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Sample records for diffuse lung metastases

  1. Unusual presentation of perirenal lung metastases

    International Nuclear Information System (INIS)

    D'Souza, D.L.; Heinze, S.B.; Dowling, R.J.

    2006-01-01

    Lung cancer is not commonly known to metastasise to the perirenal space, with only five such cases previously published. We present an unusual case of perirenal lung metastases manifesting as diffuse perinephric stranding which to our knowledge has not been described before Copyright (2006) Blackwell Publishing Asia Pty Ltd

  2. Spine Metastases in Lung Cancer

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    O.Yu. Stolyarova

    2015-10-01

    Full Text Available The purpose and the objectives of the study were to determine the incidence of metastatic lesions to various parts of the spine, the assessment of the association with other clinical signs of lung cancer (localization, form, histology, degree of differentiation, staging, nature of extraosseous metastasis, to investigate the effect of these parameters on the survi­val of the patients. Material and methods. The study included 1071 patients with lung cancer aged 24 to 86 years. None of the examined patients has been operated previously for lung cancer, and after arriving at a diagnosis, all patients received radiation therapy, 73 % of them — combined radiochemothe­rapy. Results. Metastasis in the vertebral bodies and vertebral joints occurs in 13 % of patients with lung cancer and in 61 % of patients with bone form of the disease, the ratio of the defeat of thoracic, sacral, lumbar and cervical spine was 6 : 4 : 2 : 1. The development of metastases in the spine is mostly associa­ted with the localization of the tumor in the upper lobe of the lung, the peripheral form of the disease, with non-small cell histologic variants (adenocarcinoma and squamous cell carcinoma. The number of metastases in the spinal column directly correlates with the degree of metastatic involvement of the inguinal lymph nodes, abdominal wall and the liver, has an impact on the invasion of lung tumor into the esophagus and the trachea. The life expectancy of the deceased persons with spine metastases is less than that of other patients with the lung cancer, but the overall survival rate in these groups of patients is not very different. Conclusions. Clinical features of lung cancer with metastases in the spine necessitate the development of medical technology of rational radiochemotherapy in such patients.

  3. Feasibility study on the utilization of boron neutron capture therapy (BNCT) in a rat model of diffuse lung metastases

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    Bakeine, G.J. [Department of Clinical Medicine and Neurology, Cattinara Hospital, University of Trieste (Italy)], E-mail: jamesbakeine1@yahoo.com; Di Salvo, M. [Department of Nuclear and Theoretical Physics, University of Pavia, Via Bassi 6, Pavia (Italy); Bortolussi, S.; Stella, S. [Department of Nuclear and Theoretical Physics, University of Pavia, Via Bassi 6, Pavia (Italy); National Institute of Nuclear Physics (INFN) Section of Pavia, Via Bassi 6, Pavia (Italy); Bruschi, P. [Department of Nuclear and Theoretical Physics, University of Pavia, Via Bassi 6, Pavia (Italy); Bertolotti, A.; Nano, R. [Department of Animal Biology University of Pavia, Piazza Botta, Pavia (Italy); Clerici, A.; Ferrari, C.; Zonta, C. [Department of Surgery University of Pavia, Piazza Botta, Pavia (Italy); Marchetti, A. [Scientific Research Office, Fondazione San Matteo University Policlinic, Pavia (Italy); Altieri, S. [Department of Nuclear and Theoretical Physics, University of Pavia, Via Bassi 6, Pavia (Italy); National Institute of Nuclear Physics (INFN) Section of Pavia, Via Bassi 6, Pavia (Italy)

    2009-07-15

    In order for boron neutron capture therapy (BNCT) to be eligible for application in lung tumour disease, three fundamental criteria must be fulfilled: there must be selective uptake of boron in the tumour cells with respect to surrounding healthy tissue, biological effectiveness of the radiation therapy and minimal damage or collateral effects of the irradiation on the surrounding tissues. In this study, we evaluated the biological effectiveness of BNCT by in vitro irradiation of rat colon-carcinoma cells previously incubated in boron-enriched medium. One part of these cells was re-cultured in vitro while the other was inoculated via the inferior vena cava to induce pulmonary metastases in a rat model. We observed a post-irradiation in vitro cell viability of 0.05% after 8 days of cell culture. At 4 months follow-up, all animal subjects in the treatment group that received irradiated boron-containing cells were alive. No animal survived beyond 1 month in the control group that received non-treated cells (p<0.001 Kaplan-Meier). These preliminary findings strongly suggest that BNCT has a significant lethal effect on tumour cells and post irradiation surviving cells lose their malignant capabilities in vivo. This radio-therapeutic potential warrants the investigation of in vivo BNCT for lung tumour metastases.

