Medicina Nuclear e Radioterapia

Primary intraosseous haemangiomas represent benign endothelial neoplasms that are often discovered incidentally in approximately 10 to 12 percent of the general population. Although bony haemangiomas can be found in many regions of the appendicular and axial skeleton, most of which remain asymptomatic, those that arise in the vertebral column have the potential to elicit pain and cause neurological deficits in certain patients. In fact, a subset of primary vertebral intraosseous haemangiomas have been shown, albeit extremely rarely, to demonstrate aggressive, destructive and even malignant behavior. From a clinical and therapeutic standpoint, it is essential to recognize that such lesions possess certain radiological and nuclear imaging characteristics that, when observed in conjunction with patient decline, correlate strongly with the atypical and aggressive neoplasms. Ultimately, such lesions have the potential to give rise to an extremely uncommon, widespread, highly debilitating form of haemangiomatous pathology, hereafter termed ''pseudomalignant haemangiomatosis''. Fortunately, treatment in the form of directed radiotherapy has shown remarkable results in regards to symptomatic relief and complete neurologic restoration.

Ependymoma accounts for 5% to 10% of all brain in the paediatric age group. The mainstay of the treatment is surgery followed by radiotherapy. The primary site remains the most common site (85%) for the recurrences followed by the metastatic disease (25%). Here we present a case report of a 5 year old male child who presented as an operated case of ependymoma and was treated with localized radiation therapy. After a disease free interval of one year the child relapsed in the brain and spine. He was re operated for the brain lesion and then was taken up for cranio spinal irradiation. This was followed by systemic chemotherapy. The follow up scans should complete resolution of the disease in the brain and the spine. Hence, longer follow up is needed to appreciate the long term effectiveness and toxicity of this treatment protocol.

Background: The breast cancer conservative treatment, rise importantly through screening and early diagnosis, neoadjuvant treatment, improved surgical techniques and adjuvant radiotherapy. The increase dose to the tumor bed after breast irradiation increases the rate of local control. Different techniques are used to deliver the boost to the tumor bed: the direct beam of electrons, photons with reduced tangential fields, low (LDR) and high dose rate (HDR) brachytherapy.

Purpose: To compare different boost techniques in local control and cosmetic results in breast cancer. Materials and methods: A retrospective study through a series of 74 patients treated at the National Institute of Oncology during 2007 for breast cancer and who received additional radiation to the tumor bed after whole breast irradiation.

Results: The median age of patients was 44.5 years (25-59), 81% were settled and 19% postmenopausal, 38% of tumors were stage T1, 60% T2, 1% T3, 1% T4, 62% N0, 37% N1 and 1% N2. For treatment: two patients received neoadjuvant chemotherapy (3%). Conservative surgery was lumpectomy in 54 cases (72%), quadrantectomy in 19(23%) and zonectomy in one. The oncoplastic remodeling was performed in 24 patients (32%) and reoperation in 19 patients (25%). It was an infiltrative ductal carcinoma in 90% of cases. Radiotherapy interested the breast and chest wall in 74 cases (100%), the supraclavicular fossa in 41 cases (55%), the internal mammary chain in 29 (39%) and axilla in 6 (8%). It was 50 Gy in 25 fractions in 53 patients (72%), 42 Gy in 15 fractions (2.8 Gy) in 21 patients (28%) with median of 37 days (19-60). The additional irradiation of the tumor bed was delivered by electrons at the dose of 15 Gy in five fractions in 38% of cases, or by HDR brachytherapy dose of 10 Gy in two fractions separated by 10 to 12 hours in 34%, or by LDR brachytherapy of 15 Gy in 4%, or by photons at the dose of 15 Gy in five fractions (9 patients) or six fractions in 24% (9 patients). The median time between breast irradiation and the complement was 11 days. The median follow-up was 52 months (3-47 months), 61 patients (82.5%) were in situation of good local control, three (4%) of local recurrence, 10 cases (13.5%) of distant metastases (four were always followed, two died, four lost sight) and nine (12%) were lost to follow-up. Side effects were type of fibrosis in 28 patients (38%), telangiectasia in 5 (7%), disorders of skin pigmentation in 11 (15%).

