is 18f fluorodeoxyglucose uptake by the primary tumor a prognostic factor in breast cancer

Abstract Background We retrospectively investigated 18F-FDG uptake by the primary breast tumor as a predictor for relapse and survival. Patients and methods We studied 203 patients with cT1-T3N0 breast cancer. Standardized uptake value (SUVmax), was measured on the primary tumor. After a median follow-up of 68 months (range 22–80), the relation between SUVmax and tumor factors, disease free-survival (DFS) and overall survival (OS) was investigated. Results In the PET-positive patients, the median FDG uptake by the tumor was 4.7. FDG uptake was significantly related to tumor size, number of involved axillary nodes, grade, negative ER, high Ki-67 and HER2 overexpression. No distant metastases or deaths occurred in the PET-negative group. Five-year DFS was 97% and 83%, respectively in the PET-negative and PET-positive groups (P = 0.096). At univariate analysis, DFS was significantly lower in patients with SUVmax >4.7 compared to the patients with negative PET (P = 0.042), but not to the patients with SUVmax ≤4.7 (P = 0.106). At multivariable analysis, among PET-positive patients, SUVmax was not an independent prognostic factor for DFS (HR>4.7 vs ≤4.7: 1.02 (95% CI 0.45–2.31)). Five-year OS was 100% and 93%, respectively, in the PET-negative and PET-positive groups (P = 0.126). Conclusion FDG uptake by the primary lesion was significantly associated with several prognostic variables, but it was not an independent prognostic factor

Eleven-year experience with the avidin-biotin pretargeting system in glioblastoma: Toxicity, efficacy and survival

Background: The 3-step avidin-biotin pretargeting approach is applied in patients with recurrent glioblastoma (GBM), using biotinylated anti-tenascin monoclonal antibody as the first step of pretargeting followed by avidin and 90Ybiotin. Methods: The present study reviews objective response and overall survival rates in 502 glioblastoma patients treated with 3-step radioimmunotherapy in our institute from December 1994 to December 2005. Patients underwent standard treatment before receiving Pretargeted Antibody-Guided Radionuclide Therapy with 90Y-biotin (PAGRIT ®). Results: Of the 502 patients, 272 (54%) were evaluable for response and 375 (75%) for overall survival. 174 patients (64%) continued to progress after PAGRIT ®, 77 (28%) obtained disease stabilization, and 21 (8%) showed objective tumor regression. Survival of the 375 evaluable patients was 98.4% at 6 months, 79.2% at 12 months, 51.7% at 18 months, and 30.7% at 24 months after the first cycle of PAGRIT ®. All 375 received 3-step PAGRIT ® at recurrence of GBM. The median survival time from diagnosis was 19 months. Conclusion: The results from this retrospective analysis suggest that 90Y-biotin PAGRIT ® interferes with the progression of glioblastoma, prolonging survival in a larger number of patients. Our analysis forms the basis for further prospective trials, where radioimmunotherapy, which is known to be more effective in minimal residual disease, could be offered immediately after surgery. © Grana et al.; Licensee Bentham Open

Local accelerated radionuclide breast irradiation: Avidin-biotin targeting system

Breast cancer remains the most common cancer in women in the developed world and the most frequent cause of cancer-related death among women worldwide [1]. In 2010 in the United States, the estimated number of new cases of breast cancer was 207,090 (28 % of all cancer in women), with 39,840 expected deaths (second cause of death after lung and bronchus carcinoma) [2]. Fortunately, thanks to the screening campaigns carried out in the Western countries, breast cancer can be treated in its early phase. The conventional surgical treatment for early breast cancer consists of either a mastectomy or breast conserving surgery (BCS), often accompanied by axillary dissection or sentinel node biopsy. If BCS is performed, whole breast external beam radiotherapy (EBRT) with doses around 50-60 Gy remains the gold standard for local control. The benefit of postoperative radiotherapy is well known since the completion of few prospective randomized trials conducted in the years 1976-1990, which compared conservative surgery and radiation with conservative surgery alone. Several clinical trials compared also breast conservative surgery (BCS) alone vs. BCS followed by whole breast (WB) EBRT: 10-35 % of women receiving BCS alone showed locoregional recurrence, whilst it occurred only in 0.3-8 % of women after BCS plus WB-EBRT (follow-up range: 39-102 months), although both treatments produced the same 10-year overall survival rates [3]. However, there is some recent evidence that lack of radiotherapy is associated with an increased hazard ratio for death [4]. Current accepted treatment protocol takes advantage of the above experiences and consists of BCS, usually accompanied by axillary node dissection or sentinel node biopsy. If BCS is performed, it is almost always accompanied by postoperative regional radiotherapy; 2 Gy per day delivered five times a week for 6-8 weeks, for a total dose of 50-60 Gy to eliminate microscopic cancer foci remaining after surgery [5]. A substantial benefit of an additional boost with 16 Gy to the tumor bed was recently confirmed by the EORTC [6] particularly in premenopausal women

Are we ready for an early evaluation of the response of axillary lymph node metastases to neoadjuvant therapy?

No abstract availabl

Preoperative FDG PET/CT in breast cancer patients: Where are we going?

