Positron emission tomography and neoadjuvant therapy of breast cancer.

The increasing use of neoadjuvant therapy for breast cancer has led to the development of early surrogate markers of response. Positron emission tomography (PET) allows noninvasive study of fundamental biologic processes in the tumor; furthermore, PET provides various markers to assess tumor response early in the course of therapy. Numerous studies have shown that changes in tumor glucose metabolism during therapy are significantly correlated with final response and patient outcome. Moreover, new PET tracers that are currently being developed or under evaluation, providing specific information on tumor characteristics or receptor expression, will assist the development of new targeted anticancer agents.

International expert consensus on primary systemic therapy in the management of early breast cancer: highlights of the Fourth Symposium on Primary Systemic Therapy in the Management of Operable Breast Cancer, Cremona, Italy (2010).

A panel of international breast cancer experts formulated a declaration of consensus regarding many key issues in the use of primary systemic therapy (PST) either in clinical routine or research practice. The attainment of pathological complete response (pCR), defined as no residual invasive tumor in the surgical specimens both in breast and in axillary nodes, is one of the main goals of PST, and pCR can be used as the primary objective in prospective clinical trials. However, pCR is not a reliable endpoint with all treatment approaches, and alternatives such as Ki67 index of the residual invasive disease or after 2 weeks of PST are also potential endpoints. PST has several advantages: breast conservation and the unique opportunity to obtain information on the interaction between treatment and tumor biology. Changes in tumor biology after PST are an early phenomenon; so, an additional core biopsy performed after 14 days from treatment start should be considered in clinical trials.

Brain apparent diffusion coefficient evaluation in pediatric patients with neurofibromatosis type 1.

OBJECTIVE: The most frequent intracranial appearance in children with neurofibromatosis type 1 (NF1) is represented by the presence of hyperintense lesions on T2-weighted images, the so-called "unidentified bright objects" (UBOs). Di Paolo demonstrated that these lesions represent foci of myelin vacuolization with increased water content. The aim of this study was to investigate the isotropic apparent diffusion coefficient (ADC) values within the UBOs and normal-appearing brain and at the regressed UBO sites. METHODS: Fifteen consecutive children with NF1 underwent magnetic resonance diffusion evaluation of the brain. Fifteen healthy age- and sex-matched children constituted the control group. Apparent diffusion coefficient maps were obtained, and regions of interest were placed bilaterally in 8 different areas. Two cortical areas were evaluated using single-pixel analysis. Apparent diffusion coefficient values within the UBOs were calculated by using irregular regions of interest. Regressed UBO sites were investigated by using circular regions of interest. Apparent diffusion coefficient values within the different areas were compared using a t test. RESULTS: Compared with the controls, NF1 patients showed higher ADC values (P < 0.001) in all locations. In the NF1 group, the mean ADC value in the UBOs was higher than in other locations (P < 0.001). The mean ADC value within the regressed UBO sites was higher than in the normal-appearing locations (P < 0.001). CONCLUSIONS: The higher ADC values in children with NF1 suggest an increase in water content of the normal-appearing brain. The UBOs are the areas with the highest water content. The regressed UBOs sites show higher water content than the normal-appearing areas.

"Late" regressions of metastases from renal cancer after a period of disease progression continuing the same intermittent low dose immunotherapy regimen.

We here describe two patients with metastatic renal cell cancer (mRCC) treated with immunotherapy in whom the metastases completely regressed after a period of progressive disease. The treatment schedule was based on repeated cycles of low-dose recombinant interleukin-2 and recombinant interferon-alpha, and was never changed during the course of the disease. The first patient received immunotherapy because of multiple bilateral lung metastases. Progressive disease, with mediastinal lymph node involvement and an increased number of lung metastases, was observed after 30 months of regularly repeated therapy; complete regression was achieved after 60 months of immunotherapy (after 16 immunotherapy cycles). The second patient began immunotherapy because of three small lung metastases. Disease progression was observed after three cycles, but complete regression was obtained about 16 months after the start of immunotherapy (after 5 immunotherapy cycles). Long-term low-dose immunotherapy may bring about an effective anti-tumour response even late in the course of the disease and after an initial disease progression.

