[18 F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction.

BACKGROUND: The aim of this prospective study was to assess whether [18 F]fluorodeoxyglucose PET can be used to predict histopathological response early in the course of neoadjuvant chemotherapy in patients with adenocarcinoma of the oesophagus and oesophagogastric junction. METHODS: Following the PET response criteria in solid tumours (PERCIST 1.0) as a standardized method for semiquantitative assessment of metabolic response, FDG-PET/CT was performed before (PET1) and after (PET2) initiation of the first cycle of chemotherapy. The relative changes in the peak standardized uptake value (ΔSUL) and total lesion glycolysis (ΔTLG) between PET1 and PET2 were correlated with histopathological response, defined as less than 50 per cent viable tumour cells in the resection specimen. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value with the highest accuracy of histopathological response prediction. RESULTS: PET2 was performed a median of 16 (range 12-22) days after the start of chemotherapy. Some 27 of 90 patients who underwent surgery had a histopathological response. There was no association between the median ΔSUL or median ΔTLG and the histopathological response. A post hoc analysis in 47 patients with PET2 performed 16 days or less after the start of chemotherapy showed that ΔTLG, but not ΔSUL, was associated with the histopathological response (P = 0·009). The optimal cut-off value of ΔTLG was 66 per cent or more. CONCLUSION: FDG-PET/CT after the first cycle of chemotherapy does not predict histopathological response in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.

Peri-operative chemotherapy in patients with oesophageal and gastro-oesophageal junction cancer - three years of experience.

Peri-operative chemotherapy has been found to benefit patients with oesophageal and gastro-oesophageal junction adenocarcinoma. This study's aim was to evaluate the efficacy and tolerance of this treatment. The study included patients with carcinoma of the lower oesophagus and gastro-oesophageal junction in whom the disease was evaluated as potentially operable. Chemotherapy (CHT) consisted of three preoperative and three postoperative cycles of intravenous epirubicin and cisplatin on day 1 plus a continuous infusion of fluorouracil for 21 days (ECF) or oral capecitabine for 14 days (ECCap). Postoperative radio-chemotherapy (CRT) with fluorouracil or capecitabine after CHT was indicated in patients with two and more positive lymph nodes. Sixty-three patients started the treatment. Median follow-up was 32 months. Preoperative CHT was completed by 62 patients, 52 had surgery, 46 had radical resection, 25 patients had pN0 and 21 patient pN plus findings. Postoperative CHT was started in 39 (62%) patients and completed in 32 (51%). Ten (16%) patients had postoperative CRT. Adverse events of grade 3 and 4 were: neutropenia 17%, vomiting 8%, fatigue 5%, diarrhoea 3%. Reasons for omitting surgery in 11 (17%) patients were: progression in 7 patients, medically unfit in 3 patients, other in 1 patient. In the reporting period there were recurrences in 39 of all patients, in 7 locoregional only, in 10 distant plus locoregional, and in 19 distant metastases. Median survival was 24.1 months and 3-year survival rate was 42%. Peri-operative chemotherapy ECF/ECCap was feasible and well tolerated. Radical resection was performed in most patients.

Positron emission tomography and clinical predictors of survival in primary extragonadal germ cell tumors.

BACKGROUND: Primary extragonadal germ cell tumors (EGTs) are an uncommon malignancy -accounting for 2-4% of all germ cell neoplasms in adult males. Their prognosis is worse than that for testicular germ cell tumors because of their relative chemoresistance and frequent presentation with widely disseminated metastases. We have studied the role of fluorodeoxyglucose positron emission tomography (FDG-PET) for outcome prediction of patients with EGTs. PATIENTS AND METHODS: We have retrospectively analysed 36 men with germ cell tumors originating in the mediastinum or the retroperitoneum. All patients were treated between 1994 and 2010. Negative result of testicular ultrasonographic examination and/or testicular biopsy was required for diagnosis of EGT. Platinum-based systemic therapy was used in all cases, and resectable residual tumor masses were removed surgically. RESULTS: Overall survival at one and three years was 81% (95% confidence interval [CI]: 68-94%) and 55% (CI: 38-71%), respectively. None of the patients who had positive FDG-PET findings after first line chemotherapy survived at three years after diagnosis. In contrast, 69% and 20% of patients with positive tumor markers, and 90% and 67% of patients with negative tumor markers after first line chemotherapy survived at one and three years, respectively. Negative FDG-PET after completion of treatment was also a powerful predictor of long-term survival with 100% patients surviving three years and 89% surviving five years after diagnosis. CONCLUSIONS: Negative FDG-PET after first-line chemotherapy or after the completion of systemic treatment and resection of residual tumor masses strongly predicts long-term event-free survival in patients with EGTs.

