associated costs of imaging. MRI has traditionally been used as a high-end modality, and although shown extremely important for many types of clinical scenarios, it has been suggested as too expensive by some. This editorial will try and explain how value should be addressed and gives some insights and practical examples of how value of MRI can be increased. It requires a global effort to increase accessibility, value for money, and impact on patient management. We hope this editorial sheds some light and gives some indications of where the field may wish to address some of its research to proactively demonstrate the value of MRI. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:e14-e25.
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Affiliation(s)
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Yoshimi Anzai
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia Desmond
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Garry Gold
- Department of Radiology, Engineering and Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Vikas Gulani
- Departments of Radiology, Urology and Biomedical Imaging, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Margaret Hall-Craggs
- Department of Medical Imaging and Radiology, University College Hospital NHS Trust, London, UK
| | - Tim Leiner
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht, The Netherlands
| | - C C Tschoyoson Lim
- Department of Neuroradiology, National Neuroscience Institute and Duke NUS Medical School, Singapore, Singapore
| | - James G Pipe
- Department of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Scott Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Madison, Madison, Wisconsin, USA
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Daniel K Sodickson
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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12
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Yarmish G, Sala E, Goldman DA, Lakhman Y, Soslow RA, Hricak H, Gardner GJ, Vargas HA. Abdominal wall endometriosis: differentiation from other masses using CT features. Abdom Radiol (NY) 2017; 42:1517-1523. [PMID: 28004137 DOI: 10.1007/s00261-016-0998-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall. METHODS Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations between CT features and pathology were tested using Fisher's Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing. RESULTS 24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P = 0.0188), homogeneous density (P = 0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., "gorgon" sign) (P < 0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48-0.86) and specificity (0.97, 95% CI: 0.91-1.00) for both readers occurred for patients having all three of these features present. Border type (P = 0.0199) was only significant for R2, peritoneal extension (P = 0.0188) was only significantly for R1, and the remainder of features were insignificant (P = 0.06-60). There was overlap in Hounsfield units on non-contrast CT (N = 26) between AWE (median: 45HU, range: 39-54) and other abdominal wall masses (median: 38.5HU, range: 15-58). CONCLUSION CT features are helpful in differentiating AWE from other abdominal wall soft tissue masses. Such differentiation may assist decisions regarding possible biopsy and treatment planning.
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Affiliation(s)
- Gail Yarmish
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA.
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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13
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Padhani AR, Lecouvet FE, Tunariu N, Koh DM, De Keyzer F, Collins DJ, Sala E, Fanti S, Vargas HA, Petralia G, Schlemmer HP, Tombal B, de Bono J. Rationale for Modernising Imaging in Advanced Prostate Cancer. Eur Urol Focus 2017; 3:223-239. [PMID: 28753774 DOI: 10.1016/j.euf.2016.06.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 12/25/2022]
Abstract
CONTEXT To effectively manage patients with advanced prostate cancer (APC), it is essential to have accurate, reproducible, and validated methods for detecting and quantifying the burden of bone and soft tissue metastases and for assessing their response to therapy. Current standard of care imaging with bone and computed tomography (CT) scans have significant limitations for the assessment of bone metastases in particular. OBJECTIVE We aimed to undertake a critical comparative review of imaging methods used for diagnosis and disease monitoring of metastatic APC from the perspective of their availability and ability to assess disease presence, extent, and response of bone and soft tissue disease. EVIDENCE ACQUISITION An expert panel of radiologists, nuclear medicine physicians, and medical physicists with the greatest experience of imaging in advanced prostate cancer prepared a review of the practicalities, performance, merits, and limitations of currently available imaging methods. EVIDENCE SYNTHESIS Meta-analyses showed that positron emission tomography (PET)/CT with different radiotracers and whole-body magnetic resonance imaging (WB-MRI) are more accurate for bone lesion detection than CT and bone scans (BSs). At a patient level, the pooled sensitivities for bone disease by using choline (CH)-PET/CT, WB-MRI, and BS were 91% (95% confidence interval [CI], 83-96%), 97% (95% CI, 91-99%), and 79% (95% CI, 73-83%), respectively. The pooled specificities for bone metastases detection using CH-PET/CT, WB-MRI, and BS were 99% (95% CI, 93-100%), 95% (95% CI, 90-97%), and 82% (95% CI, 78-85%), respectively. The ability of PET/CT and WB-MRI to assess therapeutic benefits is promising but has not been comprehensively evaluated. There is variability in the cost, availability, and quality of PET/CT and WB-MRI. CONCLUSIONS Standardisation of acquisition, interpretation, and reporting of WB-MRI and PET/CT scans is required to assess the performance of these techniques in clinical trials of treatment approaches in APC. PATIENT SUMMARY PET/CT and whole-body MRI scans have the potential to improve detection and to assess response to treatment of all states of advanced prostate cancer. Consensus recommendations on quality standards, interpretation, and reporting are needed but will require validation in clinical trials of established and new treatment approaches.
