Exacerbated Renal and Hematologic Toxicities to Ifosfamide and Doxorubicin-Based Chemotherapy in a Patient with Retroperitoneal Liposarcoma Harboring a Germline Mutation in the WRN Gene.

Werner's syndrome is caused by the inactivation of both WRN alleles and is characterized by premature aging and increased risk of neoplasms, especially those of mesenchymal origins, such as sarcomas. Given the characteristic genomic instability, patients with this syndrome are more susceptible to develop toxicities when exposed to cytotoxic agents, such as alkylators and anthracyclines. The impact of the monoallelic WRN mutation on treatment-associated toxicities is poorly understood. Here, we report a patient with locally advanced dedifferentiated liposarcoma of the retroperitoneum harboring a heterozygous germline inactivation mutation in the WRN gene, who was treated with a classic regimen of ifosfamide and doxorubicin and developed exacerbated and prolonged hematological and renal toxicities.

Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings.

PSMA PET imaging was originally used to assess biochemical recurrence of prostate cancer (PCa), but its clinical use was promptly extended to detection, staging and therapy response assessment. The expanding use of PSMA PET worldwide has also revealed PSMA ligand uptake in diverse nonprostatic diseases, which raised questions about the specificity of this imaging modality. Although not very common initially, a growing number of pathologies presenting PSMA uptake on PET have been reported in the last few years, and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing. Compared to cytoplasmic PSMA expression in nonprostatic cells, the molecular features of apical PSMA expression in PCa cells can help to distinguish these various conditions. Correlations of imaging findings to patient history, to the expected pattern of disease spread and mainly to computed tomography (CT) and/or magnetic resonance imaging (MRI) characteristics will reinforce the distinction of lesions that are more likely related to PCa from those that could lead to an incorrect diagnosis. The overall benefits of endothelial PSMA expression, which is associated with the neovasculature of malignant neoplasms, will be highlighted, stating the potential use of PSMA ligand uptake as a theranostic tool. This review aims to cover the collection of nonprostatic diseases, including benign and malignant tumors, in a didactic approach according to disease etiology, with discussion of bone-related conditions and inflammatory and infectious processes.

Clinical perspectives of PSMA PET/MRI for prostate cancer.

Prostate cancer imaging has become an important diagnostic modality for tumor evaluation. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has been extensively studied, and the results are robust and promising. The advent of the PET/magnetic resonance imaging (MRI) has added morphofunctional information from the standard of reference MRI to highly accurate molecular information from PET. Different PSMA ligands have been used for this purpose including 68gallium and 18fluorine-labeled PET probes, which have particular features including spatial resolution, imaging quality and tracer biodistribution. The use of PSMA PET imaging is well established for evaluating biochemical recurrence, even at low prostate-specific antigen (PSA) levels, but has also shown interesting applications for tumor detection, primary staging, assessment of therapeutic responses and treatment planning. This review will outline the potential role of PSMA PET/MRI for the clinical assessment of PCa.

Clinical perspectives of PSMA PET/MRI for prostate cancer

Prostate cancer imaging has become an important diagnostic modality for tumor evaluation. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has been extensively studied, and the results are robust and promising. The advent of the PET/magnetic resonance imaging (MRI) has added morphofunctional information from the standard of reference MRI to highly accurate molecular information from PET. Different PSMA ligands have been used for this purpose including 68gallium and 18fluorine-labeled PET probes, which have particular features including spatial resolution, imaging quality and tracer biodistribution. The use of PSMA PET imaging is well established for evaluating biochemical recurrence, even at low prostate-specific antigen (PSA) levels, but has also shown interesting applications for tumor detection, primary staging, assessment of therapeutic responses and treatment planning. This review will outline the potential role of PSMA PET/MRI for the clinical assessment of PCa.

Estimating (131)I biokinetics and radiation doses to the red marrow and whole body in thyroid cancer patients: probe detection versus image quantification.