Conclusion: The increase in dose to the tumor bed after conservative treatment of breast cancer allows increasing the rate of local control without compromising too much the aesthetic results. The comparison between the different techniques of boost did not show significant differences. Randomized trials are needed to define the optimal technique.

FDG PET/CT as a molecular imaging modality detected spinal cord metastases in a patient with medulloblastoma. Increased FDG uptake was reported as negatively correlated with survival in medulloblastoma in the literature. Although, spinal cord metastases associated with medulloblastoma detected with FDG-PET/CT imaging is a rare condition. To the best of our knowledge, this is the first report on spinal cord metastases from medulloblastoma detected by PET/CT.

The challenge lying ahead is how to exact information efficiently during data mining and computation modeling for our body but systematic network intrinsically having both biological elements and social features for data -sharing is lacking. Revealed by a critical analysis of published information from the principal investigators (PIs) in one typical institute, an unexpected trend, the shrink of “monopoly” status of authority PI and an increase of democratic one, inspires us to propose that re-screenings of impact genes crossing institute PIs’ foci may set up “nodes” contributing to biological and social networks. By sharing, this could maximize the potential of some valuable reagents, incentivize institute to address ethical and intellectual property (IP) issues, help detect irreproducibility, and accelerate novel discoveries.

Abstract

Background: Glioblastoma is the commonest brain tumor of adults carrying a very poor prognosis. Targeting the tumor accurately during surgery and radiotherapy holds promise in future. PET with various tracers is being explored worldwide to enhance the accuracy of target delineation. This study was undertaken to evaluate the differences and correlation between the target volumes delineated by using MRI and 18F-FDG PET during RT planning and to evaluate whether inclusion of PET is helpful in better coverage of high risk area for recurrence.

Materials and Methods: Fifteen post-operative patients of glioblastoma were prospectively enrolled. Planning images were acquired with CT, MRI and delayed PET. Image fusion was done to delineate MR-based (GTV-MR, CTV-MR, PTV-MR), PET-based (GTV-PET, CTV-PET) and combined (GTV-X, CTV-X) volumes. Only MR-based volume was used for actual treatment. Mean volumes were calculated for each group for volumetric analysis.

Concordance Index (CI) was calculated for GTV and CTV as CI = [(M + P)/X] -1, to find correlation between volumes, such that full concordance and full non-concordance between MRI and PET volumes would yield a value of 1 and 0 respectively.

On recurrence, the recurrent volumes (rVol) were marked and correlated with initial CTV-MR, CTV-PET and CTV-X to calculate the proportion of rVol covered within these volumes.

Observation and Results: Mean GTV-MR, GTV-PET and GTV-X were 84.4 cc, 11 cc and 89.2 cc, respectively. Median follow-up was 16.6 months for the overall group and 26.1 months for the surviving patients. Overall 1,2 years survival was 80% and 20% respectively.

Conclusion: Inclusion of PET-based abnormality while delineating the target volumes for glioblastoma leads to a non-significant increase in target volumes with better coverage of the high-risk region. Thus, targeting the common volume (CTV-X) for treatment may prove beneficial in avoiding marginal recurrences in glioblastoma.

Purpose/Objectives: Substantial cervical body volume reduction (CBVR) occurs during fractionated external beam radiation therapy (EBRT) for head-and-neck cancer (HNC) and could have potential dosimetric influences. This study aims to investigate measurable clinical factors before treatment initiation correlating with CBVR during curative EBRT in HNC patients, and to determine which patients receive the great benefit from routine adaptive radiation therapy (ART).

