18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. / La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica.

AIM: Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL: A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS: Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION: Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION: 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.

Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata / Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer

INTRODUCCIÓN: Estandarizar los protocolos de adquisición de 18F-Colina PET/TC, que permitan evitar la interferencia urinaria, evaluar el mejor tiempo del estudio de cuerpo completo y valorar si la «doble fase» permite la diferenciación entre lesiones benignas frente a malignas. MÉTODO: Estudio prospectivo que incluye 100 pacientes con cáncer de próstata: 31 estadificación y 69 recidiva bioquímica (32 posprostatectomía y 37 posradioterapia). Adquisición pélvica inmediatamente tras inyección de 18F-Colina y estudio de cuerpo completo, 1 y 2h p.i. Cálculo de media SUVmáx por territorios en todos los estudios secuenciales. Análisis de medias (χ2) y porcentaje de cambio del SUV (2/1h; 1h/0min). Patrón de dinámica metabólica: acumulativo frente a aclaramiento. Seguimiento tras tratamiento en todos los pacientes y de forma dirigida, cuando éticamente es posible. RESULTADOS: Cincuenta y tres focos prostáticos, en ninguna de las imágenes precoces actividad urinaria: Patrón acumulativo en 42, porcentaje de aumento: 0min/1h: +16,7% (X20,94); 1/2h: +10,0% (X20,83). Patrón aclaramiento en 11, porcentaje de reducción: 0min/1h: 21,4% (X20,91); 1/2h: −7,7% (X20,85), correspondiendo en 7 a estadificación y 4 a posradioterapia. Todos los focos infradiafragmáticos (n: 24) mostraron dinámica acumulativa, porcentaje de aumento: +9,1% (χ20,97), todas ellas visibles en el primer estudio. De los 12 focos supradiafragmáticos, 8 mostraron aclaramiento, porcentaje de reducción: −13,0% (χ2 0,95). Los otros 4 dinámica acumulativa, porcentaje de aumento: +13,0% (χ2 0,96), siendo valorados invasivamente. Todos los focos óseos (n: 18) mostraron dinámica acumulativa, porcentaje de aumento: +17,1% (χ20,95), todas ellas visibles en el estudio 1h. CONCLUSIONES: En la valoración prostática la mejor técnica doble fase es 0min/1h. En la diferenciación de adenopatías supradiafragmáticas es aconsejable la técnica de doble fase: 1/2h. Para la infiltración infradiafragmática y ósea, ante hallazgos dudosos, las imágenes 2h aumentan la confianza diagnóstica

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: −21.4% (χ20.91): −7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: −13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence

Nuevo escenario en la lucha contra el tabaquismo: la financiación de los tratamientos / New situation in the fight against smoking: tobacco treatments founding

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Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer. / Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata.

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: -21.4% (χ20.91): -7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: -13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence.

El tabaco de tercera mano / Thirdhand smoke

Se denomina tabaco de tercera mano (TTM) al depósito de los gases y partículas del tabaco de segunda mano sobre el polvo, superficies y objetos de ambientes interiores, así como en las partículas atmosféricas de los ambientes exteriores. Tienen un efecto sobre el entorno y la calidad del aire, permanecen en las casas incluso hasta seis meses después de dejar de fumar, y además pueden reaccionar con oxidantes y otros componentes del ambiente generando contaminantes secundarios. También es reconocido como contaminante de espacios cerrados al vapeo de segunda mano que se deposita igualmente en ambientes cerrados originando el vapeo de tercera mano (VTM). No existe un nivel seguro de exposición al TTM ni al VTM, adquiriéndose poco a poco evidencia científica de sus importantes efectos nocivos sobre la salud. La prohibición total del consumo de tabaco y cigarrillo electrónico en lugares cerrados es la única forma de luchar contra esta contaminación