OBJECTIVE: To compare the probe detection method with the image quantification method when estimating (131)I biokinetics and radiation doses to the red marrow and whole body in the treatment of thyroid cancer patients. MATERIALS AND METHODS: Fourteen patients with metastatic thyroid cancer, without metastatic bone involvement, were submitted to therapy planning in order to tailor the therapeutic amount of (131)I to each individual. Whole-body scans and probe measurements were performed at 4, 24, 48, 72, and 96 h after (131)I administration in order to estimate the effective half-life (Teff) and residence time of (131)I in the body. RESULTS: The mean values for Teff and residence time, respectively, were 19 ± 9 h and 28 ± 12 h for probe detection, compared with 20 ± 13 h and 29 ± 18 h for image quantification. The average dose to the red marrow and whole body, respectively, was 0.061 ± 0.041 mGy/MBq and 0.073 ± 0.040 mGy/MBq for probe detection, compared with 0.066 ± 0.055 mGy/MBq and 0.078 ± 0.056 mGy/MBq for image quantification. Statistical analysis proved that there were no significant differences between the two methods for estimating the Teff (p = 0.801), residence time (p = 0.801), dose to the red marrow (p = 0.708), and dose to the whole body (p = 0.811), even when we considered an optimized approach for calculating doses only at 4 h and 96 h after (131)I administration (p > 0.914). CONCLUSION: There is full agreement as to the feasibility of using probe detection and image quantification when estimating (131)I biokinetics and red-marrow/whole-body doses. However, because the probe detection method is inefficacious in identifying tumor sites and critical organs during radionuclide therapy and therefore liable to skew adjustment of the amount of (131)I to be administered to patients under such therapy, it should be used with caution.

OBJETIVO: Comparar o desempenho dos métodos de detecção de sonda e quantificação de imagens na estimativa da biocinética do radioisótopo 131I e das doses de radiação na medula óssea vermelha e no corpo inteiro durante a radioiodoterapia em pacientes com câncer de tireoide. MATERIAIS E MÉTODOS: Catorze pacientes portadores de câncer metastático de tireoide, sem acometimento ósseo, foram submetidos ao planejamento terapêutico visando estabelecer a melhor atividade de 131I a ser empregada na radioiodoterapia. Imagens cintilográficas e captações de corpo inteiro foram adquiridas 4, 24, 48, 72 e 96 h após a administração de atividades traçadoras de 131I, visando estimar a meia-vida efetiva (T1/2ef) e o tempo de residência do 131I no organismo dos pacientes. RESULTADOS: Os valores médios de T1/2ef e tempo de residência foram, respectivamente, 19 ± 9 h e 28 ± 12 h pelo método de detecção de sonda e 20 ± 13 h e 29 ± 18 h pela quantificação de imagens. As doses médias na medula óssea vermelha e no corpo inteiro foram, respectivamente, 0,061 ± 0,041 mGy/MBq e 0,073 ± 0,040 mGy/MBq pelo método de detecção de sonda e 0,066 ± 0,055 mGy/MBq e 0,078 ± 0,056 mGy/MBq pela quantificação de imagens. A análise estatística demonstrou que os dois métodos apresentam desempenho semelhante no tocante à estimativa de T1/2ef (p = 0,801), tempo de residência (p = 0,801) e doses, tanto na medula óssea vermelha (p = 0,708) como no corpo inteiro (p = 0,811), mesmo com métodos otimizados de dosimetria que levam em consideração somente dois pontos de medida (4 h e 96 h) após a administração de 131I (p > 0,914). CONCLUSÃO: Existe excelente concordância entre o método de detecção de sonda e a quantificação de imagens quanto à estimativa da biocinética do 131I e das doses absorvidas de radiação. Contudo, o método de detecção de sonda deve ser usado com cuidado por ser incapaz de identificar regiões metastáticas e órgãos críticos durante a terapia com radionuclídeos, podendo distorcer ajustes da atividade de 131I a ser administrada durante a radioiodoterapia.