  4. Feasibility study on the utilization of boron neutron capture therapy (BNCT) in a rat model of diffuse lung metastases

    International Nuclear Information System (INIS)

    Bakeine, G.J.; Di Salvo, M.; Bortolussi, S.; Stella, S.; Bruschi, P.; Bertolotti, A.; Nano, R.; Clerici, A.; Ferrari, C.; Zonta, C.; Marchetti, A.; Altieri, S.

    2009-01-01

    In order for boron neutron capture therapy (BNCT) to be eligible for application in lung tumour disease, three fundamental criteria must be fulfilled: there must be selective uptake of boron in the tumour cells with respect to surrounding healthy tissue, biological effectiveness of the radiation therapy and minimal damage or collateral effects of the irradiation on the surrounding tissues. In this study, we evaluated the biological effectiveness of BNCT by in vitro irradiation of rat colon-carcinoma cells previously incubated in boron-enriched medium. One part of these cells was re-cultured in vitro while the other was inoculated via the inferior vena cava to induce pulmonary metastases in a rat model. We observed a post-irradiation in vitro cell viability of 0.05% after 8 days of cell culture. At 4 months follow-up, all animal subjects in the treatment group that received irradiated boron-containing cells were alive. No animal survived beyond 1 month in the control group that received non-treated cells (p<0.001 Kaplan-Meier). These preliminary findings strongly suggest that BNCT has a significant lethal effect on tumour cells and post irradiation surviving cells lose their malignant capabilities in vivo. This radio-therapeutic potential warrants the investigation of in vivo BNCT for lung tumour metastases.

  5. Brain abscess mimicking lung cancer metastases; a case report.

    Science.gov (United States)

    Asano, Michiko; Fujimoto, Nobukazu; Fuchimoto, Yasuko; Ono, Katsuichiro; Ozaki, Shinji; Kimura, Fumiaki; Kishimoto, Takumi

    2013-01-01

    A 76-year-old woman came to us because of staggering, fever, dysarthria, and appetite loss. Magnetic resonance imaging (MRI) of the brain revealed multiple masses with surrounding edema. Chest X-ray and computed tomography demonstrated a mass-like lesion in the left lung and left pleural effusion. Lung cancer and multiple brain metastases were suspected. However, the brain lesions demonstrated a high intensity through diffusion-weighted MRI. The finding was an important key to differentiate brain abscesses from lung cancer metastases. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Prostatic carcinosarcoma with lung metastases.

    Science.gov (United States)

    Furlan, Stefanie R; Kang, David J; Armas, Armando

    2013-01-01

    Carcinosarcoma of the prostate is an uncommon malignancy with poor long-term prognosis. The cancer is typically discovered at an advanced stage, and with less than 100 reported cases, there is limited literature concerning treatment options. Our patient presented with a history of benign prostatic hypertrophy, erectile dysfunction, and nocturia. Biopsy of his prostate indicated that the patient had prostatic adenocarcinoma, but histopathology after prostatectomy revealed carcinosarcoma. It has been over six years since this patient's diagnosis of carcinosarcoma. Over this span of time, he has received a radical prostatectomy, radiotherapy, and androgen ablative therapy. The patient also developed multiple lung metastases that have been treated with video-assisted thoracic surgery and stereotactic body radiosurgery. Overall, he has remained unimpaired and in good condition despite his aggressive form of cancer.

