Pub Date : 2024-12-01DOI: 10.1016/j.mednuc.2024.10.006
B. Jamet, C. Bodet-Milin, F. Kraeber-Bodéré
Over the past decade, 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography coupled with computed tomography (2-[18F]FDG-PET/CT) has become a pivotal imaging tool for the investigation of multiple myeloma, both in the initial workup and in the response to therapy assessment. Indeed, in addition to the detection at baseline of disease-related osteo-medullary and extra-osteo-medullary lesions which are criteria triggering the start of the treatment, several large prospective studies have showed the high added prognostic value of biomarkers derived from 2-[18F]FDG-PET/CT imaging. Consequently, international myeloma working group considers it as one of the recommended imaging technique in multiple myeloma initial workup. For response to therapy assessment, 2-[18F]FDG-PET/CT is the gold-standard imaging according to international recommendations, because of its ability to assess early changes of focal bone and/or extra-osseous lesions’ metabolism, and its strong predictive power for survival in all studies carried out at different points of first-line therapeutic management. Furthermore, the recent standardization of interpretation criteria of 2-[18F]FDG-PET/CT imaging performed after therapy during the follow-up has considerably strengthened its legitimacy in daily clinical routine making it one of the reference imaging technique in the management of multiple myeloma.
{"title":"2-[18F]FDG-TEP/TDM dans le myélome multiple : valeur pronostique initiale et évaluation de la réponse au traitement","authors":"B. Jamet, C. Bodet-Milin, F. Kraeber-Bodéré","doi":"10.1016/j.mednuc.2024.10.006","DOIUrl":"10.1016/j.mednuc.2024.10.006","url":null,"abstract":"<div><div>Over the past decade, 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography coupled with computed tomography (2-[18F]FDG-PET/CT) has become a pivotal imaging tool for the investigation of multiple myeloma, both in the initial workup and in the response to therapy assessment. Indeed, in addition to the detection at baseline of disease-related osteo-medullary and extra-osteo-medullary lesions which are criteria triggering the start of the treatment, several large prospective studies have showed the high added prognostic value of biomarkers derived from 2-[18F]FDG-PET/CT imaging. Consequently, international myeloma working group considers it as one of the recommended imaging technique in multiple myeloma initial workup. For response to therapy assessment, 2-[18F]FDG-PET/CT is the gold-standard imaging according to international recommendations, because of its ability to assess early changes of focal bone and/or extra-osseous lesions’ metabolism, and its strong predictive power for survival in all studies carried out at different points of first-line therapeutic management. Furthermore, the recent standardization of interpretation criteria of 2-[18F]FDG-PET/CT imaging performed after therapy during the follow-up has considerably strengthened its legitimacy in daily clinical routine making it one of the reference imaging technique in the management of multiple myeloma.</div></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 6","pages":"Pages 263-266"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mednuc.2024.09.003
O.-F. Couturier , R. Abgral
Identifying patients for whom the treatment is effective is an absolute necessity regarding the effectiveness of their care and ethics and avoiding them from losing opportunities and unnecessary adverse effects. It is also an economic necessity due to the very high cost of new treatments called “expensive molecules”, in particular immunotherapy, which poses problems of access to these treatments and constitutes a real financial challenge for health systems. In clinical routine as in research, imaging is the essential tool for deciding the success or failure of treatment, with a major medico-economic impact if we consider that these very expensive treatments are only effective in a fraction of patients and that they do not always bring a major benefit.
