Molecular imaging in the combined modality treatment of lung cancer

Patients with locally advanced lung cancer receive a combined treatment of radiotherapy and chemotherapy. This dissertation studied how this treatment can be optimized by means of molecular imaging with positron emission tomography (PET). The results show that the radiation area of small-cell lung cancer can be diminished safely by using the PET scan. It is further shown that, 3 months after the treatment, a PET scan can determine the progression of the disease in a stage when re-treatment is still possible. Finally, 2 new PET tracers are evaluated, aimed at specific biological characteristics of cancer cells. The studies show that these tracers can be safely used. Future studies will be necessary to define the optimal imaging circumstances. This research received partial support from ‘KWF kankerbestrijding’.lung cance

CONFRONTO TRA IL SISTEMA DI STADIAZIONE TNM-AJCC 8a EDIZIONE E IL SISTEMA DI STADIAZIONE GIAPPONESE (JSCCR) NEL CANCRO DEL COLON

Background: La Chirurgia rimane l’approccio terapeutico più efficace nel trattamento del cancro del colon. I suoi obbiettivi principali sono il trattamento del tumore primario, determinare lo status linfonodale e la terapia della malattia metastatic. La presenza di linfonodi (LNs) positivi sono un fattore prognostico nella predizione della DFS, OS in pazienti non metastatici e lo sviluppo di malattia metastatica. Inoltre, determinano se il paziente dovrà eseguire chemioterapia adiuvante. Studi recenti hanno dimostrato che la prognosi non è determinata solo dal numero di LNs positivi, bensì, anche la loro distribuzione topografica.In occidente è utilizzata la classificazione del TNM-AJCC, che definisce una corretta linfadenectomia come l’asportazione di almeno 12 linfonodi, non tenendo conto della loro distribuzione topografica. D’altro canto, la classificazione JSCCR (Japanese Society for Cancer of the Colon and Rectum) tiene in considerazione non solo il numero di linfonodi positivi ma anche la loro distribuzione topografica. Al momento attuale non vi sono study che determinino la superiorità di un sistema di stadiazione sull’altro in termini di predizione della OS e del tempo di ricorrenza di malattia a 3 anni. Data l’importanza prognostica dello status linfonodale, la sua corretta stadiazione continua ad essere argomento di dibattito. Objectives: Obiettivi primari, 1) Applicabilità della classificazione JSCCR alla nostra popolazione. 2) Agreement tra i diversi stadi di malattia applicando entrambi i sistemi di stadiazione. Obiettivi secondari, 1) Valutare se il sistema JSCCR può individuare sottocategorie di rischio in base alla distribuzione topografica dei LN’s positivi con un follow-up di 3 anni. 2) Determinare se il sistema JSCCR può individuare sottocategorie con un tasso di mortalità diverso in base alla distribuzione topografica dei LN’s positivi. Methods: Questo è uno studio prospettico monocentrico. Abbiamo arruolato 91 pazienti con diagnosi di cancro del colon in un periodo di 12 mesi, 6 pazienti sono stati esclusi dallo studio. Criteri di inclusione: pazienti >18 anni con diagnosi di cancro del colon che eseguiranno il periodo di follow-up presso il nostro Instituto. Criteri di esclusione: pazienti con diagnosi di cancro del retto, tumori solidi sincroni, malattie oncoematologiche, pazienti che siano stati sottoposti a chemioterapia neoadiuvante e pazienti con ripresa di malattia/malattia metastatica. L’analisi riguarda solo gli obiettivi primari dato che gli obiettivi secondary stabiliscono il rischio di ricorrenza e la mortalità, che richiedono un periodo di follow-up. Le variabili continue sono caratterizzate da media e range. Le variabili categoriche sono state rapportate come assoluti e le loro relative frequenze. La classificazione JSCCR è stata definita come applicabile nei casi nei quali sia in grado di definire uno stadio di malattia. L’applicabilità per la classificazione JSCCR è stata calcolata come una percentuale con un intervallo di confidenza del 95% d’accordo con Wilson score intervals. É stato calcolata la percentuale di casi nei quali entrambi i sistemi determinavano il medesimo stadio di malattia per lo stesso paziente con un CI di 95%. Il grado di agreement è stato determinato con il coefficiente K di Cohen con un CI di 95%. Results: La Classificazione JSCCR ha provato di essere applicabile in 85/85 dei casi inclusi in questo studio. Entrambe le classificazioni, la TNM-JSCCR e la JSCCR, hanno dimostrato un forte grado di agreement (100%, 95% CI: 94.6-100). Conclusions: La classificazione JSCCR può essere applicabile alla nostra popolazione senza nessuna variabilità nei confronti della classificazione TNM-AJCC. Il forte agreement tra i due sistemi di stadiazione potrebbe essere dovuto alle ridotte dimensioni del campione.Background: Surgery remains the most efficient therapeutic approach to colon cancer. Its main targets are the treatment of the primary tumor, determining