No abstract availabl

Sentinel node detection and radioguided occult lesion localization in breast cancer

Sentinel lymph node biopsy might replace complete axillary dissection for staging of the axilla in clinically N0 breast cancer patients and represent a significant advantage as a minimally invasive procedure, considering that about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. In our Institute, Radioguided Occult Lesion Localization is the standard method to locate non-palpable breast lesions and the gamma probe is very effective in assisting intra-operative localization and removal, as in sentinel node biopsy. The rapid spread of sentinel lymph node biopsy has led to its use in clinical settings previously considered contraindications to sentinel lymph node biopsy. In this contest, we evaluated in a large group of patients possible factors affecting sentinel node detection and the reliability of sentinel lymph node biopsy carried out after large excisional breast biopsy. Our data confirm that a previous breast surgery does not prohibit efficient sentinel lymph node localization and sentinel lymph node biopsy can correctly stage the axilla in these patients

Investigation of 18F-FDG PET in the selection of patients with breast cancer as candidates for sentinel node biopsy after neoadjuvant therapy

Purpose The main objective of this study was to determine the role of [ 18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the selection of patients with breast cancer as candidates for sentinel node biopsy (SNB) after neoadjuvant therapy. Methods Forty-four patients with primary breast cancer clinically classified as cT2, cT3 or cT4 a-c cN0-N2 or cN3 M0 and with a baseline FDG PET scan positive both in the site of primary tumour and axillary lymph nodes underwent neoadjuvant therapy and then a second FDG PET scan. In the case of axillary FDG PET uptake, patients underwent axillary lymph node dissection (ALND). If the second FDG PET scan was negative for axillary involvement, SNB was performed in order to evaluate axillary lymph node status. Only in the case of SN positivity did total ALND follow. Results Specificity and positive predictive value of FDG PET for detection of axillary lymph node metastases after neoadjuvant therapy were as high as 83% (95% confidence interval: 51-97%) and 85% (95% confidence interval: 54-97%), respectively, whereas sensitivity, negative predictive value and diagnostic accuracy were inadequate for a correct staging (34, 32 and 48%, respectively). Conclusion The poor sensitivity of FDG PET in detecting axillary lymph node metastases makes SNB mandatory in cases of a negative scan. The relatively high positive predictive value seems to suggest a role of FDG PET in selecting patients who, after neoadjuvant therapy, are candidates for ALND, avoiding SNB. However, this issue requires confirmation in a larger series of patients. © Springer-Verlag 2010

Positron emission tomography for the detection of colorectal adenomas

Background: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) has been reported to detect colorectal adenomas. Aims: This study aimed at evaluating the sensitivity of 18F-FDG PET with computed tomography image fusion (PET/CT) for detecting colorectal adenomas. Methods: We retrospectively compared the results of 92 18F-FDG PET/CT studies followed by colonoscopy. Colonoscopy and histology were considered as the gold standard. Results: One hundred fifty-seven lesions were observed. All the 12 malignancies were identified by 18F-FDG PET/CT but only 27 out of 119 resected adenomas (sensitivity 22.7%) and none of the hyperplastic polyps were detected. At the univariate and multivariate analyses there was a significant statistical association between adenomas sized more than 10 mm, presence of villous component and high-grade dysplasia and the ability of 18F-FDG PET/CT to detect adenomas. 18F-FDG PET/CT showed an overall sensitivity of 29.8%, a specificity of 81.1%, a positive predictive value (PPV) of 84.8% and a negative predictive value (NPV) of 24.6% for the neoplastic colorectal lesions globally considered. Conclusion: 18F-FDG PET/CT has a low sensitivity for detecting adenomas. However, because of the specificity and PPV of the technique for neoplastic colorectal lesions, the presence of a focal colorectal FDG uptake justifies the patient undergoing colonoscopy. © 2009 Editrice Gastroenterologica Italiana S.r.l

Lymphocytic toxicity in patients after peptide-receptor radionuclide therapy (PRRT) with 177lu-DOTATATE and 90Y-DOTATOC

Purpose: Peptide-receptor radionuclide therapy (PRRT) with somatostatin analogs is an efficient new tool in patients with neuroendocrine tumors, with low risk of toxicity. Since lymphocytes express somatostatin receptors, the aim of this study was to evaluate lymphocytic toxicity after PRRT. Methods: From May 2005 to May 2007, 16 patients affected by neuroendocrine tumors received PRRT with 90Y-DOTATOC (9), 177Lu-DOTATATE (5), or both (2). Absolute count, percentage of leukocytes and lymphocytes, and lymphoid subsets (B, T, and NK) were tested at baseline and until 90 days after treatment. Results: A significant lymphoid toxicity (G2-3), mainly affecting B-cells, was observed. It was particularly evident after 90Y-DOTATOC. Toxicity resulted in being transient and resolved completely at the end of the follow-up (90 days). Conclusion: Lymphocyte toxicity in PRRT is mainly due to the selective targeting on B-cells. The relative sparing of T-lymphocytes could explain the absence of clinical side-effects in these patients, such as increased risk of infections. These findings open interesting perspectives in the treatment of B-cell lymphoproliferative disorders. © 2009 Mary Ann Liebert, Inc