{"title":"Évaluer la réponse en cancérologie : l’imagerie un outil essentiel ?","authors":"O.-F. Couturier , R. Abgral","doi":"10.1016/j.mednuc.2024.09.003","DOIUrl":"10.1016/j.mednuc.2024.09.003","url":null,"abstract":"<div><div>Identifying patients for whom the treatment is effective is an absolute necessity regarding the effectiveness of their care and ethics and avoiding them from losing opportunities and unnecessary adverse effects. It is also an economic necessity due to the very high cost of new treatments called “expensive molecules”, in particular immunotherapy, which poses problems of access to these treatments and constitutes a real financial challenge for health systems. In clinical routine as in research, imaging is the essential tool for deciding the success or failure of treatment, with a major medico-economic impact if we consider that these very expensive treatments are only effective in a fraction of patients and that they do not always bring a major benefit.</div></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 6","pages":"Pages 226-230"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.mednuc.2024.09.004
R. Abgral , O.-F. Couturier
18F-Fluoro-Deoxyglucose (FDG) Positron Emission Tomography (PET) is an imaging technique used to study glucose metabolism in cells. It is particularly useful in oncology, especially for initial diagnosis and the detection of recurrence. Thanks to its functional approach to tissues, its use has evolved towards the evaluation of anticancer treatments, both in a personalized approach to patients and as part of clinical trials of new biotherapies. This technique provides additional information compared to conventional imaging, which is not always able to assess tumor viability of potentially necrotic or fibrotic residual masses after treatment. However, the use of FDG-PET requires a rigorous methodology, both for the performance of the studies and for their interpretation. Based on a large body of literature, interpretation criteria for solid tumors have been published and updated. PERCIST 1.0 (Positron Emission Tomography Response Criteria In Solid Tumors), proposed by an American task force in 2009, aims to clarify and standardize practice. These criteria will evolve according to the specificities of new biotherapies such as immunotherapy.
{"title":"Évaluation de la réponse thérapeutique par TEP-FDG des cancers solides (critères PERCIST 1.0)","authors":"R. Abgral , O.-F. Couturier","doi":"10.1016/j.mednuc.2024.09.004","DOIUrl":"10.1016/j.mednuc.2024.09.004","url":null,"abstract":"<div><div>18F-Fluoro-Deoxyglucose (FDG) Positron Emission Tomography (PET) is an imaging technique used to study glucose metabolism in cells. It is particularly useful in oncology, especially for initial diagnosis and the detection of recurrence. Thanks to its functional approach to tissues, its use has evolved towards the evaluation of anticancer treatments, both in a personalized approach to patients and as part of clinical trials of new biotherapies. This technique provides additional information compared to conventional imaging, which is not always able to assess tumor viability of potentially necrotic or fibrotic residual masses after treatment. However, the use of FDG-PET requires a rigorous methodology, both for the performance of the studies and for their interpretation. Based on a large body of literature, interpretation criteria for solid tumors have been published and updated. PERCIST 1.0 (Positron Emission Tomography Response Criteria In Solid Tumors), proposed by an American task force in 2009, aims to clarify and standardize practice. These criteria will evolve according to the specificities of new biotherapies such as immunotherapy.</div></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 6","pages":"Pages 272-278"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.mednuc.2024.09.001
A.-L. Giraudet , P.-A. Hamon , J. Coulot , P. Pascal , E. Deshayes , F. Courbon , P.-Y. Salaun
The French Society of Nuclear Medicine (SFMN) launched the “theranostic capacity study” among establishments with nuclear medicine services (CHU, CLCC, CHG, ESPIC, Liberal Centers) to promote rapid adoption and easier access to this therapeutic innovation, either by optimizing the number of patients per service, or by considering the opening of activities in areas not covered. The SFMN intends above all to raise awareness among the establishments participating in the study about the implementation of the RIV activity, but it also wishes to enlighten national, regional and local authorities on the level of preparation of nuclear medicine services, their challenges and the difficulties they encounter. To carry out this study, the SFMN commissioned the Madis Phileo firm, which added the technical expertise of Esprimed. This study was carried out with the financial support of the company AdAcAp after validation by the Ile-de-France Regional Health Agency. The SFMN conducted this study in complete independence both in terms of the design of the study and its execution without any further intervention on the part of AdAcAp. It should be noted that in the context of this study, we talk a lot about IVR with Lu-177 PSMA, considering that it is this therapeutic modality which is likely, in the short term, to significantly increase the flow of patients. As much as possible, however, we used a global reading grid, integrating into our analyzes the other RIV treatments currently practiced in France (lutetium in neuroendocrine tumors, iodine 131, etc.), and trying, as best as possible to integrate clinical research activities which are likely to mobilize therapeutic niches. This report is made up of 2 distincts parts : Part I: National Consolidation and Part II: In-Depth Analysis.These two parts are based on the evaluation grids relating to each nuclear medicine service, anonymized and collated in an Excel file to bring together all the data collected and calculated scores in a single document. The recruitment of the 79 services was done entirely on the basis of a voluntary approach. The data collected therefore results from the cooperation of the participants to document the study and make it as relevant as possible. The restitution to all participating services of the individual nominative reports reinforced the relevance of their conclusions without giving rise to notable modifications or amendments. After checking the participating services and cross-checking the data, we are led to conclude that the study is representative of the reality of theranostic practice in France at the date of writing of this report.
{"title":"Étude capacité théranostique 2023–2024 – modélisation sur la base de la RIV-PSMA. Radiothérapie interne vectorisée (RIV), une approche théranostique à laquelle le patient doit avoir accès. Partie I : consolidation nationale","authors":"A.-L. Giraudet , P.-A. Hamon , J. Coulot , P. Pascal , E. Deshayes , F. Courbon , P.-Y. Salaun","doi":"10.1016/j.mednuc.2024.09.001","DOIUrl":"10.1016/j.mednuc.2024.09.001","url":null,"abstract":"<div><div>The French Society of Nuclear Medicine (SFMN) launched the “theranostic capacity study” among establishments with nuclear medicine services (CHU, CLCC, CHG, ESPIC, Liberal Centers) to promote rapid adoption and easier access to this therapeutic innovation, either by optimizing the number of patients per service, or by considering the opening of activities in areas not covered. The SFMN intends above all to raise awareness among the establishments participating in the study about the implementation of the RIV activity, but it also wishes to enlighten national, regional and local authorities on the level of preparation of nuclear medicine services, their challenges and the difficulties they encounter. To carry out this study, the SFMN commissioned the Madis Phileo firm, which added the technical expertise of Esprimed. This study was carried out with the financial support of the company AdAcAp after validation by the Ile-de-France Regional Health Agency. The SFMN conducted this study in complete independence both in terms of the design of the study and its execution without any further intervention on the part of AdAcAp. It should be noted that in the context of this study, we talk a lot about IVR with Lu-177 PSMA, considering that it is this therapeutic modality which is likely, in the short term, to significantly increase the flow of patients. As much as possible, however, we used a global reading grid, integrating into our analyzes the other RIV treatments currently practiced in France (lutetium in neuroendocrine tumors, iodine 131, etc.), and trying, as best as possible to integrate clinical research activities which are likely to mobilize therapeutic niches. This report is made up of 2 distincts parts : Part I: National Consolidation and Part II: In-Depth Analysis.These two parts are based on the evaluation grids relating to each nuclear medicine service, anonymized and collated in an Excel file to bring together all the data collected and calculated scores in a single document. The recruitment of the 79 services was done entirely on the basis of a voluntary approach. The data collected therefore results from the cooperation of the participants to document the study and make it as relevant as possible. The restitution to all participating services of the individual nominative reports reinforced the relevance of their conclusions without giving rise to notable modifications or amendments. After checking the participating services and cross-checking the data, we are led to conclude that the study is representative of the reality of theranostic practice in France at the date of writing of this report.</div></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 4","pages":"Pages 169-188"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.mednuc.2024.09.002
A.-L. Giraudet , P.-A. Hamon , J. Coulot , P. Pascal , E. Deshayes , F. Courbon , P.-Y. Salaun
<div><div>This in-depth analysis highlights the issues and perspectives regarding the deployment and optimization of vectorized internal radiotherapy (VIR), based on the VIR-PSMA model, which is the first theranostic modality that changes the scale of clinical management in nuclear medicine. It made it possible to confirm a characterization of health establishments based on their experience and their ability to integrate this new treatment modality into their care offering. Here are 8 key points and recommendations highlighted in the following pages: 1. Current and future reception capacity: “experienced” and “initiated” establishments have the greatest short-term reception capacity, while “medium-term future” and “long-term future” establishments will come, in the medium and long term respectively, strengthen the provision of care. They will be able to strengthen the healthcare offer and the territorial network if the award of a B rating allows them to do so. 2. Discrepancy between capacity and need: a gap is already observed between the number of patients who can be treated and the real needs of patients eligible for VIR-PSMA, even though capacity projections are voluntarily restricted to “experienced” and “initiated” services only (the “future” services in the medium and long term are not to date uniform in obtaining the necessary authorizations). This gap between capacity and need can be considered initially by optimizing the use of existing resources (in particular thanks to available land capacity), which remains mainly limited by the shortage of professionals. Secondly, the granting of authorizations to “future” services will make it possible to complete the system, and in particular to promote the regional distribution of care provision which shows disparities that could be sources of inequitable access to care in France. 