The addition of sirolimus to the graft-versus-host disease prophylaxis regimen in reduced intensity allogeneic stem cell transplantation for lymphoma: a multicentre randomized trial.

Inhibition of the mechanistic target of rapamycin (mTOR) pathway has clinical activity in lymphoma. The mTOR inhibitor sirolimus has been used in the prevention and treatment of graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation (HSCT). A retrospective study suggested that patients with lymphoma undergoing reduced intensity conditioning (RIC) HSCT who received sirolimus as part of their GVHD prophylaxis regimen had a lower rate of relapse. We therefore performed a multicentre randomized trial comparing tacrolimus, sirolimus and methotrexate to standard regimens in adult patients undergoing RIC HSCT for lymphoma in order to assess the possible benefit of sirolimus on HSCT outcome. 139 patients were randomized. There was no difference overall in 2-year overall survival, progression-free survival, relapse, non-relapse mortality or chronic GVHD. However, the sirolimus-containing arm had a significantly lower incidence of grade II-IV acute GVHD (9% vs. 25%, P = 0·015), which was more marked for unrelated donor grafts. In conclusion, the addition of sirolimus for GVHD prophylaxis in RIC HSCT is associated with no increased overall toxicity and a lower risk of acute GVHD, although it does not improve survival; this regimen is an acceptable option for GVHD prevention in RIC HSCT. This trial is registered at clinicaltrials.gov (NCT00928018).

Radiation-Associated Angiosarcoma of the Breast: What the Radiologist Needs to Know.

OBJECTIVE: The purpose of this article is to describe the diagnosis, treatment, and follow-up of radiation-associated angiosarcoma (RAS) of the breast. CONCLUSION: Radiologists play an important role in the diagnosis of RAS, which may initially present clinically as erythema, ecchymosis, or skin thickening. Conventional imaging with mammography and ultrasound is less sensitive than MRI for the diagnosis of RAS. Follow-up CT is important to monitor treatment response.

Imaging of Nervous System Involvement in Hematologic Malignancies: What Radiologists Need to Know.

OBJECTIVE: The purpose of this article is to provide a comprehensive review of the imaging features of neurologic involvement in hematologic malignancies. CONCLUSION: Neurologic involvement can be seen in lymphoma, leukemia, post-transplant lymphoproliferative disorder (PTLD), plasma cell neoplasms, and histiocytic and dendritic neoplasms. Imaging, MRI in particular, plays an important role in the workup of these patients. Familiarity with the imaging features of nervous system involvement in hematologic malignancies can help radiologists suggest the diagnosis and guide management.

Hereditary cancer syndromes: a radiologist's perspective.

OBJECTIVE: The purpose of this article is to present the important malignancies associated with the most common hereditary cancer syndromes. CONCLUSION: Hereditary cancer syndromes comprise 5% of all cancers and have an increased risk of early onset and of multiple or bilateral malignancies. Radiologists should be familiar with various hereditary cancer syndromes and their common associations because early detection of these neoplasms may help decrease patient morbidity and mortality.

A to Z of desmoid tumors.

OBJECTIVE: The purpose of this article is to illustrate the common locations of desmoid tumors (deep fibromatosis), complications of intra- and extraabdominal desmoids, and treatment-related changes in their imaging appearance. CONCLUSION: Desmoids are locally aggressive fibrous tumors with a tendency to recur. Desmoids can be intraabdominal, in the abdominal wall, or extraabdominal. Complications, such as compression or invasion of adjacent structures, and abscess formation can occur. Treatment options include observation, local treatment (surgery, radiotherapy), or systemic therapy (conventional chemotherapy, molecular targeted agents).

Multimodality imaging of indolent B cell lymphoma from diagnosis to transformation: what every radiologist should know.

Indolent B cell lymphomas are a group of lymphoid malignancies characterized by their potential to undergo histologic transformation to aggressive lymphomas. While different subtypes of indolent B cell lymphomas demonstrate specific clinical and imaging features, histologic transformation can be suspected on cross-sectional imaging when disproportionate lymph node enlargement or new focal lesions in extranodal organs are seen. On PET/CT, transformed indolent lymphoma may show new or increased nodal FDG avidity or new FDG-avid lesions in different organs. In this article, we will (1) review the imaging features of different subtypes of indolent B cell lymphomas, (2) discuss the imaging features of histologic transformation, and (3) propose a diagnostic algorithm for transformed indolent lymphoma. The purpose of this review is to familiarize radiologists with the spectrum of clinical and imaging features of indolent B cell lymphomas and to define the role of imaging in raising concern for transformation and in guiding biopsy for confirmation.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Multimodality imaging of locally recurrent and metastatic cervical cancer: emphasis on histology, prognosis, and management.

The management of recurrent and metastatic cervical cancer is evolving in concert with the available advanced imaging techniques and molecular targeted therapy. The purpose of this review is to provide an overview of imaging and treatment of cervical cancer patients with locoregional recurrence and metastatic disease, with emphasis on characteristic patterns of spread based on histology (squamous cell carcinoma and other subtypes), prognostic factors, diagnosis, and treatment response assessment, as well as updated therapeutic options.

Imaging in renal cell carcinoma.

Imaging plays a central role in the detection, diagnosis, staging, and follow-up of renal cell carcinoma (RCC). Most renal masses are incidentally detected with modern, high-resolution imaging techniques and a variety of management options exist for the renal masses encountered today. This article discusses the role of multiple imaging modalities in the diagnosis of RCC and the imaging features of specific pathologic subtypes and staging techniques. Future directions in RCC imaging are presented, including dynamic contrast-enhanced and unenhanced techniques, as well as the development of novel tracers for positron emission tomography.

Case report: Calcifying fibrous tumor presenting as an asymptomatic pelvic mass.

Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor most commonly found in the soft tissues of the extremities and pleura. It is characterized by hyalinized collagenous fibrous tissue, with bland spindle cells, psammomatous or dystrophic calcifications, and focal lymphoplasmacytic infiltrate. CFT of the gastrointestinal tract is exceedingly uncommon. We report a case of CFT arising from the small intestine and associated mesentery; this case was identified incidentally in an otherwise healthy 45-year-old man.