Pub Date : 2020-02-01DOI: 10.1177/0300891619867845
M. Gennaro, E. Meneghini, P. Baili, S. Bravaccini, A. Curcio, M. D. De Santis, L. Lozza, C. Listorti, S. Di Cosimo, M. Sant, S. Folli
Background: Ductal carcinoma in situ (DCIS) is considered a morphologic precursor of invasive cancer and is often treated with adjuvant whole-breast irradiation and endocrine therapy, as if it were an invasive cancer. Our aim was to provide further support for treatment de-escalation or enrollment of such patients in active surveillance trials. Methods: We retrospectively analyzed data on patients with conservatively treated primary DCIS subsequently diagnosed with ipsilateral invasive breast cancer (IBC) at 2 comprehensive breast cancer centers. From their merged databases, we identified 50 cases with full details on tumor grade, hormone receptor expression, and HER2 amplification, for both the primary DCIS and the corresponding IBC, and we assessed the similarities and differences between the two. Results: Distributions of hormone receptors were similar in primary DCIS and IBC, while high-grade and HER2-positive status was less common in IBC than in primary DCIS. The positivity for estrogen receptors (ER) and well-differentiated or moderately differentiated morphology in the primary DCIS persisted in 90% of the matching IBC. Changes in progesterone receptor expression were slightly more common than those in ER expression. Overall consistency for the luminal-like receptors subtype was found in 90% of cases. Conclusion: The high consistency between the features of primary DCIS and those of subsequent IBC (in the rare but not negligible cases of local failure) should be borne in mind when considering the therapeutic options. Treatment de-escalation and accrual of patients for active surveillance trials could be appropriate for luminal-like precursors.
背景:导管原位癌(Ductal carcinoma in situ, DCIS)被认为是浸润性癌症的形态学前兆，通常采用辅助全乳照射和内分泌治疗，就好像它是一种浸润性癌症一样。我们的目的是为降低治疗升级或将此类患者纳入主动监测试验提供进一步的支持。方法:我们回顾性分析2个综合性乳腺癌中心保守治疗的原发性DCIS患者随后诊断为同侧浸润性乳腺癌(IBC)的资料。从他们合并的数据库中，我们确定了50例具有肿瘤分级、激素受体表达和HER2扩增的完整细节的病例，包括原发性DCIS和相应的IBC，我们评估了两者之间的异同。结果:激素受体在原发性DCIS和IBC中的分布相似，而IBC中高级别和her2阳性状态的发生率低于原发性DCIS。在90%的匹配IBC中，原发性DCIS中雌激素受体(ER)和高分化或中度分化形态学呈阳性。孕激素受体表达的变化比内质网表达的变化更常见。在90%的病例中发现了发光样受体亚型的总体一致性。结论:原发性DCIS与继发IBC的特征高度一致(在罕见但不可忽视的局部失败病例中)，在考虑治疗方案时应牢记。主动监测试验的治疗降级和患者累积可能适用于发光样前体。
{"title":"High consistency between characteristics of primary intraductal breast cancer and subtype of subsequent ipsilateral invasive cancer","authors":"M. Gennaro, E. Meneghini, P. Baili, S. Bravaccini, A. Curcio, M. D. De Santis, L. Lozza, C. Listorti, S. Di Cosimo, M. Sant, S. Folli","doi":"10.1177/0300891619867845","DOIUrl":"https://doi.org/10.1177/0300891619867845","url":null,"abstract":"Background: Ductal carcinoma in situ (DCIS) is considered a morphologic precursor of invasive cancer and is often treated with adjuvant whole-breast irradiation and endocrine therapy, as if it were an invasive cancer. Our aim was to provide further support for treatment de-escalation or enrollment of such patients in active surveillance trials. Methods: We retrospectively analyzed data on patients with conservatively treated primary DCIS subsequently diagnosed with ipsilateral invasive breast cancer (IBC) at 2 comprehensive breast cancer centers. From their merged databases, we identified 50 cases with full details on tumor grade, hormone receptor expression, and HER2 amplification, for both the primary DCIS and the corresponding IBC, and we assessed the similarities and differences between the two. Results: Distributions of hormone receptors were similar in primary DCIS and IBC, while high-grade and HER2-positive status was less common in IBC than in primary DCIS. The positivity for estrogen receptors (ER) and well-differentiated or moderately differentiated morphology in the primary DCIS persisted in 90% of the matching IBC. Changes in progesterone receptor expression were slightly more common than those in ER expression. Overall consistency for the luminal-like receptors subtype was found in 90% of cases. Conclusion: The high consistency between the features of primary DCIS and those of subsequent IBC (in the rare but not negligible cases of local failure) should be borne in mind when considering the therapeutic options. Treatment de-escalation and accrual of patients for active surveillance trials could be appropriate for luminal-like precursors.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"85 1","pages":"64 - 69"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81240242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619868011
Chiara Pellegrini, A. Caraceni, L. Bedodi, Raffaella Sensi, Simona Breggiè, F. Gariboldi, C. Brunelli
Objective: This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors. Methods: A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010–2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis. Results: The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor. Conclusion: The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.