the lymph node status, and the treatment of metastatic disease. Lymph nodes (LNs) are a significant prognostic factor in predicting disease-free survival (DFS) and overall survival (OS) in patients without metastatic disease. LN metastases are a risk factor for disease recurrence and the development of metastatic disease. Furthermore, they determine whether or not the patient should undergo adjuvant therapy. Recent studies have stated that the prognosis is not only determined by the number of positive LNs but that their topographic distribution may carry an important role. Currently, we apply the AJCC-TNM classification, in which a correct nodal sampling is based on the retrieval of at least 12 LNs regardless of their location. On the other hand, the JSCCR (Japanese Society for Cancer of the Colon and Rectum) classification takes into consideration the topographic distribution of the positive LNs. At this moment there are no studies that determine the superiority of one system over the other in terms of predicting 3-year disease recurrence and OS. Due to the important prognostic value that the LN status has, its correct staging is a largely debated argument. Objectives: Primary aims, 1) Applicability of the JSCCR classification to our population. 2) Agreement between disease stages applying both staging systems. Secondary aims, 1) Evaluate if the JSCCR system can highlight recurrence risk subcategories based on the topographic distribution of positive LN’s with a 3-year follow-up. 2) Assess if the JSCCR system can detect a different mortality rate in subcategories based on the topographic distribution of positive LN’s. Methods and Results: This is a monocentric prospective study that aimed to confront these two grading systems. We have determined the main differences and similarities between both staging systems. We enrolled 91 patients with a diagnosis of colon cancer in a 12-month period, from which 6 patients were withdrawn from the study. Inclusion criteria: patients >18 years old with a diagnosis of colon cancer who agree to continue the follow-up period in our institution. Exclusion criteria: patients with a diagnosis of rectal cancer, synchronous solid tumors, oncohematologic diseases, patients who underwent neoadiuvant therapies, and patients with recurrent/metastatic disease. The analysis concerns only the primary aims (feasibility and agreement) because the secondary aims assess the risk of recurrence and related mortality which require a 3-year follow-up. Continuous variables were characterized by median and range. Categorical data were summarized as absolute and relative frequencies. The JSCCR classification was defined as applicable whenever it was able to define the disease stage. The applicability of the JSCCR classification was calculated as a percentage with a confidence interval of 95% according to Wilson. It was calculated the percentage of cases in which both systems appointed the same stage for each patient with a CI of 95% according to Wilson. The degree of agreement was deterred by Cohen’s K coefficient with a CI of 95%. Statistical analysis was performed with R 4.0.4 software. Results: The JSCCR classification proved to be applicable in 85/85 cases included and evaluated in the study. Both classifications, TNM-AJCC and JSCCR, showed a strong level of agreement (100%, 95% CI: 94.6-100). Conclusions: The JSCCR classification can be applied to our population without any variability concerning the vastly used TNM-AJCC classification. The fact that both systems presented such a strong level of agreement (100%) while determining the disease stage could be due to the small sample size. To better assess if the differences between both staging systems could carry and upgrade or downgrade in stage, a bigger sample size is needed

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

The impact of functional imaging on radiation medicine

Radiation medicine has previously utilized planning methods based primarily on anatomic and volumetric imaging technologies such as CT (Computerized Tomography), ultrasound, and MRI (Magnetic Resonance Imaging). In recent years, it has become apparent that a new dimension of non-invasive imaging studies may hold great promise for expanding the utility and effectiveness of the treatment planning process. Functional imaging such as PET (Positron Emission Tomography) studies and other nuclear medicine based assays are beginning to occupy a larger place in the oncology imaging world. Unlike the previously mentioned anatomic imaging methodologies, functional imaging allows differentiation between metabolically dead and dying cells and those which are actively metabolizing. The ability of functional imaging to reproducibly select viable and active cell populations in a non-invasive manner is now undergoing validation for many types of tumor cells. Many histologic subtypes appear amenable to this approach, with impressive sensitivity and selectivity reported