Association between PD1 mRNA and response to anti-PD1 monotherapy across multiple cancer types.

Background: We hypothesized that the abundance of PD1 mRNA in tumor samples might explain the differences in overall response rates (ORR) observed following anti-PD1 monotherapy across cancer types. Patients and methods: RNASeqv2 data from 10 078 tumor samples representing 34 different cancer types was analyzed from TCGA. Eighteen immune-related gene signatures and 547 immune-related genes, including PD1, were explored. Correlations between each gene/signature and ORRs reported in the literature following anti-PD1 monotherapy were calculated. To translate the in silico findings to the clinical setting, we analyzed the expression of PD1 mRNA using the nCounter platform in 773 formalin-fixed paraffin embedded (FFPE) tumor samples across 17 cancer types. To test the direct relationship between PD1 mRNA, PDL1 immunohistochemistry (IHC), stromal tumor-infiltrating lymphocytes (sTILs) and ORR, we evaluated an independent FFPE-based dataset of 117 patients with advanced disease treated with anti-PD1 monotherapy. Results: In pan-cancer TCGA, PD1 mRNA expression was found strongly correlated (r > 0.80) with CD8 T-cell genes and signatures and the proportion of PD1 mRNA-high tumors (80th percentile) within a given cancer type was variable (0%-84%). Strikingly, the PD1-high proportions across cancer types were found strongly correlated (r = 0.91) with the ORR following anti-PD1 monotherapy reported in the literature. Lower correlations were found with other immune-related genes/signatures, including PDL1. Using the same population-based cutoff (80th percentile), similar proportions of PD1-high disease in a given cancer type were identified in our in-house 773 tumor dataset as compared with TCGA. Finally, the pre-established PD1 mRNA FFPE-based cutoff was found significantly associated with anti-PD1 response in 117 patients with advanced disease (PD1-high 51.5%, PD1-intermediate 26.6% and PD1-low 15.0%; odds ratio between PD1-high and PD1-intermediate/low = 8.31; P < 0.001). In this same dataset, PDL1 tumor expression by IHC or percentage of sTILs was not found associated with response. Conclusions: Our study provides a clinically applicable assay that links PD1 mRNA abundance, activated CD8 T-cells and anti-PD1 efficacy.

Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index.

BACKGROUND: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. METHODS: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold cross-validation to predict development of serious complications following PE diagnosis. RESULTS: About 208 patients (19.3%, 95% confidence interval (CI), 17.1-21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4-12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs ⩾2), O2 saturation (<90 vs ⩾90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6%; P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1%; P<0.0001. The cross-validated risk estimate is 0.191 (s.e.=0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717-0.840). CONCLUSIONS: We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.

Home management of acute medical complications in cancer patients: a prospective pilot study.

BACKGROUND: The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization. PATIENTS AND METHODS: From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as "avoided hospitalization in outpatients" (AHO) vs. "reduced hospitalization in inpatients" (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death). RESULTS: Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1-16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period. CONCLUSIONS: The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.

1,1-Difluoroethyl-substituted triazolothienopyrimidines as inhibitors of a human urea transport protein (UT-B): new analogs and binding model.

The kidney urea transport protein UT-B is an attractive target for the development of small-molecule inhibitors with a novel diuretic ('urearetic') action. Previously, two compounds in the triazolothienopyrimidine scaffold (1a and 1c) were reported as UT-B inhibitors. Compound 1c incorporates a 1,1-difluoroethyl group, which affords improved microsomal stability when compared to the corresponding ethyl-substituted compound 1a. Here, a small focused library (4a-4f) was developed around lead inhibitor 1c to investigate the requirement of an amidine-linked thiophene in the inhibitor scaffold. Two compounds (4a and 4b) with nanomolar inhibitory potency (IC50≈40 nM) were synthesized. Computational docking of lead structure 1c and 4a-4f into a homology model of the UT-B cytoplasmic surface suggested binding with the core heterocycle buried deep into the hydrophobic pore region of the protein.

Molecular biology of water and salt regulation in the kidney.

The kidney plays a central role in the regulation of the salt and water balance, which depends upon an array of solute and water transporters in the renal tubules and upon vascular elements in the various regions of the kidney. Many recent studies have improved our understanding of this process. In this review, we summarize the current data on the molecules involved in sodium and water transport in the renal tubules, focusing in particular on aquaporins and renal sodium transporters and channels.

BioTrak virtual reality system: effectiveness and satisfaction analysis for balance rehabilitation in patients with brain injury.

