RESUMEN
The present report describes a case of typical carcinoid tumor with intense fluorodeoxyglucose (FDG) uptake. The most of tumor cells were characterized by eosinophilic cytoplasm resulting from accumulation of mitochondria, which was called an oncocytic carcinoid tumor. Glucose transporter type 1 (GLUT-1) was expressed in a membranous pattern in the oncocytic component. Oncocytic carcinoid tumors could show intense FDG uptake due to the numerous intracellular mitochondria and the membranous overexpression of GLUT-1. Thus, it could be a potential pitfall of interpreting FDG-PET/CT image.
Asunto(s)
Tumor Carcinoide/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Anciano , Transporte Biológico , Tumor Carcinoide/metabolismo , Fluorodesoxiglucosa F18/metabolismo , Humanos , Neoplasias Pulmonares/metabolismo , Masculino , Imagen MultimodalRESUMEN
OBJECTIVE: Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiotherapy (SBRT), is now a standard treatment option for patients with stage I non-small cell lung cancer or oligometastatic lung tumor who are medically inoperable or medically operable but refuse surgery. When mass-like consolidation is observed on follow-up CT after SABR, it is sometimes difficult to differentiate tumor recurrence from SABR-induced pulmonary fibrosis. In this study, we evaluated the role of (18)F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) in differentiating tumor recurrence from radiation fibrosis after SABR. METHODS: Between June 2006 and June 2009, 130 patients received SABR for stage I non-small cell lung cancer or metastatic lung cancer at our institution. Fifty-nine patients of them were imaged with FDG-PET/CT after SABR. There were a total of 137 FDG-PET/CT scans for retrospective analysis. The FDG uptake in the pulmonary region was assessed qualitatively using a 3-point scale (0, none or faint; 1, mild; or 2, moderate to intense), and the shape (mass-like or non mass-like) was evaluated. For semi-quantitative analysis, the maximum standardized uptake value (SUV(max)) was calculated. RESULTS: Sixteen of 59 patients had local failure. In recurrent tumor, the combination of intensity grade 2 and mass-like shape was most common (21/23; 91%). By contrast, in cases of radiation fibrosis, the combination of intensity grade 0 or 1 and non mass-like shape was most common (48/59; 81%). The SUV(max) of tumor recurrence after 12 months was significantly higher than that of radiation fibrosis (8.0 ± 3.2 vs. 2.1 ± 0.9, p < 0.001), and all tumor recurrence showed the SUV(max) > 4.5 at diagnosis of local failure. At ≥12 months after SABR, these two variables, the combination of intensity 2 and mass-like FDG uptake or SUV(max) > 4.5 acquired a significant high predictive value of local recurrence, finding sensitivity 100% and specificity 100% for both of them. CONCLUSIONS: The combination of FDG uptake patterns and SUV(max) was useful for distinguishing tumor recurrence from radiation fibrosis after SABR.
Asunto(s)
Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/radioterapia , Imagen Multimodal , Tomografía de Emisión de Positrones , Fibrosis Pulmonar/diagnóstico por imagen , Traumatismos por Radiación/diagnóstico por imagen , Radiocirugia/efectos adversos , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Transporte Biológico , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18/metabolismo , Humanos , Neoplasias Pulmonares/metabolismo , Masculino , Persona de Mediana Edad , Fibrosis Pulmonar/metabolismo , Traumatismos por Radiación/metabolismo , RecurrenciaRESUMEN
OBJECTIVE: Relationship between pretreatment uptake of (18)F-fluoro-2-deoxy-d-glucose and local control after stereotactic body radiotherapy in stage I non-small-cell lung cancer was examined. METHODS: Between June 2006 and June 2009, 90 clinically diagnosed stage I primary lung cancer in 86 patients were treated with stereotactic body radiotherapy in Shikoku Cancer Center. Among these, 51 tumors in 51 patients were evaluated by positron emission tomography using (18)F-fluoro-2-deoxy-d-glucose before treatment. Twenty-six tumors of histopathologically confirmed non-small-cell lung cancer were reviewed in this study. Tumors were divided into two groups by the threshold maximum standardized uptake value of 5.0 (high-uptake tumors, 9; low-uptake tumors, 17). One tumor with low uptake was pure ground-glass opacity. Typically, 48 Gy in four fractions was given at the isocenter. RESULTS: Follow-up time was 4-44 months (median, 21 months). Local failure-free rates at 15 months of the high-uptake group and the low-uptake group were 40% and 93% for all tumors (P= 0.0001), 0% and 91% for tumors 3 cm or less (P= 0.0004), 50% and 100% for tumors larger than 3 cm, and 40% and 89% for the mainly solid tumors (P= 0.0010). There were no statistically significant differences of local failure-free rates according to age, sex and tumor size (P= 0.4804, P= 0.4170 and P= 0.3638, respectively). CONCLUSIONS: High uptake of (18)F-fluoro-2-deoxy-d-glucose in a primary tumor was the significant unfavorable factor for local control after stereotactic body radiotherapy in stage I non-small-cell lung cancer.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Fluorodesoxiglucosa F18/metabolismo , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/radioterapia , Tomografía de Emisión de Positrones , Radiocirugia , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones/métodos , Radiofármacos/metabolismo , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
