Prognostic Value of Pre- and Post-Treatment FDG PET/CT Parameters in Small Cell Lung Cancer Patients

Abstract

Purpose

To evaluate the prognostic value of PET parameters obtained from pre- and post-treatment FDG PET/CT examinations in patients with SCLC.

Methods

Fifty-nine patients with initially diagnosed SCLC from 2009 to 2014 were included and had chemotherapy and/or concurrent chemoradiotherapy. FDG PET/CT examinations were performed before (PET1) and after (PET2) treatment to evaluate treatment response. A region of interest was placed over the primary lesion and metastatic lymph nodes within the thoracic cavity. PET parameters including change from PET1 to PET2 (Δ in %) were acquired: SUVmax, SUVpeak, MTV2.5, TLG, ΔSUVmax, ΔSUVpeak, ΔMTV and ΔTLG. Patient characteristics including staging, age, sex, LDH and response evaluation by RECIST were surveyed. Statistical analysis was done using Kaplan-Meier method and Cox regression analysis with respect to OS and PFS.

Results

The median follow-up was 9.6 months (2.5–80.5 months). 27 patients were LD and 32 were ED. Forty-six patients (78.0%) had died, and median OS was 8.6 months; 51 patients (86%) showed disease progression, and median PFS was 2.5 months. On univariate analysis, patients with ED, high interval change (ΔSUVmax and ΔSUVpeak) and low PET2 parameters showed longer OS and PFS. Multivariate analyses demonstrated that ΔSUVpeak (HR 2.6, P = 0.002) was an independent prognostic factors for OS, and MTV2.5 of PET2 (HR 2.8, P = 0.001), disease stage (HR 2.7, P = 0.003) and RECIST (HR 2.0, P = 0.023) were independent prognostic factors for PFS.

Conclusions

Metabolic and volumetric PET parameters obtained from pre- and post-treatment FDG PET/CT examinations in patients with SCLC have significant prognostic information.

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Unusual Contralateral Axillary Lymph Node Metastasis in a Second Primary Breast Cancer Detected by FDG PET/CT and Lymphoscintigraphy

Abstract

Contralateral metastatic axillary lymph nodes in a patient with breast cancer is a rare condition. Here, we present a 55-year-old woman with a second primary breast cancer. The patient underwent ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for staging work-up. Additionally, preoperative lymphoscintigraphy was performed to detect sentinel lymph nodes. FDG PET/CT demonstrated increased FDG uptake in the left nipple and right axillary lymph nodes. Lymphoscintigraphy identified the right axillary lymph nodes which was consistent with the FDG PET/CT findings. This case emphasizes the usefulness of FDG PET/CT and lymphoscintigraphy for identifying unpredictable contralateral axillary lymph node metastasis from a second primary breast cancer.

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Effects of PBM in different energy densities and irradiance on maintaining cell viability and proliferation of pulp fibroblasts from human primary teeth

Abstract

This study aimed to compare the effects of photobiomodulation (PBM) in different energy densities and irradiances on maintaining cell viability, and proliferation of pulp fibroblasts from human primary teeth (HPF) were cultured in DMEM and used between the fourth and eighth passages. Then, HPF were irradiated with the following different energy densities: 1.25 J/cm² (a), 2.50 J/cm² (b), 3.75 J/cm² (c), 5.00 J/cm² (d), and 6.25 J/cm² (e); but varying either the time of irradiation (groups 1a–1e) or the output power (groups 2a–2e). Positive (groups 1f and 2f) and negative controls (groups 1g and 2g), respectively, comprised non-irradiated cells grown in regular nutritional conditions (10% fetal bovine serum [FBS]) and under nutritional deficit (1% FBS). Cell viability and proliferation were respectively assessed through MTT and crystal violet (CV) assays at 24, 48, and 72 h after irradiation. Statistical analysis was performed by two-way ANOVA, followed by Tukey test (P < 0.05). The negative controls showed significantly lower viability in relation to most of the corresponding subgroups, both for MTT and CV assays. For both assays, the intragroup comparison showed that the periods of 24 h exhibited lower viability than the periods of 48 and 72 h for most of the subgroups, except the negative controls with lower viability. The different irradiation protocols (equal energy densities applied with different irradiances) showed no statistically significant differences on cell viability and proliferation at the evaluated periods. The proposed PBM in different energy densities and irradiance did not affect the viability and proliferation of pulp fibroblasts from human primary teeth.