3. Clinical pathway and harmonization of practices: the clinical pathway for patients benefiting from a VIR requires harmonization of practices and the making of recommendations by the SFMN (from the assessment of eligibility to post-dose monitoring, including the organization of treatments and the reception of patients). 4. Training and recruitment needs: the anticipated growth in demand for VIR requires strengthening teams through the recruitment of all staff involved in the patient's journey, as well as the creation of cooperation protocols between all health professionals by strengthening the initial and continuing training of all professionals involved. 5. Investments and adaptation of infrastructure: significant investments in specialized infrastructure and in the upgrading of “up-and-coming” establishments are necessary to support the increase in VIR-related activity. 6. Define a valuation model allowing these care activities to be sustained while meeting specific constraints in terms of operation, infrastructure, and regulations. 7. Role of regional health agencies (ARS): the ARS play a crucial role in coordinati
{"title":"Étude capacité théranostique 2023–2024 – Modélisation sur la base de la RIV-PSMA. Radiothérapie interne vectorisée (RIV), une approche théranostique à laquelle le patient doit avoir accès. Partie II : analyse approfondie","authors":"A.-L. Giraudet , P.-A. Hamon , J. Coulot , P. Pascal , E. Deshayes , F. Courbon , P.-Y. Salaun","doi":"10.1016/j.mednuc.2024.09.002","DOIUrl":"10.1016/j.mednuc.2024.09.002","url":null,"abstract":"<div><div>This in-depth analysis highlights the issues and perspectives regarding the deployment and optimization of vectorized internal radiotherapy (VIR), based on the VIR-PSMA model, which is the first theranostic modality that changes the scale of clinical management in nuclear medicine. It made it possible to confirm a characterization of health establishments based on their experience and their ability to integrate this new treatment modality into their care offering. Here are 8 key points and recommendations highlighted in the following pages: 1. Current and future reception capacity: “experienced” and “initiated” establishments have the greatest short-term reception capacity, while “medium-term future” and “long-term future” establishments will come, in the medium and long term respectively, strengthen the provision of care. They will be able to strengthen the healthcare offer and the territorial network if the award of a B rating allows them to do so. 2. Discrepancy between capacity and need: a gap is already observed between the number of patients who can be treated and the real needs of patients eligible for VIR-PSMA, even though capacity projections are voluntarily restricted to “experienced” and “initiated” services only (the “future” services in the medium and long term are not to date uniform in obtaining the necessary authorizations). This gap between capacity and need can be considered initially by optimizing the use of existing resources (in particular thanks to available land capacity), which remains mainly limited by the shortage of professionals. Secondly, the granting of authorizations to “future” services will make it possible to complete the system, and in particular to promote the regional distribution of care provision which shows disparities that could be sources of inequitable access to care in France. 3. Clinical pathway and harmonization of practices: the clinical pathway for patients benefiting from a VIR requires harmonization of practices and the making of recommendations by the SFMN (from the assessment of eligibility to post-dose monitoring, including the organization of treatments and the reception of patients). 4. Training and recruitment needs: the anticipated growth in demand for VIR requires strengthening teams through the recruitment of all staff involved in the patient's journey, as well as the creation of cooperation protocols between all health professionals by strengthening the initial and continuing training of all professionals involved. 5. Investments and adaptation of infrastructure: significant investments in specialized infrastructure and in the upgrading of “up-and-coming” establishments are necessary to support the increase in VIR-related activity. 6. Define a valuation model allowing these care activities to be sustained while meeting specific constraints in terms of operation, infrastructure, and regulations. 7. Role of regional health agencies (ARS): the ARS play a crucial role in coordinati","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 4","pages":"Pages 189-223"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.mednuc.2024.03.002
C. Awoudou II Jr. , E.H.A.L. Bathily , M.S. Djigo , B. Ndong , M. Mbodj , P. Paulus
Introduction
The aim of our study was to evaluate the efficacy and tolerance of 223RaCl2 in patients with mCRPC with bone metastases, then analyse the impact of any change in treatment protocol on the efficacy of 223RaCl2 in mCRPC patients with bone metastases, by determining overall survival, progression-free survival and events occurring during therapeutic monitoring.
Materiel and methods
Our retrospective, analytical and descriptive study, carried out in Luxembourg, included patients eligible for le 223RaCl2 treatment who were assessed during and at the end of treatment, and 3 to 4 months after the end of treatment.
Results
Our sample included 41 cases. The mean age of patients was 74 years (min = 52, max = 87), with 32 (78.1%) deaths recorded. Median overall survival was 18.0 months (95% CI: 12.1–23.9): 11 months for those who experienced progression during treatment versus 47 months for those who experienced a partial response. Median progression-free survival was 15.0 months (95% CI: 0.0–36.4). Overall survival was positively correlated with progression-free survival (Rho Spearman = 0.713, P-value < 0.001); however, a one-month increase in progression-free survival decreased the risk of death by 6% and thus increased overall survival (HR = 0.937, 95% CI : 0.903–0.973, P < 0.001).
Conclusion
Administration of the complete 223RaCl2 protocol improved overall survival and progression-free survival in patients treated for mCRPC with bone metastases, with good hematological tolerability despite the occurrence of complications such as epiduritis and fractures.
{"title":"Efficacité et tolérance du dichlorure de radium 223 chez les patients traités pour cancer de la prostate résistant à la castration avec métastases osseuses","authors":"C. Awoudou II Jr. , E.H.A.L. Bathily , M.S. Djigo , B. Ndong , M. Mbodj , P. Paulus","doi":"10.1016/j.mednuc.2024.03.002","DOIUrl":"10.1016/j.mednuc.2024.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of our study was to evaluate the efficacy and tolerance of <sup>223</sup>RaCl<sub>2</sub> in patients with mCRPC with bone metastases, then analyse the impact of any change in treatment protocol on the efficacy of <sup>223</sup>RaCl<sub>2</sub> in mCRPC patients with bone metastases, by determining overall survival, progression-free survival and events occurring during therapeutic monitoring.</p></div><div><h3>Materiel and methods</h3><p>Our retrospective, analytical and descriptive study, carried out in Luxembourg, included patients eligible for le <sup>223</sup>RaCl<sub>2</sub> treatment who were assessed during and at the end of treatment, and 3 to 4<!--> <!-->months after the end of treatment.</p></div><div><h3>Results</h3><p>Our sample included 41 cases. The mean age of patients was 74<!--> <!-->years (min<!--> <!-->=<!--> <!-->52, max<!--> <!-->=<!--> <!-->87), with 32 (78.1%) deaths recorded. Median overall survival was 18.0<!--> <!-->months (95% CI: 12.1–23.9): 11<!--> <!-->months for those who experienced progression during treatment versus 47 months for those who experienced a partial response. Median progression-free survival was 15.0 months (95% CI: 0.0–36.4). Overall survival was positively correlated with progression-free survival (Rho Spearman<!--> <!-->=<!--> <!-->0.713, <em>P</em>-value<!--> <!--><<!--> <!-->0.001); however, a one-month increase in progression-free survival decreased the risk of death by 6% and thus increased overall survival (HR<!--> <!-->=<!--> <!-->0.937, 95% CI : 0.903–0.973, <em>P</em> <!--><<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>Administration of the complete <sup>223</sup>RaCl<sub>2</sub> protocol improved overall survival and progression-free survival in patients treated for mCRPC with bone metastases, with good hematological tolerability despite the occurrence of complications such as epiduritis and fractures.</p></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 3","pages":"Pages 150-157"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.mednuc.2024.03.001
O. Vural Topuz , T.S. Akkurt , G.U. Erdem , E.M. Kaya , M. Kaya , B.E. Akkaş
Objective
To assess the utility of metabolic parameters obtained from baseline and post-neoadjuvant chemotherapy (NAC) 18F FDG PET/CT scans in predicting postoperative residual cancer burden (RCB) scores in locally-advanced breast cancer (LABC).
Methods
In our retrospective study, we enrolled 58 LABC patients who underwent baseline and post-treatment 18F FDG PET/CT scans followed by surgery between June 2020 and February 2022. Patients were categorized by their molecular subtypes as Luminal groupe (Luminal A and Luminal B (HER 2 negative)), HER2 positive and triple-negative (TN). We recorded various metabolic parameters, including maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake lean body mass (SULmax), and mean SUV lean body mass (SULmean) of the primary tumor (T). To minimize the effect of SUV changes between PET studies, SUV ratios of tumor and liver were recorded for each study as TLR1 and TLR2 respectively. We calculated the percent reduction in SUVmax (ΔSUVmax%) between 2 PET studies. Patients were categorized into two groups based on postoperative RCB scores: RCB0/I (pathological responders, pR) and RCB II/III (pathological non-responders, non-pR).
Results
Twenty-six patients (44.8%) were pR and 32 (55.2%) were non-pR. Baseline metabolic parameters were similar in 2 groups. Post-treatment T SUVmax2, T SUVmean2, T SULmax2, T SULmean2, TLR SUV2, and TLR SUL2 values were significantly different between the pR and non-pR patients across all molecular subgroups. Also, pR patients exhibited a significantly higher mean ΔSUVmax compared to non-pR patients. In the Luminal and HER2 positive groups, T SUVmax2 and T SUVmean2 values successfully discriminated the pR and non-pR groups with high accuracy, achieving 100% sensitivity and 100% specificity in the luminal group. In the luminal group, a −75.4% cut-off value for ΔSUVmax predicted pR with 100% sensitivity.
Conclusion
Our findings indicate that SUV parameters, normalized to lean body mass as recommended by PERCIST, can be valuable for the early non-invasive prediction of pR and non-pR patients using post-NAC 18F FDG PET/CT.
