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1.
Br J Radiol ; 93(1114): 20200543, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32877210

RESUMO

OBJECTIVES: To evaluate interobserver agreement for T2 weighted (T2W) and diffusion-weighted MRI (DW-MRI) contours of locally advanced rectal cancer (LARC); and to evaluate manual and semi-automated delineations of restricted diffusion tumour subvolumes. METHODS: 20 cases of LARC were reviewed by 2 radiation oncologists and 2 radiologists. Contours of gross tumour volume (GTV) on T2W, DW-MRI and co-registered T2W/DW-MRI were independently delineated and compared using Dice Similarity Coefficient (DSC), mean distance to agreement (MDA) and other metrics of interobserver agreement. Restricted diffusion subvolumes within GTVs were manually delineated and compared to semi-automatically generated contours corresponding to intratumoral apparent diffusion coefficient (ADC) centile values. RESULTS: Observers were able to delineate subvolumes of restricted diffusion with moderate agreement (DSC 0.666, MDA 1.92 mm). Semi-automated segmentation based on the 40th centile intratumoral ADC value demonstrated moderate average agreement with consensus delineations (DSC 0.581, MDA 2.44 mm), with errors noted in image registration and luminal variation between acquisitions. A small validation set of four cases with optimised planning MRI demonstrated improvement (DSC 0.669, MDA 1.91 mm). CONCLUSION: Contours based on co-registered T2W and DW-MRI could be used for delineation of biologically relevant tumour subvolumes. Semi-automated delineation based on patient-specific intratumoral ADC thresholds may standardise subvolume delineation if registration between acquisitions is sufficiently accurate. ADVANCES IN KNOWLEDGE: This is the first study to evaluate the feasibility of semi-automated diffusion-based subvolume delineation in LARC. This approach could be applied to dose escalation or 'dose painting' protocols to improve delineation reproducibility.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Retais/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Variações Dependentes do Observador , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Carga Tumoral
2.
Nat Commun ; 11(1): 4308, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32855399

RESUMO

Distant metastasis (DM) is the main cause of treatment failure in locally advanced rectal cancer. Adjuvant chemotherapy is usually used for distant control. However, not all patients can benefit from adjuvant chemotherapy, and particularly, some patients may even get worse outcomes after the treatment. We develop and validate an MRI-based radiomic signature (RS) for prediction of DM within a multicenter dataset. The RS is proved to be an independent prognostic factor as it not only demonstrates good accuracy for discriminating patients into high and low risk of DM in all the four cohorts, but also outperforms clinical models. Within the stratified analysis, good chemotherapy efficacy is observed for patients with pN2 disease and low RS, whereas poor chemotherapy efficacy is detected in patients with pT1-2 or pN0 disease and high RS. The RS may help individualized treatment planning to select patients who may benefit from adjuvant chemotherapy for distant control.


Assuntos
Antineoplásicos/uso terapêutico , Nomogramas , Protectomia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Adulto , Idoso , Quimioterapia Adjuvante/estatística & dados numéricos , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/prevenção & controle , Estadiamento de Neoplasias , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 456-460, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842424

RESUMO

Imaging plays a key role in the diagnosis and decision-making process including pre-treatment planning, surgical strategy, and follow-up. The critical point in diagnosis of presacral recurrent rectal cancer by imaging modalities is to distinguish the recurrent tumor from nonmalignant tissues induced by operation or radiotherapy. The practice guideline recommends CT as surveillance imaging modality for recurrent rectal cancer. MRI shows higher accuracy, sensitivity, and specificity in diagnosis of presacral recurrent rectal cancer compared with CT. If CT or MRI can not make final diagnosis in challenging cases, 18-fluorodeoxyglucose positron emission tomography ((18)FDG PET) is recommended to aid diagnosis with high sensitivity and specificity, though false-positivity and negativity should be considered. If new or enlarging soft tissue are shown in the follow-up examination, tumor recurrence should be suspected. In addition, tumor-related high risk factors, treatment protocol, surgery, quality of specimen and pathological stages should also be considered when presacral recurrent rectal cancer is to be diagnosed.