目的:本研究回顾了科学文献，以确定和描述在儿童肿瘤和神经肿瘤康复中使用的评估工具(ATs)，以及为中枢神经系统(CNS)肿瘤儿童建立的发展神经精神运动(DNPM) ATs。方法:系统检索PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of tumor数据库和专业期刊。该研究历时7年(2010-2017)，使用了不同组合的相关关键词。进一步检索了DNPM康复手册和学术论文。结果:我们检索到35篇符合条件的文章，包含63个ATs。最常见的是执行功能行为评定量表(BRIEF)和韦氏儿童智力量表(WISC)。大多数智力测验只涉及儿童发展的一个领域，包括行为/心理、认知和运动领域。在手册和论文中发现了159个at，而在期刊检索中发现的at只有17个。在这两项研究中发现的ATs都不是专门为患有中枢神经系统肿瘤的儿童开发的。结论:研究结果强调了开发和验证儿童中枢神经系统肿瘤的全球多维AT的必要性，克服了评估程序的碎片化，促进了标准化的康复方案。
{"title":"Tools for the assessment of neuropsychomotor profile in the rehabilitation of children with central nervous system tumor: a systematic review","authors":"Chiara Pellegrini, A. Caraceni, L. Bedodi, Raffaella Sensi, Simona Breggiè, F. Gariboldi, C. Brunelli","doi":"10.1177/0300891619868011","DOIUrl":"https://doi.org/10.1177/0300891619868011","url":null,"abstract":"Objective: This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors. Methods: A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010–2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis. Results: The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor. Conclusion: The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"32 1","pages":"12 - 24"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87970577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619867836
A. Mastroianni, R. Panella, D. Morelli
Introduction: The accuracy of serum neuron-specific enolase (NSE) measurements is critical, particularly in neurologic diseases and cancer. NSE measurements are compromised by slight, even invisible, hemolysis, which can produce apparently higher NSE levels, leading to inappropriate clinical decisions. In this article, we describe this issue and propose a solution for avoiding incorrect results. Methods: Twenty blood samples from donors with NSE values that were within the reference interval were considered. Experimental hemolysis was induced in vitro to examine the relationship between the degree of hemolysis and the increase in serum NSE. The data were then subjected to statistical analysis. Results: There was excellent correlation (r2 0.953) between the degree of hemolysis and the rise in NSE concentration. Each hemolysis unit (equal to 1 mg/dL of free hemoglobin) corresponded to a mean value of 0.29 ± 0.09 ng/mL NSE that was released from red blood cells. Conclusion: The hemolysis index must be measured in every sample with no evident hemolysis before assaying it for NSE. Moreover, if the degree of hemolysis is between 5 and 30 units, the increase in NSE (from 1.5 to 9.0 ng/mL) must be calculated, and the laboratory results should be appended with comments that suggest the approximate rise in NSE.
{"title":"Invisible hemolysis in serum samples interferes in NSE measurement","authors":"A. Mastroianni, R. Panella, D. Morelli","doi":"10.1177/0300891619867836","DOIUrl":"https://doi.org/10.1177/0300891619867836","url":null,"abstract":"Introduction: The accuracy of serum neuron-specific enolase (NSE) measurements is critical, particularly in neurologic diseases and cancer. NSE measurements are compromised by slight, even invisible, hemolysis, which can produce apparently higher NSE levels, leading to inappropriate clinical decisions. In this article, we describe this issue and propose a solution for avoiding incorrect results. Methods: Twenty blood samples from donors with NSE values that were within the reference interval were considered. Experimental hemolysis was induced in vitro to examine the relationship between the degree of hemolysis and the increase in serum NSE. The data were then subjected to statistical analysis. Results: There was excellent correlation (r2 0.953) between the degree of hemolysis and the rise in NSE concentration. Each hemolysis unit (equal to 1 mg/dL of free hemoglobin) corresponded to a mean value of 0.29 ± 0.09 ng/mL NSE that was released from red blood cells. Conclusion: The hemolysis index must be measured in every sample with no evident hemolysis before assaying it for NSE. Moreover, if the degree of hemolysis is between 5 and 30 units, the increase in NSE (from 1.5 to 9.0 ng/mL) must be calculated, and the laboratory results should be appended with comments that suggest the approximate rise in NSE.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"2 1","pages":"79 - 81"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79231823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619868287
Huan Wan, Bin Xu, N. Zhu, Baozhong Ren
