Primary mediastinal B-cell lymphoma : metabolic and anatomical features in 18FDG-PET/CT and response to therapy

Aim of the study : Determining the role of PET/CT imaging in the evaluation of treatment efficacy in primary mediastinal B-cell lymphoma (PMBCL). Material and methods : Retrospective analysis of seven PMBCL patients, treated at the University Hospital in Krakow, with interim PET/CT after the third course of chemo-immunotherapy. The analysis was based on the calculation of exact tumour volume and metabolic activity, compared with initial values (directly after diagnosis). Results: Patients (five females, two males, average age 26.2 years, range 18–40 years), in clinical stage IIBX at diagnosis, were treated with eight cycles of R-CHOP-14 regimen, with radiotherapy consolidation (7/7) and central nervous system prophylaxis (6/7). The observed decrease in tumour volume between the initial staging and the interim PET ranged 72–89%. The mean ∆SUV max reduction between initial (when available) and interim PET was 87% (range 84–89%). In 3/7 cases in the interim PET/CT, the uptake of the tumour was higher than the liver (Deauville Criteria score 4–5), and in 4/7 it was lower than the liver but higher than mediastinal blood pool structures (score 3 according to Deauville Criteria). After a median follow-up of 58 months – OS and EFS is 100%. Conclusions: The excellent clinical outcome in the study group corresponds with very good metabolic and volumetric response in the interim PET. The ∆SUV max seems to be easier in implementation and has a more significant impact than other measurements

F

The aim of the study was to evaluate the usefulness of 18F-FLT PET/CT in the detection and differentiation of gastric cancers (GC). 104 consecutive patients (57 cases of adenocarcinoma tubulare (G2 and G3), 17 cases of mucinous adenocarcinoma, 6 cases of undifferentiated carcinoma, 14 cases of adenocarcinoma partim mucocellulare, and 10 cases of end stage gastric cancer) with newly diagnosed advanced gastric cancer were examined with FLT PET/CT. For quantitative and comparative analyses, the maximal standardized uptake value (SUVmax) was calculated for both the tumors and noninvaded gastric wall. Results. There were found, in the group of adenocarcinoma tubulare, SUVmax 1.5–23.1 (7.46±4.57), in mucinous adenocarcinoma, SUVmax 2.3–10.3 (5.5±2.4), in undifferentiated carcinoma, SUVmax 3.1–13.6 (7.28±3.25), in adenocarcinoma partim mucocellulare, SUVmax 2–25.3 (7.7±6.99), and, in normal gastric wall, SUVmax 1.01–2.55 (1.84±0.35). For the level of 2.6 cut-off value between the normal wall and neoplasm FLT uptake from ROC analysis, all but five gastric cancers showed higher accumulation of FLT than noninfiltrated mucosa. Conclusion. Gastric cancer presents higher accumulation of 18F-FLT than normal, distended gastric mucosa. Significantly higher accumulation was shown in cancers better differentiated and with higher cellular density

Synthesis and application of (18F) fluorodeoxyglucose in oncology diagnosis

[18F] Fluorodeoxyglucose ([18F] FDG) is the most commonly used radiopharmaceutical in clinical positron emission tomography (PET) in oncology. Cancer cells create their own specific microenvironment to survive and grow. Specific tumor microenvironment contributes to cancer metabolic reprogramming. Therefore, even with sufficient oxygen availability, cancer cells choose anaerobic glycolysis. Cancer cells compensate less energy efficient process by increasing the intensity of anaerobic glycolysis. Tumor cells have a high rate of metabolism and because of this, they take up more of the radioactive glucose (FDG). This makes the tumor cells appear more visible than other areas on the PET scan pictures. This paper presents nucleophilic synthesis of the [18F] FDG marker and basics of tumor development which can affect the [18F] FDG biochemical significance. Reference was made to clinical images obtained in PET technology using the [18F] FDG radiopharmaceutical

EBV-negatywny poprzeszczepowy zespół limfoproliferacyjny u chorej po transplantacji wątroby