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Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
| | - Frederic E Lecouvet
- Department of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Frederik De Keyzer
- Department of Radiology, Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Heinz Peter Schlemmer
- Department of Radiology, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Johann de Bono
- Drug Development Unit, Institute of Cancer Research and the Royal Marsden NHS Trust, Surrey, UK
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14
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Sala E, Mema E, Himoto Y, Veeraraghavan H, Brenton JD, Snyder A, Weigelt B, Vargas HA. Unravelling tumour heterogeneity using next-generation imaging: radiomics, radiogenomics, and habitat imaging. Clin Radiol 2017; 72:3-10. [PMID: 27742105 PMCID: PMC5503113 DOI: 10.1016/j.crad.2016.09.013] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 12/18/2022]
Abstract
Tumour heterogeneity in cancers has been observed at the histological and genetic levels, and increased levels of intra-tumour genetic heterogeneity have been reported to be associated with adverse clinical outcomes. This review provides an overview of radiomics, radiogenomics, and habitat imaging, and examines the use of these newly emergent fields in assessing tumour heterogeneity and its implications. It reviews the potential value of radiomics and radiogenomics in assisting in the diagnosis of cancer disease and determining cancer aggressiveness. This review discusses how radiogenomic analysis can be further used to guide treatment therapy for individual tumours by predicting drug response and potential therapy resistance and examines its role in developing radiomics as biomarkers of oncological outcomes. Lastly, it provides an overview of the obstacles in these emergent fields today including reproducibility, need for validation, imaging analysis standardisation, data sharing and clinical translatability and offers potential solutions to these challenges towards the realisation of precision oncology.
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Affiliation(s)
- E Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - E Mema
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, New York Presbyterian/Columbia University Medical Center, 622 W 168th St., New York, NY 10032, USA
| | - Y Himoto
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - H Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - J D Brenton
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - A Snyder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - B Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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15
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Padhani AR, Lecouvet FE, Tunariu N, Koh DM, De Keyzer F, Collins DJ, Sala E, Schlemmer HP, Petralia G, Vargas HA, Fanti S, Tombal HB, de Bono J. METastasis Reporting and Data System for Prostate Cancer: Practical Guidelines for Acquisition, Interpretation, and Reporting of Whole-body Magnetic Resonance Imaging-based Evaluations of Multiorgan Involvement in Advanced Prostate Cancer. Eur Urol 2017; 71:81-92. [PMID: 27317091 PMCID: PMC5176005 DOI: 10.1016/j.eururo.2016.05.033] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/25/2016] [Indexed: 12/23/2022]
Abstract
CONTEXT Comparative reviews of whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography/computed tomography (CT; with different radiotracers) have shown that metastasis detection in advanced cancers is more accurate than with currently used CT and bone scans. However, the ability of WB-MRI and positron emission tomography/CT to assess therapeutic benefits has not been comprehensively evaluated. There is also considerable variability in the availability and quality of WB-MRI, which is an impediment to clinical development. Expert recommendations for standardising WB-MRI scans are needed, in order to assess its performance in advanced prostate cancer (APC) clinical trials. OBJECTIVE To design recommendations that promote standardisation and diminish variations in the acquisition, interpretation, and reporting of WB-MRI scans for use in APC. EVIDENCE ACQUISITION An international expert panel of oncologic imagers and oncologists with clinical and research interests in APC management assessed biomarker requirements for clinical care and clinical trials. Key requirements for a workable WB-MRI protocol, achievable quality standards, and interpretation criteria were identified and synthesised in a white paper. EVIDENCE SYNTHESIS The METastasis Reporting and Data System for Prostate Cancer guidelines were formulated for use in all oncologic manifestations of APC. CONCLUSIONS Uniformity in imaging data acquisition, quality, and interpretation of WB-MRI are essential for assessing the test performance of WB-MRI. The METastasis Reporting and Data System for Prostate Cancer standard requires validation in clinical trials of treatment approaches in APC. PATIENT SUMMARY METastasis Reporting and Data System for Prostate Cancer represents the consensus recommendations on the performance, quality standards, and reporting of whole-body magnetic resonance imaging, for use in all oncologic manifestations of advanced prostate cancer. These new criteria require validation in clinical trials of established and new treatment approaches in advanced prostate cancer.
