Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

BACKGROUND: Multidrug chemotherapy increases the efficacyof the treatment, but at the same time rises its cardiotoxicity. Themajority of cardiac complications are caused by anthracyclines.Radiation therapy may intensify cardiotoxicity. The aim of thisstudy was to determine early changes of cardiac function usingradionuclide ventriculography in patients with breast cancer andto compare the toxicity of AC and AT chemotherapy programs.MATERIAL AND METHODS: The study included 71 patientswith breast cancer between the ages of 38 and 71 years. Allpatients after surgery were qualified for chemotherapy, and for37 (52%) of them subsequent irradiation treatment was planned.Patients received chemotherapy according to the scheme: AC— 47 patients (66%) and AT — 24 patients (34%). Patients wereirradiated using a photon beam (4 to 6 MeV) and an electronbeam (6–15 MeV). In all patients, before and six months afterthe treatment, radionuclide ventriculography was performed.RESULTS: In all 71 patients a reductions in left ventricularejection fraction (EF) and in peak filling rate (PFR) as well asan increase in the end-systolic and end-diastolic volumes (ESvol,EDvol) were observed. AC chemotherapy, where cumulativeanthracycline dose was higher, significantly decreased leftventricular ejection fraction and PFR and increased ESvol. AfterAT chemotherapy the EF reduction proved to be smaller. Radiotherapydid not significantly lower the value of EF as comparedto the group of patients who underwent chemotherapy.CONCLUSIONS: Radionuclide ventriculography is a usefulmethod of evaluating the cardiotoxicity of the treatment. Earlyindicators of myocardial damage are EF, PFR, ESvol and EDvol.AC chemotherapy, where the average cumulative dose of anthracyclineswas higher, caused more cardiotoxic effects thanAT chemotherapy.Applying additional radiotherapy did not significantly increasethe cardiotoxicity of the treatment

Problems of diagnostic assessment in advanced pancreatic neuroendocrine neoplasm and treatment implications: a case report and literature review

We are reporting a case of a 55-year-old woman who was diagnosed as having a non-functioning pancreatic neuroendocrine neoplasm (NF-PNEN), the World Health Organization (WHO) low grade (G1) with liver metastases. In the staging process the positron emission tomography — computed tomography with Fluorine-18-Fluorodeoxyglucose (F-FDG PET-CT) and spiral CT then the gallium-DOTA-octreotate positron emission tomography — computer tomography (68Ga-DOTATATE PET-CT) shown difference in burden of disease. In first line therapy, everolimus (Afinitor®, Novartis Pharma GmbH, Germany) at the oral dose of 10 mg once daily and octreotide long-acting release (Sandostatin LAR®) 30 mg i.m. every 4 weeks were administered. Then, due to disease progression — radioisotope therapy with b-emitter Yttrium-90 (90Y). Based on this experience and on the review of the literature, we recommend that the discrepancy between the imaging studies could be due to heterogeneity of proliferation rate and somatostatin receptors (SSTR) expression within a primary PNEN and metastases. Therefore in such cases of advanced PNEN WHO G1 in the lack of response to everolimus and octreotide LAR administration isotope therapy without a prior chemotherapy should be considered as a palliative treatment according to ESMO Clinical Practice Guidelines and Polish Network of Neuroendocrine Tumors.  We are reporting a case of a 55-year-old woman who was diagnosed as having a non-functioning pancreatic neuroendocrine neoplasm (NF-PNEN), the World Health Organization (WHO) low grade (G1) with liver metastases. In the staging process the positron emission tomography — computed tomography with Fluorine-18-Fluorodeoxyglucose (F-FDG PET-CT) and spiral CT then the gallium-DOTA-octreotate positron emission tomography — computer tomography (68Ga-DOTATATE PET-CT) shown difference in burden of disease. In first line therapy, everolimus (Afinitor®, Novartis Pharma GmbH, Germany) at the oral dose of 10 mg once daily and octreotide long-acting release (Sandostatin LAR®) 30 mg i.m. every 4 weeks were administered. Then, due to disease progression — radioisotope therapy with b-emitter Yttrium-90 (90Y). Based on this experience and on the review of the literature, we recommend that the discrepancy between the imaging studies could be due to heterogeneity of proliferation rate and somatostatin receptors (SSTR) expression within a primary PNEN and metastases. Therefore in such cases of advanced PNEN WHO G1 in the lack of response to everolimus and octreotide LAR administration isotope therapy without a prior chemotherapy should be considered as a palliative treatment according to ESMO Clinical Practice Guidelines and Polish Network of Neuroendocrine Tumors

The diagnostic role of 68Ga-DOTATATE PET/CT in the detection of neuroendocrine tumours

BACKGROUND: Positron emission tomography (PET) combined with computer tomography (CT) using 68Ga-DOTATATE is a promising method for the evaluation of patients with recognised or suspected neuroendocrine tumours (NET). The aim of this study was to assess the diagnostic value of 68Ga-DOTATATE PET/CT in the visualisation of the expression of somatostatin receptors (SSTR) and identification of new lesions. MATERIAL AND METHODS: Between December 2009 and January 2011 ninety-seven patients with confirmed (88 cases) or suspected (9 cases) NET underwent 68Ga DOTATATE PET/CT. The primary, confirmed or suspected, NET localizations were: GEP tumours — 71 patients; medullary thyroid carcinoma — 4 patients; cancer of an unknown primary — 14 patients; and NET in other localisations — 8 patients. PET/CT acquisitions were performed using standard techniques, 45 to 60 minutes after the intravenous injection of 111–185 MBq 68Ga-DOTATATE. RESULTS: 68Ga-DOTATATE PET/CT detected the presence of lesions demonstrating the somatostatin receptor affinity in 50 of the 97 patients (51.5%) and was negative in 47 patients (48.5%). Among 14 patients with metastatic unknown primary cancer, in 5 patients (45.5%) the primary tumour site was identified, and in 4 patients with medullary thyroid cancer distant metastases with SSTR expression were localized in only one patient. CONCLUSIONS: Our findings confirm the diagnostic role of 68Ga-DOTATATE PET/CT as an accurate method of identifying primary tumours and distant metastases. It provides information on tumour cell receptors status, which has a significant bearing on planning target radionuclide therapy. Overall, 68Ga-DOTATATE PET/CT can be used in staging, re-staging, and in regular follow up of oncology patients. Nuclear Med Rev 2011; 14, 1: 16–2