  7. Treatment strategies for lung cancer brain metastases

    International Nuclear Information System (INIS)

    Nakade, Masaharu; Kohno, Keijirou; Watanabe, Hiroyoshi

    1997-01-01

    Forty-one patients suffered initial relapses with brain metastasis after surgery for non-small lung cancer at our hospital between 1978 and 1995. These patients were a total of 8.4% of all cases of surgical removal, and had an average relapse period of 8.6 months ± 8.0 months after surgery on the primary lesions. Of these, surgical removal of metastasized lesions was performed on 18 patients (43%), in which the 5-year post-operative survival rate was 35.7%, and the median survival time was good at 28 months. It was found that the survival period was significantly extended in the group whose relapse period was less than one year after surgery on the primary lesions, and in the group who received cranial irradiation post-operatively on the metastasized brain lesion. Following surgery on the metastasized lesion, second relapses occurred in nine patients, and six patients suffered from second relapses in the brain, of which four did not receive cranial irradiation post-operatively. Cases of radiotherapy in patients of 70 years of age or more frequently manifested post-radiotherapy subacute neuropathy. From the above, it is thought that the following procedures should be adopted: Periodic examination for brain metastasis during the 24 months following surgery for non-small cell lung carcinoma for purposes of early detection; in cases where brain metastasis is detected, if no metastasis is identified in other organs, a policy of surgical removal should be adopted where possible; and, in cases of 70 years of age or less following surgery on the metastasized lesion, cranial irradiation should be considered. (author)

  8. Boron absorption imaging in rat lung colon adenocarcinoma metastases

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    Altieri, S [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Bortolussi, S [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Bruschi, P [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Fossati, F [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Vittor, K [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Nano, R [Dipartimento di Biologia Animale Universita degli Studi di Pavia (Italy); Facoetti, A [Dipartimento di Biologia Animale Universita degli Studi di Pavia (Italy); Chiari, P [Dipartimento di Fisica Nucleare e Teorica Universita degli Studi di Pavia (Italy); Bakeine, J [Dipartimento di Scienze Biomediche e Biotecnologie Universita degli Studi di Brescia (Italy); Clerici, A [Dipartimento di Chirurgia Universita degli Studi di Pavia (Italy); Ferrari, C [Dipartimento di Chirurgia Universita degli Studi di Pavia (Italy); Salvucci, O [Dipartimento di Scienze Biomediche e Biotecnologie Universita degli Studi di Brescia (Italy)

    2006-05-15

    Given the encouraging results from our previous work on the clinical application of BNCT on non-resectable, chemotherapy resistant liver metastases, we explore the possibility to extend our technique to lung metastases. A fundamental requirement for BNCT is achieving higher {sup 10}B concentrations in the metastases compared to those in healthy tissue. For this reason we developed a rat model with lung metastases in order to study the temporal distribution of {sup 10}B concentration in tissues and tumoral cells. Rats with induced lung metastases from colon adenocarcinoma were sacrificed two hours after intraperitoneal Boronphenylalanine infusion. The lungs were harvested, frozen in liquid nitrogen and subsequently histological sections underwent neutron autoradiography in the nuclear reactor Triga Mark II, University of Pavia. Our findings demonstrate higher Boron uptake in tumoral nodules compared to healthy lung parenchyma 2 hours after Boronphenylalanine infusion.

  9. CT findings of small bowel metastases from primary lung cancer

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    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  10. CT findings of small bowel metastases from primary lung cancer

    International Nuclear Information System (INIS)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu

    2002-01-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  11. Hemorrhagic brain metastases with high signal intensity on diffusion-weighted MR images. A case report

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    Mori, H.; Abe, O.; Aoki, S.; Masumoto, T.; Yoshikawa, T.; Kunimatsu, A; Hayashi, N.; Ohtomo, K. [Graduate School of Medicine, Univ. of Tokyo (Japan). Dept. of Radiology

    2002-11-01

    Diffusion-weighted MR imaging has been applicable to the differential diagnosis of abscesses and necrotic or cystic brain tumors. However, restricted water diffusion is not necessarily specific for brain abscess. We describe ring-enhancing metastases of lung carcinoma characterized by high signal intensity on diffusion-weighted MR images. The signal pattern probably reflected intralesional hemorrhage. The present report adds to the growing literature regarding the differential diagnosis of ring-enhancing brain lesions.

