Coinfection of Invasive Pulmonary Aspergillosis and Pneumocystis Jiroveci Pneumonia in a Non-HIV Patient

Invasive pulmonary aspergillosis (IPA) and pneumocystis jiroveci pneumonia (PCP) are life-threatening opportunistic infections that occur in immunocompromised hosts. Early diagnosis and treatment of these opportunistic infections is essential to the survival of immunocompromised patients. We report a 60-year-old man undergoing short-term steroid therapy after surgical resection of a brain tumor infected with combined invasive pulmonary aspergillosis and pneumocystis jiroveci pneumonia diagnosed by bronchoscopy with bronchoalveolar lavage. Our case demonstrated that short-term systemic steroid therapy in non-HIV patients with underlying chronic lung conditions and malignancies was a risk factor for IPA and PCP, and for a combination of these infections

Clinical value of FAZA-PET/CT in advanced lung cancer patients: comparison with FDG-PET/CT

Objective: The presence of hypoxia in cancer tissue is known to increase not only their refractoriness to treatment, but also their malignant potential. The information of cancer hypoxia, therefore, is important for the management of cancer patients such as prediction of treatment response and the selection of appropriate treatment strategy. The aim of the present study was to evaluate the clinical value of PET/CT with FAZA, a PET probe to detect cancer hypoxia, in advanced non-small cell lung cancer patients, in comparison to FDG-PET/CT, especially on the prediction of patients’ prognosis. Methods: Thirty eight patients with advanced non-small cell lung cancer (clinical stage: stage III - 23 patients and stage IV - 15 patients; histology: squamous cell carcinoma (SCC) - 11 patients, adenocarcinoma (Adeno) - 19 patients, large cell carcinoma (LC) - 8 patients) received FAZA- and FDG-PET/CT before treatment. Patients were followed to determine the treatment response and survival. Uptake parameters of FAZA (tumor-muscle ratio at 2h (T/M)) and FDG (SUVmax at 1h (SUV)) in primary lesion and lymph node (LN) metastasis were compared with various clinical parameters (histology, clinical stage, etc.). Progression-free survival (PFS) periods and overall survival (OS) periods were compared with various clinical and FAZA/FDG uptake parameters. Kaplan-Meier analyses with Log Rank test were performed for all (stage III + IV) patients and for stage III (IIIA + IIIB) patients. Study protocol was approved by the institutional review board, and informed consent was obtained from all patients. Results: There was a weak correlation between FAZA T/M and FDG SUV of primary lesion (p = 0.040), but intra-tumoral distribution patterns of FAZA and FDG for individual patients were not identical for three histological subtypes, SCC, Adeno and LC. There was a significant difference in FAZA T/M among histological subtypes (p = 0.036). As for the prognosis, clinical stage (stage IV vs. III, p = 0.017; stage IIIA vs. IIIB, p = 0.046) and FAZA T/M in LN metastasis (> 1.800 vs. 1.800 vs. 1.800 vs. 1.800 vs. </= 1.800, p = 0.034). No significant predictor of OS was detected in stage III + IV patients. Conclusion: FAZA T/M in LN metastasis was a strong predictor of survival of advanced lung cancer patients. PET/CT with FAZA is expected to afford useful information on the management of lung cancer patients.2015 World Molecular Imaging Congress (WMIC

Prognostic value of (18) F-fluoroazomycin arabinoside PET/CT in patients with advanced non-small cell lung cancer.

This study evaluated the prognostic value of positron emission tomography/computed tomography (PET/CT) using (18) F-fluoroazomycin arabinoside (FAZA) in patients with advanced non-small cell lung cancer (NSCLC) compared with (18) F-fluorodeoxyglucose (FDG). Thirty-eight patients with advanced NSCLC (stage III: 23 patients; stage IV: 15 patients) underwent FAZA and FDG PET/CT before treatment. PET parameters (tumor-to-muscle ratio [T/M] at 1 and 2 h for FAZA, maximum standardized uptake value [SUVmax] for FDG) in the primary lesion and lymph node (LN) metastasis and clinical parameters were compared concerning their effects on progression-free (PFS) and overall survival (OS). In univariate analysis in all patients, clinical stage and FAZA T/M in LNs at 1 and 2 h were predictive of PFS (p = 0.021, 0.028, and 0.002, respectively) Multivariate analysis also indicated that clinical stage and FAZA T/M in LNs at 1 and 2 h were independent predictors of PFS. Subgroup analysis of chemoradiotherapy (CRT)-treated stage III patients revealed that only FAZA T/M in LNs at 2 h was predictive of PFS (p = 0.025). FDG PET/CT parameters were not predictive of PFS. No parameter was a significant predictor of OS. In patients with advanced NSCLC, FAZA uptake in LNs, but not in primary lesions, was predictive of treatment outcome. These results suggest the importance of characterization of LN metastases in advanced NSCLC patients. This article is protected by copyright. All rights reserved