Purpose: The present study aims to investigate the efficacy and mechanisms of peroxisome proliferator-activated receptor γ coactivator 1-α agonist, as adjuvant to programmed death-1 (PD-1) blockade in hyporesponsive lung cancer cells–derived in vivo tumor model, using bezafibrate. Methods: Mouse Lewis lung carcinoma (LLC) xenograft models were established and treated with programmed death-ligand 1 (PD-L1) monoclonal antibodies with or without bezafibrate. Tumors or peripheral blood of mice were harvested to investigate the quality, quantity, and function as well as energetic metabolism of cytotoxic T lymphocytes (CTLs) by flow cytometry or quantitative real-time polymerase chain reaction. Results: The combination of bezafibrate plus anti-PD-L1 reached synergistic tumoricidal effect in LLC xenograft mouse models, even though bezafibrate alone had no effect on tumor growth. Bezafibrate significantly facilitated CD8+ T cells infiltrating into tumor tissues by enhancing the expression of CXCL9 and CXCL10 within tumors as well as the receptor CXCR3 in infiltrating CTLs. Activated CTLs within tumors were also significantly upregulated by bezafibrate. Further data demonstrated that bezafibrate treatment could maintain the survival and functional capacity of tumor-infiltrating CTLs. Moreover, cellular reactive oxygen species in infiltrating CTLs and fatty acid oxidation (FAO)–related genes (PGC-1α, Cpt1a, and LCAD) expression within tumors were significantly increased after treatment with bezafibrate. Conclusions: Bezafibrate synergized the tumoricidal effect of PD-1 blockade in hyporesponsive lung cancer by expansion of effector CTLs within tumor microenvironment. The potential mechanism may relate to the capacity of bezafibrate in regulating FAO of tumor-infiltrating CTLs.
{"title":"PGC-1α activator–induced fatty acid oxidation in tumor-infiltrating CTLs enhances effects of PD-1 blockade therapy in lung cancer","authors":"Huan Wan, Bin Xu, N. Zhu, Baozhong Ren","doi":"10.1177/0300891619868287","DOIUrl":"https://doi.org/10.1177/0300891619868287","url":null,"abstract":"Purpose: The present study aims to investigate the efficacy and mechanisms of peroxisome proliferator-activated receptor γ coactivator 1-α agonist, as adjuvant to programmed death-1 (PD-1) blockade in hyporesponsive lung cancer cells–derived in vivo tumor model, using bezafibrate. Methods: Mouse Lewis lung carcinoma (LLC) xenograft models were established and treated with programmed death-ligand 1 (PD-L1) monoclonal antibodies with or without bezafibrate. Tumors or peripheral blood of mice were harvested to investigate the quality, quantity, and function as well as energetic metabolism of cytotoxic T lymphocytes (CTLs) by flow cytometry or quantitative real-time polymerase chain reaction. Results: The combination of bezafibrate plus anti-PD-L1 reached synergistic tumoricidal effect in LLC xenograft mouse models, even though bezafibrate alone had no effect on tumor growth. Bezafibrate significantly facilitated CD8+ T cells infiltrating into tumor tissues by enhancing the expression of CXCL9 and CXCL10 within tumors as well as the receptor CXCR3 in infiltrating CTLs. Activated CTLs within tumors were also significantly upregulated by bezafibrate. Further data demonstrated that bezafibrate treatment could maintain the survival and functional capacity of tumor-infiltrating CTLs. Moreover, cellular reactive oxygen species in infiltrating CTLs and fatty acid oxidation (FAO)–related genes (PGC-1α, Cpt1a, and LCAD) expression within tumors were significantly increased after treatment with bezafibrate. Conclusions: Bezafibrate synergized the tumoricidal effect of PD-1 blockade in hyporesponsive lung cancer by expansion of effector CTLs within tumor microenvironment. The potential mechanism may relate to the capacity of bezafibrate in regulating FAO of tumor-infiltrating CTLs.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"11 1","pages":"55 - 63"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79994963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619869513
S. Tanzi, S. D. Leo, E. Mazzini, M. Castagnetti, Caterina Turrà, C. Peruselli, M. Costantini
Background: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. Measures: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. Results: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. Conclusion: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.