It is called thirdhand tobacco (THT) to the deposit of gases and particles of second-hand tobacco (SHT) on dust, surfaces and objects in indoor environments, as well as in atmospheric particles in outdoor environments. They have an effect on the environment and air quality, remain in homes even up to six months after quitting, and can also react with oxidants and other components of the environment generating secondary pollutants. It is also recognized as a contaminant of closed spaces the second-hand vaping that is also deposited in closed environments causing third-hand vaping (THV)). There is no safe level of exposure to THT or THV, gradually acquiring scientific evidence of its important harmful effects on health. The total ban on tobacco and electronic cigarette consumption in closed places is the only one to fight against this contamination

Serum amyloid A and plasma fibrinogen concentrations in horses following emergency exploratory celiotomy.

BACKGROUND: Acute-phase proteins may help assess the nature and severity of lesions and outcome in horses undergoing colic surgery. OBJECTIVES: To compare serum amyloid A and plasma fibrinogen concentrations ([SAA] and [fibrinogen]) in the immediate post-operative period after exploratory celiotomy and determine their value in assessment of post-operative complications and survival to discharge. STUDY DESIGN: Observational study. METHODS: This study included horses over 1 year of age undergoing exploratory celiotomy. Surgical procedures, lesions, post-operative care, complications and survival to discharge were recorded. [SAA] and [fibrinogen] were measured prior to surgery and 5 days post-operatively. Statistical analyses included Yate's Chi-square test, linear mixed effects model, Mann-Whitney U test and logistic regression. RESULTS: Of 300 horses, 52.0% developed post-operative complications and 83.7% survived to discharge, with significantly reduced chance of survival in horses that developed post-operative complications (P<0.01). Median [SAA] at days 1, 2, 3, 4 and 5 and median [fibrinogen] at days 3, 4 and 5 were significantly different between horses that did and did not develop post-operative complications (P<0.05). Median [SAA] at days 1, 4 and 5 were significantly different between horses that did and did not survive to discharge (P<0.05). Logistic regression revealed post-operative complications to be associated with strangulating lesions (OR 2.35, 95% confidence interval [CI] 1.41-3.91, P≤0.001) and higher [fibrinogen] at admission (OR 1.21, 95% CI 1.00-1.45, P<0.05), and survival to discharge to be associated with lower [SAA] at 5 days post-operatively (OR 0.965, 95% CI 0.94-0.99, P = 0.002). MAIN LIMITATIONS: A large variety of lesions and complications prevented detailed analysis of associations between inflammatory markers, lesions and complications. CONCLUSIONS: Horses that develop post-operative complications have acute-phase responses of greater magnitudes and durations compared with those that do not develop complications. This is also seen in horses that do not survive to discharge. Measuring [SAA] daily and [fibrinogen] at admission, may help predict the development of post-operative complications.

20 años en tabaquismo / 20 years in smoking

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Estudio genético de la fractura femoral atípica mediante la secuenciación del exoma en tres hermanas afectas y tres pacientes no relacionadas / Genetic study of atypical femoral fractures using exome sequencing in three affected sisters and three unrelated patients

Objetivos: Las fracturas atípicas de fémur (FAF) son un tipo de fracturas poco frecuentes, a menudo relacionadas con un tratamiento prolongado con bisfosfonatos (BPs). Actualmente no se conocen con exactitud sus mecanismos patogénicos y no hay pruebas para identificar aquellos pacientes con un alto riesgo de sufrir una FAF. El objetivo de este trabajo es investigar las bases genéticas de las FAFs. Material y métodos: Se secuenció el exoma completo de 3 hermanas y de 3 pacientes adicionales no relacionadas, todas tratadas con BPs durante más de 5 años. Se seleccionaron variantes compartidas por las hermanas, de baja frecuencia y potencialmente patogénicas, y se construyó una red de interacciones de genes y proteínas con los datos hallados. Resultados: Identificamos 37 variantes raras (en 34 genes) compartidas por las 3 hermanas, algunas de ellas no descritas anteriormente. La variante más llamativa fue la mutación p.Asp188Tyr en el enzima geranilgeranil pirofosfato sintasa (codificada por el gen GGPS1), de la vía del mevalonato y esencial para la función del osteoclasto. Otro hallazgo interesante fueron dos mutaciones (una en las 3 hermanas y una en una paciente no relacionada) en el gen CYP1A1, implicado en el metabolismo de los esteroides. Identificamos otras variantes que también podrían estar involucradas en la susceptibilidad a las FAFs o en el fenotipo osteoporótico subyacente, tales como las presentes en los genes SYDE2, NGEF, COG4 y la FN1. Conclusiones: Nuestros datos son compatibles con un modelo donde la acumulación de variantes de susceptibilidad podría participar en la base genética de las FAF