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Medicare Telehealth Parity Act of 2017 Would Expand Role of Audiology

Much of the focus of the Over-the-Counter (OTC) Hearing Aid Act of 2017 (S.670 and H.R.1652) has been on improving accessibility and affordability to hearing aids by providing a "do it yourself" (DIY) distribution channel for patients who are comfortable with self-assessment and fitting of hearing aids.

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'Alternative Medicine' for Cancer Ups Death Risk

Cancer patients who reject conventional treatments and choose alternative treatments exclusively are rare and are rarely studied. New data are sobering.
Medscape Medical News

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The Four Ws of Skin Cancer Surveillance in Melanoma Patients

Why, Who, When, and Where? The author of this commentary explores these questions surrounding the need for a personalized follow-up regimen for patients with melanoma.
The British Journal of Dermatology

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Fibromatosis-like Spindle Cell Carcinoma of the Breast

This case describes the clinical and imaging findings of a rare triple negative, fibromatosis-like metaplastic spindle cell breast carcinoma.
Applied Radiology

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New Data Address Critical Surgical Questions in Ovarian Cancer

At ASCO 2017, two trials tackled important surgical questions in ovarian cancer management, with the potential to eventually change practice, according to Dr Maurie Markman.
Medscape Oncology

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Viscosupplementation for hip osteoarthritis: a systematic review and meta-analysis of the efficacy for pain, disability and adverse events

Publication date: Available online 11 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Victor Figueiredo Leite, João Eduardo Daud Amadera, Anna Maria Buehler
ObjectiveTo assess the efficacy of viscosupplementation (HA) in hip osteoarthritis (OA) pain, disability and adverse events.Data SourcesPubmed, EMBASE, Cochrane Library, ClinicalTrials.gov database and specific journals up to March 2017.Study SelectionRandomized controlled trials comparing HA with any other intra-articular injection.Data ExtractionPerformed according to Cochrane/GRADE criteria. Two authors extracted data, assessed risk of bias and quality of evidence. Random-effects meta-analysis was conducted. Protocol registered on PROSPERO under CRD42015017312Data SynthesisEight RCTs were retrieved (n=807): four comparing HA to placebo (PBO); three with platelet-rich plasma (PRP), three with methylprednisolone (MPA), and one mepivacaine (MPV). Some RCTs had three arms. There is VERY LOW evidence that HA is not superior to PBO in pain at 3 months (SMD=-0.06 [95% CI -0.38; 0.25], p=0.69), and HIGH evidence that is not superior in adverse events (RR=1.21 [95%CI 0.79; 1.86], p=0.38).There is LOW evidence that HA is not superior to PRP for pain at 1 month. There is VERY LOW evidence that HA is not superior to PRP for pain at 6 and 12 months (mean difference in VAS in cm= -0.05 [95%CI -0.81, 0.71]; 1.0 [95%CI -1.5, 3.50]; 0.81 [95%CI -1.11, 2.73], respectively).There is HIGH evidence that HA is no different from MPA for pain at 1 month (SMD=0.02 [95% CI -0.18; 0.22], p=0.85). There is LOW evidence HA is no different from MPA for OMERACT-OARSI responders index at 1 month (RR=0.44 [95%CI 0.10; 1.95], p=0.28; There is HIGH evidence HA is no different from MPA for adverse events (RR=1.21 [95%CI 0.79; 1.87], p=0.38).ConclusionsWe do not recommend viscosupplementation for hip OA. Compared to placebo, data shows scarce evidence of its efficacy up to 3 months, and suggests no difference at 6 months. However, future RCTs could present HA as an alternative to MPA for short-term symptom relief.



