Development of Photoonycholysis with Vandetanib Therapy

Vandetanib therapy is a novel once-daily oral multitargeted tyrosine kinase inhibitor, which is currently used in advanced or metastatic medullary thyroid cancer. Skin toxicities are among the most prevalent adverse events reported with this targeted therapy (e.g. acne-like rash, hand-foot skin reaction, hair changes, and paronychia). In addition, photosensitivity reactions may affect more than one third of treated patients. We report here 2 patients developing photosensitivity reactions with vandetanib therapy, including photoonycholysis. Our patients presented a wide range of phototoxic reactions with exaggerated sunburn reactions solely located to photoexposed areas or hyperpigmentation with visible blue dots. More importantly, both patients concomitantly developed nail changes consistent with type 1 photoonycholysis, which had never been reported so far neither with vandetanib therapy nor with other anticancer-targeted therapies. In addition, histopathologic findings and reflectance confocal microscopy imaging performed in one patient suffering from photodistributed skin hyperpigmentation both strengthen the likelihood of a postinflammatory mechanism. Clinicians should be aware of these underestimated but very characteristic photoinduced adverse events, which can lead to treatment interruption and require very strict photoprotective measures in treated patients.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Development of Photoonycholysis with Vandetanib Therapy

Vandetanib therapy is a novel once-daily oral multitargeted tyrosine kinase inhibitor, which is currently used in advanced or metastatic medullary thyroid cancer. Skin toxicities are among the most prevalent adverse events reported with this targeted therapy (e.g. acne-like rash, hand-foot skin reaction, hair changes, and paronychia). In addition, photosensitivity reactions may affect more than one third of treated patients. We report here 2 patients developing photosensitivity reactions with vandetanib therapy, including photoonycholysis. Our patients presented a wide range of phototoxic reactions with exaggerated sunburn reactions solely located to photoexposed areas or hyperpigmentation with visible blue dots. More importantly, both patients concomitantly developed nail changes consistent with type 1 photoonycholysis, which had never been reported so far neither with vandetanib therapy nor with other anticancer-targeted therapies. In addition, histopathologic findings and reflectance confocal microscopy imaging performed in one patient suffering from photodistributed skin hyperpigmentation both strengthen the likelihood of a postinflammatory mechanism. Clinicians should be aware of these underestimated but very characteristic photoinduced adverse events, which can lead to treatment interruption and require very strict photoprotective measures in treated patients.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Optimized reconstruction of the position of interaction in high-performances <math display="inline" id="d1e855" altimg="si26.svg"><mi>γ</mi></math>-cameras

International audienceVectorized internal radiotherapy is an efficient modality for cancer treatment but requires a personalized dosimetry to adapt the administered dose for each patient, in order to limit the toxicity to organs-at-risk and maximize therapeutic effects. This can be done by performing quantitative imaging of the target organ with high resolution γ-imaging devices in order to evaluate the uptake and biokinetics of the radiotracer. We developed a high-resolution portable γ-camera with a 10 × 10 cm2 field of view dedicated to thyroid imaging during diseases treatments with 131I. In addition to the optimization of the detection elements, the quality of the images also depends on the implementation of efficient methods to reconstruct the interaction position of gamma rays in the monolithic scintillator from the measurement of the scintillation light distribution. We present here the results obtained with two different machine learning methods based on experimental data for reconstruction of the γ-rays interaction position. Those methods reach high spatial performances such as millimeter spatial resolution and submillimeter distortion in the center of the field of view

Cystic form of cervical lymphadenopathy in adults. Guidelines of the French Society of Otorhinolaryngology (short version). Part 2–etiological diagnosis procedure: Clinical and imaging assessment

International audienceThe authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for clinical and radiological assessment of cystic neck lymphadenopathy of unknown primary in adults. Most cases concern head and neck carcinoma metastasis, often in the oropharyngeal area, or less frequently differentiated thyroid carcinoma or non-keratinizing nasopharyngeal carcinoma.Methods: A multidisciplinary task force was commissioned to carry out a review of the literature on the etiological work-up in cystic neck lymphadenopathy in adults: clinical examination, conventional imaging (ultrasound, CT, MRI) and metabolic imaging. Guidelines were drafted based on the articles retrieved, and graded A, B, C or expert opinion according to decreasing level of evidence.Results: Oriented clinical examination, cervical and thyroid ultrasound scan and contrast-enhanced neck and chest CT scan are recommended in the assessment of cystic neck lymphadenopathy of unknown primary in adult patients. PET-CT is recommended prior to panendoscopy, to identify the primary tumor.Conclusion: Clinical and radiological assessment is fundamental for etiologic diagnosis of cystic neck lymphadenopathy in adult patients, and should be completed by cytological examination before in initiating treatment

A High-Resolution Portable Gamma-Camera for Estimation of Absorbed Dose in Molecular Radiotherapy

International audienceMolecular radiotherapy is a treatment modality that requires personalized dosimetry for efficient treatment and reduced toxicity. Current clinical imaging systems and miniaturized gamma-cameras lack the necessary features for this task. In this article, we present the design and optimization of a mobile gamma-camera with a 10×10 cm2 field of view tailored for quantitative imaging during 131I therapy of thyroid diseases. The camera uses a monolithic 10×10×1 cm3 CeBr3 scintillator coupled to a 16×16 SiPMs array and commercial electronics. It exhibits high imaging performance with an intrinsic spatial resolution (SR) of 1.15-mm FWHM, an energy resolution of 8% FWHM at 356 keV and negligible deadtime up to 150 kcps. Images are reconstructed in real time using a convolutional neural network. The manufacturing method of tungsten collimators and shielding was optimized using laser 3-D printing to achieve an effective density of 97% that of bulk tungsten. Their geometry was adjusted with Monte-Carlo simulations in order to reduce septal penetration and scattering and optimize the signal-to-noise ratio at short times after treatment administration. Two high-energy parallel-hole collimators with high sensitivity or very high SR were designed for treatment planning and post-treatment control. The fully operational gamma-camera will soon be clinically assessed