We present a case of 60-years-old woman with post-transplant lymphoproliferative disorder,EBV-negative, that was diagnosed in the large intestine 5 years after liver transplantationdue to hepatitis B virus infection. The diagnostic procedures and treatment were guided bythe recommendations of the Polish Lymphoma Research Group. Firstly, reduction ofimmunosupression was initiated followed by rituximab at a dose of 375 mg/m2 intravenousevery 7 days for 4 weeks. No response was observed and CHOP chemotherapy was added forsubsequent 4 cycles. The patient achieved complete remission (CR) confirmed by a computedtomography. Unfortunately the patient died being in CR probably due to pulmonary embolism.W pracy przedstawiono przypadek 60-letniej chorej z EBV-negatywnym potransplantacyjnymzespołem limfoproliferacyjnym (PTLD), zlokalizowanym w jelicie grubym, który zdiagnozowano5 lat po przeszczepieniu wątroby, wykonanym z powodu infekcji wirusem zapalenia wątrobytypu B. Diagnostykę i leczenie PTLD prowadzono zgodnie z rekomendacjami PolskiejGrupy Badawczej Chłoniaków. Początkowo zmniejszono dawkę leków immunosupresyjnych,a następnie chora otrzymywała rytuksymab w dawce 375 mg/m2 dożylnie co 7 dni przez4 tygodnie. Z powodu braku odpowiedzi do rytuksymabu dołączono chemioterapię wedługschematu CHOP. Po 4 cyklach uzyskano całkowitą remisję (CR), potwierdzoną w badaniachobrazowych. Niestety, chora nagle zmarła, pozostając w CR, najprawdopodobniej z powoduzatorowości płucnej

Alendronate 70 therapy in elderly women with post-menopausal osteoporosis: the problem of compliance

Introduction: More than half of those with chronic diseases, including osteoporosis, discontinue treatment during the first year of its administration. This problem increases over the course of continued follow-up. Additionally, it has been observed that 13% of women, prescribed oral daily alendronate, do not even start the treatment, while 20% of patients discontinue the therapy during the first four months. On the other hand, those patients who are compliant achieve increased bone mass density with a simultaneous decrease of fracture risk. The aim of our study was to assess the adherence to the recommended alendronate 70 administration protocol over the course of 12 months by women with post-menopausal osteoporosis. Material and methods: Adherence (compliance plus persistence) to alendronate 70 therapy was assessed in a prospective study of 153 post-menopausal women, followed up for one year with monitoring every two months. Results: Adherence to therapy of all the study participants was high during the entire study period, the patients remaining compliant after a year in 95.08 ± 1.39% (mean ± SEM) of cases, and the mean persistence with medication was 347.05 ± 5.07 days. In the group of patients who interrupted treatment, the mean persistence was 212.44 days. One of the study participants did not start the treatment, and another two discontinued the therapy within 30-60 days of the study onset (between the first two visits). Facilitated contacts with the doctor, continuous access to prescribed treatment and frequent visits significantly improved patient compliance. The common reason for discontinuation was side effects, while age (but not education) affected the rate of compliance with therapy. The worst results were obtained in the group of patients with osteoporosis diagnosed more than five years before the study, particularly in the subgroup where alendronate was being used for the first time or where treatment resumed after a substantial break. Conclusions: The obtained results indicate that better adherence to alendronate 70 therapy, administered once a week, depends on more frequent monitoring of treated patients. (Pol J Endocrinol 2011; 62 (1): 24-29)Wstęp: Wykazano, że ponad 50% pacjentów leczonych z powodu chorób przewlekłych, w tym osteoporozy, przerywa terapię w ciągu pierwszego roku jej stosowania. Problem ten narasta z czasem trwania obserwacji. Stwierdzono, że 13% pacjentów z osteoporozą w ogóle nie rozpoczyna leczenia, a ponad 20% przerywa terapię w ciągu pierwszych 4 miesięcy trwania choroby. Wykazano, że przestrzeganie przez pacjentów wprowadzonej terapii osteoporozy poprawia gęstość mineralną kości i zmniejsza ryzyko złamań. Celem pracy była ocena, w rocznym badaniu prospektywnym, stopnia przestrzegania zaleceń długotrwałej terapii preparatem alendronian 70 przez pacjentki leczone z powodu osteoporozy. Materiał i metody: Ocenie poddano 153 pacjentki w wieku 48-89 lat z rozpoznaną osteoporozą leczone alendronianem 70 mg, jeden raz w tygodniu, przez okres roku. Pacjentki monitorowano co 2 miesiące. Wzięto pod uwagę czas trwania choroby, ciągłość i systematyczność przyjmowania leków oraz przyczynę przerwania stosowanego leczenia. Wyniki: Podczas trwania badania stopień przestrzegania zasad terapii u wszystkich uczestniczek badania był wysoki i łącznie systematyczność po roku utrzymało 95,08 ± 1,39% (średnia ± SEM), a średnia długość przyjmowania leków wyniosła 347,05 ± 5,07 dni. W grupie pacjentek, które przerwały leczenie średni okres stosowania się do zaleceń wyniósł 212,44 dnia. Z całej grupy jedna pacjentka w ogóle nie podjęła leczenia, 2 przerwały w okresie 30-60 dni stosowania, czyli między 2 kolejnymi wizytami. Ułatwienie pacjentowi kontaktu z lekarzem, stały dostęp do leku oraz częste wizyty w znaczny sposób poprawiają stosowanie się pacjentów do zaleceń. Najczęstszą przyczyną przerwania leczenia były działania niepożądane stosowanego preparatu. Wiek, lecz nie wykształcenie, miały wpływ na przestrzeganie terapii. Najgorsze wyniki uzyskano w grupie pacjentek z rozpoznaniem osteoporozy dłuższym niż 5 lat, szczególnie w podgrupie, u której włączono alendronian 70 pierwszy raz lub podjęto leczenie po przerwie. Uzyskane wyniki wskazują na fakt lepszego przestrzegania zaleceń lekarskich przez pacjentów leczonych z powodu osteoporozy w trakcie dobrego monitorowania terapii preparatem cotygodniowym. Krytycznymi momentami decydującymi o przerwaniu leczenia były objawy niepożądane związane z terapią. Wnioski: W przeprowadzonym badaniu wykazano, że częstsze monitorowanie w znaczący sposób poprawia przestrzeganie zasad terapii alendronianem stosowanym w dawkach cotygodniowych. (Endokrynol Pol 2011; 62 (1): 24-29