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Affiliation(s)
- Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
| | - Frederic E Lecouvet
- Department of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Frederik De Keyzer
- Department of Radiology, Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Evis Sala
- Department of Radiology, Memorial Sloan-Kettering Cancer Centre, New York, NY, USA
| | - Heinz Peter Schlemmer
- Department of Radiology, German Cancer Research Centre Heidelberg (DKFZ), Heidelberg, Germany
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Centre, New York, NY, USA
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - H Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Johann de Bono
- Drug Development Unit, Institute of Cancer Research and The Royal Marsden NHS Trust, Sutton, Surrey, UK
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16
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Robertson NL, Hricak H, Sonoda Y, Sosa RE, Benz M, Lyons G, Abu-Rustum NR, Sala E, Vargas HA. The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer. Gynecol Oncol 2016; 140:420-4. [PMID: 26790773 DOI: 10.1016/j.ygyno.2016.01.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the changes in prognostic impression and patient management following PET/CT in patients with vulvar and vaginal carcinoma; and to compare PET/CT findings with those of conventional imaging modalities. METHODS We summarized prospectively and retrospectively collected data for 50 consecutive patients from our institution that enrolled in the National Oncologic PET Registry and underwent FDG-PET/CT for a suspected or known primary or recurrent vulvar/vaginal cancer. RESULTS 54/83 (65%) studies included had a diagnosis of vulvar cancer, and the remaining 29/83 (35%), a diagnosis of vaginal cancer. Following FDG-PET/CT, the physician's prognostic impression changed in 51% of cases. A change in patient management, defined as a change to/from a non-interventional strategy (observation or additional imaging), to/from an interventional strategy (biopsy or treatment), was documented in 36% of studies. The electronic records demonstrated that 95% of the management strategies recorded in the physician questionnaires were implemented as planned. MRI and/or CT were performed within one month of the FDG-PET/CT in 20/83 (24%) and 28/83 (34%) cases, respectively. FDG-PET/CT detected nodes suspicious for metastases on 29/83 (35%) studies performed. MRI and CT detected positive nodes on 6 and 11 studies respectively. Distant metastases were identified in 10 cases imaged with FDG-PET and 5 cases that had additional conventional CT imaging. All suspicious lesions seen on CT were positively identified on PET/CT. In 4 cases, an abnormality identified on PET/CT, was not seen on diagnostic CT. CONCLUSIONS FDG-PET/CT may play an important role in the management of vulvar and vaginal carcinoma.
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Affiliation(s)
- N L Robertson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA.
| | - H Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
| | - Y Sonoda
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
| | - M Benz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
| | - G Lyons
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
| | - N R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY 10065, USA
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Rivera-Cabello D, Huanca-Mamani W, Vargas HA. Macaria mirthae Vargas et al (Lepidoptera: Geometridae): Confirmation of the Use of an Invasive Host Plant in the Northern Atacama Desert of Chile Based on DNA Barcodes. Neotrop Entomol 2015; 44:357-364. [PMID: 26174961 DOI: 10.1007/s13744-015-0289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/14/2015] [Indexed: 06/04/2023]
Abstract
Macaria mirthae Vargas et al (Lepidoptera: Geometridae) is a geometrid moth native to the northern Atacama Desert of Chile. Its oligophagous larvae are associated with native hosts of the plant family Fabaceae, the most important of which is Acacia macracantha. The invasive tree Leucaena leucocephala (Fabaceae) was recently recorded as a host plant for M. mirthae based on morphology. The taxonomic status of larvae collected on A. macracantha and L. leucocephala was assessed using sequences of the DNA barcode fragment of the cytochrome c oxidase subunit I (COI) gene. Genetic divergence between samples from the host plants was found to be 0%-0.8% (Kimura 2-parameter model). Neighbor-joining and maximum likelihood analyses were also performed, including additional barcode sequences of Neotropical geometrid moths from GenBank and BOLD databases. Sequences of the larvae from both host plants clustered in a single clade with high statistical support in both analyses. Based on these results, it is concluded that M. mirthae has effectively expanded its host range and its larvae are currently feeding on the exotic tree L. leucocephala. Additionally, the importance of this new host association in a highly disturbed habitat is briefly discussed in terms of the field biology of this native geometrid moth.