Assuntos
Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Imagem por Ressonância Magnética , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X
4.
Clin Imaging ; 67: 177-188, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829150

RESUMO

OBJECTIVE: This study sought to assess the feasibility of diffusion tensor imaging (DTI) to noninvasively evaluate histological grade and lymph node metastasis in patients with rectal carcinoma (RC). METHODS: Thirty-seven consecutive patients with histologically confirmed RC were examined by 1.5-T MRI. DTI was performed using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm2 and motion-probing gradients in nine noncollinear directions. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) maps were compared with histopathological findings. RESULTS: The FA values (0.357 ±â€¯0.047) of the RCs were significantly lower than those of the normal rectal wall, muscle, prostate, and uterus (P < 0.001 for all), while the AD, MD, and RD values (1.221 ±â€¯0.131, 0.804 ±â€¯0.075, and 0.667 ±â€¯0.057 × 10-3 mm2/s, respectively) were also significantly lower than their respective normal values (P < 0.001 for all). The FA, AD, MD, and RD values for RC additionally showed significant inverse correlations with histological grades (r = -0.781, r = -0.750, r = -0.718, and r = -0.682, respectively; P < 0.001 for all). Further, the FA (0.430 vs. 0.611), AD (1.246 vs. 1.608 × 10-3 mm2/s), MD (0.776 vs. 1.036 × 10-3 mm2/s), and RD (0.651 vs. 0.824 × 10-3 mm2/s) (P < 0.001 for all) of the metastatic and nonmetastatic lymph nodes were significantly different. CONCLUSIONS: DTI may be clinically useful for the noninvasive evaluation of histological grade and lymph node metastasis in patients with RC.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Anisotropia , Imagem de Difusão por Ressonância Magnética , Imagem de Tensor de Difusão/métodos , Imagem Ecoplanar , Feminino , Humanos , Linfonodos , Metástase Linfática , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Útero
5.
J Comput Assist Tomogr ; 44(5): 759-765, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842061

RESUMO

OBJECTIVE: To compare the intravoxel incoherent motion (IVIM) parameters of rectal tumors before and after lumen distension obtained with sonography transmission gel. METHODS: Twenty-five patients were enrolled. The multiple b values of IVIM including 0, 20, 50, 100, 150, 200, 400, 600, 800, 1000, 1500, and 2000 s/mm. Two blinded readers have drawn the region of interests and calculated the D, D*, and f values. Interobserver variability between the 2 readers was measured by intraclass correlation coefficients and Altman-Bland plots. The intergroup differences of the average values were compared with the paired sample t test. RESULTS: After distention, the interrater agreement of the D* value increased obviously (from 0.547 to 0.692) and that of the D and f values increased slightly (from 0.731 and 0.618 to 0.807 and 0.666). The difference in the D value had statistical significance (P = 0.0043). CONCLUSIONS: Intraluminal distension can increase the repeatability of IVIM parameters and the value of IVIM.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Géis/uso terapêutico , Neoplasias Retais/diagnóstico por imagem , Reto/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Variações Dependentes do Observador , Neoplasias Retais/fisiopatologia , Reto/fisiopatologia , Ultrassonografia
6.
Cancer Radiother ; 24(5): 444-452, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620457

RESUMO

The aim of the present paper is to systematically review all available literature on preradiotherapy high uptake areas (hotspots) as a potential target for dose escalation in different tumour sites, and to understand the potential role and limitations of fluorodeoxyglucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) in this context. An electronic database (Medline) search was conducted to identify articles reporting on a correlation between high tracer uptake on pretreatment PET and preferential sites of local recurrence after radiotherapy. Search was limited to English language. No date range limitation was applied. Among 45 studies initially identified, nine series matching with inclusion criteria have finally been retained from the literature after reviewing (5 retrospective and 4 prospective). Primary tumour locations were head-neck (n=2), lung (n=4), oesophageal (n=2) and rectal (n=1) areas. Overlaps between FDG hotspot on preradiotherapy PET/CT and site of local recurrence on post-treatment scan showed good to excellent agreement. Only studies on head-neck cancer reported moderate agreement probably explained by the lack of reproducibility of the patients positioning between pre- and post-treatment FDG-PET/CT; and by the rigid registration process of images limited by post-therapeutic changes that highly affect anatomical landmarks. FDG hotspot-guided radiotherapy may allow dose escalation in respecting a robust methodology (treatment position, co-registration method, four-dimensional PET).