OBJECTIVE: To study effectiveness of and satisfaction with a virtual reality-based balance rehabilitation system (BioTrak) for patients with acquired brain injury (ABI). MATERIAL AND METHODS: Ten patients with chronic hemiparesis (chronicity>6 months) following an ABI completed a 20-session programme using the balance reaching-task module of the BioTrak system. All patients were assessed at baseline, at the end of treatment, and one month later with the Berg Balance Scale (BBS), the Tinetti Performance-Oriented Mobility Assessment (POMA), and the computerised posturography tool NedSVE/IBV. The posturography study included analysis of sensory indexes, limits of stability, and rhythmic weight shift. The usability study was conducted using an ad hoc questionnaire. RESULTS: Repeated measures ANOVA showed a significant improvement in BBS (P<.01), TBS (P<.01), vestibular index (P<.05), and anterior-posterior weight shift (P<.05); a trend in the same direction was also found for medial lateral weight shift (P=.059). The post-hoc analysis revealed significant improvement between the initial and final assessments for BBS, POMA and anterior-posterior weight shift control; gains remained a month after completing the programme. The system showed a high degree of usability in terms of presence, immersion and user-friendliness, and there was a significant absence of adverse effects. CONCLUSION: Our results confirm the utility of virtual reality systems for balance rehabilitation in this population. Usability data suggest that BioTrak could be adapted for use in multiple rehabilitation settings by a high number of patients.

[Thermal radiofrequency as an alternative in the treatment of persistent localized neuropathic pain due to entrapment of a collateral nerve of the hand]. / Radiofrecuencia térmica como alternativa en el tratamiento del dolor neuropático localizado persistente por atrapamiento de un nervio colateral de la mano.

Localized neuropathic pain (LNP) is a relatively common cause of musculoskeletal pain, which can be present in up to 60% of neuropathic pain conditions. Its appearance can be associated with numerous pathologies (herpes, diabetes, etc.). A less common cause would be the direct compression of a peripheral nerve branch. Its diagnosis is usually clinical since complementary tests such as neurophysiological tests do not provide definitive data. As therapeutic measures we have oral analgesics, anticonvulsants, analgesic skin patches and interventional actions, including radiofrequency (RF). Thermal RF consists in the transmission of an electric impulse through a needle reaching a controlled increase in temperature with which a nerve ablative injury is achieved. We present a clinical case where thermal RF of the collateral nerve of the hand is proposed as a therapeutic alternative, whose entrapment is the cause of pain, obtaining a satisfactory clinical improvement.

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool.

BACKGROUND: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. METHODS: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. RESULTS: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. CONCLUSIONS: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

Biomarkers associated with survival and favourable outcome of radioembolization with yttrium-90 glass microspheres for colon cancer liver metastases: Single centre experience.

OBJECTIVE: To determine the therapeutic effectiveness and safety of transarterial radioembolization (TARE) with Yttrium-90 in patients with colorectal cancer (CRC) liver metastases and to evaluate the prognostic value of different biomarkers. MATERIAL AND METHODS: This prospective longitudinal study enrolled consecutive patients with CRC liver metastases treated with TARE between November 2015 and june 2020. The therapeutic response at three and six months (RECIST1.1 criteria) and the relationship of biomarkers with therapeutic response, by calculating objective tumor response rates (ORR) and disease control (DCR), and overall survival (OS) and progression-free (PFS). RESULTS: Thirty TAREs were performed in 23 patients (mean age, 61.61 ±â€¯9.13 years; 56.5% male). At three months, the objective response rate (ORR) was 16.7% and the disease control rate (DCR) 53.3%. At six months, the disease progressed in 80%. The ORR and DCR were significantly associated with age at diagnosis (P = 0.047), previous bevacizumab treatment (P = 0.008), pre-TARE haemoglobin (P = 0.008), NLR (P = 0.040), pre-TARE albumin (P = 0.012), pre-TARE ALT (P = 0.023) and tumour-absorbed dose > 115 Gy (P = 0.033). Median overall survival (OS) was 12 months (95% CI, 4.75-19.25 months) and median progression-free survival (PFS) 3 months (95% CI, 2.41-3.59). OS was significantly associated with primary tumour resection (P = 0.019), KRAS mutation (HR: 5.15; P = 0.024), pre-TARE haemoglobin (HR: 0.50; p = 0.009), pre-TARE NLR (HR: 1.65; P = 0.005) and PLR (HR: 1.01; P = 0.042). CONCLUSION: TARE prognosis and therapeutic response were predicted by different biomarkers, ranging from biochemical parameters to tumour dosimetrics.

Incidental versus symptomatic venous thrombosis in cancer: a prospective observational study of 340 consecutive patients.