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Affiliation(s)
- D Rivera-Cabello
- Depto de Recursos Ambientales, Fac de Ciencias Agronómicas, Univ de Tarapacá, Casilla 6-D, Arica, Chile
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Vargas HA, Burger IA, Goldman DA, Miccò M, Sosa RE, Weber W, Chi DS, Hricak H, Sala E. Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery. Eur Radiol 2015; 25:3348-53. [PMID: 25916387 DOI: 10.1007/s00330-015-3729-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/05/2015] [Accepted: 03/20/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim was to evaluate the associations between quantitative (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) uptake metrics, optimal debulking (OD) and progression-free survival (PFS) in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery. METHODS Fifty-five patients with recurrent ovarian cancer underwent FDG-PET/CT within 90 days prior to surgery. Standardized uptake values (SUVmax), metabolically active tumour volumes (MTV), and total lesion glycolysis (TLG) were measured on PET. Exact logistic regression, Kaplan-Meier curves and the log-rank test were used to assess associations between imaging metrics, OD and PFS. RESULTS MTV (p = 0.0025) and TLG (p = 0.0043) were associated with OD; however, there was no significant association between SUVmax and debulking status (p = 0.83). Patients with an MTV above 7.52 mL and/or a TLG above 35.94 g had significantly shorter PFS (p = 0.0191 for MTV and p = 0.0069 for TLG). SUVmax was not significantly related to PFS (p = 0.10). PFS estimates at 3.5 years after surgery were 0.42 for patients with an MTV ≤ 7.52 mL and 0.19 for patients with an MTV > 7.52 mL; 0.46 for patients with a TLG ≤ 35.94 g and 0.15 for patients with a TLG > 35.94 g. CONCLUSION FDG-PET metrics that reflect metabolic tumour burden are associated with optimal secondary cytoreductive surgery and progression-free survival in patients with recurrent ovarian cancer. KEY POINTS • Both TLG and MTV were associated with optimal tumour debulking. • There was no significant association between SUVmax and tumour debulking status. • Patients with higher MTV and/or TLG had significantly shorter PFS. • SUVmax was not significantly related to PFS.
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Affiliation(s)
- H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA.
| | - I A Burger
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
| | - D A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Av, New York, NY, 10065, USA
| | - M Miccò
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
| | - R E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
| | - W Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
| | - D S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Av, New York, NY, 10065, USA
| | - H Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
| | - E Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Av, room C278, New York, NY, 10065, USA
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Mundaca EA, Macaya EC, Vargas HA. Palatability and feeding preferences ofUresiphita maorialis(Lepidoptera: Crambidae) for threeSophoraspecies. New Zealand Journal of Zoology 2015. [DOI: 10.1080/03014223.2015.1018281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vargas HA, Benítez HA. Egg Phenology of a Host-Specialist Butterfly in the Western Slopes of the Northern Chilean Andes. Neotrop Entomol 2013; 42:595-599. [PMID: 27193277 DOI: 10.1007/s13744-013-0170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 08/29/2013] [Indexed: 06/05/2023]
Abstract
Phenological studies are especially important in order to understand the ecological process operating at temporal level. The western slopes of the northern Chilean Andes at about 3,500 m asl are a mosaic of arid environments in which precipitations are highly seasonal, mostly concentrated in summer. Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) is one of the most conspicuous and regularly observed butterflies flying in this region; it is a host specialist associated with the native shrub Senna birostris var. arequipensis (Fabaceae). The objectives of this study were (1) to characterize the temporal variations in the relative abundance of eggs of this host-specialist butterfly and (2) to examine the relationship of these variations with leaf phenology. Monthly samplings of eggs were carried out from February 2011 to January 2012. Circular statistical analyses of the relative abundance of eggs indicated clustered distribution along the year with the mean vector in June. Temporal variation in the relative abundance of eggs was correlated (Spearman rank correlation test) with the availability of plant substrate for egg laying and larval feeding.