Assuntos
Fluordesoxiglucose F18 , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Pontos de Referência Anatômicos/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Neoplasias/radioterapia , Posicionamento do Paciente , Estudos Prospectivos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 99(27): e20941, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629697

RESUMO

RATIONALE: Tailgut cyst (TGC) is a rare congenital disease that originates from residues of the tail intestine during the embryonic period. Most TGCs are benign lesions and the malignant transition is very rare. PATIENT CONCERNS: A 50-year-old woman attended our department complaining of defecation difficulty for more than 2 months. She reported irregular defecation with a small amount of liquid stool, 3 to 4 times per day. DIAGNOSIS: Biochemical analysis showed high levels of carcinoembryonic antigen (79.89 ng/mL; normal, 0-3 ng/mL) and carbohydrate antigen 199 (57.60 U/mL; normal, 0-35 U/mL). Abdominal computer tomography and magnetic resonance imaging showed a large cystic mass with enhanced signals. Post-surgical histopathology indicated that the mass was a TGC with adenocarcinoma transition. INTERVENTIONS: The cyst was completely resected. Symptomatic treatment was further performed, and the patient recovered well. LESSONS: We reported a rare case of a large TGC with adenocarcinoma transition. CT, MRI, and histopathology are important to diagnose TGC. Complete surgical resection is the first choice to treat TGC.


Assuntos
Adenocarcinoma/diagnóstico , Cistos/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Retais/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Biomarcadores Tumorais/sangue , Antígeno Carcinoembrionário/sangue , Cistos/diagnóstico por imagem , Cistos/patologia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Proteínas Ligadas por GPI/sangue , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Tomografia Computadorizada por Raios X
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 572-577, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521977

RESUMO

Objective: To explore the feasibility of using faster regional convolutional neural network (Faster R-CNN) to evaluate the status of circumferential resection margin (CRM) of rectal cancer in the magnetic resonance imaging (MRI). Methods: This study was registered in the Chinese Clinical Trial Registry (ChiCTR-1800017410). Case inclusion criteria: (1) the positive area of CRM was located between the plane of the levator ani, anal canal and peritoneal reflection; (2) rectal malignancy was confirmed by electronic colonoscopy and histopathological examination; (3) positive CRM was confirmed by postoperative pathology or preoperative high-resolution MRI. Exclusion criteria: patients after neoadjuvant therapy, recurrent cancer after surgery, poor quality images, giant tumor with extensive necrosis and tissue degeneration, and rectal tissue construction changes in previous pelvic surgery. According to the above criteria, MRI plain scan images of 350 patients with rectal cancer and positive CRM in The Affiliated Hospital of Qingdao University from July 2016 to June 2019 were collected. The patients were classified by gender and tumor position, and randomly assigned to the training group (300 cases) and the validation group (50 cases) at a ratio of 6:1 by computer random number method. The CRM positive region was identified on the T2WI image using the LabelImg software. The identified training group images were used to iteratively train and optimize parameters of the Faster R-CNN model until the network converged to obtain the best deep learning model. The test set data were used to evaluate the recognition performance of the artificial intelligence platform. The selected indicators included accuracy, sensitivity, positive predictive value, receiver operating characteristic (ROC) curves, areas under the ROC curves (AUC), and the time taken to identify a single image. Results: The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CRM status determined by the trained Faster R-CNN artificial intelligence approach were 0.884, 0.857, 0.898, 0.807, and 0.926, respectively; the AUC was 0.934 (95% CI: 91.3% to 95.4%). The Faster R-CNN model's automatic recognition time for a single image was 0.2 s. Conclusion: The artificial intelligence model based on Faster R-CNN for the identification and segmentation of CRM-positive MRI images of rectal cancer is established, which can complete the risk assessment of CRM-positive areas caused by in-situ tumor invasion and has the application value of preliminary screening.


Assuntos
Imagem por Ressonância Magnética/métodos , Margens de Excisão , Redes Neurais de Computação , Neoplasias Retais/diagnóstico por imagem , Simulação por Computador , Estudos de Viabilidade , Humanos , Modelos Biológicos , Terapia Neoadjuvante , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Medição de Risco
11.
Cancer Radiother ; 24(5): 388-397, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32448741

RESUMO

The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (18F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.


Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Quimiorradioterapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Feminino , Fluordesoxiglucose F18 , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/terapia , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Compostos Radiofarmacêuticos , Radioterapia Adjuvante , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia
12.
Clin Nucl Med ; 45(7): e309-e310, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404709

RESUMO

We report the case of a 63-year-old man who underwent MRI and Ga-PSMA-11 PET/CT for biochemical recurrence localization after radical prostatectomy (serum PSA, 0.25 ng/mL) and describe the incidental discovery of a rectal adenocarcinoma. Immunohistochemical analysis showed PSMA staining in the tumor-associated neovasculature, but not in normal vasculature, or tumor cells. After surgical removal, he was treated with salvage radiotherapy to the postoperative prostate bed. This case example has several implications: the findings confirm the expression of PSMA in the tumor-associated neovasculature of a rectal cancer, nonprostate cancers' stroma may represent a potentially relevant target for nuclear theranostics.


Assuntos
Adenocarcinoma/metabolismo , Antígenos de Superfície/metabolismo , Regulação Neoplásica da Expressão Gênica , Glutamato Carboxipeptidase II/metabolismo , Neovascularização Patológica/metabolismo , Medicina Nuclear , Neoplasias Retais/metabolismo , Nanomedicina Teranóstica , Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prostatectomia , Neoplasias Retais/irrigação sanguínea , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia
13.
Anticancer Res ; 40(4): 2171-2177, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234911

RESUMO

BACKGROUND/AIM: To develop a nomogram for predicting the pathological tumor response to preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer based on pre-treatment magnetic resonance imaging (MRI) and blood test characteristics. PATIENTS AND METHODS: This retrospective study included 514 patients who underwent MRI and received preoperative CRT followed by surgical resection. Pathological tumor response was assessed as good [Dworak tumor regression grade (TRG) 3 or 4] or poor (TRG 0-2). A nomogram for good response was developed using stepwise logistic regression analysis. RESULTS: A nomogram based on longitudinal tumor diameter, extramural tumor invasion depth, carcinoembryonic antigen and hemoglobin levels, age, and interval between CRT and surgery gave an area under the receiver operating characteristic curve for a good response of 0.721 (95%CI=0.676-0.768). CONCLUSION: Our nomogram based on pre-treatment clinical characteristics can predict the tumor response to CRT, which may help identify patients who can benefit most from CRT.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Radioterapia/métodos , Neoplasias Retais/terapia , Idoso , Quimiorradioterapia , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nomogramas , Período Pré-Operatório , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Estudos Retrospectivos , Resultado do Tratamento
14.
Anticancer Res ; 40(4): 2079-2087, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234900

RESUMO

BACKGROUND/AIM: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity. PATIENTS AND METHODS: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance<96.4 mm (2 points), ymrT stage≥T3b (4 points), and male sex (1 point). RESULTS: The sample was composed of 141 patients, of whom 23 (16.3%) had a difficult L-TME. The EuMaRCS score demonstrated high accuracy in predicting difficult surgery (AROC: 0.806, 95%CI=0.72-0.88), with a cut-off >3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%). CONCLUSION: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Quimiorradioterapia , Feminino , Humanos , Laparoscopia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Análise de Sobrevida
15.
Cancer Radiother ; 24(5): 437-443, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32247689

RESUMO

Radiation therapy has undergone significant advances these last decades, particularly thanks to technical improvements, computer science and a better ability to define the target volumes via morphological and functional imaging breakthroughs. Imaging contributes to all three stages of patient care in radiation oncology: before, during and after treatment. Before the treatment, the choice of optimal imaging type and, if necessary, the adequate functional tracer will allow a better definition of the volume target. During radiation therapy, image-guidance aims at locating the tumour target and tailoring the volume target to anatomical and tumoral variations. Imaging systems are now integrated with conventional accelerators, and newer accelerators have techniques allowing tumour tracking during the irradiation. More recently, MRI-guided systems have been developed, and are already active in a few French centres. Finally, after radiotherapy, imaging plays a major role in most patients' monitoring, and must take into account post-radiation tissue modification specificities. In this review, we will focus on the ongoing projects of nuclear imaging in oncology, and how they can help the radiation oncologist to better treat patients. To this end, a literature review including the terms "Radiotherapy", "Radiation Oncology" and "PET-CT" was performed in August 2019 on Medline and ClinicalTrials.gov. We chose to review successively these novelties organ-by-organ, focusing on the most promising advances. As a conclusion, the help of modern functional imaging thanks to a better definition and new specific radiopharmaceuticals tracers could allow even more precise treatments and enhanced surveillance. Finally, it could provide determinant information to artificial intelligence algorithms in "-omics" models.


Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Radioterapia Guiada por Imagem/métodos , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antígenos de Superfície , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Previsões , Glutamato Carboxipeptidase II , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Linfoma/diagnóstico por imagem , Linfoma/radioterapia , Imagem por Ressonância Magnética , Masculino , Aceleradores de Partículas , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Compostos Radiofarmacêuticos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Sarcoma/diagnóstico por imagem , Sarcoma/radioterapia
16.
Cancer Radiother ; 24(5): 403-410, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32265157

RESUMO

PURPOSE: Radiomics are a set of methods used to leverage medical imaging and extract quantitative features that can characterize a patient's phenotype. All modalities can be used with several different software packages. Specific informatics methods can then be used to create meaningful predictive models. In this review, we will explain the major steps of a radiomics analysis pipeline and then present the studies published in the context of radiation therapy. METHODS: A literature review was performed on Medline using the search engine PubMed. The search strategy included the search terms "radiotherapy", "radiation oncology" and "radiomics". The search was conducted in July 2019 and reference lists of selected articles were hand searched for relevance to this review. RESULTS: A typical radiomics workflow always includes five steps: imaging and segmenting, data curation and preparation, feature extraction, exploration and selection and finally modeling. In radiation oncology, radiomics studies have been published to explore different clinical outcome in lung (n=5), head and neck (n=5), esophageal (n=3), rectal (n=3), pancreatic (n=2) cancer and brain metastases (n=2). The quality of these retrospective studies is heterogeneous and their results have not been translated to the clinic. CONCLUSION: Radiomics has a great potential to predict clinical outcome and better personalize treatment. But the field is still young and constantly evolving. Improvement in bias reduction techniques and multicenter studies will hopefully allow more robust and generalizable models.


Assuntos
Diagnóstico por Imagem/métodos , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Radio-Oncologistas , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Análise de Dados , Curadoria de Dados/métodos , Aprendizado Profundo , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Fenótipo , Radioterapia/métodos , Neoplasias Retais/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
Radiol Med ; 125(10): 990-998, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32277332

RESUMO

PURPOSE: The potential role of neoadjuvant radiation dose intensification in locally advanced rectal cancer (LARC) is still largely debated. In the present study, a comparative analysis between radiation dose intensification and conventional fractionation was performed. MATERIALS AND METHODS: In the current prospective observational study (protocol ID RT-03/2011), 56 patients diagnosed with LARC were enrolled between January 2013 and December 2016. More specifically, 25 patients underwent preoperative conventional radiation dose [i.e., 50.4 Gy in 28 fractions here defined as standard dose radiotherapy (SDR)-group 1], whereas 31 patients were candidate for radiation dose intensification (RDI) (i.e., 60 Gy in 30 fractions-group 2). The primary endpoint was the complete pathological response (pCR) rate. Secondary endpoints were postoperative complications and ChT-RT-related toxicity. RESULTS: No statistical significance was observed in pCR rate (20.8% and 22.6% in SDR and RDI group, respectively, p = 0.342). Of contrast, the RDI group showed a significantly higher primary tumor downstaging in case of T3 tumor compared to SDR group (p = 0.049). Sphincter-preserving surgery was 84% and 93.5% in SDR and RDI groups, respectively (p = 0.25). All patients had R0 margins. No surgical-related death was recorded. No statistically significant difference was observed regarding surgical complications and incomplete mesorectal excision. Acute genitourinary toxicity was significantly higher in RDI group (p = 0.015). CONCLUSIONS: The intensification of the neoadjuvant radiotherapy for LARC seems to produce a major pathological response in T3 tumors. The radiation dose intensification appears probably associated with a higher rate of genitourinary toxicity.


Assuntos
Quimiorradioterapia/métodos , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Quimiorradioterapia/efeitos adversos , Fracionamento da Dose de Radiação , Feminino , Cabeça do Fêmur/efeitos da radiação , Hospitalização , Humanos , Intestinos/efeitos da radiação , Laparoscopia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/efeitos da radiação , Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Doses de Radiação , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia de Intensidade Modulada , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Bexiga Urinária/efeitos da radiação
19.
Chirurgia (Bucur) ; 115(1): 95-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155404