Materials/Methods: Fifty-six patients with oropharyngeal squamous cell carcinoma (OSCC) and 67 patients with hypopharyngeal squamous cell carcinoma (HSCC) had received curative EBRT between 2006 and 2013 were enrolled. For EBRT planning, computed tomography (CT) images were acquired before EBRT initiation and between two to seven weeks after the start of EBRT for replanning in each patient. A MATLAB program was used to evaluate the CBVR rate (CBVRR) between the initial and replanning CT imaging. The following factors were assessed for correlation with CBVRR: the T and N stage, induction and concurrent chemotherapy, the initial gross tumor volume (GTV), the GTV reduction rate (GTVRR) between the initial and replanning CT imaging, the initial body weight (BW) and the BW loss rate (BWLR) during the EBRT course.

Results: In the OSCC group, the CBVRR ranged from 1.8 to 17.1% (median, 6.8%). In the HSCC group, the CBVRR ranged from 1.2 to 23.7% (median, 6.5%). In non-parametric univariate analysis, the N3 stage demonstrated a greater trend with the CBVRR than the N2c≥ stage in the HSCC group (p=0.023), whereas marginal inclination (p=0.096) was found in the OSCC group. The CBVRR was substantially related to the GTVRR (p=0.001) in the HSCC group.

In 2013, breast cancer affected 232,340 women in the US. Of these diagnoses, 52% were in women aged 65 and older. Although age is a risk factor for the development of breast cancer, women diagnosed at an older age generally have a more favorable prognosis due to often less aggressive tumor biology. Elderly women tend to have higher rates of hormone receptor positive tumors and also tumors with lower proliferative indices (Ki-67). Despite these favorable prognostic factors, breast cancer specific mortality has only decreased at a rate of 1.1% per year for women aged 75+ in comparison to 2.4% per year for women aged <50. It has been hypothesized that this is related to under-treatment of elderly patients due to increased comorbidities which can limit treatment options as well as social influences such as distance to treatment facilities and lack of transportation. Older women are less likely to be offered standard treatment including surgery, radiotherapy, chemotherapy and endocrine therapy regardless of their breast cancer stage.

Background: The purpose of this article is to review the role of bone-seeking targeted radionuclide therapy (BT-RNT) in metastatic prostate cancer. The mechanisms of actions, radiobiology and clinical benefits of BT-RNTs will be reviewed.

Methods: Relevant studies of CRPC and targeted therapies were identified from literature and clinical trial databases, websites, and conference abstracts.

Results: BT-RNT in mCRPC has a proven beneficial palliative role in treatment of patients with mCRPC. The use of these agents as a monotherapy as well as combination with other palliative therapies are evolving. Among the various BT-RNT’s the alpha emitter ²²³Ra which is highly targeted and well tolerated has shown significant clinical benefit and survival advantage in this patient population.

Conclusion: BT-RNT represents an exciting treatment option for patients with mCRPC. ²²³Ra represents a new treatment paradigm for patients with mCRPC.

According to the literature, performance status, stage-tumor dimension and nodal status, weight loss, were the most important prognostic factors for survival in patients with locally advanced non-small cell lung cancer. To evaluate the treatment results and prognostic variables in our patients, study of 85 patients was randomly assigned to one of the two treatment arms. In the sequential arm, 45 patients had previously received sequential chemotherapy with 4 cycles of and etoposide followed by conformal radiotherapy (RT). In the second concurrent group, 40 patients received concomitant chemotherapy of cisplatine and etoposide and conformal RT, followed by two cycles of consolidation chemotherapy of carboplatine and etoposide. We described all phases of the conformal three dimensional (3-D) RT. From October 2005 to April 2008, 85 patients were enrolled. Eight patients were not eligible, seven had stage IV and one patient had pleural effusion. They were all initially considered to have stage IIIB disease. The median survival was 13 months for the patients in the sequential arm and 19 months for those in the concurrent treatment arm. The differences were statistically significant (log-rank test p=0.0039). The disease-free survival was 9 months in the sequential arm and 16 months in the concurrent treatment group. The differences were statistically significant (log-rank test p=0.0023). We found that the following prognostic factors significantly influenced the survival in lung cancer patients treated with conservative method: (1) age: p<0.05; (2) Performance status: p<0.001; (3) Weight loss: p<0.001; (4) Tumor dimension: p<0.05; (5) Nodal involvement: p<0.05 Conclusions: Given the higher toxicity in the concurrent-consolidation schedule, it should be reserved for patients younger than 70 years, having good performance status and minimal weight loss. Also we highly recommend precisely define the stage of disease and the prognostic factors in lung cancer patients for giving better treatment.

