Comparación del valor pronóstico de diferentes criterios de respuesta metabólica determinados por PET/TC en pacientes con cáncer de mama metastásico en tratamiento con inhibidores de CDK 4/6 / Comparison of prognostic value of different metabolic response criteria determined by PET/CT in patients with metastatic breast cancer under CDK 4/6 inhibitor treatment

Objetivo Este estudio evalúa el papel pronóstico de diferentes criterios de respuesta metabólica de la PET/TC con [18F]FDG en pacientes con cáncer de mama metastásico (CMM) tratadas con inhibidores de la cinasa dependiente de ciclina 4/6 (CDK 4/6). Materiales y métodos Evaluamos retrospectivamente los datos de pacientes con CMM tratados con inhibidores de CDK 4/6 a los que se les realizó una [18F]FDG PET/TC antes de iniciar y durante el tratamiento. La respuesta de [18F]FDG PET/CT se evaluó con la Organización Europea para la Investigación y el Tratamiento del Cáncer, los criterios de respuesta de PET en tumores sólidos (PERCIST) y los criterios de glucólisis de lesión total de cuerpo entero (WBTLG). Fleiss kappa se calculó para evaluar la concordancia entre los criterios de respuesta metabólica. El criterio de valoración del estudio fue la supervivencia libre de progresión (PFS). Los datos de SLP se analizaron mediante el método de Kaplan-Meier y se compararon mediante la prueba de rango logarítmico. Resultados El estudio incluyó a 16 pacientes con CMM que recibieron terapia con inhibidores de CDK 4/6. Según PERCIST, se encontró respuesta metabólica parcial (PMR) en siete pacientes, enfermedad metabólica estable (SMD) en siete pacientes y enfermedad metabólica progresiva (PMD) en dos pacientes. Según la Organización Europea para la Investigación y el Tratamiento del Cáncer, se detectó PMR en ocho pacientes, SMD en siete pacientes y PMD en un paciente. Según WBTLG, se encontró PMR en 10 pacientes, SMD en cuatro pacientes y PMD en dos pacientes. Hubo un acuerdo justo entre los tres criterios. Si bien se detectó progresión en siete de los pacientes durante el seguimiento, no se detectó progresión en nueve de ellos. El análisis de Kaplan-Meier reveló que los que respondieron según WBTLG mostraron una SLP significativamente más larga que los que no respondieron (AU)

Purpose This study evaluates the prognostic role of different [18F]FDG PET/CT metabolic response criteria in metastatic breast cancer (MBC) patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK 4/6). Materials and methods We retrospectively evaluated the data of MBC patients treated with CDK 4/6 inhibitors who underwent an [18F]FDG PET/CT scan before starting and during treatment. [18F]FDG PET/CT response was assessed with the European Organization for Research and Treatment of Cancer, PET response criteria in solid tumors (PERCIST), and whole-body total lesion glycolysis (WBTLG) criteria. Fleiss kappa was computed to assess the agreement between metabolic response criteria. The endpoint of the study was progression-free survival (PFS). PFS data were analyzed by the Kaplan–Meier method and compared using the log-rank test. Results The study included 16 MBC patients who received CDK 4/6 inhibitors therapy. According to PERCIST, partial metabolic response (PMR) was found in seven patients, stable metabolic disease (SMD) in seven patients, and progressive metabolic disease (PMD) in two patients. According to the European Organization for Research and Treatment of Cancer, PMR was detected in eight patients, SMD in seven patients, and PMD in one patient. According to WBTLG, PMR was found in 10 patients, SMD in four patients, and PMD in two patients. There was a fair agreement between the three criteria. While progression was detected in seven of the patients during follow-up, no progression was detected in nine of them. Kaplan–Meier analysis revealed that the responders according to WBTLG showed significantly longer PFS than non-responders. Conclusion Treatment response according to WBTLG criteria during treatment appears to be associated with prolonged PFS in patients treated with CDK 4/6 inhibitors for MBC (AU)

Posterior leukoencephalopathy after combination chemotherapy in a patient with lymphoma.

Posterior leukoencephalopathy syndrome is a recently described syndrome involving mainly parieto-occipital gray/white matter of the brain. It occurs secondary to various clinical entities, like hypertension and immunosuppressive therapy. Few cases after combination chemotherapy have been reported. This study describes a 36-year-old woman with primary refractory T-cell lymphoma, who developed central nervous system toxicity due to treatment with intrathecal methotrexate and intravenous ifosfamide, idarubicine and etoposide given as a salvage regimen. Both clinical features as well as magnetic resonance imaging findings were typical for posterior leukoencephalopathy syndrome. The patient died despite anti-hypertensive therapy and haemodialysis. Central nervous system toxicity related to chemotherapeutics and posterior leukoencephalopathy syndrome are discussed briefly.

Coincidental detection of T-cell rich B cell lymphoma in the para-aortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer: a case report.

The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B cell lymphoma in dissected lymph nodes has not been reported to our knowledge. In our case, the biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, para-aortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolon) chemotherapy for the lymphoma and concomitant pelvic chemoradiotherapy with cisplatin for cervical cancer were given. In this rare coincidence, the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screennig test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient is HIV-negative.

Coincidental detection of T-cell rich B-cell lymphoma in the paraaortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer.

The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B-cell lymphoma in dissected lymph nodes has not been reported to our knowledge. We report such a case. The biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, paraaortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B-cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) chemotherapy for the lymphoma and concomitant pelvic chemo-radiotherapy with cisplatin for cervical cancer were given. In this rare coincidence; the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screening test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient was HIV-negative.