RESUMO

Introduction: Diverting ostomy is a commonly perfomed procedure but may be associated to its own morbidity (early or late complications). Colostomy-related evisceration is a rare but potentially life threatening condition (requiring emergency surgery), relatively undocumented for its mechanisms. Case report: A male aged 84 was admited for chronic low digestive occlusion due to a locally advanced, stenosing, rectal adenocarcinoma. Prior to neoadjuvant therapy, a loop sigmoidostomy was indicated using a left iliac open aproach, with no preparation of the colic content. The sigmoid was loaded with hard stools. The parietal breach was reaproximated by 2 monofilament nylon sutures, fascial and colocutaneus fixation. Colostomy was opened two days later, but was not functional (postoperative paralytic ileus). Parastomal evisceration of ileum in day 3, dehiscence of parietal suture. Emergency operation, using the same aproach. Results: Favourable outcome. Thoraco-abdominal CT scan: N0,M0. Pelvic MRI: proliferative mass of inferior and middle rectum, involving mesorectum fascia, levator ani and a few regional lymphatic nodes. Radio-chemotherapy and abdomino-perineal resection. Pathologic result: colorectal adenocarcinoma, G2, ypT1ypN0, ICD-O: 8140/3. Conclusions: We rewiewed 8 case reports published since 2011, equally distributed as late or early complications. There was no connection with the princeps indication (colorectal cancer in half of cases); neither related to topography (transverse or sigmoid) or type of colostomy (loop or end). Occurence of the complication is not time-dependent (5 to18 months in late, 3 to 12 days for early eviscerations). The main premise is colostomy itself (a place of reduced parieto-abdominal resistence), stressed by increassed intra-abdominal pressure (eg. bronchopulmonary disease, digestive obstruction). Predisposing factors for late evisceration seems to be related to spontaneous rupture of parastomal hernia/colostomy prolapse. As for early evisceration, both technical details and surgical strategy must be considered (indequate fixation; creation of a larger than necessary colostomy aperture).


Assuntos
Adenocarcinoma/cirurgia , Colostomia/efeitos adversos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Retais/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Obstrução Intestinal/etiologia , Pseudo-Obstrução Intestinal/etiologia , Masculino , Protectomia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Tomografia Computadorizada por Raios X
20.
Tumori ; 106(4): 286-294, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32116150

RESUMO

INTRODUCTION: Extramural vascular invasion (EMVI) has been recommended as an independent prognostic factor for poor overall survival rate in rectal cancer and can be used as a potential biomarker. Early prediction of prevalence of synchronous metastasis can elevate the disease-free survival rate. We aimed to evaluate the magnetic resonance imaging (MRI)-detected EMVI (mrEMVI) scoring system in predicting distant metastasis in T3 rectal cancer. METHODS: Patients with postoperative histopathologically confirmed T3 rectal cancer without previous treatment from July 2014 to December 2015 were enrolled in this study. Two blinded radiologists evaluated mrEMVI status. mrEMVI was categorized as EMVI-positive or EMVI-negative in T2-weighted images using an mrEMVI scoring system. The results, along with other clinical characteristics (age, sex, tumor location, MRI-detected distance of mesorectal extension, lymphatic invasion, perineural invasion, mrEMVI score, and carcinoembryonic antigen [CEA]), were then correlated with synchronous metastases to determine the risk factors using univariate and multivariate analysis. RESULTS: Of 180 patients, 38 were confirmed to be mrEMVI-positive, 142 mrEMVI-negative. There were 34 patients with synchronous metastasis, of whom 25 were mrEMVI-positive and 9 were mrEMVI-negative. Three factors were significantly associated with synchronous metastasis: mrEMVI (p = 0.001; odds ratio = 8.665), histopathologic lymphatic invasion (p = 0.001; odds ratio = 12.940), and preoperative CEA (p = 0.026; odds ratio = 4.124). mrEMVI score 4 was more likely for synchronous metastasis (p = 0.044; odds ratio = 9.429) than mrEMVI score 3 in rectal cancer. CONCLUSIONS: mrEMVI positivity is an independent risk factor for synchronous distant metastasis in rectal cancer. mrEMVI score 4 is a stronger risk factor for synchronous metastasis than mrEMVI score 3 in rectal cancer.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Imagem por Ressonância Magnética , Invasividade Neoplásica/diagnóstico , Neoplasias Retais/diagnóstico , Idoso , Vasos Sanguíneos/patologia , Antígeno Carcinoembrionário/sangue , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/irrigação sanguínea , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Neoplasias Retais/sangue , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Fatores de Risco
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