COMBINATION OF DWI/DCE-MRI AND [18F]FECH PET/CT IN PATIENTS WITH BIOCHEMICAL RELAPSE OF PROSTATE CANCER: IMPACT ON TREATMENT DECISION MAKING

In prostate cancer patients with biochemical recurrence, distinguishing between local and distant failure is crucial to choose the most suitable treatment. In this study we assessed if the combination of f-MRI and [18F]FECH PET/CT could serve to optimize treatment decision making in patients with recurrent PCa after curative first-line treatment. We enrolled 30 patients (mean age 72±7 yr) with biochemical relapse of PCa presenting about 6 yr after radical prostatectomy underwent consecutive DWI/DCE-MRI and [18F]FECH PET/CT dynamic PET imaging of the pelvic region + whole-body images, for a total of 60 studies. Each exam was classified as: indeterminate, negative or positive. Positive scans were further classified as positive for local relapse (candidate for standard salvage EBRT), oligo-metastatic (≤5 total lesions, candidate for EBRT) and pluri-metastatic disease (>5 total lesions, candidate for hormonal therapy, ADT). The combination of DWI/DCE-MRI and [18F]FECH PET/CT detected disease recurrence in 27/30 patients: local relapse in 7, oligometastatic in 18 and plurimetastatic in 2. MRI was clearly superior in detecting local recurrence.On the other hand, [18F]FECH PET/CT detected more tumor lesions in case of metastatic disease. The combination of these two imaging modalities allowed in our patients an accurate definition of treatment planning, avoiding unnecessary systemic therapies

Long-Term PSA Control with Repeated Stereotactic Body Radiotherapy in a Patient with Oligometastatic Castration-Resistant Prostate Cancer

Prostate cancer (PCa) is one of the most common malignancies and main causes of cancer death in Western countries. In the presence of metastatic disease, systemic treatment remains the main clinical option. However, since the introduction of highly sensitive imaging techniques, a new clinical 'entity' of metastatic patients with a limited number of lesions has been defined: oligometastatic patients. In this patient group, the use of stereotactic body radiotherapy (SBRT) or other local therapies against all active sites of disease revealed by 18F-choline positron emission tomography/computed tomography (PET/CT) could achieve sufficient prostate-specific antigen (PSA) control. However, a clear benefit of this procedure in terms of significant endpoints is yet to be demonstrated. This case report describes our experience with treating a castration-resistant PCa patient with 18F-choline PET/CT-guided SBRT. Because of the occurrence of 5 metachronous lesions over 4 years, the pattern of recurrence was defined by the local multidisciplinary team as oligometastatic disease, and the patient was treated with 5 courses of SBRT which yielded good PSA control. He started systemic therapy with abiraterone acetate almost 5 years after the diagnosis of recurrent PCa

The value of oro-pharyngo-esophageal scintigraphy in the management of patients with aspiration into the tracheo-bronchial tree and consequent dysphagia

Tracheo-bronchial aspiration is the most invalidating condition which can happen to patients affected by dysphagia, especially when caused by central neurologic disorders; the associated pneumonia episodes represent the most frequent cause of death in these patients. Oro-pharyngo-esophageal scintigraphy (OPES) allows both functional imaging and semiquantitative evaluation of the subsequent phases of swallowing. CASE REPORT: We evaluated by means of OPES a woman who had previously undergone high-dose external beam radiation therapy for a nasopharyngeal carcinoma, which determined tissue fibrosis and progressive dysphagia. CONCLUSION: In this patient with dysphagia, OPES was a simple, inexpensive, noninvasive, and reliable technique that allowed to show the presence of bolus aspiration and quantified tracheobronchial aspirate

Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

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