{"title":"Long-term sustainability of a quality improvement program on cancer pain management: a complex intervention in an inpatient setting","authors":"S. Tanzi, S. D. Leo, E. Mazzini, M. Castagnetti, Caterina Turrà, C. Peruselli, M. Costantini","doi":"10.1177/0300891619869513","DOIUrl":"https://doi.org/10.1177/0300891619869513","url":null,"abstract":"Background: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. Measures: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. Results: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. Conclusion: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"21 1","pages":"25 - 32"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74448473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619868012
P. Cegła, J. Kazmierska, S. Gwóźdź, R. Czepczyński, J. Malicki, W. Cholewiński
Objective: Several genetic analyses have identified tumor diversity not only among tumors from different patients (intertumor heterogeneity) but also within individual tumors (intratumor heterogeneity). The aim of this study was to analyze the intratumor heterogeneity and other biological parameters based on in vivo distribution in triple-tracer positron emission tomography with computed tomography (PET/CT) study in patients with newly diagnosed head and neck (H&N) cancer. Methods: Thirty-six patients with newly diagnosed H&N cancer were included in the study. Institutional Bioethical Committee approved the study protocol and informed consent was received from every participant. All patients underwent series of 3 PET/CT scans with [18F]Fluorodeoxyglucose (18F-FDG-PET), [18F]Fluorothymidine (18F-FLT-PET), and [18F]Fluoromisonidazole (18F-FMISO-PET) before treatment. Scans were performed on separate days, within a timeframe of 2 weeks. Several PET/CT parameters grading tumor biology including maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), its equivalent (total hypoxic lesion [TLH] and total proliferative lesion [TLP]), and heterogeneity (area under the curve–cumulative SUV histogram) for the primary tumor were compared. Results: All patients showed increased uptake of 18F-FDG in primary tumor, ranging from 2.29 to 14.89 SUVmax. Respectively, SUVmax values for 18F-FLT ranged from 0.93 to 16.11 and for 18F-FMISO 0.36–4.07. Based on 3-year follow-up, we divided patients in terms of survival forecasts (first with good prognosis and second with worse). Higher values of TLG/TLP/TLH and SUVmax were observed in the second group in all 3 tracers (for 18F-FDG: 167.40 vs 100.32, 11.15 vs 8.95; for 18F-FLT: 116.61 vs 60.67, 7.09 vs 5.47; for 18F-FMISO: 37.34 vs 22.30, 1.70 vs 1.61 respectively). Statistically significant differences were shown in SUVmax in 18F-FDG and 18F-FLT (P<0.034, P<0.034, respectively; in TLG, P=0.05; TLP, P=0.04; and TLH, P=0.05). Conclusion: Our preliminary results suggest worse prognosis in patients with higher heterogeneity values of primary tumor in proliferation and hypoxia images and combination of metabolic and volumetric parameters in TLG and its equivalent and heterogeneity of primary tumor seems to be a prognostic factor.
目的:一些遗传分析已经确定了肿瘤的多样性，不仅在不同患者的肿瘤之间(肿瘤间异质性)，而且在单个肿瘤内(肿瘤内异质性)。本研究的目的是分析新诊断头颈部(H&N)癌患者的三示踪正电子发射断层扫描与计算机断层扫描(PET/CT)研究中基于体内分布的肿瘤内异质性和其他生物学参数。方法:对36例新诊断的H&N癌患者进行研究。机构生物伦理委员会批准了研究方案，并收到了每位参与者的知情同意。所有患者在治疗前均采用[18F]氟脱氧葡萄糖(18F- fdg -PET)、[18F]氟胸苷(18F- flt -PET)和[18F]氟咪唑(18F- fmiso -PET)进行了3次PET/CT扫描。扫描在两周的时间框架内，在不同的日子进行。我们比较了原发肿瘤的几种PET/CT分级肿瘤生物学参数，包括最大标准化摄取值(SUVmax)、病变总糖酵解(TLG)及其等效值(全缺氧病变[TLH]和全增生性病变[TLP])和异质性(曲线累积SUV直方图下面积)。结果:所有患者在原发肿瘤中均显示18F-FDG的摄取增加，范围从2.29到14.89 SUVmax。18F-FLT和18F-FMISO的SUVmax值分别为0.93 ~ 16.11和0.36 ~ 4.07。在3年随访的基础上，我们根据生存预测对患者进行了分类(第一组预后良好，第二组预后较差)。在第二组中，所有3种示踪剂的TLG/TLP/TLH和SUVmax值均较高(18F-FDG: 167.40 vs 100.32, 11.15 vs 8.95;18F-FLT: 116.61 vs 60.67, 7.09 vs 5.47;18F-FMISO分别为37.34 vs 22.30, 1.70 vs 1.61)。18F-FDG、18F-FLT的SUVmax差异有统计学意义(P<0.034, P<0.034);TLG组，P=0.05;张力腿平台,P = 0.04;TLH, P=0.05)。结论:我们的初步结果提示，原发肿瘤增殖和缺氧图像异质性值较高的患者预后较差，TLG的代谢和体积参数与其原发肿瘤的等效性和异质性的结合可能是预后的一个因素。
