Case Report: Subtotal Lymphoid and Total Marrow Irradiation as Bridge Therapy to CD19-Directed CAR T Cells in a Chemorefractory DLBCL With Leukemic Involvement.

CAR T cell therapy has transformed the salvage approach for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Maintaining disease control before CAR T cell infusion during product manufacturing (so-called bridging therapy) is an important step to optimizing outcome. Among possible bridging therapies, radiation therapy (RT) represents a valuable option, particularly when the disease is limited. Here, we report for the first time on a patient with chemorefractory-transformed DLBCL showing nodal, extranodal, and massive bone marrow (BM) lymphoma infiltration associated with leukemic involvement, a successful bridge therapy to CD19-directed CAR T cell therapy by subtotal lymphoid/total marrow irradiation plus thiothepa followed by reinfusion of CD34+ autologous hematopoietic stem cells. Such a novel bridging regimen allowed a significant reduction of nodal and BM tumor volume while improving blood cell count before CAR T cell infusion. The PET-CT scan and BM evaluation performed at 1, 3, and 6 months after treatment showed complete remission of the disease. A relapse occurred at almost 1 year in lymph nodes because of CD19 antigen escape while the BM remained free of disease. This extended radiotherapy approach may be an effective bridging therapy for chemorefractory DLBCL patients eligible for CAR T cells who present with a high tumor burden, including massive BM involvement associated with leukemic involvement. This preliminary evidence is worth confirming in additional patients.

Long-Lasting Palliation of Bone Oligometastatic Prostate Cancer After Repeated Stereotactic Body Radiotherapy.

Background: Oligometastatic disease has emerged as a distinct clinical state, with a tumor burden intermediate between localized and extensive systemic disease. Oligometastatic prostate cancer has generally been classified as ≤3 metastases in bone or lymph nodes only. Improvements in diagnostic modalities such as functional imaging allow a greater frequency of oligometastases diagnosis. Selected bone oligometastatic prostate cancer patients can be treated with metastasis-directed stereotactic body radiotherapy (SBRT) rather than androgen deprivation therapy (ADT). We describe a case representative of this scenario. Case Report: A 72-year-old male underwent surgery and salvage radiotherapy for a Gleason score 7 (3+4) adenocarcinoma confined in the prostate but with microscopic-positive surgical margins. Eight months after the end of radiotherapy, bone metastasis was diagnosed and treated with SBRT only because the patient refused ADT. In the subsequent 10 years, 6 more courses of SBRT were administered for new bone oligometastases encountered during follow-up. Neither local recurrence nor toxicity was observed after SBRT treatments. The patient, who is now 83 years old, has a Karnofsky Performance Status score of 90% and has preserved a satisfactory potentia coeundi. Conclusion: SBRT is a promising treatment for patients with bone oligometastatic prostate cancer, providing a high control rate within the irradiated volume and low toxicity. The ability to administer consecutive SBRT courses when new bone oligometastases are encountered in other sites can delay initiation of ADT. This case report reflects emerging trends for bone oligometastases treatment with metastasis-directed radiotherapy.

Role of FDG-PET/CT in follow-up of patients treated with resective gastric surgery for tumour.

INTRODUCTION: Gastric cancer has a poor prognosis and a high rate of recurrences after surgery. The optimal method for assessing early recurrences is not defined: conventional imaging (ultrasonography, CT and MRI) have difficulty in detecting them, because they don't give information regarding metabolic features or tumor response to chemotherapy. Actually 18F-fluorodeoxyglucose positron emission (18FDG-PET) has several indications for the primary staging and the follow-up of colon-rectal, lung, breast, neck cancers and lymphoma, but its clinical role in gastric cancer is not assessed. Our study analyzes the role of 18FDG-PET integrated with CT scan in the detection of gastric cancer recurrence. MATERIALS AND METHODS: We retrospectively reviewed 50 patients which underwent follow-up 18FDG-PET/CT from 2006 to 2009 after radical surgery for gastric adenocarcinoma. Each study was repeated every 6 months for the first two years after surgery and every 12 months for the subsequent three years. RESULTS: 18FDG-PET/CT was positive for suspected neoplastic disease in 29 (58%) and negative in 21 (42%) patients, with 3 false positive and 3 false negative results. 18FDG-PET/CT showed highly effectiveness in early detection of recurrences, as observed in 17 patients that were totally asymptomatic, allowing the initiation of multimodal treatment resulting in an important increasing of survival. CONCLUSIONS: 18FDG-PET-CT has a very good sensitivity (89.7%) and specificity (85.7%) in detecting local and distant recurrences during post-operative follow-up. Positive 18FDG-PET/CT findings may lead to an early change in the management of these patients, directing them towards rescue surgery or chemotherapy thereby improving their overall survival

[Postoperative follow-up of gastric adenocarcinoma with neoplastic markers and 18-FDG-PET/TC]. / Follow-up postchirurgico del cancro gastrico mediante markers neoplastici e 18-FDG-PET/TC.

INTRODUCTION: The usefulness of tumour markers CEA, CA19.9 and CA72.4 in association with FDG-PET/TC were prospectively evaluated in the post-operative follow-up of gastric cancer patients. MATERIAL AND METHODS: Fifty one consecutive patients were enrolled in a follow-up programme entailing with periodical clinical evaluations, instrumental examinations and tumour markers assay FDG-PET/TC was performed only in cases of suspected recurrence. RESULTS: Sensitivity of CEA, CA19.9 e CA72.4 during the follow-up period was respectively: 16%, 33.3% e 50%. Overall sensitivity was 66.6%. Specificity was 100% for CEA, 93.3% for CA19.9, 100% for CA72.4, with an overall specificity of 96.2%. FDG-PET/TC had a sensitivity of 100%. CONCLUSIONS: Tumour markers in association with FDG-PET/TC allow an early identification of recurrences after surgery, with the advantage to start chemotherapy or surgical protocols before the tumour has reached an advanced stage.