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Predictors of survival in head and neck mucosal melanoma

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Matthew Q. Schmidt, John David, Emi J. Yoshida, Kevin Scher, Alain Mita, Stephen L. Shiao, Allen S. Ho, Zachary S. Zumsteg
ObjectivesTo evaluate hospital-based data of head and neck mucosal melanoma patients in order to identify predictors of survival.Materials and methodsThe National Cancer Data Base was used to identify 1368 patients with head and neck mucosal melanoma diagnosed between the years of 2004 and 2012. The Kaplan-Meier method was utilized to estimate overall survival, and multivariate Cox regression analyses were performed to assess the impact of covariates on survival after adjusting for confounding variables.ResultsMedian follow-up was 55.2months. Median survival of all patients was 29.3months, and the 5-year survival was 27.4%. After adjusting for other prognostic factors in multivariate analysis, paranasal sinus location [hazard ratio (HR)=1.54, 95% Confidence Interval (CI)=1.30–1.82, P<0.001)] and the use of radiotherapy alone for definitive local treatment (HR=2.27, 95% CI=1.72–2.98, P<0.001) were associated with worse survival. Similar results were seen in the subgroup of patients with complete clinical staging information. In terms of patterns of care, the use of combined surgery and radiotherapy as the primary local treatment modality has significant increased from 2004 and 2012 (P=0.03).ConclusionOutcomes in mucosal melanoma of the head and neck remain suboptimal, despite increased use of multimodality local therapy, likely due to the high risk of distant metastases. Mucosal melanomas arising from the paranasal sinuses have particularly poor prognosis. Novel therapeutic paradigms for head and neck mucosal melanoma, incorporating systemic therapies to decrease the risk of distant relapse, should be pursued in clinical trials.



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Incidence of facial nerve sacrifice in parotidectomy for primary and metastatic malignancies

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Brian Swendseid, Shawn Li, Jason Thuener, Rod Rezaee, Pierre Lavertu, Nicole Fowler, Chad Zender
IntroductionThe parotid gland may become involved by primary parotid malignancies and secondarily by metastases from other primary sites. Surgical resection of these tumors can be technically challenging due to the intimate relationship of the parotid gland and the facial nerve. The primary aim of this project was to determine the incidence of facial nerve sacrifice in parotidectomy for primary and secondary malignancies of the parotid.MethodsA retrospective chart review of was performed. Patients who received parotidectomy with final pathology consistent with a malignant neoplasm were included. The primary outcome studied was necessity for facial nerve sacrifice. Co-variates included preoperative facial nerve function, preoperative pain, superficial versus total parotidectomy and pathologic diagnosis. Univariate analysis was performed using student t-test to determine odds ratios.ResultsWe identified 75 patients who had a parotidectomy for a malignant process in our review. 30 patients had facial nerve sacrifice: 14 total and 16 partial sacrifices. Patients were more likely to require facial nerve sacrifice when they presented with preoperative facial nerve dysfunction [100% vs 19.6%, p=0.0006, OR 154.3, CI (8.66–2750.9)], pre-op pain [76.5% vs. 29.3%, p=0.001, OR 7.84, CI (2.23–27.50)], and required excision of both superficial and deep lobes of the parotid gland [64.9% vs 15.8%, p=0.0001, OR 9.85, CI (3.27–29.66)].ConclusionOur data illustrates that many patients with normal facial nerve function, even in the setting of malignancy, can have their facial nerve preserved. Pain, deep lobe involvement and preoperative facial nerve dysfunction are associated with an increased risk of needing at least partial facial nerve sacrifice in the setting of parotid gland malignancies.



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Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

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Highlights From Our July Issue

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Surgery is essential in squamous cell cancer of the rectum

Abstract

Purpose

Squamous cell cancer (SCC) is a rare histological subtype of rectal cancer. It is unclear whether SCC should be treated by multimodal therapy, including surgery, or by chemoradiation alone. The objective of the study was to define an optimal treatment strategy.

Methods

Patients with rectal cancer and SCC histology were identified in the Surveillance Epidemiology and End Results Database between 1990 and 2013. According to treatment, three groups were defined: radiotherapy and surgery (RT/SX), radiotherapy (RT), and surgery (SX). Overall survival (OS) and disease-specific survival (DSS) for localized, regional, and distant disease were assessed using a multivariable Cox regression model.

Results

Out of 856,435 colorectal cancer patients, 1747 with SCC of the rectum were eligible. Four hundred and fifty-five were treated with RT/SX, 994 with RT, and 298 with SX. Adjusted hazard ratios (HR) did not differ for OS and DSS in localized disease. In regional disease, OS and DSS were improved for RT/SX compared to RT (HR 0.751, 95% CI 0.566–0.997, P = 0.048 and HR 0.679, 95% CI 0.478–0.966, P = 0.031). In distant disease, OS and DSS were not different.

Conclusions

Multimodal therapy including surgery improved OS and DSS compared to receiving a treatment without surgery for regional disease in rectal SCC. No difference was observed in localized and distant disease. The findings contradict with recent reports favoring definitive chemoradiation.

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Fibrinogen promotes malignant biological tumor behavior involving epithelial–mesenchymal transition via the p-AKT/p-mTOR pathway in esophageal squamous cell carcinoma

Abstract

Purpose

Hyperfibrinogenemia is associated with unfavorable prognosis and advanced tumor behavior in various malignancies, including esophageal squamous cell carcinoma (ESCC). However, its biological function in ESCC is unknown. The present study was designed to further validate the prognostic value of preoperative plasma hyperfibrinogenemia and evaluate the biological role of fibrinogen, as well as the underlying mechanism in ESCC.

Methods

Data from 452 cases with newly diagnosed ESCC followed by curative surgery between 2006 and 2010 were retrospectively evaluated. The Clauss method was utilized to measure the preoperative plasma fibrinogen level. Correlations between the fibrinogen level and clinicopathologic characteristics and survival analysis were performed. The effects of fibrinogen on malignant behaviors, including tumor cell viability, colony formation, migration, and invasion, were also investigated.

Results

The optimal cut-off value for plasma fibrinogen level was defined as 4.0 g/L according to recommendations. Thus, the proportion of hyperfibrinogenemia was 24.8% (112/452). Preoperative plasma hyperfibrinogenemia was significantly associated with advanced tumor length, deep tumor invasion, advanced tumor–node–metastasis stage, alcohol consumption, a higher white blood cell count, a higher platelet count, and high globulin levels. Univariate survival analysis revealed that compared to those with normal plasma fibrinogen levels, patients with hyperfibrinogenemia tended to have poorer disease-free survival (DFS) [hazard ratio (HR), 1.692; 95% confidence interval (CI), 1.304–2.196; P < 0.001] and overall survival (OS) (HR 1.864; 95% CI 1.424–2.440; P < 0.001). In the multivariate Cox regression models, these factors remained independent predictors for impaired DFS (HR 1.491; 95% CI 1.138–1.955; P = 0.004) and OS (HR 1.648; 95% CI 1.246–2.180; P < 0.001) after adjusting for other confounding variables. In addition, fibrinogen could significantly promote cell migration and invasion but not proliferation. Moreover, it could also induce epithelial–mesenchymal transition (EMT) and increase the levels of p-PTEN, p-AKT, and p-mTOR in ESCC cell lines.

Conclusions

Preoperative plasma hyperfibrinogenemia might serve as an independent predictor of unfavorable survival in ESCC. Furthermore, fibrinogen may promote cell motility by inducing EMT via the p-AKT/p-mTOR pathway.

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Simulated implant dentistry app

British Dental Journal 223, 229 (2017). doi:10.1038/sj.bdj.2017.675

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'Minimum intervention' – MI inspiring future oral healthcare?

British Dental Journal 223, 133 (2017). doi:10.1038/sj.bdj.2017.644

Author: Avijit Banerjee

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Orthodontics: A number of points

British Dental Journal 223, 137 (2017). doi:10.1038/sj.bdj.2017.645

Author: N. Stanford

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Everything you need in vibrant colours

British Dental Journal 223, 232 (2017). doi:10.1038/sj.bdj.2017.682

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Primary dental care: Heresy, dam it!

British Dental Journal 223, 137 (2017). doi:10.1038/sj.bdj.2017.646

Author: R. Shamash

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