  12. Skin metastases from lung cancer: a case report.

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    Pajaziti, Laura; Hapçiu, Syzana Rexhepi; Dobruna, Shkendije; Hoxha, Naim; Kurshumliu, Fisnik; Pajaziti, Artina

    2015-04-11

    Lung cancer is one of the most frequent malignancies, with high mortality rates. It can metastasize in almost all organs, but more often invades hilar nodes, liver, adrenal glands, bones and brain. There are various data on the incidence of lung cancer metastases in the skin. In 1-12% of patients with lung cancer are developed skin metastases. Metastases in the skin may be the first sign of lung cancer. Forty-five years old Albanian male, smoker, was admitted to our department with multiple nodules localized in the skin of the head, neck, back and chest. The nodules measuring 5-15 millimeters in greatest dimension were round and skin-colored, with telangiectasias, firm and tender. They appeared in an eruptive form about two weeks before being admitted at our hospital. In addition, the patient exhibited signs of weight loss, anorexia and fatigue. Excisional biopsy was performed to one of the lesions. Histopathology confirmed metastatic nature of the lesion namely, malignant tumor of neuroendocrine phenotype consistent with small-cell carcinoma. Chest X-ray and computed tomography revealed an expansive process in the 7(th) segment of the left lung, left hilar and mediastinal lymphadenopathy and a suspicious initial secondary deposit in the left adrenal gland. The patient was referred to the department of oncology for further treatment. After the third cycle of chemotherapy, the magnetic resonance imaging revealed brain metastases. The patient passed away four months after the diagnosis of lung cancer first presented with skin metastases. Metastases in skin may be the first sign of lung cancer. Although rare appearing, we should raise suspicion in cases of atypical lesions in the skin not only of the smokers, but also of the non-smokers. Skin metastases from small-cell lung carcinoma are a poor prognostic indicator. The appearance of multiple skin metastases with other internal metastases shorten the survival time.

  13. Diffuse infiltrative lung disease

    International Nuclear Information System (INIS)

    Niden, A.H.; Mishkin, F.S.

    1984-01-01

    The authors discuss their approach to the diagnosis and management of patients with DILD. Gallium scans play a central role in this process. Not only do they help them decide whom to biopsy, but also where to biopsy. The scans can be used for the early detection of disease in a high-risk population, for following the progression and regression of disease, for the regulation of medication, and for the evaluation of therapy. Bronchoalveolar lung lavage appears to be equally sensitive. However, patients are less willing to undergo repeated fiberoptic bronchoscopies than lung scans. Both tests may prove useful, one complementing the other. Gallium imaging has also been utilized by the authors in select patients with questionable diffuse lung infiltrates roentgenographically or with a normal chest roentgenogram, chronic respiratory symptoms, and abnormal pulmonary function studies. An abnormal gallium lung scan in these clinical situations helps them select which patients have a diffuse active pulmonary process meriting transbronchial biopsies. This has proven to be of particular value in the management of older patients

  14. Correlation of the apparent diffusion coefficient (ADC with the standardized uptake value (SUV in lymph node metastases of non-small cell lung cancer (NSCLC patients using hybrid 18F-FDG PET/MRI.

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    Benedikt Michael Schaarschmidt

    Full Text Available To compare the apparent diffusion coefficient (ADC in lymph node metastases of non-small cell lung cancer (NSCLC patients with standardized uptake values (SUV derived from combined 18F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI.38 patients with histopathologically proven NSCLC (mean age 60.1 ± 9.5 y received whole-body PET/CT (Siemens mCT™ 60 min after injection of a mean dose of 280 ± 50 MBq 18F-FDG and subsequent PET/MRI (mean time after tracer injection: 139 ± 26 min, Siemens Biograph mMR. During PET acquisition, simultaneous diffusion-weighted imaging (DWI, b values: 0, 500, 1000 s/mm² was performed. A maximum of 10 lymph nodes per patient suspicious for malignancy were analyzed. Regions of interest (ROI were drawn covering the entire lymph node on the attenuation-corrected PET-image and the monoexponential ADC-map. According to histopathology or radiological follow-up, lymph nodes were classified as benign or malignant. Pearson's correlation coefficients were calculated for all lymph node metastases correlating SUVmax and SUVmean with ADCmean.A total of 146 suspicious lymph nodes were found in 25 patients. One hundred lymph nodes were eligible for final analysis. Ninety-one lymph nodes were classified as malignant and 9 as benign according to the reference standard. In malignant lesions, mean SUVmax was 9.1 ± 3.8 and mean SUVmean was 6.0 ± 2.5 while mean ADCmean was 877.0 ± 128.6 x10(-5 mm²/s in PET/MRI. For all malignant lymph nodes, a weak, inverse correlation between SUVmax and ADCmean as well as SUVmean and ADCmean (r = -0.30, p<0.05 and r = -0.36, p<0.05 existed.The present data show a weak inverse correlation between increased glucose-metabolism and cellularity in lymph node metastases of NSCLC patients. 18F-FDG-PET and DWI thus may offer complementary information for the evaluation of treatment response in lymph node metastases of NSCLC.

  15. Choroidal Metastases as the Initial Presentation of Lung Cancer: A ...

    African Journals Online (AJOL)

    We report the case of a 49-year-old female patient who presented with ... nonsmall cell carcinoma of the right lung, which had multiple distant metastases. KEYWORDS: ... metastasis in lung cancer is very low, reported to be ... Kolkata, West Bengal, India. E-mail: .... awareness regarding this rare presentation of lung cancer.

  16. of lung metastases carcinoma of the cervix Surgical excision from ...

    African Journals Online (AJOL)

    of lung metastases carcinoma of the cervix. Surgical excision from squamous. A report of 2 cases. N. G. DE MOOR, A. V. BERRY, M. M. NISSENBAUM. These2casereportsservetoemphasizetwoimpor- tant points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; ...

  17. Diffuse parenchymal lung disease

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    Sara Tomassetti

    2017-04-01

    Full Text Available Between September 2015 and August 2016 there were >1500 publications in the field of diffuse parenchymal lung diseases (DPLDs. For the Clinical Year in Review session at the European Respiratory Society Congress that was held in London, UK, in September 2016, we selected only five articles. This selection, made from the enormous number of published papers, does not include all the relevant studies that will significantly impact our knowledge in the field of DPLDs in the near future. This review article provides our personal view on the following topics: early diagnosis of idiopathic pulmonary fibrosis, current knowledge on the multidisciplinary team diagnosis of DPLDs and the diagnostic role of transbronchial cryobiopsy in this diagnostic setting, insights on the new entity of interstitial pneumonia with autoimmune features, and new therapeutic approaches for scleroderma-related interstitial lung disease.

  18. Results of radiotherapy for brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Tatsuno, Ikuro; Tada, Akira; Takanaka, Tsuyoshi; Choto, Shuichi; Watanabe, Kihichiro

    1987-01-01

    Ten patients with brain metastases from lung cancer treated by irradiation between 1982 and 1985 were reviewed. Neurologic improvement by irradiation was obtained in all patients. The median duration of neurologic function control by irradiation and the median survival from the diagnosis of brain metastases were 9 months and 11 months, respectively. General performance status, neurologic function class and the presence or absence of other sites of metastases were important prognostic factors for survival. More than 50 Gy brain irradiation except small cell carcinoma was thought to be necessary to control the brain metastases. CT examinations were useful but limited to evaluate the effectiveness of irradiation. (author)

  19. Results of radiotherapy for brain metastases from lung cancer

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    Tatsuno, Ikuro; Tada, Akira; Takanaka, Tsuyoshi; Choto, Shuichi; Watanabe, Kihichiro

    1987-02-01

    Ten patients with brain metastases from lung cancer treated by irradiation between 1982 and 1985 were reviewed. Neurologic improvement by irradiation was obtained in all patients. The median duration of neurologic function control by irradiation and the median survival from the diagnosis of brain metastases were 9 months and 11 months, respectively. General performance status, neurologic function class and the presence or absence of other sites of metastases were important prognostic factors for survival. More than 50 Gy brain irradiation except small cell carcinoma was thought to be necessary to control the brain metastases. CT examinations were useful but limited to evaluate the effectiveness of irradiation.

  20. Lung cancer revealed by multiple metastases of the scalp | Fetohi ...

    African Journals Online (AJOL)

    Skin metastases of lung cancer are rare. They are symptoms of progressive disease and usually a sign of a poor prognosis. We report a case of 69-years-old man with no significant medical history, never smoker, which consulted a dermatologist for scalp nodules that appeared for more than 16 months in the scalp and ...