{"title":"Assessment of biological parameters in head and neck cancer based on in vivo distribution of 18F-FDG-FLT-FMISO-PET/CT images","authors":"P. Cegła, J. Kazmierska, S. Gwóźdź, R. Czepczyński, J. Malicki, W. Cholewiński","doi":"10.1177/0300891619868012","DOIUrl":"https://doi.org/10.1177/0300891619868012","url":null,"abstract":"Objective: Several genetic analyses have identified tumor diversity not only among tumors from different patients (intertumor heterogeneity) but also within individual tumors (intratumor heterogeneity). The aim of this study was to analyze the intratumor heterogeneity and other biological parameters based on in vivo distribution in triple-tracer positron emission tomography with computed tomography (PET/CT) study in patients with newly diagnosed head and neck (H&N) cancer. Methods: Thirty-six patients with newly diagnosed H&N cancer were included in the study. Institutional Bioethical Committee approved the study protocol and informed consent was received from every participant. All patients underwent series of 3 PET/CT scans with [18F]Fluorodeoxyglucose (18F-FDG-PET), [18F]Fluorothymidine (18F-FLT-PET), and [18F]Fluoromisonidazole (18F-FMISO-PET) before treatment. Scans were performed on separate days, within a timeframe of 2 weeks. Several PET/CT parameters grading tumor biology including maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), its equivalent (total hypoxic lesion [TLH] and total proliferative lesion [TLP]), and heterogeneity (area under the curve–cumulative SUV histogram) for the primary tumor were compared. Results: All patients showed increased uptake of 18F-FDG in primary tumor, ranging from 2.29 to 14.89 SUVmax. Respectively, SUVmax values for 18F-FLT ranged from 0.93 to 16.11 and for 18F-FMISO 0.36–4.07. Based on 3-year follow-up, we divided patients in terms of survival forecasts (first with good prognosis and second with worse). Higher values of TLG/TLP/TLH and SUVmax were observed in the second group in all 3 tracers (for 18F-FDG: 167.40 vs 100.32, 11.15 vs 8.95; for 18F-FLT: 116.61 vs 60.67, 7.09 vs 5.47; for 18F-FMISO: 37.34 vs 22.30, 1.70 vs 1.61 respectively). Statistically significant differences were shown in SUVmax in 18F-FDG and 18F-FLT (P<0.034, P<0.034, respectively; in TLG, P=0.05; TLP, P=0.04; and TLH, P=0.05). Conclusion: Our preliminary results suggest worse prognosis in patients with higher heterogeneity values of primary tumor in proliferation and hypoxia images and combination of metabolic and volumetric parameters in TLG and its equivalent and heterogeneity of primary tumor seems to be a prognostic factor.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"50 1","pages":"33 - 38"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75736099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619868006
L. Ferella, A. Cavallo, R. Miceli, N. Iacovelli, T. Giandini, E. Pignoli, G. Calareso, P. Bossi, C. Resteghini, G. Gravina, P. Nicolai, P. Castelnuovo, C. Piazza, L. Licitra, C. Fallai, E. Orlandi
Background: We evaluated the prognostic role of gross tumor volumes (GTVs) of primary tumor and positive lymph nodes on overall survival (OS) and progression-free survival (PFS) in locally advanced unresectable sinonasal cancer (SNC) treated with definitive intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Methods: Primary tumor GTV (GTV-T), pathologic neck nodes GTV (GTV-N), and positive retropharyngeal nodes GTV (GTV-RPN) of 34 patients with epithelial nonglandular SNC receiving IMRT with or without chemotherapy were retrospectively measured. The GTV variables were analyzed in relation with OS and PFS. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test. We also estimated the crude cumulative incidence of locoregional relapses only. The optimal volume cutoff value was determined using an outcome-oriented method among the observed values. Results: GTV-T was significantly associated with decreased OS (P=0.003) and PFS (P=0.003). Moreover, patients with disease total volumes (GTV) smaller than 149.44 cm³ had better OS and PFS than patients with higher volumes (P<0.0001 for both). Neck nodal metastasis impacted on OS and PFS (P=0.030 and P=0.033, respectively), but GTV-N did not (P=0.961; P=0.958). Retropharyngeal nodes metastasis was not associated with prognosis (OS: P=0.400; PFS: P=0.104). When GTV-RPN was added to GTV-N (GTV-TN), a relation with PFS (P=0.041) and a trend toward significance for OS (P=0.075) were found. Conclusions: Our results show that tumor volume is a powerful predictor of outcome in SNC. This could be useful to identify patients with worse prognosis deserving different treatment strategies.
