Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2) / Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)

Objetivo. Evaluar la validez diagnóstica de la tomografía por emisión de positrones con 18F-fluoro-2-deoxi-D-glucosa y la tomografía computarizada (PET/TAC) en la estadificación ganglionar mediastínica (N2) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) y analizar el papel de la estadificación mediante pruebas invasivas para la verificación de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computerizada (TAC). Material y métodos. Estudio retrospectivo incluyendo a pacientes con diagnóstico histopatológico de CPCNP, estadificados como N2 mediante TAC+C y estudiados con PET/TAC. Se confirmaron mediante análisis histopatológico de la pieza quirúrgica cuando se dispuso o por consenso iconográfico en el comité de tumores torácicos. Se ha calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del estudio PET/TAC en la correcta clasificación de los pacientes N2. Resultados. Se incluyeron 34 pacientes clasificados como N2 mediante TAC+C. El PET/TAC clasificó a 30 pacientes como estadio N2. Se encontraron discrepancias en 4 pacientes, dos clasificados como N1 y dos como N0. Los resultados fueron confirmados histológicamente en 20 pacientes. El estudio PET/TAC no mostró falsos positivos. La sensibilidad fue del 94,7%, la especificidad y el valor predictivo positivo fue del 100% y el valor predictivo negativo del 50%. Conclusiones. El estudio PET/TAC presenta una alta sensibilidad y valor predictivo positivo en la correcta clasificación de pacientes con afectación ganglionar mediastínica (N2). Nuestros resultados sugieren que en pacientes con cáncer de pulmón potencialmente resecable, candidatos a tratamiento con quimioterapia neoadyuvante, la mediastinoscopia podría reservarse para la re-estadificación(AU)

Purpose. To evaluate the accuracy of integrated positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. Material and methods. A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. Results. A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. Conclusions. Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy(AU)

[Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)]. / Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2).

PURPOSE: To evaluate the accuracy of integrated positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. MATERIAL AND METHODS: A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. RESULTS: A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. CONCLUSIONS: Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy.

Biochemotherapy in the treatment of metastatic melanoma in selected patients

INTRODUCTION: Bioimmunochemotherapy (BCT) is a combination of biological agents and cytostatics that has shown an increase in response rate (RR) in metastatic melanoma patients. The aim of the study is to evaluate RR, progression- free survival (PFS), overall survival (OS) and treatment toxicity. MATERIALS AND METHODS: Retrospective analysis of 11 metastatic melanoma patients treated from January 2002 to June 2008 with cisplatin 20 mg/m(2) i.v. days 1.4, dacarbazine 800 mg/m(2) i.v. day 1, vinblastine 1.5 mg/m(2) i.v. days 1.4, interleukin (IL)-2 9 MIU/m(2) s.c. 5.8 days and interferon (IFN)-alpha-2b 5 MIU/m2 s.c. days 5.9, 11, 13 and 15, with the support of granulocyte colony-stimulating factor (G-CSF) and antibiotics. Patients with ECOG 0, age < or = 65 years and with measurable disease were included. The planned number of courses was 4. RR was measured by Revised Evaluation Criteria in Solid Tumour (RECIST) criteria (computed tomography [CT]+/-proton emission tomography [PET]). Toxicity was measured according to the National Cancer Institute (NCI) common toxicity criteria. RESULTS: Observed RRs were 18% complete response (CR), 27% partial response (PR), 9% stable disease (SD) and 46% disease progression. The median PFS was 4 months (95% CI, 0.10 m), with a 23% one-year PFS. Median OS was 4.6 months (95% CI, 0.9.19 m), with a 29% one-year OS. Eighty-three percent of patients experienced grade 3-4 toxicity, mainly due to neutropenia, thrombocytopenia and flu-like syndrome. CONCLUSIONS: Treatment with BCT shows an increase in RR, some achieving durable CR; nevertheless it cannot be considered a standard treatment and should be employed only in selected patients (AU)