{"title":"Can post neoadjuvant chemotherapy 18F-FDG PET/CT predict residual cancer burden in locally advanced breast cancer?","authors":"O. Vural Topuz , T.S. Akkurt , G.U. Erdem , E.M. Kaya , M. Kaya , B.E. Akkaş","doi":"10.1016/j.mednuc.2024.03.001","DOIUrl":"10.1016/j.mednuc.2024.03.001","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the utility of metabolic parameters obtained from baseline and post-neoadjuvant chemotherapy (NAC) 18F FDG PET/CT scans in predicting postoperative residual cancer burden (RCB) scores in locally-advanced breast cancer (LABC).</p></div><div><h3>Methods</h3><p>In our retrospective study, we enrolled 58 LABC patients who underwent baseline and post-treatment 18F FDG PET/CT scans followed by surgery between June 2020 and February 2022. Patients were categorized by their molecular subtypes as Luminal groupe (Luminal A and Luminal B (HER 2 negative)), HER2 positive and triple-negative (TN). We recorded various metabolic parameters, including maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake lean body mass (SULmax), and mean SUV lean body mass (SULmean) of the primary tumor (T). To minimize the effect of SUV changes between PET studies, SUV ratios of tumor and liver were recorded for each study as TLR1 and TLR2 respectively. We calculated the percent reduction in SUVmax (ΔSUVmax%) between 2 PET studies. Patients were categorized into two groups based on postoperative RCB scores: RCB0/I (pathological responders, pR) and RCB II/III (pathological non-responders, non-pR).</p></div><div><h3>Results</h3><p>Twenty-six patients (44.8%) were pR and 32 (55.2%) were non-pR. Baseline metabolic parameters were similar in 2 groups. Post-treatment T SUVmax2, T SUVmean2, T SULmax2, T SULmean2, TLR SUV2, and TLR SUL2 values were significantly different between the pR and non-pR patients across all molecular subgroups. Also, pR patients exhibited a significantly higher mean ΔSUVmax compared to non-pR patients. In the Luminal and HER2 positive groups, T SUVmax2 and T SUVmean2 values successfully discriminated the pR and non-pR groups with high accuracy, achieving 100% sensitivity and 100% specificity in the luminal group. In the luminal group, a −75.4% cut-off value for ΔSUVmax predicted pR with 100% sensitivity.</p></div><div><h3>Conclusion</h3><p>Our findings indicate that SUV parameters, normalized to lean body mass as recommended by PERCIST, can be valuable for the early non-invasive prediction of pR and non-pR patients using post-NAC 18F FDG PET/CT.</p></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 3","pages":"Pages 141-149"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.mednuc.2024.02.003
S. Gülbahar Ateş , B.B. Demirel , G. Uçmak
An extensive tumor thrombus is an extremely rare entity in thyroid cancer. It is related to aggressive tumor behavior and a poorer prognosis. 18F-FDG PET is a useful tool for accurate staging and restaging in malignancies as well as the determination of tumor thrombus and its differential diagnosis from benign thromboembolism. We report a rare case of 66-year-old patient with an extensive tumor thrombus in superior vena cava on 18F-FDG PET/CT.
广泛的肿瘤血栓在甲状腺癌中极为罕见。它与肿瘤的侵袭性和较差的预后有关。18F-FDG PET 是对恶性肿瘤进行准确分期和再分期的有用工具，也是确定肿瘤血栓及其与良性血栓栓塞鉴别诊断的有用工具。我们报告了一例罕见病例，66 岁的患者在 18F-FDG PET/CT 检查中发现上腔静脉存在广泛的肿瘤血栓。
{"title":"Poorly differentiated thyroid cancer with an extensive tumor thrombus in superior vena cava on 18F-FDG PET/CT: A case report","authors":"S. Gülbahar Ateş , B.B. Demirel , G. Uçmak","doi":"10.1016/j.mednuc.2024.02.003","DOIUrl":"https://doi.org/10.1016/j.mednuc.2024.02.003","url":null,"abstract":"<div><p>An extensive tumor thrombus is an extremely rare entity in thyroid cancer. It is related to aggressive tumor behavior and a poorer prognosis. 18F-FDG PET is a useful tool for accurate staging and restaging in malignancies as well as the determination of tumor thrombus and its differential diagnosis from benign thromboembolism. We report a rare case of 66-year-old patient with an extensive tumor thrombus in superior vena cava on 18F-FDG PET/CT.</p></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 3","pages":"Pages 161-164"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.mednuc.2024.02.002
C. Sezgin , Y. Parlak , G. Mutevelizade , G. Gumuser , E. Sayit
Fluorodeoxyglucose (FDG) 18F-FDG PET/CT plays an important role in lymphoma staging and evaluation of treatment response. Mimics should be considered when evaluating 18F-FDG PET/CT images to perform correct staging and correct treatment response evaluation. Splenosis is one of the causes that may cause misinterpretation by mixing with lymph nodes in lymphoma patients. In our case report, we visualized splenosis mimicking lymph node in a 50-year-old lymphoma patient with 99mTc nano-colloid scintigraphy.