The role of 18F-FDG PET/CT in the diagnosis of recurrent colorectal cancer

Rak jelita grubego jest jednym z najczęściej występujących nowotworów złośliwych w Polsce i na świecie. Coraz częściej stosowaną i uznaną w onkologii metodą diagnostyczną jest badanie PET/CT — jedna z najnowocześniejszych metod diagnostyki obrazowej. Dzięki połączeniu obrazowania anatomicznego (CT) z obrazowaniem metabolicznym (PET) umożliwia wczesną identyfikację zmian rozrostowych, dokładną ocenę stopnia zaawansowania nowotworu. W diagnostyce wznowy raka jelita grubego badanie PET/CT z zastosowaniem fluorodeoksyglukozy (18F-FDG) ma udowodnioną wartość kliniczną. Informacje uzyskane w badaniu w istotnym stopniu wpływają na podejmowane decyzje terapeutyczne. W przypadku planowanej metastazektomii metoda ta pozwala precyzyjniej niż inne ocenić stopień zaawansowania wznowy, zlokalizować wszystkie ogniska nawrotu, a co za tym idzie, pozwala uniknąć niepotrzebnych zabiegów. Standardowo wykonywane badanie 18F-FDG PET/CT, polegające na wykonaniu badania tomografi i komputerowej tzw. low dose bez podania dożylnego środka kontrastującego, a następnie rejestracji PET i wykonaniu fuzji obu obrazów, nie dostarcza jednak wystarczających informacji dotyczących oceny stosunku guza bądź nacieku do narządów sąsiednich oraz naczyń, niezbędnych do pełnej oceny operacyjności wznowy, dostępnych w badaniu tomografi ikomputerowej z zastosowaniem dożylnego środka kontrastującego. Wykonanie badania 18F-FDG PET/CT wg schematu low dose CT, PET, a następnie CT z dożylnym podaniem środka kontrastującego umożliwia uzyskanie na podstawie jednego badania wszystkich niezbędnych informacji dotyczących operacyjności zmiany i może w przyszłości stać się badaniem z wyboru w diagnostyce wznowy raka jelita grubego.Colorectal cancer is one of the most common cancers worldwide, including Poland. PET/CT is a relatively new diagnostic imaging method which has gained wide acceptance in oncology. The combination of anatomical imaging (CT) and metabolic imaging (PET) enables early identification of proliferative changes and thus an accurate staging of cancer. In the diagnosis of recurrent colorectal cancer, PET/CT with fluorodeoxyglucose (18F-FDG) has proven to be of high clinical value. The information obtained in this study has a significant impact on patient management. When there is suspicion of relapse, it is important to use an effective restaging tool to accurately define the extent of the recurrence and to plan the proper therapy. In the standard protocol for the 18F-FDG PET/CT study, fused images of low dose CT (without intravenous contrastagent) and PET are performed. This approach does not provide sufficient information of local tumor or invasion to adjacent organs and vessels to enable assessment of the suitability for resectability. This information is, however, available from computed tomography when intravenous contrast agent is used. Implementation of the PET/CT protocol consisting of low dose CT, with PET followed by CT with intravenous contrast agent in the corresponding region, provides in a single study all the necessary information required to qualify patients for surgery. It may in the future become the modality of choice in the diagnosis of colorectal cancer recurrence

Role of Advanced Glycation End Products in Assessment of Diabetes Mellitus as a Risk Factor for Retinal Vein Occlusion

Aim: In this study, we aimed to assess the correlation between diabetes mellitus (DM) and the retinal vein occlusion (RVO) based on skin autofluorescence (SAF) measurement, which reflects the accumulation of advanced glycation end products (AGE) in patients who have undergone an episode of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). Material and methods: In total, 23 patients (16 males, 7 females) with RVO were included in this study. Among these 23 participants, 12 (52%) had been diagnosed with CRVO and 11 (48%) with BRVO. The control group consisted of 14 healthy volunteers (11 females, 3 males). To calculate the risk of cardiovascular diseases (CVD) and DM, we conducted SAF examinations. We compared the SAF levels in three groups of patients: (1) with CRVO, (2) with BRVO, and (3) the control group. Basic demographic and clinical information and detailed history of the concurrent diagnoses of systemic diseases, such as systemic hypertension (HTN), DM, hyperlipidemia (HL), and heart diseases, were obtained. Results: In total, 10 (43.5%) patients were diagnosed with DM, 6 (55%) in the BRVO group and 4 (33%) in the CRVO group. The mean SAF value was significantly higher in the BRVO group than in the control group (2.64 a.u. and 2.35 a.u., respectively) (p = 0.023). More patients with risk of DM were identified in the CRVO group than in the BRVO group (p = 0.024). Conclusions: The advanced glycation end products (AGE) in the skin autofluorescence (SAF) is a viable method of evaluating the risk of DM in patients with RVO. We confirmed a correlation between RVO and DM, which was significantly pronounced in the CRVO form, although further carefully devised studies on the relationship between RVO and DM with a larger number of responders should be conducted in the future