Objectives: Atypical femoral fractures (AFF) are rare, often related to long-term bisphosphonate (BPs) treatment. Their pathogenic mechanisms are not precisely known and there is no evidence to identify patients with a high risk of AFF. The aim of this work is to study the genetic bases of AFFs. Material and methods: Whole-exome sequencing was carried out on 3 sisters and 3 unrelated additional patients, all treated with BPs for more than 5 years. Low frequency, potentially pathogenic variants shared by the 3 sisters, were selected, were selected and a network of gene and protein interactions was constructed with the data found. Results: We identified 37 rare variants (in 34 genes) shared by the 3 sisters, some not previously described. The most striking variant was the p.Asp188Tyr mutation in the enzyme geranylgeranyl pyrophosphate synthase (encoded by the GGPS1 gene), from the mevalonate pathway and essential for osteoclast function. Another noteworthy finding was two mutations (one in the 3 sisters and one in an unrelated patient) in the CYP1A1 gene, involved in the metabolism of steroids. We identified other variants that could also be involved in the susceptibility to AFFs or in the underlying osteoporotic phenotype, such as those present in the SYDE2, NGEF, COG4 and FN1 genes. Conclusions: Our data are compatible with a model where the accumulation of susceptibility variants could participate in the genetic basis of AFFs

[Clinical and molecular study in a family with multiple osteochondromatosis]. / Estudio clínico y molecular en una familia con osteocondromatosis múltiple.

We present two cases of a family with the diagnosis of multiple osteochondromatosis, which was confirmed by molecular study with nonsense in heterozygosis mutation c.1219CT, (p.Gln407Stop) in the EXT1 gene. In these cases, the Madelung deformity was presented in one patient as an uncommon finding and chondrosarcoma as a feared complication in the other case, highlighting intrafamilial variation, which is why individual and interdisciplinary evaluation is recommended. In addition, before a genetic entity should provide adequate and timely family genetic counseling to all its members.

Se presentan dos casos de una familia con diagnóstico de osteocondromatosis múltiple, el cual fue confirmado por estudio molecular con mutación sin sentido en heterocigosis c.1219CT, (p.Gln407Stop) en el gen EXT1. En el primer caso, en un paciente se presentó deformidad de Madelung como hallazgo infrecuente y en el otro caso, condrosarcoma como complicación temida, resaltando la variación intrafamiliar, por lo que se recomienda la evaluación individual e interdisciplinaria. Además, ante una entidad genética debe brindarse el adecuado y oportuno asesoramiento genético familiar a todos sus integrantes.

Estudio clínico y molecular en una familia con osteocondromatosis múltiple / Clinical and molecular study in a family with multiple osteochondromatosis

Resumen: Se presentan dos casos de una familia con diagnóstico de osteocondromatosis múltiple, el cual fue confirmado por estudio molecular con mutación sin sentido en heterocigosis c.1219C>T, (p.Gln407Stop) en el gen EXT1. En el primer caso, en un paciente se presentó deformidad de Madelung como hallazgo infrecuente y en el otro caso, condrosarcoma como complicación temida, resaltando la variación intrafamiliar, por lo que se recomienda la evaluación individual e interdisciplinaria. Además, ante una entidad genética debe brindarse el adecuado y oportuno asesoramiento genético familiar a todos sus integrantes.