BACKGROUND: The clinical significance of incidental venous thrombosis (IVT) is uncertain. The objective of this study was to compare the clinical characteristics and the outcome of cancer patients with IVT with those of patients with symptomatic venous thrombosis (SVT). PATIENTS AND METHODS: Prospective observational study enrolling consecutive cancer patients newly diagnosed with venous thromboembolism (May 2006-April 2009). Diagnosis of IVT was based on vascular filling defects in scheduled computed tomography scans in the absence of clinical symptoms. Anticoagulant therapy was routinely prescribed regardless of SVT or IVT. RESULTS: IVT was diagnosed in 94 out of 340 (28%) patients. Patients with IVT were older (63.7 ± 10.5 versus 60.8 ± 10.5 years, P = 0.035), more frequently had metastatic cancer (82% versus 65%, P = 0.01) and were less likely to be receiving chemotherapy at the time of the thrombotic event (53% versus 67%, P = 0.018). Mean follow-up was 477 days. A lower risk of venous rethromboses was observed in patients with IVT (log-rank P = 0.043), with no differences in major bleeding and overall survival compared with SVT patients. CONCLUSIONS: A high proportion of venous thrombotic events in cancer patients are diagnosed incidentally during scheduled imaging. Prospective controlled trials evaluating the optimal therapy in this setting are required.

Consensus statement of the Spanish Society of Internal Medicine and the Spanish Society of Medical Oncology on secondary thromboprophylaxis in patients with cancer.

Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course. VTD greatly impacts morbidity, mortality, quality of life and pharmaceutical expenditure. In addition, both thrombotic relapse and major haemorrhages derived from VTD treatment are more likely in oncological patients. To make the decision to establish secondary thromboprophylaxis as an indefinite treatment in these patients, it is important to review all the risk factors involved, whether related to the disease, the patient or the prior thrombotic event. The objectives of this consensus of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna-SEMI) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM) are to establish recommendations that help assess the risk of recurrence of VTD and haemorrhagic risk in patients with cancer, as well as to analyse the evidence that exists on the currently available drugs, which will allow the establishment of a protocol for shared decision-making with the informed patient.

Outcomes in patients with acute pulmonary embolism and patent foramen ovale: Findings from the RIETE registry.

INTRODUCTION: An increased risk of ischemic stroke in patients with acute pulmonary embolism (PE) and patent foramen ovale (PFO) was reported but few data exist regarding prognostic outcomes of those patients. MATERIAL AND METHODS: Using data in the RIETE registry, we compared the characteristics, therapeutic approaches and outcomes of patients with PE according to the presence or absence of PFO. RESULTS: From August 2016 to January 2020, 4148 patients with acute PE were enrolled. Of these, 2775 (67%) had no transthoracic echocardiogram (TTE), 993 (24%) underwent TTE but had no reported results on PFO. Among the remaining 380 patients, 287 (74%) did not have PFO and 93 (26%) had PFO. Patients with PFO were more likely to have chronic heart failure, prior myocardial infarction or ischemic stroke than those without PFO. Patients with PFO had a higher rate of subsequent ischemic stroke than those without PFO (hazard ratio (HR): 9.28; 95% CI: 1.83-69.1), than those with TTE but no data on PFO (HR: 10.1; 95% CI: 2.56-42.4) or without TTE (HR: 9.78; 95% CI: 3.02-28.4). On multivariable analysis, patients with PFO were at increased risk for subsequent ischemic stroke than those without PFO (HR: 8.96; 95% CI: 1.68-47.7). CONCLUSIONS: PFO was searched in a minority of patients with an acute PE in real life setting. Subject to possible selection and measurement biases, our results confirmed a higher risk of ischemic stroke in PE patients with PFO compared to those without PFO. This association warrants further investigation before determining the best therapeutic option in patients with acute PE and concomitant PFO.

Biomarkers associated with survival and favourable outcome of radioembolization with yttrium-90 glass microspheres for colon cancer liver metastases: Single centre experience. / Biomarcadores asociados con la supervivencia y la respuesta terapéutica a la radioembolización con esferas cargadas de itrio-90 en las metástasis hepáticas del carcinoma colorrectal: nuestra experiencia.

