FDG-PET/CT for cancer management

FDG-PET/CT is increasingly being used for staging, restaging, and treatment monitoring for cancer patients. The introduction of a PET/CT system enables both morphological and metabolic imaging to be performed in a single session. Knowledge of the normal physiologic distribution of FDG and an understanding of the clinical indications and limitations of PET/CT enable accurate diagnosis and thus a better level of care for patients

FDG-PET/CT for diagnosis and follow-up of vasculitis

We report three cases of vasculitis evaluated by FDG-PET/CT. Vasculitis is defined as inflammatory changes and necrosis in the aterial wall. The patients presented with non-specific symptoms such as fever up or elevated inflammatory markers. FDG-PET/CT clearly demonstrated intense FDG uptake in vessel walls. A 72-year-old female patient with a one month history of pyrexia had abnormal laboratory data suggesting an inflammatory process. FDG-PET/CT was very useful for the diagnosis of vasculitis. Steroid therapy was introduced. Normalization of laboratory data and symptomatic improvement correlated with normalization of FDG uptake in the vessels

Clear-cell sarcoma of the small intestine detected by FDG-PET/CT during comprehensive examination of an inflammatory reaction

Clear-cell sarcoma (CCS) is a rare, malignant, soft-tissue tumor, which involves the extremities, particularly the foot and foot joint tendons and aponeuroses. It is morphologically similar to but histochemically distinct from malignant melanoma. CCS arising in the gastrointestinal tract has rarely been reported. The prognosis of CCS is reportedly poor because of the high incidence of metastases at the time of initial diagnosis and the high frequency of recurrence. We report a case of early-stage CCS of the small intestine detected by 18F-fluoro-2-deoxy D-glucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) during the comprehensive examination of an inflammatory reaction. In this case, FDG-PET/CT clearly visualized the lesion, which was difficult to detect by contrast CT

Is FDG-PET/CT useful for managing malignant pleural mesothelioma?

Objective : Imaging techniques such as CT, MRI and PET/CT have essential preand post-treatment roles in detecting tumors and evaluating the extension of malignant pleural mesothelioma (MPM). We sough to evaluate the advantages and limitations on FDG-PET/CT findings. Patients and Methods : We performed 13 FDG-PET/CT studies in 9 patients with MPM (8 males, 1 female, aged 51 to 84 years, 9 at the initial diagnosis, 4 follow up studies). We reviewed FDG-PET/CT findings of primary tumors, recurrent tumors, lymph nodes, metastasis. Results : All primary and recurrent tumors were FDG positive. The uptake patterns at initial diagnosis were diffuse+multi-nodular uptake pattern in 5, diffuse irregular thickened uptake pattern in 2, some focal thickened pattern in one, and a slight diffuse uptake pattern in one. Two of the 3 patients diagnosed as N0 by PET and operated on had negative lymph nodes confirmed pathologically. The other patient diagnosed as N0 by PET, who had one month of time lag between PET/CT examination and surgery, was confirmed as N2 by extrapleural pneumonectomy. In 3 patients, hilar or mediastinal lymph nodes were difficult to distinguish from irregular pleural thickening. One patient had a FDG positive lymph node in the ipsilateral supraclavicular region confirmed as metastasis (N3). One patient had a FDG positive lymph node in the para-aortic region. Lung metastasis was seen in one patient (M1). In another patient, two focal nodular uptakes in the colon were detected and confirmed as colon polyps (pathologically Group 3- 4). At restaging, 3 of 4 patients showed diffuse+multi-nodular uptake and one patient showed multi-nodular uptake. Conclusions : The utility of FDG-PET/CT is limited for evaluation of primary tumor extension and nodal status. FDG-PET/CT is useful for detecting distant metastasis and for evaluating activity in supraclavicular or abdominal lymph nodes. It is also useful for identifying unsuspected diseases

Factors Affecting Persistent Postoperative Pain in Patients with Hip Fractures

Osteoporotic fractures are common among older people, and hip fractures (HF) can be devastating. Surgery is indicated for most cases of HF, and chronic persistent postoperative pain is likely to occur. This study investigated the multifaceted factors related to persistent pain occurring during the acute phase and subacute phase of recovery after HF surgery. We conducted a prospective 8-week study of older HF patients after surgery. We evaluated pain intensity, depression symptoms, the fear of falling, pain catastrophizing, cognition and attention, the ability to perform activities of daily living, and the physical performance at 2 weeks (acute phase) and at 4 weeks (subacute phase) after surgery. Patients were divided into the light group (Verbal Rating Scale (VRS) score ?1) and severe group (VRS score ?2) according to pain intensity at 8 weeks (recovery phase) after surgery. Factors affecting persistent postoperative pain during recovery were examined using logistic regression analysis. Seventy-two patients were analyzed: 50 in the light group and 22 in the severe group. In the severe group, pain with movement and Pain Catastrophizing Scale scores were higher than those of the light group at 2 weeks and at 4 weeks after surgery. The regression analysis showed that pain with movement at 2 weeks and at 4 weeks after surgery and pain catastrophizing at 4 weeks after surgery were related to persistent postoperative pain. HF patients may have persistent pain if they continue to experience pain and catastrophize their pain during the acute phase and subacute phase after surgery

Effects of a Rehabilitation Program Combined with Pain Management That Targets Pain Perception and Activity Avoidance in Older Patients with Acute Vertebral Compression Fracture: a Randomised Controlled Trial