18F-FDG PET/CT Osteometabolic Activity in Metastatic Parathyroid Carcinoma.

Parathyroid cancer is an uncommon type of malignancy, which is frequently associated with poor prognosis. Clinical manifestations are caused by elevated serum calcium and parathyroid hormone (PTH). Diagnostic imaging studies as neck ultrasonography, technetium Tc Tc-sestamibi whole body scintigraphy, CT, and MR are already established tools for this malignancy. Nevertheless, the role of F-FDG PET/CT remains unknown in this scenario, with few published studies in literature. Hence, in this article, we aimed to report an illustrative case of increased skeletal FDG uptake associated with high calcium and PTH levels.

Estimating 131I biokinetics and radiation doses to the red marrow and whole body in thyroid cancer patients: probe detection versus image quantification / Estimativa da biocinética do 131I e das doses de radiação na medula óssea vermelha e no corpo inteiro em pacientes com câncer de tireoide: comparação entre o método de detecção de sonda e a quantificação de imagens cintilográficas

Abstract Objective: To compare the probe detection method with the image quantification method when estimating 131I biokinetics and radiation doses to the red marrow and whole body in the treatment of thyroid cancer patients. Materials and Methods: Fourteen patients with metastatic thyroid cancer, without metastatic bone involvement, were submitted to therapy planning in order to tailor the therapeutic amount of 131I to each individual. Whole-body scans and probe measurements were performed at 4, 24, 48, 72, and 96 h after 131I administration in order to estimate the effective half-life (Teff) and residence time of 131I in the body. Results: The mean values for Teff and residence time, respectively, were 19 ± 9 h and 28 ± 12 h for probe detection, compared with 20 ± 13 h and 29 ± 18 h for image quantification. The average dose to the red marrow and whole body, respectively, was 0.061 ± 0.041 mGy/MBq and 0.073 ± 0.040 mGy/MBq for probe detection, compared with 0.066 ± 0.055 mGy/MBq and 0.078 ± 0.056 mGy/MBq for image quantification. Statistical analysis proved that there were no significant differences between the two methods for estimating the Teff (p = 0.801), residence time (p = 0.801), dose to the red marrow (p = 0.708), and dose to the whole body (p = 0.811), even when we considered an optimized approach for calculating doses only at 4 h and 96 h after 131I administration (p > 0.914). Conclusion: There is full agreement as to the feasibility of using probe detection and image quantification when estimating 131I biokinetics and red-marrow/whole-body doses. However, because the probe detection method is inefficacious in identifying tumor sites and critical organs during radionuclide therapy and therefore liable to skew adjustment of the amount of 131I to be administered to patients under such therapy, it should be used with caution.

Resumo Objetivo: Comparar o desempenho dos métodos de detecção de sonda e quantificação de imagens na estimativa da biocinética do radioisótopo 131I e das doses de radiação na medula óssea vermelha e no corpo inteiro durante a radioiodoterapia em pacientes com câncer de tireoide. Materiais e Métodos: Catorze pacientes portadores de câncer metastático de tireoide, sem acometimento ósseo, foram submetidos ao planejamento terapêutico visando estabelecer a melhor atividade de 131I a ser empregada na radioiodoterapia. Imagens cintilográficas e captações de corpo inteiro foram adquiridas 4, 24, 48, 72 e 96 h após a administração de atividades traçadoras de 131I, visando estimar a meia-vida efetiva (T1/2ef) e o tempo de residência do 131I no organismo dos pacientes. Resultados: Os valores médios de T1/2ef e tempo de residência foram, respectivamente, 19 ± 9 h e 28 ± 12 h pelo método de detecção de sonda e 20 ± 13 h e 29 ± 18 h pela quantificação de imagens. As doses médias na medula óssea vermelha e no corpo inteiro foram, respectivamente, 0,061 ± 0,041 mGy/MBq e 0,073 ± 0,040 mGy/MBq pelo método de detecção de sonda e 0,066 ± 0,055 mGy/MBq e 0,078 ± 0,056 mGy/MBq pela quantificação de imagens. A análise estatística demonstrou que os dois métodos apresentam desempenho semelhante no tocante à estimativa de T1/2ef (p = 0,801), tempo de residência (p = 0,801) e doses, tanto na medula óssea vermelha (p = 0,708) como no corpo inteiro (p = 0,811), mesmo com métodos otimizados de dosimetria que levam em consideração somente dois pontos de medida (4 h e 96 h) após a administração de 131I (p > 0,914). Conclusão: Existe excelente concordância entre o método de detecção de sonda e a quantificação de imagens quanto à estimativa da biocinética do 131I e das doses absorvidas de radiação. Contudo, o método de detecção de sonda deve ser usado com cuidado por ser incapaz de identificar regiões metastáticas e órgãos críticos durante a terapia com radionuclídeos, podendo distorcer ajustes da atividade de 131I a ser administrada durante a radioiodoterapia.

