O PET/CT interim com fluoreto- 18 F é capaz de predizer desfechos após a terapia com rádio-223?

To dichloride ( 223 RaCl 2 ) therapy is able to identify patients that will not respond to treatment. We retrospectively reviewed 34 histologically confirmed cases of hormone-refractory prostate cancer with bone metastasis in patients submitted to 223 RaCl 2 therapy. All of the patients underwent baseline and interim 18 F-fluoride PET/CT studies. The interim study was performed immediately prior to the fourth cycle of 223 RaCl 2 . The skeletal tumor burden—expressed as the total lesion fluoride uptake above a maximum standardized uptake value of 10 (TLF 10 )—was calculated for the baseline and the interim studies. The percent change in TLF 10 between the baseline and interim studies (%TFL 10 ) was calculated as follows: %TFL 10 = interim TLF 10 − baseline TLF 10 / baseline TLF 10 . End points were overall survival, progression-free survival, and skeletal-related events. The mean age of the patients was 72.4 ± 10.2 years (range, 43.3–88.8 years). The %TLF 10 was not able to predict overall survival (p = 0.6320; hazard ratio [HR] = 0.753; 95% confidence interval [CI]: 0.236–2.401), progression-free survival (p = 0.5908; HR = 1.248; 95% CI: 0.557–2.797) nor time to a bone event (p = 0.5114; HR = 1.588; 95% CI: 0.399–6.312). The skeletal tumor burden on an interim 18 F-fluoride PET/CT, performed after three cycles of 223 RaCl 2 , is not able to predict overall survival, progression-free survival, or time to bone event, and should not be performed to monitor response at this time5213340FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão temAvaliar se o PET/CT interim com fluoreto-18F após a terceira dose da terapia com dicloreto de rádio-223 (223Ra) é capaz de identificar pacientes que não responderão ao tratamento. Revisamos, retrospectivamente, 34 pacientes com diagnóstico histológico de câncer de próstata refratários a hormonioterapia e com metástases ósseas que foram submetidos a 223Ra. Todos os pacientes foram submetidos a PET/CT com fluoreto-18F antes de iniciar o tratamento (basal) e imediatamente antes da quarta dose de 223Ra (interim). A carga tumoral esquelética (TLF10) foi calculada em ambos os exames da PET/CT com fluoreto-18F de cada paciente e foi determinada a alteração percentual na TLF10 entre eles (%TFL10 = TLF10 interim - TLF10 basal / TLF10 basal). Foram avaliados a sobrevida global, a sobrevida livre de progressão e o tempo para um evento ósseo. A idade média dos pacientes foi 72,4 ± 10,2 anos (variação: 43,3-88,8 anos). A %TLF10 não foi capaz de predizer a sobrevida global (p = 0,6320; HR = 0,753; intervalo de confiança [IC] 95%: 0,236-2,101), a sobrevida livre de progressão (p = 0,5908; HR = 1,248; IC 95%: 0,557-2,797) nem o tempo para um evento ósseo (p = 0,5114; HR = 1,588; IC 95%: 0,399-6,312). A carga tumoral esquelética da PET/CT com fluoreto-18F realizada após três doses de 223Ra não é capaz de predizer sobrevida global, sobrevida livre de progressão ou tempo até um evento ósseo, e não deve ser realizada para monitorar a resposta ao tratamento desses pacientes, nesse momento

Subclinical cardiotoxicity following adjuvant dose-escalated FEC, high-dose chemotherapy, or CMF in breast cancer

We compared adjuvant chemotherapy-related myocardial damage by antimyosin scintigraphy in patients who received either nine cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) where the doses of epirubicin and cyclophosphamide were escalated according to the leucocyte nadir (group I, n = 14), three cycles of FEC followed by high-dose chemotherapy with alkylating agents (CTCb) given with the support of peripheral blood stem cell transplantation (group II, n = 14), or six cycles of standard intravenous CMF (cyclophosphamide, methotrexate and fluorouracil; group III, n = 8). The cardiac uptake of In-111-antimyosin-Fab (R11D10) antibody was measured and the heart-to-lung ratio (HLR) calculated 8–36 months after the last dose of chemotherapy. Cardiac antimyosin antibody uptake was considerably higher among patients treated with nine cycles of dose-escalated FEC than among those who were treated with three cycles of FEC and high-dose CTCb (HLR, median 1.98; range 1.36–2.24 vs median 1.51; range 1.20–1.82;P< 0.001), or those treated with CMF (median 1.44; range 1.15–1.68;P< 0.001). The difference between groups II and III was not significant (P> 0.1). A linear association was found between the cumulative dose of epirubicin and the cardiac antimyosin uptake (P< 0.001). We conclude that subclinical cardiac damage caused by three cycles of conventional-dose FEC followed by one cycle of high-dose CTCb chemotherapy is small as compared with the damage caused by dose-escalated FEC. © 2000 Cancer Research Campaig

LU-177-PSMA TREATMENT FOR METASTATIC PROSTATE CANCER – CASE EXAMPLES OF MIRACLE RESPONSES

Prostate specific membrane antigen (PSMA) is expressed in unfavorable prostate cancer. PSMA is basis for new diagnostics and theranostics. 177Lu-PSMA radioligand therapy is mainly used for patients with endstage prostate cancer. This report describes two patients: one patient with a multiple recurrences and one with extensive metastastic disease during the first visit. Both these patients were treated with 177Lu-PSMA radioligand therapy with major response, i.e. complete response by imaging and substantial reduction of PSA. 177Lu-PSMA radioligand therapy gave only mild adverse effects. In conclusion, patients with metastatic prostate cancer, 177Lu-PSMA-617 radioligand therapy had an attractive therapeutic profile which had to be adjusted according to the patient´s need

[F-18]Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography Imaging in Oncology: Initial Staging and Evaluation of Cancer Therapy

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas