Purpose
Peptide receptor radionuclide therapy (PRRT) using
177
LuLu-DOTATATE has been shown to effectively prolong progression free survival in grade 1–2 gastroenteropancreatic neuroendocrine ...tumours (GEP-NET), but is less efficacious in patients with extensive liver metastases. The aim was to investigate whether tumour uptake in liver metastases can be enhanced by intra-arterial administration of
177
LuLu-DOTATATE into the hepatic artery, in order to improve tumour response without increasing toxicity.
Methods
Twenty-seven patients with grade 1–2 GEP-NET, and bi-lobar liver metastases were randomized to receive intra-arterial PRRT in the left or right liver lobe for four consecutive cycles. The contralateral liver lobe and extrahepatic disease were treated via a “second-pass” effect and the contralateral lobe was used as the control lobe. Up to three metastases (> 3 cm) per liver lobe were identified as target lesions at baseline on contrast-enhanced CT. The primary endpoint was the tumour-to-non-tumour (T/N) uptake ratio on the 24 h post-treatment
177
LuLu-SPECT/CT after the first cycle. This was calculated for each target lesion in both lobes using the mean uptake. T/N ratios in both lobes were compared using paired-samples
t
-test.
Findings
After the first cycle, a non-significant difference in T/N uptake ratio was observed: T/N
IA
= 17·4 vs. T/N
control
= 16·2 (
p
= 0·299). The mean increase in T/N was 17% (1·17; 95% CI 1·00; 1·37). Of all patients, 67% (18/27) showed any increase in T/N ratio after the first cycle.
Conclusion
Intra-arterial
177
LuLu-DOTATATE is safe, but does not lead to a clinically significant increase in tumour uptake.
The success of cellular therapies will depend in part on accurate delivery of cells to target organs. In dendritic cell therapy, in particular, delivery and subsequent migration of cells to regional ...lymph nodes is essential for effective stimulation of the immune system. We show here that in vivo magnetic resonance tracking of magnetically labeled cells is feasible in humans for detecting very low numbers of dendritic cells in conjunction with detailed anatomical information. Autologous dendritic cells were labeled with a clinical superparamagnetic iron oxide formulation or (111)In-oxine and were co-injected intranodally in melanoma patients under ultrasound guidance. In contrast to scintigraphic imaging, magnetic resonance imaging (MRI) allowed assessment of the accuracy of dendritic cell delivery and of inter- and intra-nodal cell migration patterns. MRI cell tracking using iron oxides appears clinically safe and well suited to monitor cellular therapy in humans.
Summary The development of targeted therapies is a major breakthrough in the treatment of cancer. By evoking necrosis and cavitation, evaluation based on tumour size alone, as is done in the RECIST ...criteria, is no longer an adequate method. New molecular and functional imaging techniques are developed. This review focuses on the use of new imaging modalities for the evaluation of treatment response of pathway based targeted therapies. First, the basic principles of functional and molecular imaging modalities are briefly discussed. Thereafter, their clinical application in targeted therapies is correlated to the underlying biological mechanism. In this way, the best method for response evaluation for a new agent can be identified.
Background
Radioactive seed localization (RSL) is an alternative to wire localization for guiding surgical excision of non‐palpable breast cancer. This review provides an overview of the available ...evidence on the accuracy of RSL in patients undergoing breast‐conserving surgery.
Methods
PubMed, Embase and the Cochrane Library were searched systematically in January 2012 for studies that addressed localization of non‐palpable breast cancer using an iodine‐125‐labelled seed. Studies were deemed eligible if they reported on the proportion of patients with tumour‐positive margins after RSL, the proportion of patients needing re‐excision after RSL, and procedural complications.
Results
Six studies reported data on RSL in 1611 patients with non‐palpable breast lesions. Overall complete resection rates ranged from 73 to 96·7 per cent. Three studies included over 300 patients, and complete resection rates in these studies varied between 89·5 and 96·7 per cent. The risk of seed migration and failure of seed placement ranged from 0 to 0·6 per cent and 0 to 7·2 per cent respectively.
Conclusion
Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non‐palpable breast lesions.
Useful method
Radioembolisation is a locoregional treatment modality for hepatic malignancies. It consists of several stages that are vital to its success, which include a pre-treatment angiographic simulation ...followed by nuclear medicine imaging, treatment activity choice, treatment procedure and post-treatment imaging. All these stages have seen much advancement over the past decade. Here we aim to provide an overview of the practice of radioembolisation, discuss the limitations of currently applied methods and explore promising developments.