Abstract: We present two cases of a family with the diagnosis of multiple osteochondromatosis, which was confirmed by molecular study with nonsense in heterozygosis mutation c.1219C>T, (p.Gln407Stop) in the EXT1 gene. In these cases, the Madelung deformity was presented in one patient as an uncommon finding and chondrosarcoma as a feared complication in the other case, highlighting intrafamilial variation, which is why individual and interdisciplinary evaluation is recommended. In addition, before a genetic entity should provide adequate and timely family genetic counseling to all its members.

Protocolo de deshabituación en fumadores ingresados en un hospital de segundo nivel / Smoking cessation protocol in smokers hospitalized in a second level hospital

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Utilidad de la PET con 11C-metionina en la diferenciación precoz entre recurrencia tumoral y radionecrosis de pacientes tratados de glioma de alto grado con RM indeterminada / The value of 11C-methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high-grade glioma and indeterminate MRI

Objetivo. Valorar la contribución de la PET con 11C-metionina en la diferenciación precoz entre recurrencia tumoral y radionecrosis en pacientes tratados de gliomas de alto grado. Método. Treinta pacientes tratados de glioma (grado iii/iv) con cirugía/radioterapia/quimioterapia (5-18 meses) con RM indeterminada. A todos se les realizó estudio de PET con 11C-metionina (<15 días tras RM) con análisis visual (grado de intensidad y morfología de captación), cuantificación (relación SUV máximo lesión/SUV medio fondo) y corregistro PET/RM (3D-Flair). El manejo de los pacientes se decidió en el comité de neurooncología: seguimiento clínico-imagen, tratamiento de segunda línea o cirugía. Resultados. Veintitrés estudios de PET con 11C-metionina fueron visualmente positivos. La morfología fue: 15 focales, 4 difusos y 4 anulares. Tres de los focales fueron resecados (AP+). En 16 se realizó terapia de segunda línea (11 respuesta, 5 progresión). En los 4 de morfología anular se decidió seguimiento, con progresión en 2 (verdaderos positivos) y libres de enfermedad en 2 (6 y 7 meses después) (falsos positivos). Siete estudios de PET con 11C-metionina fueron visualmente negativos, todos ellos libres de enfermedad (3-12 meses). La relación SUV lesión/fondo en la recurrencia tumoral fue de 2,79±1,35 mientras que en la radionecrosis fue de 1,53±0,39 (p<0,05). Con umbral de corte SUV lesión/fondo de 2,35 se obtuvo una sensibilidad y especificidad del 90,5 y 100%. Conclusión. La valoración de la PET con 11C-metionina, con análisis visual, cuantitativo y corregistro PET/RM muestra un papel complementario en los pacientes con RM no concluyente, permitiendo una diferenciación precoz entre recurrencia tumoral y radionecrosis, que ayuda a la individualización de la terapia (AU)

Objective. To evaluate the contribution of 11C-Methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high grade glioma. Method. The study included 30 patients with glioma (III/IV grade) treated with surgery/radiotherapy/chemotherapy (5-8 months) and with an indeterminate MRI. All patients underwent a 11C-Methione PET (within 15 days of MRI) and studies were visually analysed (intensity and morphology of uptake), quantified (SUV max/SUV mean background), and coregistered to MRI (3D-Flair). Patient management was decided by the neuro-oncology committee to clinical and imaging follow-up, second-line treatment, or surgery. Results. There were 23 11C-Methionine PET studies visually positive. Morphology of uptake was focal in 15, diffuse in 4, and ring-shaped in 4. Three out of the focal uptake cases underwent resection (Histopathology +). Sixteen underwent second-line therapy (11 responded; 5 progressed). The 4 cases with ring-shaped uptake were followed-up, and progression was found in 2 (true-positive), and disease-free in 2 (follow-up of 6 and 7 months, respectively) (false-positive). Seven out of 11C-Methionine studies PET were visually negative, and all of them were disease-free (follow-up of 3-12 months). SUV lesion/background was 2.79±1.35 in tumour recurrence, and 1.53±0.39 in radionecrosis (P<.05). Taking into account a SUV lesion/background threshold of 2.35, the sensitivity and specificity values were 90.5% and 100%, respectively. Conclusion. Visual analysis, quantitative and PET/MRI coregistration of 11C-Methionine PET showed their complementary role in patients with indeterminate MRI results, thus allowing early differentiation between tumour recurrence and radionecrosis, and helping in the individual therapy approach (AU)

