RESUMO
Radioiodine uptake in the thyroid tissue, metastasis of differentiated thyroid cancer (DTC), and in other tissues, depends on the expression of sodium-iodide symporter (NIS). Vascular permeability, effusions, inflammation, and other mechanisms may also play a role in the accumulation of radioactive iodine. A 63-year-old woman underwent radioiodine therapy, as well as a post-therapy whole-body scan, as she was suspected of having lung metastasis from thyroid carcinoma. The scan not only showed uptake at the lung metastasis but also a faint diffuse bilateral uptake in the posterior thorax. On SPECT/CT this uptake was located in a known Elastofibroma Dorsi (ED) previously diagnosed by contrast CT and viewed in a FDG PET/CT. The radioiodine uptake in ED, especially if typical, is not a diagnostic problem in SPECT/CT study, but can be misleading in a study limited to a few planar images, particularly if the uptake occurs asymmetrically, or ED is located in a unsuspected area.
Assuntos
Fibroma/diagnóstico por imagem , Radioisótopos de Flúor/farmacocinética , Fluordesoxiglucose F18/farmacocinética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos/farmacocinética , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias Torácicas/diagnóstico por imagem , Carcinoma Papilar/radioterapia , Carcinoma Papilar/secundário , Diagnóstico Diferencial , Feminino , Fibroma/metabolismo , Humanos , Radioisótopos do Iodo/farmacocinética , Radioisótopos do Iodo/uso terapêutico , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Cintilografia , Compostos Radiofarmacêuticos/uso terapêutico , Radioterapia Adjuvante , Nódulo Pulmonar Solitário/diagnóstico por imagem , Neoplasias Torácicas/metabolismo , Neoplasias Torácicas/secundário , Neoplasias da Glândula Tireoide/radioterapia , Distribuição TecidualRESUMO
BACKGROUND: Regenerating gene 1A (REG1A) plays an important role in tissue regeneration and in cell proliferation in the mucous membrane of the gastrointestinal tract. We previously reported that the positive expression status of REG1A was predictive of chemoradiosensitivity in patients treated with preoperative chemoradiotherapy before esophagectomy or with definitive chemoradiotherapy. To further confirm the utility of REG1A as a chemosensitivity marker, we carried out an additional retrospective clinical study aimed at determining whether REG1A is a reliable chemosensitivity marker in patients treated with esophagectomy followed by adjuvant chemotherapy. METHOD: A total of 177 patients with T2-4 thoracic esophageal squamous cell carcinoma received curative surgery without preoperative treatment at Akita University Hospital between 2001 and 2011. A tissue microarray was constructed, and REG1A expression status was analyzed immunohistochemically. We then statistically analyzed the relationships between REG1A expression status and 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). RESULTS: In the adjuvant group (n=105), REG1A-positive patients showed significantly better prognoses than REG1A-negative patients. (5-year OS, p=.0022; DSS, p=.0004; and DFS, p=.0040). However, there were no significant differences between REG1A-positive and REG1A-negative patients in the surgery group (n=72). Univariate and multivariate analyses showed REG1A expression status to be a significant prognostic factor affecting 5-year DSS, comparable to lymph node metastatic status. CONCLUSION: The present study suggests REG1A expression status has the potential to be a highly reliable and clinically useful chemosensitivity marker in patients treated with advanced thoracic esophageal squamous cell carcinoma. REG1A expression status will provide a good indication of treatment strategy and enable more individualized treatment for patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Quimiorradioterapia/mortalidade , Resistencia a Medicamentos Antineoplásicos , Neoplasias Esofágicas/patologia , Esofagectomia/mortalidade , Litostatina/metabolismo , Idoso , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Terapia Combinada , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Torácicas/metabolismo , Neoplasias Torácicas/mortalidade , Neoplasias Torácicas/patologia , Neoplasias Torácicas/terapia , Análise Serial de TecidosRESUMO
Ninety-seven patients with cancer, undergoing radiation treatment, were studied. Forty-two were given special dietary counseling and supplements of Sustagen or Isocal; 42 controls received no special advice or supplements. Thirteen patients were excluded because of poor prognoses and the ethical need for food supplements. Nutrient intake of all groups was assessed by 3-d diet records in household measures in the first and the last week of treatment. Intake was significantly higher in the adjunctive than the control group. The excluded group, despite supplementation, had intakes similar to the control group. No difference was observed between the control and adjunctive groups in clinical status at the end of treatment or in long-term outcome.