OBJETIVE: To determine the therapeutic effectiveness and safety of transarterial radioembolization (TARE) with Yttrium-90 in patients with colorectal cancer (CRC) liver metastases and to evaluate the prognostic value of different biomarkers. MATERIAL AND METHODS: This prospective longitudinal study enrolled consecutive patients with CRC liver metastases treated with TARE between November 2015 and june 2020. The therapeutic response at three and six months (RECIST1.1 criteria) and the relationship of biomarkers with therapeutic response, by calculating objective tumor response rates (ORR) and disease control (DCR), and overall survival (OS) and progression-free (PFS). RESULTS: Thirty TAREs were performed in 23 patients (mean age, 61,61±9,13 years; 56,5% male). At three months, the objective response rate (ORR) was 16,7% and the disease control rate (DCR) 53,3%. At six months, the disease progressed in 80%. The ORR and DCR were significantly associated with age at diagnosis (P=.047), previous bevacizumab treatment (P=.008), pre-TARE haemoglobin (P=.008), NLR (P=.040), pre-TARE albumin (P=.012), pre-TARE ALT (P=.023) and tumour-absorbed dose>115Gy (P=.033). Median overall survival (OS) was 12 months (95% CI, 4.75-19.25 months) and median progression-free survival (PFS) 3 months (95% CI, 2.41-3.59). OS was significantly associated with primary tumour resection (P=.019), KRAS mutation (HR: 5.15; P=.024), pre-TARE haemoglobin (HR: .50; p=.009), pre-TARE NLR (HR: 1.65; P=.005) and PLR (HR: 1.01; P=.042). CONCLUSION: TARE prognosis and therapeutic response were predicted by different biomarkers, ranging from biochemical parameters to tumour dosimetrics.

Tobacco-related tumours of the lung, bladder and larynx: changes in Spain.

The association between tobacco use and lung cancer and other tumours has been confirmed by a large number of studies. In Spain, the prevalence of smoking has been declining since 1978. This study describes lung, bladder and laryngeal cancer mortality and incidence rates and their trends in Spain. Mortality data were furnished by the National Statistics Institute (2001-07) and incidence data by population-based cancer registries (1975-2004). Changes in rates were calculated using Poisson regression models, which enable trend changes to be estimated. In the case of lung cancer, mortality rates decreased among men [annual percentage change (APC) -1.3%] though not among women (APC 3.5%), whereas incidence rates increased in both sexes, overall and adjusted for registry, by 0.75% among men and 3.2% among women. Bladder cancer mortality rates decreased among men (APC -1.2%) and women (APC -0.8%), yet incidence rates increased across the sexes. While laryngeal cancer mortality rates decreased among men (APC -5.5%) and women (APC -0.03%) alike, incidence rates decreased (-1.28%) among men but not among women (3.95%). A decrease in male versus female mortality due to tobacco-related tumours is evident in Spain. Incidence rates are beginning to reflect the progressive cessation of smoking that has been observed among men rather than women.

[Fibrous dysplasia of the bone. Contribution of nuclear medicine in the diagnosis of suspicion of sarcomatous degeneration]. / Displasia fibrosa ósea. Aportación de la Medicina Nuclear al diagnóstico de sospecha de degeneración sarcomatosa.

Fibrous dysplasia (FD) is a relatively frequent benign disease of the bone in which there is a maturation disorder of the bone-forming mesenchyme where the lamellar bone marrow is replaced with abnormal fibrous tissue. Its diagnosis is often an accidental finding when X-ray studies or bone scans are performed for other reasons since it is usually asymptomatic. There may be complications such as deformities, pathological fractures and exceptionally malignant transformation. The differential diagnosis between malignancy and FD can be complicated and lead to late diagnosis when sarcomatous degeneration already exists. In this context, the positron tomography with (18)F-fluorodeoxyglucose (FDG-PET) may be useful in the monitoring of this condition. We present two cases of patients diagnosed of FD with suspicion of malignization of their bone lesions who were referred to Nuclear Medicin.

[Perivascular epithelioid tumors: Utility of the positron emission tomography with 18F-fluorodesoxyglucose (PET-TAC FDG) in their staging and follow-up]. / Tumor epitelioide perivascular uterino. Utilidad de la tomografía por emisión de positrones con (18)F-fluordesoxiglucosa en su estadificación y seguimiento.

Perivascular epithelioid tumors (PEComas) are a rare group of mesenchymal neoplasms with an unpredictable natural history and uncertain malignant potential. Uterine involvement and their association with tuberous sclerosis are typical for these tumors. We present a case of a 40-year old patient who was incidentally diagnosed of a uterine PEComa and serial studies of PET-CT with FDG were performed for staging and therapeutic response assessment. FDG PET-CT proved to be a valuable tool for detecting unsuspected pulmonary metastases and defining the reassessment of the patient after chemotherapy. The findings suggest that since this is a rare tumor, which does not always have benign behaviour, PET-CT may be a useful diagnostic imaging procedure for staging and clinical monitoring of patients who suffer this type of tumors.