Câncer colorretal: características clínicas e anatomopatológicas em pacientes com idade inferior a 40 anos / Colorectal cancer: clinical and anatomopathological features in patients below 40 years of age

O câncer colorretal (CCR) é a quarta neoplasia maligna mais incidente no Brasil. Seu diagnóstico em pacientes jovens é geralmente subestimado pelos médicos por ser frequentemente considerada como condição clínica de pacientes idosos. O presente trabalho tem como objetivo avaliar variáveis clínico-patológicas em pacientes com menos de 40 anos, no que diz respeito a idade, sexo e raça do paciente, história familiar, tabagismo, sinais e sintomas, tempo entre início dos sintomas e o diagnóstico, e localização da lesão primária, através de estudo retrospectivo de 11 casos de CCR atendidos no Hospital Universitário - HUUFMA no período de 1995 a 2005. Os pacientes incluídos representaram 11 (3,27 por cento) dos casos, sendo mais freqüente o sexo feminino (54,5 por cento). A idade média ao diagnóstico foi de 30,5 anos. Os sinais e sintomas mais prevalentes foram dor abdominal, alteração do hábito intestinal, perda ponderal, dor retal e hematoquezia. O tempo médio entre o início da sintomatologia e o aparecimento dos sintomas foi de 9,09 meses. A maioria das lesões encontrava-se no retossigmóide e reto (81,8 por cento). Cerca de 80 por cento dos pacientes apresentaram carcinoma estágios C e D da classificação de Dukes Astler-Coller. Pacientes jovens portadores de CCR apresentam, geralmente, sintomatologia rica, com doença avançada ao diagnóstico, portanto, com menor possibilidade de cura e prognóstico mais reservado.

The colorectal cancer (CRC) is the fourth incident malignant neoplasm in Brazil. Its diagnosis in young patients is usually underestimated by being frequently considered as elderly patients' clinical condition. This research has the objective to evaluate clinical-pathological variables in patients below 40 years, according to age, gender, ethnic, family history, smoking, signs and symptoms, time from the beginning of the symptoms to the diagnosis, and location of the primary lesion through retrospective study of 11 cases of CRC assisted at the Academical Hospital - HUUFMA in the period from 1995 to 2005. The included patients represented 11 (3,27 percent) of the cases which are more frequent in women (54,5 percent). The average age to the diagnosis was 30,5 years. The signs and symptoms more prevalent were abdominal pain, intestinal habit alterations, weight loss, rectal pain and hematoquezy. The average time from the beginning of the sintomatology to the emergence of the symptoms was of 9,09 months. Most of the lesions were founded in the recto-sigmoid and rectum (81,8 percent). Around 80 percent of the patients presented carcinoma in stages C and D of Dukes Astler-Coller's classification. Young patients with CRC have usually vast symptomatology with advanced disease at the diagnosis, therefore with smaller cure possibility and worse prognosis.