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Affiliation(s)
- H A Vargas
- Depto de Recursos Ambientales, Fac de Ciencias Agronómicas, Univ de Tarapacá, Casilla 6-D, Arica, Chile.
| | - H A Benítez
- Fac of Life Sciences, The Univ of Manchester, Manchester, UK
- Instituto de Alta Investigación, Univ de Tarapacá, Arica, Chile
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Mazaheri Y, Vargas HA, Nyman G, Shukla-Dave A, Akin O, Hricak H. Diffusion-weighted MRI of the prostate at 3.0T: Comparison of endorectal coil (ERC) MRI and phased-array coil (PAC) MRI—The impact of SNR on ADC measurement. Eur J Radiol 2013; 82:e515-20. [DOI: 10.1016/j.ejrad.2013.04.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/06/2013] [Accepted: 04/02/2013] [Indexed: 12/17/2022]
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Franiel T, Vargas HA, Mazaheri Y, Böhmer S, Hricak H, Akin O, Beyersdorff D. Role of endorectal prostate MRI in patients with initial suspicion of prostate cancer. ROFO-FORTSCHR RONTG 2013; 185:967-974. [PMID: 24490232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the role of conventional endorectal prostate MRI in patients with initial suspicion of prostate cancer. MATERIALS AND METHODS Ethics board approval was received for this retrospective study of 87 men who underwent 1.5-Tesla conventional prostate MRI with a combination of endorectal and body phased-array coils for suspected prostate cancer before their first systematic 12-core TRUS-guided biopsy. Three radiologists independently analyzed the images, dividing the prostate into 12 regions corresponding to the biopsy scheme and scoring each region for the presence of prostate cancer on a 5-point scale. Results were analyzed by prostate region. ROC analysis was done and descriptive statistics were calculated. The negative predictive value, specificity, sensitivity and positive predictive value were calculated using dichotomized scores (benign tissue = scores of 1 and 2; malignant tissues = scores of 3, 4, and 5). RESULTS Biopsy revealed cancer in 47/87 patients (26 low-grade [Gleason score 6]; 21 high-grade [Gleason score ≥ 3 + 4]), and 184/1044 cores (77 low-grade and 107 high-grade) with a median of 3 positive cores per cancer patient (range 1 – 12). The areas under ROC curves were 0.65 – 0.67 for cancer detection by region overall and 0.75 – 0.76 for the detection of high-grade cancer by region. Statistic figures for the detection of all cancers/high-grade cancers by region were as follows: negative predictive value, 87.4 – 88.2 %/92.6 – 93.1 %; specificity, 72.3 – 79.4 %/71.5 – 79.8 %; sensitivity, 49.5 – 54.8 %/62.6 – 69.2 %; and positive predictive value, 29.3 – 34.0 %/29.4 – 34.7 %. CONCLUSION In patients with suspected prostate cancer, negative MRI findings indicate the absence of high-grade prostate cancer on subsequent TRUS-guided 12-core biopsy with high probability. However, agreement between conventional 1.5-T endorectal prostate MRI and systematic 12-core TRUS-guided biopsy for the detection of prostate cancer appears to be moderate.
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Milgrom SA, Vargas HA, Sala E, Kelvin JF, Hricak H, Goodman KA. Acute effects of pelvic irradiation on the adult uterus revealed by dynamic contrast-enhanced MRI. Br J Radiol 2013; 86:20130334. [PMID: 24052311 DOI: 10.1259/bjr.20130334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Pelvic radiation therapy (RT) can influence fertility in female rectal cancer survivors. Data regarding its effects on the adult uterus are scant. This study aims to evaluate the uterus before and after RT, using dynamic contrast-enhanced MRI. METHODS Eligible patients (n=10) received RT for rectal cancer, had an intact uterus and underwent dynamic contrast-enhanced MRI before and after RT. Seven patients were pre-menopausal. RESULTS Patients received pelvic RT (median, 50.2 Gy) with concurrent 5-fluorouracil. Five patients were treated with intensity modulated RT (IMRT) and five with a three-field technique. The median D95 of the uterus was 30 Gy; D05 was 48 Gy; and V95 was 97%. The median cervical D95 was 45 Gy; D05, 50 Gy; and V95, 100%. Cervical dose was higher with IMRT than with three-field plans (p≤0.038). On T2 MRI, the junctional zone was visible in nine patients before and in one after RT (p=0.001). Median cervical length (2.3 vs 3.0 cm) and endometrial thickness (2.6 vs 5.9 mm) were reduced after RT (p≤0.008). In pre-menopausal patients, the volume transfer constant, K(trans), (0.069 vs 0.195, p=0.006) and the extracellular extravascular volume fraction, V(e), (0.217 vs 0.520, p=0.053) decreased. CONCLUSION Pelvic RT significantly affected uterine anatomy and perfusion. Cervical dose was higher with IMRT than three-field plans, but no attempt was made to constrain the dose. ADVANCES IN KNOWLEDGE Pelvic RT significantly affects the adult uterus. These findings are crucial to understand the potential consequences of RT on fertility, and they lay the groundwork for further prospective studies.