Intraoperative ultrasound (IOUS) can be used in the operation theatre for localization of non-palpable breast cancers. In this prospective cohort study, we compared the yield of IOUS to guidewire ...localization (GWL). A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999 and 2010. GWL was performed in 138 (54 %) and IOUS in 120 (46 %) patients. Tumor dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm,
P
< 0.001), while microcalcifications were more common in the GWL group (19 vs. 3 %,
P
< 0.001). Even after stratification for tumor diameter, presence of DCIS and findings on mammography, resection volumes were similar in both groups. Tumor-free resection margins were obtained in >93 % of patients (93.5 % with GWL vs. 93.3 % with IOUS,
P
= 0.958) and re-excision was performed in 11 % of patients undergoing GWL and 12.5 % of patients undergoing IOUS (
P
= 0.684). For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumor removal, re-excision rate and excised volume.
Abstract Background In patients undergoing breast conserving surgery for non-palpable breast cancer, obtaining tumour free resection margins is important to prevent reexcision and local recurrence. ...We developed a model to predict positive resection margins in patients undergoing breast conserving surgery for non-palpable invasive breast cancer. Methods A total of 576 patients with non-palpable invasive breast cancer underwent breast conserving surgery in five hospitals in the Netherlands. A prediction model for positive resection margins was developed using multivariate logistic regression. Calibration and discrimination of the model were assessed and the model was internally validated by bootstrapping. Results Positive resection margins were present in 69/576 (12%) patients. Factors independently associated with positive resection margins included mammographic microcalcifications (OR 2.14, 1.22–3.77), tumour size (OR 1.75, 1.20–2.56), presence of DCIS (OR 2.61, 1.41–4.82), Bloom and Richardson grade 2/3 (OR 1.82, 1.05–3.14), and caudal location of the lesion (OR 2.4, 1.35–4.27). The model was well calibrated and moderately able to discriminate between patients with positive versus negative resection margins (AUC 0.70, 95% CI, 0.63–0.77, and 0.69 after internal validation). Conclusion The presented prediction model is moderately able to differentiate between women with high versus low risk of positive margins, and may be useful for surgical planning and preoperative patient counselling.
Highlights • In ICU patients, contrast injection via central venous catheters is a safe alternative to peripheral injection. • Implementing a safety protocol before power injection via central venous ...catheters is advisable. • The quality of scans varies and remains not sufficiently investigated in scans with higher flow rates.
Objectives
To correlate pharmacokinetic parameters of 3-T dynamic contrast-enhanced (DCE-)MRI with histopathologic microvascular and lymphatic parameters in organ-confined prostate cancer.
Methods
In ...18 patients with unilateral peripheral zone (pT2a) tumours who underwent DCE-MRI prior to radical prostatectomy (RP), the following pharmacokinetic parameters were assessed: permeability surface area volume transfer constant (
K
trans
), extravascular extracellular volume (Ve) and rate constant (
K
ep
). In the RP sections blood and lymph vessels were visualised immunohistochemically and automatically examined and analysed. Parameters assessed included microvessel density (MVD), area (MVA) and perimeter (MVP) as well as lymph vessel density (LVD), area (LVA) and perimeter (LVP).
Results
A negative correlation was found between age and
K
trans
and
K
ep
for tumour (
r
= −0.60,
p
= 0.009;
r
= −0.67,
p
= 0.002) and normal (
r
= −0.54,
p
= 0.021;
r
= −0.46,
p
= 0.055) tissue. No correlation existed between absolute values of microvascular parameters from histopathology and DCE-MRI. In contrast, the ratio between tumour and normal tissue (correcting for individual microvascularity variations) significantly correlated between
K
ep
and MVD (
r
= 0.61,
p
= 0.007) and MVP (
r
= 0.54,
p
= 0.022). The lymphovascular parameters showed only a correlation between LVA and
K
ep
(
r
= −0.66,
p
= 0.003).
Conclusions
Significant correlations between DCE-MRI and histopathologic parameters were found when correcting for interpatient variations in microvascularity.
Key Points
•
Normal prostate tissue shows strong heterogeneity in microvascularity.
•
Peripheral zone prostate cancer shows increased and less heterogeneous microvascularity.
•
Normal and tumour tissue shows considerable variation in microvascularity between patients.
•
DCE-MRI should take into account the interprostatic heterogeneity of microvasculature between patients.
Two methods were compared for the detection of small lymph-node metastases in men with prostate cancer: conventional magnetic resonance imaging (MRI) and MRI performed 24 hours after the intravenous ...injection of lymph-node–seeking nanoparticles containing an iron oxide core. The latter method proved superior to conventional MRI in sensitivity and specificity.
Better detection with MRI after injection of iron oxide nanoparticles.
In 2001, about 198,000 new cases of prostate cancer were diagnosed in the United States and 31,500 men died of the disease.
1
The natural history and aggressiveness of the disease vary widely, and the means to identify men with clinically occult lymph-node metastases is greatly needed.
2
–
8
The adverse prognostic implications of lymph-node metastases have been widely established.
9
,
10
Magnetic resonance imaging (MRI) provides images with excellent anatomical detail and soft-tissue contrast but is relatively insensitive for the detection of lymph-node metastases.
11
However, the results of MRI can be improved by using different imaging agents and acquisition techniques.
12
–
14
In . . .
PDF