{"title":"Prognostic role of primary tumor, nodal neck, and retropharyngeal GTVs for unresectable sinonasal cancers treated with IMRT and chemotherapy","authors":"L. Ferella, A. Cavallo, R. Miceli, N. Iacovelli, T. Giandini, E. Pignoli, G. Calareso, P. Bossi, C. Resteghini, G. Gravina, P. Nicolai, P. Castelnuovo, C. Piazza, L. Licitra, C. Fallai, E. Orlandi","doi":"10.1177/0300891619868006","DOIUrl":"https://doi.org/10.1177/0300891619868006","url":null,"abstract":"Background: We evaluated the prognostic role of gross tumor volumes (GTVs) of primary tumor and positive lymph nodes on overall survival (OS) and progression-free survival (PFS) in locally advanced unresectable sinonasal cancer (SNC) treated with definitive intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Methods: Primary tumor GTV (GTV-T), pathologic neck nodes GTV (GTV-N), and positive retropharyngeal nodes GTV (GTV-RPN) of 34 patients with epithelial nonglandular SNC receiving IMRT with or without chemotherapy were retrospectively measured. The GTV variables were analyzed in relation with OS and PFS. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test. We also estimated the crude cumulative incidence of locoregional relapses only. The optimal volume cutoff value was determined using an outcome-oriented method among the observed values. Results: GTV-T was significantly associated with decreased OS (P=0.003) and PFS (P=0.003). Moreover, patients with disease total volumes (GTV) smaller than 149.44 cm³ had better OS and PFS than patients with higher volumes (P<0.0001 for both). Neck nodal metastasis impacted on OS and PFS (P=0.030 and P=0.033, respectively), but GTV-N did not (P=0.961; P=0.958). Retropharyngeal nodes metastasis was not associated with prognosis (OS: P=0.400; PFS: P=0.104). When GTV-RPN was added to GTV-N (GTV-TN), a relation with PFS (P=0.041) and a trend toward significance for OS (P=0.075) were found. Conclusions: Our results show that tumor volume is a powerful predictor of outcome in SNC. This could be useful to identify patients with worse prognosis deserving different treatment strategies.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"25 1","pages":"39 - 46"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76956762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-18DOI: 10.1177/0300891619886656
Yu Feng, Hui Liu, Yingying Ding, Ya Zhang, C. Liao, Yan Jin, Conghui Ai
Purpose: To prospectively investigate changes in quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in patients with cervical cancer before and after neoadjuvant chemotherapy (NACT). Methods: Thirty-eight patients with cervical cancer underwent DCE-MRI and DWI 1 week before and 4 weeks after NACT. The patients were classified into 2 groups: significant reaction (sCR) group and the non-sCR group. DCE-MRI parameters and ADC values were measured and compared between the 2 groups. Results: Before NACT, the mean Ktrans value was higher, but the mean Ve was lower, in the sCR group compared with the non-sCR group; these differences were statistically significant (p<0.05). After NACT, the mean Ktrans value and the delta (i.e., changed) value of Ktrans were significantly lower in the sCR group compared with the non-sCR group (p<0.05). However, the mean ADC and the delta value of the mean ADC between the 2 groups were slightly higher in the sCR group compared with the non-sCR group (p<0.05). The area under the curve of pre-mean Ktrans, DKtrans, and pre-mean Ktrans combined with post-mean ADC values were 0.801, 0.955, and 0.878, respectively (p<0.05). The optimal cutoff values for distinguishing sCR from non-sCR were pretreatment Ktrans (0.7020 min−1) and DKtrans (0.0437 min−1). Conclusions: Quantitative parameters (pre-mean Ktrans, DKtrans, and pre-mean Ktrans) combined with post-mean ADC could predict treatment efficacy more precisely. However, quantitative DCE-MRI combined with DWI could not significantly improve prognostic efficacy.