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Affiliation(s)
- S A Milgrom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Franiel T, Vargas HA, Vargas AH, Mazaheri Y, Böhmer S, Hricak H, Akin O, Beyersdorff D. Role of endorectal prostate MRI in patients with initial suspicion of prostate cancer. ROFO-FORTSCHR RONTG 2013; 184:967-74. [PMID: 23999785 DOI: 10.1055/s-0033-1350415] [Citation(s) in RCA: 3] [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] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the role of conventional endorectal prostate MRI in patients with initial suspicion of prostate cancer. MATERIALS AND METHODS Ethics board approval was received for this retrospective study of 87 men who underwent 1.5-Tesla conventional prostate MRI with a combination of endorectal and body phased-array coils for suspected prostate cancer before their first systematic 12-core TRUS-guided biopsy. Three radiologists independently analyzed the images, dividing the prostate into 12 regions corresponding to the biopsy scheme and scoring each region for the presence of prostate cancer on a 5-point scale. Results were analyzed by prostate region. ROC analysis was done and descriptive statistics were calculated. The negative predictive value, specificity, sensitivity and positive predictive value were calculated using dichotomized scores (benign tissue = scores of 1 and 2; malignant tissues = scores of 3, 4, and 5). RESULTS Biopsy revealed cancer in 47/87 patients (26 low-grade [Gleason score 6]; 21 high-grade [Gleason score ≥ 3 + 4]), and 184/1044 cores (77 low-grade and 107 high-grade) with a median of 3 positive cores per cancer patient (range 1 - 12). The areas under ROC curves were 0.65 - 0.67 for cancer detection by region overall and 0.75 - 0.76 for the detection of high-grade cancer by region. Statistic figures for the detection of all cancers/high-grade cancers by region were as follows: negative predictive value, 87.4 - 88.2 %/92.6 - 93.1 %; specificity, 72.3 - 79.4 %/71.5 - 79.8 %; sensitivity, 49.5 - 54.8 %/62.6 - 69.2 %; and positive predictive value, 29.3 - 34.0 %/29.4 - 34.7 %. CONCLUSION In patients with suspected prostate cancer, negative MRI findings indicate the absence of high-grade prostate cancer on subsequent TRUS-guided 12-core biopsy with high probability. However, agreement between conventional 1.5-T endorectal prostate MRI and systematic 12-core TRUS-guided biopsy for the detection of prostate cancer appears to be moderate.
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Affiliation(s)
- T Franiel
- Department of Radiology, University Hospital Jena
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Vargas HA, Vargas-Ortiz M, Huanca-Mamani W, Bobadilla D. First record of Acrocercops serrigera serrigera Meyrick (Lepidoptera: Gracillariidae) from Chile. Neotrop Entomol 2013; 42:112-114. [PMID: 23949720 DOI: 10.1007/s13744-012-0089-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/02/2012] [Indexed: 06/02/2023]
Abstract
Acrocercops Wallengren (Gracillariidae) is recorded for the first time from Chile. The little known Acrocercops serrigera serrigera Meyrick is reported from the Azapa Valley, Arica Province, northern Chilean coastal desert. Specimens were reared from Malva nicaeensis and Waltheria ovata (both Malvaceae). Specimen identification is based on comparisons of the male genitalia with that of the lectotype of the species originated from Peru. Sequences of a fragment of the mitochondrial gene cytochrome oxidase subunit I of specimens reared on both plants indicate that there is only one Acrocercops species involved as only one substitution site was found over the 524-bp sequenced.
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Affiliation(s)
- H A Vargas
- Depto de Recursos Ambientales, Fac de Ciencias Agronómicas, Univ de Tarapacá, Arica, Chile.