[Positron emission tomography in the diagnosis and monitoring of patients with nonseminomatous germ cell tumours]. / Pozitronová emisní tomografie v diagnostice a sledování pacientu s neseminomovými germinálními nádory.

The role of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the diagnosis and monitoring of nonseminomatous germ cell tumours is currently unclear. Clinical studies have suggested that FDG-PET has relatively low sensitivity and specificity in the setting of initial staging and viability assessment of post-chemotherapy residual lesions. On the other hand, FDG-PET provides potentially useful information in patients with elevated tumour markers and/or multiple residual lesions with limited resectability. Other possible indications of FDG-PET are the early assessment of tumour chemosensitivity and the diagnosis of inflammatory treatment complications.

[Embolization of uterine arteries during myoma treatment from the patient's point of view]. / Embolizace delozních tepen pri lécbe myomu z pohledu pacientek.

OBJECTIVES: To acquire information about the patient's follow-up evaluation of treating fibroids by uterine artery embolization (UAE). DESIGN: A retrospective multicenter clinical trial. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: 45 women who underwent the UAE due to uterine fibroids from 1999 to 2003 were asked to complete a questionnaire. The questionnaire included 26 questions asking how the women had been informed and what they had expected. Further questions were focused on the course of embolization itself, early post-procedural difficulties (post-embolization syndrome) and patient's overall evaluation of treatment in a longer term. Those women who had completed the questionnaire and had been ready to co-operate were thereafter examined and included in the follow-up monitoring and, if necessary, further treatment was recommended. RESULTS: Thirty one out of 45 patients from 26 to 48 years of age, who had been addressed (68.9%) answered the questionnaire. UAE was indicated 12 times (38.7%) on account of symptoms, 10 times (32.3%) because of sterility, 5 times (16.1%) as a preventive measure within the framework of family planning and 4 times (12.9%) for an asymptomatic but growing leiomyoma. Twenty seven (87.1%) women were also offered an alternative treatment, which they refused. As far as problems are concerned, 18 (58%) women described the course of treatment as corresponding with what they had expected, 5 times it was less painful, and 8 times it was worse than expected. The long-term results were considered as positive by 87.1% of responders, only 12.9% considered the treatment as failure. 5 in 11 women planning pregnancy became pregnant, 3 of them gave birth in term and 2 miscarried in the 1st trimester. CONCLUSION: From the point of view of the patients, the evaluated method proves highly successful, it is well tolerated and it involves a low risk of complications. It is not possible, at this point, however, to give an unequivocal answer to the question whether the method should also be routinely offered to women who are planning pregnancy.

[Nucleotomy--a new method in the treatment of lumboischiadic syndrome]. / Nukleotomie--nová metoda v lécbe lumboischiadického syndromu.

BACKGROUND: Degenerative changes in the lumbosacral portion of the spine are frequently associated with the lumboischiadic syndrome (LI syndrome). Its treatment is traditionally conservative or surgical. In the seventies and eighties to these two procedures percutaneous punctures were added. The objective of the authors is to present their own experience with a new puncture method of LI syndrome--APLD (automated percutaneous lumbar discectomy). METHODS AND RESULTS: The number of operated patients in 1991-1994 comprised 45 patients, 19 men and 28 women, mean age 40.7 years (18-64 years). APLD was performed 47 times (four times at the level of L3/4, 30 times at the level of L4/5 and 13 times at the level of L5/S1; in two subjects the operation was repeated because the first operation was not effective. APLD is a miniinvasive method made under local anaesthesia with skiascopic control, using special instruments of Surgical Dynamics, USA. Patients with the LI syndrome are selected for treatment according to strict clinical and radiological criteria, the effectiveness of treatment depends on the selection of patients. In the published group treatment was successful in 83% (17% not improved, 38% improved, 45% cured) which is consistent with the experience of others, in particular authors abroad. Only in one instance a minor peroperative complication occurred; the authors did not record any postoperative complications. CONCLUSIONS: APLD is an effective and safe method of invasive treatment of prolapse of lumbar intervertebral discs in an indicated group of patients. It does not replace surgical treatment but reduces the period of conservative treatment. If this treatment is not successful after 4-6 weeks, APLD should be the method of choice. Therefore doctors who are the first to treat these patients should become familiar with the clinical indications.