[PET/CT: focal lung uptake of 18F-fluorodeoxyglucose on PET but no structural alterations on CT]. / PET-TAC: captación pulmonar focal de FDG sin alteracion estructural en TAC.

The combination of positron emission tomography (PET) and computed tomography (CT) in a single device (PET/CT) offers a powerful diagnostic tool that opens up new horizons for imaging diagnosis. In order to correctly interpret PET/CT studies, knowledge of the biodistribution of 18F-fluorodeoxyglucose (FDG), the physiological variants as well as the pitfalls, including artefacts, which may be found, is necessary. We report four cases performed during the follow-up diagnostic context of an oncology study performed with 18F-FDG-PET/CT. In every case, this study showed focal uptake in the lung parenchyma in the PET study with no structural lesions being found on the CT scan. Radiotracer extravasation in three of these patients and a recent change in the injection protocol used suggest that an artefact was responsible for these discrepancies.

Management actions to mitigate the occurrence of pharmaceuticals in river networks in a global change context.

Human consumption of pharmaceuticals leads to high concentrations of pharmaceuticals in wastewater, which is usually not or insufficiently collected and treated before release into freshwater ecosystems. There, pharmaceuticals may pose a threat to aquatic biota. Unfortunately, occurrence data of pharmaceuticals in freshwaters at the global scale is scarce and unevenly distributed, thus preventing the identification of hotspots, the prediction of the impact of Global Change (particularly streamflow and population changes) on their occurrence, and the design of appropriate mitigation actions. Here, we use diclofenac (DCL) as a typical pharmaceutical contaminant, and a global model of DCL chemical fate based on wastewater sanitation, population density and hydrology to estimate current concentrations in the river network, the impact of future changes in runoff and population, and potential mitigation actions in line with the Sustainable Development Goals. Our model is calibrated against measurements available in the literature. We estimate that 2.74 ± 0.63% of global river network length has DCL concentrations exceeding the proposed EU Watch list limit (100 ng L-1). Furthermore, many rivers downstream from highly populated areas show values beyond 1000 ng L-1, particularly those associated to megacities in Asia lacking sufficient wastewater treatment. This situation will worsen with Global Change, as streamflow changes and human population growth will increase the proportion of the river network above 100 ng L-1 up to 3.10 ± 0.72%. Given this background, we assessed feasible source and end-of-pipe mitigation actions, including per capita consumption reduction through eco-directed sustainable prescribing (EDSP), the implementation of the United Nations Sustainable Development Goal (SDG) 6 of halving the proportion of population without access to safely managed sanitation services, and improvement of wastewater treatment plants up to the Swiss standards. Among the considered end-of-pipe mitigation actions, implementation of SDG 6 was the most effective, reducing the proportion of the river network above 100 ng L-1 down to 2.95 ± 0.68%. However, EDSP brought this proportion down to 2.80 ± 0.64%. Overall, our findings indicate that the sole implementation of technological improvements will be insufficient to prevent the expected increase in pharmaceuticals concentration, and that technological solution need to be combined with source mitigation actions.

[18F-fluorodeoxyglucose positron emission tomography in the evaluation of therapy response assessment in lymphomas. Systematic literature review and meta-analysis]. / Tomografía de positrones con 18F-fluorodesoxiglucosa en la valoración de la respuesta de los linfomas al tratamiento. Revisión sistemática de la literatura y metaanálisis.

This systematic review of literature analyze the utility of positron emission tomography (PET or PET-CT) with 18F-fluorodeoxyglucose, as a diagnostic tool in the assessment of response to chemotherapy and immunotherapy in lymphomas, in terms of diagnostic accuracy in prospective publications. A literature search was conducted in major databases and through manual review from the reference lists of articles that were recovered. The methodological quality of the selected items was evaluated using the QUADAS questionnaire. 9 publications were analyzed after the filtering process. The methodological quality of the same was broadly acceptable. In patients with LH, the negative predictive value of FDG-PET after 2-3 cycles of chemotherapy, was ranged between 93.4% (95% CI, 92.6-94.3) and 100% (95% CI, 99.3-100%), and after the treatment, the negative predictive value of PET-FDG, was between 94.3% (95% CI, 92.8-95.7) and 100% (95% CI, 97.1-100). In patients with residual masses and LH, the meta-analysis of results showed a sensitivity of 100% (95% CI, 0.753-1) and a specificity of 84% (95% CI, 0.699-0.934). PET-FDG seems to be a useful tool to evaluate the response to treatment of patients with lymphoma. However, it recommended further prospective studies and that possibly conducted in hybrid PET-CT scans, to determine its usefulness.