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Vargas HA. First host plant record for Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) and evidence for local specialization. Neotrop Entomol 2012; 41:524-525. [PMID: 23949680 DOI: 10.1007/s13744-012-0076-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/09/2012] [Indexed: 06/02/2023]
Abstract
The shrub Senna birostris var. arequipensis (Fabaceae) is recorded as the first host plant for the little known butterfly Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) in the occidental slopes of the Andes, northernmost Chile. Observations on egg-laying and larva-feeding behavior suggest that this butterfly is host specific.
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Affiliation(s)
- H A Vargas
- Depto de Recursos Ambientales, Facultad de Ciencias Agronómicas, Univ de Tarapacá, Arica, Chile.
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Khadem NR, Karimi S, Peck KK, Yamada Y, Lis E, Lyo J, Bilsky M, Vargas HA, Holodny AI. Characterizing hypervascular and hypovascular metastases and normal bone marrow of the spine using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2012; 33:2178-85. [PMID: 22555585 DOI: 10.3174/ajnr.a3104] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The role of DCE-MR imaging in the study of bone marrow perfusion is only partially developed, though potential applications for routine use in the clinical setting are beginning to be described. We hypothesize that DCE-MR imaging can be used to discriminate between hypervascular and hypovascular metastases based on measured perfusion variables. MATERIALS AND METHODS We conducted a retrospective study of 26 patients using conventional MR imaging and DCE-MR imaging. Patients were assigned to a hypervascular or hypovascular group based on tumor pathology. ROIs were drawn around normal-appearing bone marrow (internal controls) and enhancing tumor areas. Average wash-in enhancement slope, average peak enhancement signal percentage change, and average peak enhancement signal percentage change in areas of highest wash-in enhancement slope were calculated. Indices were compared among control, hypervascular, and hypovascular groups. Conventional imaging was assessed by calculating pre- to postgadolinium signal percentage changes in hypervascular and hypovascular lesions. RESULTS Hypervascular and hypovascular tumors differed significantly with regard to wash-in enhancement slope (P < .01; hypervascular 95% CI, 22.5-26.5 AU/s; hypovascular 95% CI, 14.1-20.9 AU/s) and peak enhancement signal percentage change in areas of highest wash-in enhancement slope (P < .01; hypervascular 95% CI, 174.1-323.3%; hypovascular 95% CI, 39.5-150.5%). Peak enhancement signal percentage change over all voxels was not significant (P = .62). Areas of normal-appearing marrow showed no appreciable contrast enhancement. Conventional contrast-enhanced MR imaging was unable to differentiate between hypervascular and hypovascular tumors (P = .58). CONCLUSIONS Our data demonstrate that, unlike conventional MR imaging sequences, DCE-MR imaging may be a more accurate technique in discriminating hypervascular from hypovascular spinal metastases.
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Affiliation(s)
- N R Khadem
- Departments of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Abstract
Male and female adults of a new species of Alucita L. (Lepidoptera: Alucitidae) are described and illustrated from the Azapa Valley, northern Chile. Immature stages are associated with fruit of "chuve", Tecoma fulva (Cav.) D. Don. (Bignoniaceae). This is the first species of Alucitidae described from Chile.
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Affiliation(s)
- H A Vargas
- Depto de Recursos Ambientales, Facultad de Ciencias Agronómicas, Univ de Tarapacá, Arica, Chile.
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Vargas HA. Stigmella epicosma (Meyrick) (Lepidoptera: Nepticulidae): first distribution records from Chile and first host plant record. Neotrop Entomol 2011; 40:152-153. [PMID: 21437500 DOI: 10.1590/s1519-566x2011000100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 10/20/2009] [Indexed: 05/30/2023]
Abstract
The presence of Stigmella epicosma (Meyrick) is reported for the first time from two coastal valleys from northern Chile: Azapa and Chaca. Adults examined were reared from leafminer larvae on Trixis cacalioides (Asteraceae), the first host plant known for S. epicosma.
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Affiliation(s)
- H A Vargas
- Depto de Recursos Ambientales, Facultad de Ciencias Agronómicas, Univ de Tarapacá, Arica, Chile.
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Vargas HA, Hoey ETD, Gopalan D, Agrawal SKB, Screaton NJ, Gulati GS. Congenital and acquired conditions of the aortic root: multidetector computed tomography features. Postgrad Med J 2009; 85:383-91. [DOI: 10.1136/pgmj.2008.075531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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