Design and development of new combinations of the CMF agents with taxanes (paclitaxel or docetaxel) in advanced breast cancer: a feasibility study.

AIMS AND BACKGROUND: We previously designed and tested combinations made up of the CMF agents, two at a time by rotation, and of doxorubicin or epirubicin. The present study was aimed to similarly test new combinations made up of the CMF agents, two at a time by rotation, and paclitaxel or docetaxel. METHODS: The doses of each taxane were escalated with the objective of reaching at least a single dose level of 90 mg/m2 of paclitaxel and 45 mg/m2 of docetaxel on days 1 and 8 of each four-week cycle. Thirty-two patients with advanced breast carcinoma were randomized to receive increasing doses of paclitaxel (45, 65, 80, 90 and 100 mg/m2) or docetaxel (30, 35, 40, 45 and 50 mg/m2) together with the CMF agents at the same dose as that used in the conventional regimen. Each dose level was administered to a triplet of patients. No direct comparison of the two taxanes was made. RESULTS: The fourth dose level was reached for paclitaxel and docetaxel. The most important toxicities were grade 4 neutropenia and grade 1-2 nausea/vomiting and stomatitis. The objective response rate, assessed only after the third cycle at any dose level, was 31% (95% CI, 15-47%). CONCLUSIONS: The combinations of the CMF agents (two at a time in rotation) with paclitaxel (90 mg/m2) or docetaxel (45 mg/m2) on days 1 and 8 of each four-week cycle are feasible and lead to definite signs of therapeutic activity, and the side effects are generally mild. Further studies are therefore warranted.

Diagnostic applications of cardiac multislice CT with sixteen-row scanner: state of the art.

Coronary angiography is nowadays the diagnostic standard in the evaluation of coronary artery anatomy, in the identification of stenoses and in the follow-up of revascularization procedures (PTCA-stenting, bypass). The limitations of such technique in terms of invasivity and high cost has targeted research efforts towards the development of non invasive diagnostic tools. Technological evolution in the field of helical CT has provided 2, 4, 8 and 16 detector-row multislice scanners characterized by progressive improvements in terms of spatial and temporal resolution that have made them increasingly suitable for the analysis of moving structures with high quality anatomic detail. The main cardiologic applications of multislice CT include coronary calcium scoring, the evaluation of coronary vascular anatomy and disease, follow-up of revascularization procedures (stenting, bypass), and the evaluation of cardiac walls and chambers. The aim of this paper is to describe the applications of sixteen detector-row multisclice CT in non invasive evaluation of cardiac and coronary diseases.

Small cell carcinoma of the uterine corpus: CT appearance.

We report a rare case of small-cell carcinoma of the uterine corpus. To our knowledge, this is the first radiological report. Computed tomography (CT) demonstrates a hypodense lesion within the endometrial cavity with nonhomogeneous contrast enhancement.

Carotid and vertebral artery dissection: Magnetic Resonance findings in 15 cases.

PURPOSE: Spontaneous dissection of the carotid and vertebral arteries represents a rare pathology. Its pathogenesis, probably multi-factorial, can be related to neck trauma and to a genetic basis, extensively demonstrated in the cases of association with type IV fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan's syndrome, pseudoxanthoma elasticum and osteogenesis imperfecta. Onset symptoms include neck, facial pain and diffuse headache. Cranial nerve palsy has been also described. The aim of this study was to evaluate MR angiography and MR findings in a population of patients with carotid and vertebral artery dissections. MATERIALS AND METHODS: We reviewed the MR angiography and MR exams of 15 patients (10 males, 5 females, average age 42.0, age range 30-55) with carotid and/or vertebral artery dissection; the serial MR follow-up studies were also examined. RESULTS: Twelve internal carotid arteries (ICA) showed the presence of an irregular stenosis; three of these showed complete occlusion. In two patients both ICA were involved. Six vertebral arteries (VA) showed irregular stenosis (only one patient suffered from both CI and VA dissection); in one case there was also a pseudoaneurysm of the VA. Follow-up studies showed vessel lumen re-opening in 5/11 ICA (one patient underwent vascular stent positioning) and in 3/6 VA. CONCLUSIONS: The present study confirms the usefulness of MR angiography and MR in the diagnosis and follow-up of patients with carotid and vertebral artery dissection.