Izotopowe określenie prawidłowych wartości perfuzji mięśni kończyn dolnych w spoczynku i wysiłku z uwzględnieniem możliwości ich zastosowania w diagnostyce klinicznej

Background: The lack of a range of normal values of perfusion in the lower limbs during stress and at rest narrows the use of this type of diagnostic tool to the estimation of the current state of relative perfusion without indications of the presence or level of perfusion disturbances. Numerous reports on early changes in endothelium reactivity (depending on disease and degree of vessel pathology) encouraged us to assess lower limb perfusion in healthy people. Our goal was to 1) work out a program and method which would enable lower limb perfusion assessment under stress and at rest in patients without signs of lower limb circulation deprivation and 2) establish the normal range of indexes of lower limb perfusion under stress and at rest which would enable their use in the diagnostics of lower limb muscle circulation. Material and Methods: 33 male patients aged between 25 to 45 years (mean: 35.30 ± 6.04) without signs of circulatory problems were entered into the study. To exclude circulatory disturbances, Doppler USG, blood pressure, and laboratory tests were performed on every patient at rest 5 min. after the injection of 11.1 MBq/kg 99 mTc MIBI. Whole body as well as thigh and calf scintigrams were made with an ELSCINT SP6HR gamma-camera. The symmetry of the thigh and calf perfusion (WSU, WSP) and the indexes of the thigh (WPLU, WPPU) and calf (WPLP, WSPP) perfusion of both lower limbs were estimated. Results: At rest: WSP: 96.47% ± 1.02, WSP: 96.47% ± 1.02, WPLP: 9.77 ± 0.32, WPPP: 9.78 ± 0.31, WPLU: 8.45 ± 0.22, WPPU: 8.48 ± 0.22. Under stress: WSP: 96.69% ± 1.32, WSU: 96.41% ± 1.20, WPLP: 8.78 ± 0.26, WPPP: 8.81 ± 0.25, WPLU: 7.77 ± 0.25, WPPU: 7.82 ± 0.26. Anamnesis, additional studies, and laboratory tests in the group examined did not show any circulatory disturbances. Conclusions: The estimated values in patients without circulatory disturbances are similar and within a narrow range, which allows us to calculate the norms of lower limb perfusion at rest and under stress. The determined normal values may be essential in diagnostics in permitting differentiation of healthy patients from those with vascular pathology of the lower limb circulation at an early stage