RESUMO
PURPOSE: Strategies for the treatment of liver metastases from colon cancer (lmCRC) are constantly evolving. Radioembolization with yttrium 90 (Y-90 TARE) has made significant advancements in treating liver tumors and is now considered a potential option allowing for future resection. This study reviewed the scientific evidence and developed recommendations for using Y-90 TARE as a treatment strategy for patients with unresectable lmCRC. METHODS: A multidisciplinary scientific committee, consisting of experts in medical oncology, hepatobiliary surgery, radiology, and nuclear medicine, all with extensive experience in treating patients with ImCRC with Y-90 TARE, led this project. The committee established the criteria for conducting a comprehensive literature review on Y-90 TARE in the treatment of lmCRC. The data extraction process involved addressing initial preliminary inquiries, which were consolidated into a final set of questions. RESULTS: This review offers recommendations for treating patients with lmCRC using Y-90 TARE, addressing four areas covering ten common questions: 1) General issues (multidisciplinary tumor committee, indications for treatment, contraindications); 2) Previous process (predictive biomarkers for patient selection, preintervention tests, published evidence); 3) Procedure (standard procedure); and 4) Post-intervention follow-up (potential toxicity and its management, parameters for evaluation, quality of life). CONCLUSIONS: Based on the insights of the multidisciplinary committee, this document offers a comprehensive overview of the technical aspects involved in the management of Y-90 TARE. It synthesizes recommendations for applying Y-90 TARE across various phases of the treatment process.
Assuntos
Carcinoma Hepatocelular , Neoplasias Colorretais , Neoplasias Hepáticas , Humanos , Radioisótopos de Ítrio/uso terapêutico , Qualidade de Vida , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/patologia , Neoplasias Colorretais/induzido quimicamente , Carcinoma Hepatocelular/patologiaRESUMO
Objective To evaluate the usefulness of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET) in the follow-up of endometrial cancer patients with suspicion of recurrence due to elevated serum tumour markers and suggestive conventional imaging findings. Material and methods A retrospective review was conducted of 17 FDG-PET studies performed in 11 patients with a previous diagnosis of endometrial cancer (6 patients underwent 2 studies) between April 2002 and October 2005. Mean age of patients was 63.4 yrs (range, 52-69 yrs), and mean time since diagnosis was 56 months (range, 11 months - 12 yrs). Initially, 7 patients were in stage I, 3 in stage III, and 1 in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid and 3 non-endometrioid cancers. Results FDG-PET showed infradiaphragmatic uptake in three patients and disseminated disease in seven; findings were negative in one patient. Computed tomography (CT, n=7) or magnetic resonance (MRI, n=7) images revealed infradiaphragmatic lesions in five patients and visceral lesions in two. All patients showed elevated serum tumour markers (CA125, n=9; CA19.9, n=2; CA15.3, n=2). FDG-PET results modified the information provided by conventional imaging techniques in seven patients and provided no additional information in the remaining four. There was histological confirmation of lesions in two patients. Nine patients were clinically followed up, including imaging studies (mean follow-up, 8.7 months; range, 3-20 months).
Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Adenocarcinoma , Carcinoma Adenoescamoso , Neoplasias do Endométrio , Neoplasias Uterinas , Tomografia Computadorizada de Emissão/métodos , Complicações Pós-Operatórias , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Seguimentos , Biomarcadores Tumorais/análise , Neoplasias do Endométrio/cirurgia , Neoplasias Uterinas/cirurgia , Compostos Radiofarmacêuticos , Recidiva/prevenção & controleRESUMO
PURPOSE: To evaluate the efficacy of FDG-PET in the definition of tumour lung node lesions and to compare the diagnostic validity of CT and FDGPET in the staging of patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT and FDG-PET. PET images were analysed by researchers blinded to results of other imaging modalities. Definitive tumour diagnosis was by histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. Diagnostic accuracy was evaluated by comparing CT/PET results with the definitive diagnosis. RESULTS: In 13% of patients, no FDG-PET findings were observed and the histological study was negative for tumour. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumour. Mediastinal staging by CT and FDG-PET was correct in 56% and 87% of patients, respectively. CT indicated mediastinal invasion in 17% of patients with no FDG-PET finding of mediastinal involvement. Conversely, mediastinal spread was undetected by CT in 14% of patients with FDG-PET findings of mediastinal involvement. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumour disease.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Primary linitis plastica of the rectum is an infrequent and unusual rectal carcinoma. We report a new case that presented clinically as a haemorrhoidal syndrome. We comment on the characteristics--clinical picture and histopathology--of this uncommon presentation of rectal tumour, as well as its clinical history and prognosis taking into account that the literature consulted indicated the unusualness of primary linitis plastica of the rectum.