A solitary fibrous tumor (SFT) originating in the pancreas is rare. We report a 55-year-old woman with an asymptomatic pancreatic mass incidentally discovered on abdominal ultrasonography. Contrast-enhanced computed tomography (CT) showed a well-demarcated exophytic mass in the pancreatic head with prolonged and delayed enhancement. The mass showed hypointensity on T1-weighted images and heterogeneous hypointensity with spotty hyperintensity foci on T2-weighted images. Fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT showed no significant FDG uptake. The resected mass was composed of spindle cells that were positive for CD34; and hemangiopericytomatous vessels were focally detected. The mass was finally diagnosed as an SFT of the pancreas.
Asunto(s)
Neoplasias Pancreáticas/diagnóstico , Tumores Fibrosos Solitarios/diagnóstico , Medios de Contraste , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Intensificación de Imagen Radiográfica/métodos , Radiofármacos , Tomografía Computarizada por Rayos X/métodos , UltrasonografíaRESUMEN
OBJECTIVE: The optimal dose of stereotactic body radiotherapy (SBRT) for metastatic lung tumors has not been clarified. Local control rates of metastatic lung tumors treated with SBRT of 48 Gy in four fractions, which is one of the common dose schedules for Stage I primary lung cancer in Japan, were examined. METHODS: Between 2006 and 2008, 12 metastatic lung tumors (colorectal cancer, 7; others, 5) in 10 patients and 56 lesions of Stage I primary lung cancer (T1, 43; T2, 13) in 52 patients were treated with SBRT of 48 Gy in four fractions at the isocenter. RESULTS: Two-year overall survival rates were 86% for patients with metastatic lung tumors and 96% for patients with Stage I primary lung cancer (P = 0.4773). One- and 2-year local control rates were 48% and 25% for metastatic lung tumors, and 91% and 88% for Stage I primary lung cancer, respectively (P < 0.0001). CONCLUSIONS: The local control rates after SBRT of 48 Gy in four fractions were significantly worse in metastatic lung tumors compared with Stage I primary lung cancer. In SBRT, metastatic lung tumors should be clearly differentiated from primary lung cancer and should be given higher doses.
Asunto(s)
Neoplasias Colorrectales/radioterapia , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Recurrencia Local de Neoplasia/radioterapia , Radiocirugia , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Japón , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Radiocirugia/efectos adversos , Dosificación Radioterapéutica , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: The incidence of supraclavicular metastasis as the initial failure and the failure patterns in patients with four or more positive axillary lymph nodes (PALNs) after breast-conserving therapy (BCT) without prophylactic supraclavicular irradiation were investigated. MATERIALS AND METHODS: Between 1991 and 2002, a total of 48 women with four or more PALNs underwent BCT without prophylactic supraclavicular irradiation (33 patients with 4-9 PALNs; 15 patients with > or =10 PALNs). RESULTS: The median follow-up time was 50 months. Among the patients with 4-9 PALNs, 3% had isolated supraclavicular metastasis as the initial failure, and 30% had distant metastasis as the initial failure. Among patients with > or =10 PALNs, 7% had isolated supraclavicular metastasis as the initial failure, and 40% had distant metastasis as the initial failure. The 4-year isolated supraclavicular failure rates were 5% for all patients, 3% for patients with 4-9 PALNs, and 8% for patients with >/=10 PALNs. CONCLUSION: In patients who had undergone BCT and had had four or more PALNs, the major failure pattern was distant failure with or without locoregional failure; isolated supraclavicular failure as the initial failure comprised a less common failure pattern. Omission of prophylactic supraclavicular irradiation may be acceptable for this subset of patients.