{"title":"Combined dynamic DCE-MRI and diffusion-weighted imaging to evaluate the effect of neoadjuvant chemotherapy in cervical cancer","authors":"Yu Feng, Hui Liu, Yingying Ding, Ya Zhang, C. Liao, Yan Jin, Conghui Ai","doi":"10.1177/0300891619886656","DOIUrl":"https://doi.org/10.1177/0300891619886656","url":null,"abstract":"Purpose: To prospectively investigate changes in quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in patients with cervical cancer before and after neoadjuvant chemotherapy (NACT). Methods: Thirty-eight patients with cervical cancer underwent DCE-MRI and DWI 1 week before and 4 weeks after NACT. The patients were classified into 2 groups: significant reaction (sCR) group and the non-sCR group. DCE-MRI parameters and ADC values were measured and compared between the 2 groups. Results: Before NACT, the mean Ktrans value was higher, but the mean Ve was lower, in the sCR group compared with the non-sCR group; these differences were statistically significant (p<0.05). After NACT, the mean Ktrans value and the delta (i.e., changed) value of Ktrans were significantly lower in the sCR group compared with the non-sCR group (p<0.05). However, the mean ADC and the delta value of the mean ADC between the 2 groups were slightly higher in the sCR group compared with the non-sCR group (p<0.05). The area under the curve of pre-mean Ktrans, DKtrans, and pre-mean Ktrans combined with post-mean ADC values were 0.801, 0.955, and 0.878, respectively (p<0.05). The optimal cutoff values for distinguishing sCR from non-sCR were pretreatment Ktrans (0.7020 min−1) and DKtrans (0.0437 min−1). Conclusions: Quantitative parameters (pre-mean Ktrans, DKtrans, and pre-mean Ktrans) combined with post-mean ADC could predict treatment efficacy more precisely. However, quantitative DCE-MRI combined with DWI could not significantly improve prognostic efficacy.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"1 7","pages":"155 - 164"},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91427031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-18DOI: 10.1177/0300891619886657
M. Miccò, M. Sbarra, B. Gui, N. Bianco, E. Rodolfino, R. Manfredi
Objective: To evaluate computed tomography (CT) findings able to predict outcome in patients with ovarian cancer (OC) and concomitant bowel occlusion. Methods: This institutional review board–approved retrospective study included 31 patients with OC and clinical evidence of bowel occlusion who underwent CT at presentation between February 2013 and June 2015. Two radiologists recorded various qualitative CT features. Correlations between CT and survival data were made with Mann-Whitney test, Wilcoxon test, and χ2 test, as appropriate. Receiver operating characteristic curves were generated for statistically significant CT findings using logistic regression model. Results: Two of 31 patients (6.5%) were alive at the end of this study; 29 patients (93.5%) died of disease. Median overall survival was 90 days. CT features associated with short life expectancy were bowel mural thinning (p=0.03), mesenteric tumor deposits (p=0.009), mesenteric infiltration (p=0.02), and ascites (p=0.04). Area under the curve was 0.728 (p=0.03) for mesenteric tumor deposits in predicting malignant bowel obstruction. Conclusions: Accurate interpretation of CT features may guide decisions in care of women with OC and bowel obstruction.
{"title":"Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer","authors":"M. Miccò, M. Sbarra, B. Gui, N. Bianco, E. Rodolfino, R. Manfredi","doi":"10.1177/0300891619886657","DOIUrl":"https://doi.org/10.1177/0300891619886657","url":null,"abstract":"Objective: To evaluate computed tomography (CT) findings able to predict outcome in patients with ovarian cancer (OC) and concomitant bowel occlusion. Methods: This institutional review board–approved retrospective study included 31 patients with OC and clinical evidence of bowel occlusion who underwent CT at presentation between February 2013 and June 2015. Two radiologists recorded various qualitative CT features. Correlations between CT and survival data were made with Mann-Whitney test, Wilcoxon test, and χ2 test, as appropriate. Receiver operating characteristic curves were generated for statistically significant CT findings using logistic regression model. Results: Two of 31 patients (6.5%) were alive at the end of this study; 29 patients (93.5%) died of disease. Median overall survival was 90 days. CT features associated with short life expectancy were bowel mural thinning (p=0.03), mesenteric tumor deposits (p=0.009), mesenteric infiltration (p=0.02), and ascites (p=0.04). Area under the curve was 0.728 (p=0.03) for mesenteric tumor deposits in predicting malignant bowel obstruction. Conclusions: Accurate interpretation of CT features may guide decisions in care of women with OC and bowel obstruction.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"11 1","pages":"149 - 154"},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78679251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-08DOI: 10.1177/0300891619888021
A. Ferrari, P. Gasparini, M. Casanova