The value of 11C-methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high-grade glioma and indeterminate MRI. / Utilidad de la PET con 11C-metionina en la diferenciación precoz entre recurrencia tumoral y radionecrosis de pacientes tratados de glioma de alto grado con RM indeterminada.

OBJECTIVE: To evaluate the contribution of 11C-Methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high grade glioma. METHOD: The study included 30 patients with glioma (III/IV grade) treated with surgery/radiotherapy/chemotherapy (5-8 months) and with an indeterminate MRI. All patients underwent a 11C-Methione PET (within 15 days of MRI) and studies were visually analysed (intensity and morphology of uptake), quantified (SUV max/SUV mean background), and coregistered to MRI (3D-Flair). Patient management was decided by the neuro-oncology committee to clinical and imaging follow-up, second-line treatment, or surgery. RESULTS: There were 23 11C-Methionine PET studies visually positive. Morphology of uptake was focal in 15, diffuse in 4, and ring-shaped in 4. Three out of the focal uptake cases underwent resection (Histopathology +). Sixteen underwent second-line therapy (11 responded; 5 progressed). The 4 cases with ring-shaped uptake were followed-up, and progression was found in 2 (true-positive), and disease-free in 2 (follow-up of 6 and 7 months, respectively) (false-positive). Seven out of 11C-Methionine studies PET were visually negative, and all of them were disease-free (follow-up of 3-12 months). SUV lesion/background was 2.79±1.35 in tumour recurrence, and 1.53±0.39 in radionecrosis (P<.05). Taking into account a SUV lesion/background threshold of 2.35, the sensitivity and specificity values were 90.5% and 100%, respectively. CONCLUSION: Visual analysis, quantitative and PET/MRI coregistration of 11C-Methionine PET showed their complementary role in patients with indeterminate MRI results, thus allowing early differentiation between tumour recurrence and radionecrosis, and helping in the individual therapy approach.

Peritoneal Cancer Index mediante 18F-FDG PET/TC pre y poscirugía citorreductiva radical y quimioterapia intraperitoneal con hipertermia. A propósito de un caso / Peritoneal Cancer Index by 18F-FDG PET/TC pre and post-hyperthermic intraperitoneal chemotherapy. Report of a case

La cirugía citorreductora radical seguida de quimioterapia intraperitoneal con hipertermia aumenta la supervivencia de los pacientes con carcinomatosis peritoneal. El Peritoneal Cancer Index cuantifica el tumor en el acto quirúrgico y permite planificar el tratamiento y establecer el pronóstico de la enfermedad. Se obtiene combinando la distribución del tumor en 13 regiones abdominopélvicas con el tamaño de la lesión más grande. La tomografía por emisión de positrones/tomografía computarizada con fluorodesoxiglucosa es la técnica de elección en la selección de los pacientes candidatos a cirugía citorreductora radical seguida de quimioterapia intraperitoneal con hipertermia debido a su mayor tasa de detección de la carcinomatosis y a que, además, permite el diagnóstico de enfermedad extraperitoneal. El Peritoneal Cancer Index simplificado (9 regiones definidas por 2 planos transversales y 2 sagitales) obtenido mediante tomografía por emisión de positrones/tomografía computarizada con fluorodesoxiglucosa permite su correlación con el acto quirúrgico, siendo su estandarización aconsejable (AU)

Radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy increases survival in patients with end-stage peritoneal carcinomatosis, and who are under palliative therapy. The Peritoneal Cancer Index enables the tumor burden to be quantified during surgery, as well as treatment planning and patient prognosis. It is obtained by combining the tumor spread in 13 abdominal and pelvic regions with the largest tumor size. Fluorodeoxyglucose positron emission tomography/computed tomography is the technique of choice for those patients selected to undergo radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, due to its higher detection rate of carcinomatosis, and since it allows extra-peritoneal disease staging. The simplified Peritoneal Cancer Index (9 regions defined by 2 transverse and 2 sagittal planes) obtained by fluorodeoxyglucose positron emission tomography/computed tomography allows correlation with the surgical procedure, therefore its standardization is advisable (AU)

Radioterapia de rescate en pacientes con cáncer de próstata. Planificación, respuesta al tratamiento y pronóstico mediante PET/TC con 11C-colina / Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using 11C-choline PET/CT

Objetivo. Evaluar el valor pronóstico de la respuesta terapéutica mediante 11C-colina PET/TC en pacientes con recidiva bioquímica de cáncer de próstata en los que la exploración ha indicado el tratamiento con radioterapia radioguiada. Método. Treinta y siete pacientes inicialmente tratados con prostatectomía, acudieron por recidiva bioquímica. La 11C-colina PET/TC permitió la detección de infiltración adenopática infradiafragmática. Todos ellos fueron seleccionados para radioterapia de intensidad modulada, escalando la dosis según los hallazgos de la PET/TC. Al año se les realizó PSA y 11C-colina PET/TC categorizando la respuesta (completa/parcial/progresión). Se efectuó seguimiento clínico/analítico/imagen hasta aparición de segunda recidiva o 36 meses en pacientes libres de enfermedad. Resultados. La 11C-colina PET/TC permitió la detección adenopática en los 37 pacientes. En 18 (48,6%) fue supracentimétrica y en 19 (51,3%) no había criterios patológicos por TC: 9 (24,3%) ganglios positivos supra + infracentimétricos y 10 (27,0%) únicamente infracentimétricos. Categorizamos la respuesta mediante 11C-colina PET/TC un año tras la radioterapia: 16 pacientes (43,2%) respuesta completa; 15 (40,5%) respuesta parcial; 6 (16,2%) progresión. La respuesta fue concordante entre PSA y 11C-colina PET/TC en 32 pacientes (86,5%) y discordante en 5 (13,5%). Se detectó nueva recidiva en 12 pacientes (80%) con respuesta parcial y en 5 (31,2%) con respuesta completa. La media de tiempo libre de enfermedad ha sido 9 meses tras respuesta parcial y 18 meses tras respuesta completa (diferencia significativa, p < 0,0001). Conclusión. La 11C-colina PET/TC permite la selección de los pacientes con recidiva de cáncer de próstata candidatos a radioterapia, planificando la misma. La evaluación de la respuesta terapéutica mediante 11C-colina PET/TC presenta significación pronóstica (AU)

Objective. To assess the prognostic value of the therapeutic response by 11C-choline PET/CT in prostate cancer patients with biochemical recurrence in which 11C-choline PET/CT indicated radio-guided radiotherapy. Methods. The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. 11C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and 11C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. Results. 11C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by 11C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and 11C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). Conclusion. 11C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by 11C-choline PET/CT has prognostic significance (AU)

Una visión global de las terapias sustitutivas con nicotina / A global view of nicotine replacement therapies

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Peritoneal Cancer Index by (18)F-FDG PET/TC pre and post-hyperthermic intraperitoneal chemotherapy. Report of a case. / Peritoneal Cancer Index mediante (18)F-FDG PET/TC pre y poscirugía citorreductiva radical y quimioterapia intraperitoneal con hipertermia. A propósito de un caso.

Radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy increases survival in patients with end-stage peritoneal carcinomatosis, and who are under palliative therapy. The Peritoneal Cancer Index enables the tumor burden to be quantified during surgery, as well as treatment planning and patient prognosis. It is obtained by combining the tumor spread in 13 abdominal and pelvic regions with the largest tumor size. Fluorodeoxyglucose positron emission tomography/computed tomography is the technique of choice for those patients selected to undergo radical cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, due to its higher detection rate of carcinomatosis, and since it allows extra-peritoneal disease staging. The simplified Peritoneal Cancer Index (9 regions defined by 2 transverse and 2 sagittal planes) obtained by fluorodeoxyglucose positron emission tomography/computed tomography allows correlation with the surgical procedure, therefore its standardization is advisable.

Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using (11)C-choline PET/CT. / Radioterapia de rescate en pacientes con cáncer de próstata. Planificación, respuesta al tratamiento y pronóstico mediante PET/TC con (11)C-colina.

OBJECTIVE: To assess the prognostic value of the therapeutic response by (11)C-choline PET/CT in prostate cancer patients with biochemical recurrence in which (11)C-choline PET/CT indicated radio-guided radiotherapy. METHODS: The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. (11)C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and (11)C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. RESULTS: (11)C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by (11)C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and (11)C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). CONCLUSION: (11)C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by (11)C-choline PET/CT has prognostic significance.

Estudio de pacientes con síndrome febril prolongado con 18F-FDG PET-TC / Study of patients with prolonged fever with 18F-FDG PET/CT

Objetivo. Revisar el resultado de la tomografía por emisión de positrones (PET)-tomografía computarizada (TC) con flúor-18-fluorodesoxiglucosa (18F-FDG) en pacientes con fiebre de origen desconocido de más de 7 días de evolución. Material y métodos. Estudio observacional descriptivo retrospectivo de 93 estudios de PET-TC con 18F-FDG solicitados para detectar el foco causante de la fiebre en tres centros de medicina nuclear entre octubre de 2006 y febrero de 2014. Un especialista en medicina nuclear y un radiólogo revisaron las imágenes buscando focos de captación patológica. Las discrepancias se resolvieron con la opinión de un nuevo especialista. El resultado de la 18F-FDG PET-TC se comprobó clínica y/o anatomopatológicamente. Resultados. En la PET-TC se observaron captaciones anómalas de la 18F-FDG que podían justificar la causa de la fiebre en 52 de los 93 estudios (56%). La causa se confirmó en 50 de estos 52 estudios. De las 50 causas de fiebre diagnosticadas, la infección (54%) fue la más frecuente, seguida de la enfermedad inflamatoria no infecciosa (28%) y la enfermedad tumoral (18%). Conclusión. La PET-TC con 18F-FDG es útil para diagnosticar la causa del síndrome febril prolongado, por lo que puede ser práctico emplearla en una etapa más precoz del proceso diagnóstico (AU)

Objective. To review the findings on 18F-FDG PET-CT in patients with fever of unknown origin lasting more than 7 days. Material and methods. This retrospective descriptive observational study included 93 18F-FDG PET-CT studies to detect a fever-causing focus done at three nuclear medicine centers from October 2006 through February 2014. A nuclear medicine specialist and a radiologist reviewed the images for foci of pathological uptake; another specialist's opinion resolved discrepancies. The findings on 18F-FDG PET-CT studies were checked against clinical and/or histological findings. Results. Abnormal 18F-FDG uptake on PET-CT that could explain the cause of the fever was found in 52 (56%) of the 93 studies, and the cause of the fever was confirmed in 50 of these 52 studies. In the 50 cases in which the cause of the fever was confirmed, infection was the most common cause (54%), followed by noninfectious inflammatory disease (28%) and tumors (18%). Conclusion. 18F-FDG PET-CT is useful in diagnosing the cause of prolonged febrile illness, so it might be practical to use it earlier in the diagnostic process (AU)