This study aimed to investigate the efect of a rehabilitation program combined with pain management targeting pain perception and activity avoidance on multifaceted outcomes in older patients with acute vertebral compression fractures (VCFs). We randomised 65 older adults with acute VCFs to either an intervention group (n = 32), involving usual rehabilitation combined with pain management that targeted pain perception and activity avoidance, or a control group (n = 33), involving only usual rehabilitation. Te usual rehabilitation was initiated immediately after admission. All patients were treated conservatively. Pain management aimed to improve the patients’ daily behaviour by increasing their daily activities despite pain, rather than by focusing on eliminating the pain. Pain intensity and psychological statuses such as depression, pain catastrophising, and physical activity levels were assessed on admission. Two weeks postadmission and at discharge, physical performance measures were assessed along with the above-given measurements. A signifcant main efect of the group was observed for the intensity of lower back pain, favouring the intervention group (F = 5.135, p = 0.027). At discharge, it was signifcantly better in the intervention group than in the control group (p = 0.011). A time-by-group interaction emerged for magnifcation of the pain catastrophising scale (p = 0.012), physical activity levels (p < 0.001), and six-minute walking distance (p = 0.006), all favouring the intervention group. Rehabilitation programs combined with pain management targeting pain perception and activity avoidance could be an efective conservative treatment for older patients with acute VCFs

ホウシャセン タンドク リョウホウ ガ ソウコウ シタ Merkel サイボウガン ノ 1レイ

A ９１-year-old man was diagnosed with Merkel cell carcinoma after removal of a mass about １ cm in diameter from the right upper eyelid on August ５, ２０１X. Curative surgery was recommended, but the patient declined. Lymph node metastases to the right lateral angle of the eye and in front of the right ear, and cancer pain in the stump recurrence manifested. Accordingly, irradiation of the right upper eyelid was started from October ３ at ２．５Gy/fraction, and the right lateral corneal lymph nodes were included from October １１, ending at ３５ Gy in １４ fractions. From November ２２，irradiation of the lymph node metastasisin front of the right ear was started, ending at ３２. ５ Gy in １３ fractions. During irradiation, cancer pain was alleviated with opioids. Stump recurrence and lymph node metastases were decreased in size, and Computed Tomography indiated complete response. Radiation monotherapy of Merkel cell carcinoma appears to offer a treatment that should be proactively applied when curative surgery proves difficult or not desired by the patient. Use of opioids during radiotherapy may improve quality of life and enhance the therapeutic effect

ゲンパツ フメイ ガン ニオケル PET/CT ケンサ ノ ユウヨウセイ ニツイテ

We reported the utility of１８F-FDG-PET/CT examination for patients with cancer of unknownprimary origin. Twenty six patients（13 men, 13 women, aged 27-91 years, mean 71）were examined.The indication for PET/CT examination was tumor maker elevation（14 patients）, suspectedmetastatic tumor（14）and metastasis diagnosed histopathologically（3）. Patients weretold not to eat for at least four hours and a PET/CT image was obtained one hour after theadministration of 3.7MBq/kg FDG. From April to August 2006, 33 patients diagnosed with a cancerof unknown primary origin were referred to our hospital for PET/CT examination from anoutside institution. Twenty six patients could be investigated for outcomes. Seventeen patientsshowed an abnormal accumulation, with 14 of the 17 having their primary regions detected histopathologicallyor clinically. For one patient, the abnormal accumulation could not be determined toshow the origin. For 2 patients, it was difficult to diagnose if these abnormal accumulationsshowed the primary region or not, but CT examinations were helpful for a diagnosis. Seven of the9 patients who showed no abnormal accumulation were treated conservatively and the primaryregion for their cancer could not be detected during the follow up study. In 21 of 26 patients, theseresults were useful to select an appropriate therapy to be applied or a relevant examination. Weconsidered PET/CT examination, where it is possible to scan the whole body at one time, was veryuseful to get both morphologic and metabolic information. PET/CT examination showed a highersensitivity for detecting abnormal lesions than other imaging modalities

Methylsulfonylmethane Suppresses Breast Cancer Growth by Down-Regulating STAT3 and STAT5b Pathways

Breast cancer is the most aggressive form of all cancers, with high incidence and mortality rates. The purpose of the present study was to investigate the molecular mechanism by which methylsulfonylmethane (MSM) inhibits breast cancer growth in mice xenografts. MSM is an organic sulfur-containing natural compound without any toxicity. In this study, we demonstrated that MSM substantially decreased the viability of human breast cancer cells in a dose-dependent manner. MSM also suppressed the phosphorylation of STAT3, STAT5b, expression of IGF-1R, HIF-1α, VEGF, BrK, and p-IGF-1R and inhibited triple-negative receptor expression in receptor-positive cell lines. Moreover, MSM decreased the DNA-binding activities of STAT5b and STAT3, to the target gene promoters in MDA-MB 231 or co-transfected COS-7 cells. We confirmed that MSM significantly decreased the relative luciferase activities indicating crosstalk between STAT5b/IGF-1R, STAT5b/HSP90α, and STAT3/VEGF. To confirm these findings in vivo, xenografts were established in Balb/c athymic nude mice with MDA-MB 231 cells and MSM was administered for 30 days. Concurring to our in vitro analysis, these xenografts showed decreased expression of STAT3, STAT5b, IGF-1R and VEGF. Through in vitro and in vivo analysis, we confirmed that MSM can effectively regulate multiple targets including STAT3/VEGF and STAT5b/IGF-1R. These are the major molecules involved in tumor development, progression, and metastasis. Thus, we strongly recommend the use of MSM as a trial drug for treating all types of breast cancers including triple-negative cancers

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701