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Adulto , Anciano , Axila , Neoplasias de la Mama/radioterapia , Clavícula , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Mastectomía Segmentaria , Persona de Mediana Edad , Metástasis de la Neoplasia , Factores de Riesgo , Análisis de Supervivencia , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: To find vertebral metastases with high risk of symptomatic malignant spinal cord compression (MSCC), features of vertebral metastases caused motor deficits of the lower extremities were examined. METHODS: From 2004 through 2006, 78 patients with metastases of the thoracic and/or the cervical spine were treated with radiation therapy (RT). Of these, 86 irradiated lesions in 73 patients were evaluable by magnetic resonance imaging and/or computed tomography at the initiation of RT and were reviewed retrospectively in this study. Twenty-eight patients (38%) had motor deficits at the initiation of RT. Assessed factors were age, sex, primary disease (lung, breast, digestive system and other cancer), lamina involvement, main level of tumor location and vertebral-body involvement. RESULTS: Incidence of motor deficits at the initiation of RT was 55% for lesions with lamina involvement and 5% for lesions without lamina involvement (P < 0.0001). Incidence of motor deficits was 15% for lesions located mainly in the cervical spine and/or the upper thoracic spine (Th1-4), 54% for lesions located mainly in the middle thoracic spine (MTS) (Th5-8) and 30% for lesions located mainly in the lower thoracic spine (Th9-12) (P = 0.0095). Age, sex, primary disease and vertebral-body involvement were not statistically significant factors for incidence of motor deficits due to MSCC (P > 0.9999, P = 0.7798, P = 0.1702 and P = 0.366, respectively). CONCLUSIONS: Vertebral metastases with lamina involvement tended to cause symptomatic MSCC. Latent development of MSCC occurred more frequently in the MTS compared with other levels of the thoracic and the cervical spine.
Asunto(s)
Vértebras Cervicales/patología , Compresión de la Médula Espinal/etiología , Neoplasias de la Columna Vertebral/secundario , Vértebras Torácicas/patología , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/radioterapia , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: The incidence and patterns of isolated brain failure was examined in patients with stage III non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiation (CCRT). MATERIALS AND METHODS: Between 1996 and 2003, a total of 68 patients with stage III NSCLC were treated with radical CCRT. Among them, 63 patients were evaluable. Radiation therapy with a mean total dose of 61.4 Gy and chemotherapy (typically platinum-based) were administered concurrently. RESULTS: Other than locoregional failure, isolated brain failure was the most common failure pattern as the initial failure, occurring 2-37 months (median 6.5 months) after radical CCRT. The isolated brain failure rates as the initial failure at 1, 3, and 4 years were 9%, 13%, and 25%, respectively. Isolated brain failure as the initial failure occurred more frequently in T4 cases (39% at 4 years) compared to T1-3 cases (14% at 4 years) in our series (P = 0.0099). CONCLUSION: Except for locoregional failure, isolated brain failure was the most common initial failure pattern of stage III NSCLCs treated with radical CCRT. Isolated brain failure as the initial failure occurred even after 3 years. Isolated brain failure as the initial failure occurred more frequently in T4 cases than in T1-3 cases.
Asunto(s)
Encefalopatías/fisiopatología , Encéfalo/fisiopatología , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Encefalopatías/etiología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Terapia Combinada/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/fisiopatología , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
PURPOSE: In stereotactic conformal radiotherapy of the CyberKnife, multiple narrow beams from a cylindrical collimator are delivered to a planning target volume (PTV) without an isocenter by inverse planning. The influence of collimator size on stereotactic conformal radiotherapy was examined. MATERIALS AND METHODS: Five targets including two spherical targets (2.1 ml, 16.4 ml), an ellipsoidal target (2.9 ml), and two irregularly shaped targets (1.6 ml, 6.6 ml) were evaluated. Conformity and homogeneity of dose distribution, doses covering 95% volume of PTVs (D95), dose volume histograms (DVHs), and patterns of dose distribution were investigated in relation to collimator size for each target. We evaluated conformity and homogeneity using VD95/PTV (VD95 = volume covered by a D95 isodose surface) and Dmax/Dmin (Dmax, Dmin = maximum and minimum dose within the PTV, respectively), respectively. RESULTS: Conformity and homogeneity were not significantly influenced by collimator size. By using a considerably smaller collimator compared with the minor axis of the target the central dose of the target fell by less than 10% and D95 often decreased slightly. CONCLUSION: In stereotactic conformal radiotherapy of the CyberKnife, a smaller collimator tended to reduce the central dose and D95. These characteristics of the CyberKnife system should be considered.