GATE is advanced open source software dedicated to numerical simulations in medical imaging and radiotherapy. It currently supports simulations of Emission Tomography (Positron Emission Tomography - PET and Single Photon Emission Computed Tomography - SPECT), Computed Tomography (CT) and Radiotherapy experiments. This work focused on the commercial Biograph 6 PET/CT scanner. The study targeted to (a) port previously developed and validated GATE codes to the currently available stable version GATE v.6.1, (b) evaluate model's validity detecting sources of bias (c) investigate differentiations imposed if different sources were employed, namely F-18 (Fluorine-18), O-15 (Oxygen-15) and C-11 (Carbon-11). The geometry of the system components was described in GATE, including detector ring, crystal blocks, PMTs etc. Energy and spatial resolution were taken into account. The GATE results were compared to experimental data obtained according to the NEMA NU-2-2001 protocol, Analysis was limited to scatter fraction, count looses and randoms. Good agreement was achieved between experimental and GATE results. Significant sources of bias were the (a) dead time value, (b) dead-time mode (paralysable-nonparalysable), (c) modelled activity (d) modelled source, (e) additional dead time values adopted in GATE modules.

Introduction/objective: To evaluate short-term, treatment-specific endpoints observed following transperineal permanent prostate brachytherapy (TPPB) in patients with low and intermediate risk prostate cancer using a 20- gauge (g) needle technique as compared to traditional 18g needle technique. Our goal was to assess the impact of treatment on urinary, bowel, sexual function and bother as measured by Expanded Prostate Cancer Index Composite (EPIC) quality of life instrument prior to treatment and at 1,3,6 months after treatment. Additionally, acute urinary retention as measured by catheter use following prostate brachytherapy was investigated.
Methods and materials: This study was a single institution, balanced, randomized, non-blinded, dual arm interventional study. We accrued 242 low to intermediate risk patients between June 2010 and August 2012. There were 111 patients randomized to 18 g needles (Arm 1) and 131 patients randomized to 20g needles (Arm 2). A matched peripheral dose of 145 Gy was prescribed in all cases.
Patients completed EPIC questionnaires prior to TPPB and at 1, 3 and 6 months post treatment. Results: Upon analysis of EPIC scores at each time point post implantation, there was no significant difference between the two arms at any given time period specific to the urinary, bowel and sexual function and bother domains. However, 6/111 (5.4%) patients in Arm 1 and 0/131 (0%) patients in Arm 2 required Foley catheterization secondary to AUR, demonstrating a significant difference (p=0.007). Less than 2cc of perineal bleeding was seen in all patients, with no perineal pain or bruising reported. Conclusion: These data demonstrate that there was no statistically significant difference regarding quality of life parameters between Arm 1 and Arm 2. There was, however, a statistically significant outcome for AUR favoring the 20 g cohort that had 0% AUR.

Radiation pneumonitis and radiation-induced cryptogenic organizing pneumonia are common complications after external beam radiation therapy following breast conserving surgery for patients with early stage breast cancer. Intraoperative radiation therapy (IORT) is designed to decrease radiation exposure to the lung, skin, soft tissue, and contralateral breast. A single-center, retrospective cohort of all patients receiving IORT between 2009 and 2013 was analyzed, and 122 cases of IORT were found. There were no instances of pulmonary complication in patients receiving IORT without whole breast irradiation. The only instance of radiation pneumonitis identified was in a patient who received subsequent external beam radiation after boost IORT. As there are no previous systemic evaluations of pulmonary complications of IORT, this study supports its reported safety.