Rhabdomyosarcoma is a rare tumor, with an annual incidence of 4 in 1 million population. Around 400 cases are diagnosed among 0to 19-year-olds in Europe each year,1 50–60 of them in Italy.2,3 It is nonetheless the most common soft tissue sarcoma in children and adolescents. This highly malignant tumor has a strong propensity to metastasize, but also a good chance of responding to conventional chemotherapy. Recent pediatric oncology studies report overall survival rates exceeding 70% for patients with localized rhabdomyosarcoma given risk-adapted multidisciplinary treatments, including surgery, radiotherapy, and multiagent chemotherapy in particular.4 The outcome is unsatisfactory for some patient categories, however, such as adolescents and young adults with rhabdomyosarcoma, patients with an alveolar histology, and those with distant metastases or relapsing disease. In September 2019, the European pediatric Soft Tissue Sarcoma Study Group (EpSSG) published the results of a rhabdomyosarcoma study (EpSSG RMS 2005), particularly reporting on the efficacy of maintenance therapy.5 When the study findings were presented at the plenary sessions of the congresses held by the American Society of Clinical Oncology in June 2018 and by the European Society of Paediatric Oncology in May 2019, the media described them as a “home run” for the treatment of rhabdomyosarcoma. Here we retrace the story of this important study to glean useful hints and explore what to do next in clinical research on rhabdomyosarcoma. The phase III randomized EpSSG RMS 2005 trial was tailored to patients under 21 years old with localized rhabdomyosarcoma. The protocol paid special attention to the so-called high-risk patients, i.e., those with incompletely resected embryonal rhabdomyosarcoma arising at unfavorable sites and age ⩾10 years and/or tumor size >5 cm, any embryonal rhabdomyosarcoma with nodal involvement, or any alveolar rhabdomyosarcoma without nodal involvement. This high-risk group was believed to represent 55%–60% of all patients with localized rhabdomyosarcoma, whose 5-year event-free survival (EFS) and overall survival (OS) rates were estimated at around 50%– 55% and 60%, respectively. For these patients, the protocol included 2 randomizations (Figure 1). The first, applied at the time of diagnosis, was used to investigate whether patients with rhabdomyosarcoma might benefit from a higher doxorubicin dose intensity in the initial period of their treatment. The results were published in 2018: with 484 patients treated, the 3-year EFS rate was 63.3% for patients in the standard arm (ifosfamide, vincristine, and actinomycin-D; IVA), and 67.5% for those in the experimental arm (ifosfamide, vincristine and actinomycin-D plus doxorubicin; IVADo) (p = 0.33). The study showed that adding dose-intensified doxorubicin to the standard IVA chemotherapy did not significantly improve the outcome for patients with high-risk nonmetastatic rhabdomyosarcoma. Acute toxicity was signif
{"title":"A home run for rhabdomyosarcoma after 30 years: What now?","authors":"A. Ferrari, P. Gasparini, M. Casanova","doi":"10.1177/0300891619888021","DOIUrl":"https://doi.org/10.1177/0300891619888021","url":null,"abstract":"Rhabdomyosarcoma is a rare tumor, with an annual incidence of 4 in 1 million population. Around 400 cases are diagnosed among 0to 19-year-olds in Europe each year,1 50–60 of them in Italy.2,3 It is nonetheless the most common soft tissue sarcoma in children and adolescents. This highly malignant tumor has a strong propensity to metastasize, but also a good chance of responding to conventional chemotherapy. Recent pediatric oncology studies report overall survival rates exceeding 70% for patients with localized rhabdomyosarcoma given risk-adapted multidisciplinary treatments, including surgery, radiotherapy, and multiagent chemotherapy in particular.4 The outcome is unsatisfactory for some patient categories, however, such as adolescents and young adults with rhabdomyosarcoma, patients with an alveolar histology, and those with distant metastases or relapsing disease. In September 2019, the European pediatric Soft Tissue Sarcoma Study Group (EpSSG) published the results of a rhabdomyosarcoma study (EpSSG RMS 2005), particularly reporting on the efficacy of maintenance therapy.5 When the study findings were presented at the plenary sessions of the congresses held by the American Society of Clinical Oncology in June 2018 and by the European Society of Paediatric Oncology in May 2019, the media described them as a “home run” for the treatment of rhabdomyosarcoma. Here we retrace the story of this important study to glean useful hints and explore what to do next in clinical research on rhabdomyosarcoma. The phase III randomized EpSSG RMS 2005 trial was tailored to patients under 21 years old with localized rhabdomyosarcoma. The protocol paid special attention to the so-called high-risk patients, i.e., those with incompletely resected embryonal rhabdomyosarcoma arising at unfavorable sites and age ⩾10 years and/or tumor size >5 cm, any embryonal rhabdomyosarcoma with nodal involvement, or any alveolar rhabdomyosarcoma without nodal involvement. This high-risk group was believed to represent 55%–60% of all patients with localized rhabdomyosarcoma, whose 5-year event-free survival (EFS) and overall survival (OS) rates were estimated at around 50%– 55% and 60%, respectively. For these patients, the protocol included 2 randomizations (Figure 1). The first, applied at the time of diagnosis, was used to investigate whether patients with rhabdomyosarcoma might benefit from a higher doxorubicin dose intensity in the initial period of their treatment. The results were published in 2018: with 484 patients treated, the 3-year EFS rate was 63.3% for patients in the standard arm (ifosfamide, vincristine, and actinomycin-D; IVA), and 67.5% for those in the experimental arm (ifosfamide, vincristine and actinomycin-D plus doxorubicin; IVADo) (p = 0.33). The study showed that adding dose-intensified doxorubicin to the standard IVA chemotherapy did not significantly improve the outcome for patients with high-risk nonmetastatic rhabdomyosarcoma. Acute toxicity was signif","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"103 1","pages":"11 - 5"},"PeriodicalIF":0.0,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75666151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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