Image-guided robotic stereotactic radiosurgery for unresectable liver metastases: preliminary results.

The aim of this study was to evaluate the usefulness of image-guided robotic stereotactic radiosurgery for the local control of unresectable liver metastases from colorectal and non-colorectal cancer. Twenty-seven consecutive patients (median age 62 years, range 47-80 years) with liver metastases considered unsuitable for surgery were enrolled in the study. The diagnosis was colorectal cancer liver metastasis in 11 (41%) and other secondary malignancies in 16 (59%) patients. The patients were treated with 25 to 60 Gy (median 36 Gy) delivered in 3 consecutive fractions, and the isodose value covering the planning target volume was 80% of the prescribed dose. Overall, the mean tumour volume was 81.6+/-35.9 ml. Inhibition of growth or a reduction in size was obtained in 20 (74.1%) patients: 7 with complete response and 13 with partial response. There was a local complete response with other single lesions appearing in 3 (11.1%) patients and progressive disease in 4 (14.8%). The median post-treatment volume of the tumour was 24 ml (range 0-54 ml) among the responders. Mild or moderate transient hepatic dysfunction was evident in 9 patients and minor complications in five. Two patients with progressive disease died of liver failure. In conclusion, in patients with liver metastases unsuitable for surgery, stereotactic radiosurgery achieves high rates of local disease control, representing an acceptable alternative therapy, but should be further studied in larger series.

The effect of 18F-FDG-PET/CT respiratory gating on detected metabolic activity in lung lesions.

OBJECTIVE: Respiratory gated PET/CT (positron emission tomography/computed tomography) of the lung is expected to increase the accuracy of quantitative determinations in lesional activities, regardless of the gating method used; reasonably, respiratory gating should increase standard uptake value (SUV; and possibly decrease lesional size), on the basis of the reduction of the "smearing effect." However, literature data are very limited, particularly for in vivo studies. The objective of this article is to test the SUV variations in a large group of lung lesion studies. METHODS: A group of 26 consecutive positive studies (21 men, 5 women, age 36-84, mean 68), performed on patients referred to our institution for known or suspected lung cancer, are examined. All studies were performed both with conventional PET/CT total body scan and with Real-Time Position Management (RPM) triggered selective gated study of the thorax. Four studies were considered technically unsatisfactory and were discarded; the remaining 22 studies are the object of this work. Max lesional SUVs were evaluated in both settings by semi-automated algorithms; for the gated studies, both values of the bin that showed more relevant variations from the clinical routinary study ("best bin") and an average value that was calculated over all bins were determined. Results were compared on a one-to-one basis. RESULTS: In conventional, SUV showed a mean +/- standard deviation (SD) value of 9.2 +/- 6.9 (range 0.9-26). In the averaged gated studies, the mean +/- SD value was 13.4 +/- 11.7 (range 1.4-47); in the "best bin" dataset the mean +/- SD was 14.9 +/- 12.9, ranging from 1.6 to 53.1. In general, the use of respiratory trigger induced rather variable but overall consistent increases in SUV. If the percentage variations in the average trigger dataset are considered, there is an average increase of +60%, SD +/- 97 (P < 0.05). Similar results are found in the "best bin" dataset, the average percentage increase in SUV values being +77.2% (SD +/- 04.6). CONCLUSIONS: In lung cancer, triggering procedures increase the signal to noise ratio. The increase in SUV determined by gating is very variable, but generally relevant. This could lead to an SUV values cut-off revision, and may have an impact on smaller lesions detection.

Pre-therapy hyperfunctioning follicular thyroid carcinoma evaluation with I-131 whole-body scan and with F-18 FDG PET/CT.

We describe a patient with persistent hyperthyroidism after total thyroidectomy for toxic multinodular goiter and without therapy with levothyroxine evaluated with I-131 whole-body scan and with F-18 FDG PET/CT scan. Scintigraphy performed 48 hours after radiopharmaceutical administration showed many areas of focal radioiodine uptake. A week later we performed a PET/CT scan to better localize the anatomic site of the iodine-positive lesions. Both scans, performed after methimazole withdrawal, visualized the same lesions, and these results were used as a guide for biopsy. Histologic examination was consistent with metastatic follicular thyroid carcinoma.

Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina.

BACKGROUND: Intramyocardial injection of autologous bone marrow (ABM) may induce angiogenesis. We tested the safety and feasibility of catheter-based direct percutaneous intramyocardial delivery of ABM in patients with refractory angina pectoris. METHODS: Ten patients (9 men, 67 +/- 8 years) with refractory angina (Canadian Cardiovascular Society class III-IV) and documented myocardial ischemia were enrolled. After left ventricular electromechanical mapping, freshly aspirated and filtered ABM was percutaneously injected into target myocardial ischemic areas. Clinical symptoms (as assessed according to the Canadian Cardiovascular Society class), quality of life, and myocardial perfusion were evaluated before the procedure and through the follow-up. RESULTS: In all patients, ABM was successfully injected into the target regions. No periprocedural complications occurred. At 12 months, no major cardiac events (death, acute myocardial infarction, stroke, and malignant ventricular arrhythmias) occurred. Severity of angina improved of > or = 2 classes in 3 patients. Quality of life showed a significant improvement in all patients. Myocardial perfusion in the target regions improved in 4 of 8 patients. CONCLUSIONS: Direct percutaneous intramyocardial delivery of ABM appears feasible and safe. Further evaluation is warranted to test its clinical efficacy.