{"title":"Splenosis imaging with 99mTc nano-colloid as a different mimicker in a lymphoma patient on 18F- FDG PET/CT","authors":"C. Sezgin , Y. Parlak , G. Mutevelizade , G. Gumuser , E. Sayit","doi":"10.1016/j.mednuc.2024.02.002","DOIUrl":"10.1016/j.mednuc.2024.02.002","url":null,"abstract":"<div><p>Fluorodeoxyglucose (FDG) 18F-FDG PET/CT plays an important role in lymphoma staging and evaluation of treatment response. Mimics should be considered when evaluating 18F-FDG PET/CT images to perform correct staging and correct treatment response evaluation. Splenosis is one of the causes that may cause misinterpretation by mixing with lymph nodes in lymphoma patients. In our case report, we visualized splenosis mimicking lymph node in a 50-year-old lymphoma patient with <sup>99m</sup>Tc nano-colloid scintigraphy.</p></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 3","pages":"Pages 165-167"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.mednuc.2023.11.002
C. Cohen , P. Sabouret , E. Meppiel , C. Berrou , F. Ecarnot , R. Cohen , J.-F. Grellier , D. Lussato
For 15 years, regadenoson, a selective adenosine 2A (A2A) receptor agonist, has been largely used as a pharmacologic stress agent in myocardial perfusion studies. It acts by increasing coronary blood flow. It has been shown to be non-inferior to adenosine for the detection of reversible myocardial ischemia. Regadenoson has several advantages, including less serious adverse effects, better tolerance and easier practical administration. However, specific adverse effects on the central nervous system, although rarely reported, can provocoke seizure through A2A receptor activation. We report here a case of regadenoson-associated-seizure and review the relevant literature. A 73-year-old male with a past medical history of hypertension, atrial fibrillation, stroke, hemodialysis and type 2 diabetes was referred for evaluation of hypokinesia of the apical segments. He had an unique episode of epilepsia in 2008. Less than one minute after regadenoson injection, he had a partial tonic-clonic seizure of the right upper and lower limbs, which lasted for 30 seconds and resolved spontaneously. This case report is a reminder that this under-diagnosed adverse effect must be taken into consideration when using regadenoson for cardiac stress testing.
{"title":"Seizure and regadenoson: An underestimated concern","authors":"C. Cohen , P. Sabouret , E. Meppiel , C. Berrou , F. Ecarnot , R. Cohen , J.-F. Grellier , D. Lussato","doi":"10.1016/j.mednuc.2023.11.002","DOIUrl":"10.1016/j.mednuc.2023.11.002","url":null,"abstract":"<div><p>For 15 years, regadenoson, a selective adenosine 2A (A2A) receptor agonist, has been largely used as a pharmacologic stress agent in myocardial perfusion studies. It acts by increasing coronary blood flow. It has been shown to be non-inferior to adenosine for the detection of reversible myocardial ischemia. Regadenoson has several advantages, including less serious adverse effects, better tolerance and easier practical administration. However, specific adverse effects on the central nervous system, although rarely reported, can provocoke seizure through A2A receptor activation. We report here a case of regadenoson-associated-seizure and review the relevant literature. A 73-year-old male with a past medical history of hypertension, atrial fibrillation, stroke, hemodialysis and type 2 diabetes was referred for evaluation of hypokinesia of the apical segments. He had an unique episode of epilepsia in 2008. Less than one minute after regadenoson injection, he had a partial tonic-clonic seizure of the right upper and lower limbs, which lasted for 30<!--> <!-->seconds and resolved spontaneously. This case report is a reminder that this under-diagnosed adverse effect must be taken into consideration when using regadenoson for cardiac stress testing.</p></div>","PeriodicalId":49841,"journal":{"name":"Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique","volume":"48 3","pages":"Pages 158-160"},"PeriodicalIF":0.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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