  1. Surgical excision of lung metastases from squamous carcinoma of ...

    African Journals Online (AJOL)

    These 2 case reports serveto emphasizetwo important points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; and (ii). in selected cases surgical excision of a secondary deposit in the lung is the treatment of choice and may even result -in cure.

  2. Diffuse cavitary lung lesions

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    Grunzke, Mindy; Garrington, Timothy [University of Colorado Denver, Department of Pediatrics, Aurora, CO (United States); The Children' s Hospital, Rick Wilson Center for Cancer and Blood Disorders, Aurora, CO (United States); Hayes, Kari [The Children' s Hospital, Pediatric Radiology, Aurora, CO (United States); Bourland, Wendy [Children' s Hospital at St. Francis, Warren Clinic, Inc., Tulsa, OK (United States)

    2010-02-15

    An 11-year-old girl presented with a 2-month history of progressively worsening cough, daily fevers, and weight loss. A chest radiograph revealed multiple cystic cavitary lung lesions. An extensive infectious work-up was negative. Chest CT verified multiple cavitary lung lesions bilaterally, and [F-18]2-fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) positron emission tomography with CT (PET/CT) showed increased uptake in the lung lesions as well as regional lymph nodes. Subsequent biopsy of an involved lymph node confirmed classical Hodgkin lymphoma, nodular sclerosis type. This case represents an unusual presentation for a child with Hodgkin lymphoma and demonstrates a role for {sup 18}F-FDG PET/CT in evaluating a child with cavitary lung lesions. (orig.)

  3. Diffuse cavitary lung lesions

    International Nuclear Information System (INIS)

    Grunzke, Mindy; Garrington, Timothy; Hayes, Kari; Bourland, Wendy

    2010-01-01

    An 11-year-old girl presented with a 2-month history of progressively worsening cough, daily fevers, and weight loss. A chest radiograph revealed multiple cystic cavitary lung lesions. An extensive infectious work-up was negative. Chest CT verified multiple cavitary lung lesions bilaterally, and [F-18]2-fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography with CT (PET/CT) showed increased uptake in the lung lesions as well as regional lymph nodes. Subsequent biopsy of an involved lymph node confirmed classical Hodgkin lymphoma, nodular sclerosis type. This case represents an unusual presentation for a child with Hodgkin lymphoma and demonstrates a role for 18 F-FDG PET/CT in evaluating a child with cavitary lung lesions. (orig.)

  4. [Lung metastases: tumor reduction as an oncologic concept].

    Science.gov (United States)

    Dienemann, H; Hoffmann, H; Trainer, C; Muley, T

    1998-01-01

    The principle of surgery for lung metastases is the removal of all lesions in the lung that are either visible or detectable by palpation. This may be combined with complete dissection of all ipsilateral lymph nodes. Therefore, "tumor reduction" rather than "complete" or "radical resection" may be an adequate description of this surgical approach. Since the dissemination of--macroscopically not detectable--tumor cells represents the major mannerism of every metastatic disease, any local therapy appears to be a discrepancy. However, in most cases the rationale of surgery for lung metastases is the lack of effective systemic therapy and the low morbidity of surgery, along with up to 60% 5-year survival rates.

  5. Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix

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    Renata Raś

    2016-07-01

    Full Text Available Benign metastasizing leiomyoma (BML usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1 uterus with multiple leiomyomas, 2 four tumors in the parametria, 3 tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%. Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations.

  6. Lung cancer brain metastases – the role of neurosurgery

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    V. A. Aleshin

    2016-01-01

    Full Text Available Lung cancer is mostly common occurring oncological disease in the developed countries. Currently lung cancers are subdivided into nonsmall-cell (adenocarcinoma, large-cell, squamous cell and small-cell. The difference in the clinical and morphological picture leads to the necessity of choosing therapeutic approaches to patients of various groups.Lung cancer should be referred to encephalotropic diseases since metastatic lesion of the central nervous system is sufficiently common complication. Successes of complex treatment of primary tumor result in increase of total longlivety currently ther is ageing of patients suffering lung cancer. These factors increase the risk of metastatic lesions of the brain.Interest to the problem of neurosurgical treatment of patients suffering lung cancer is determined by frequency of lesion, varicosity of morphological variants of the disease, requiring various algorithms of treatment and diagnosis.The main role of neurosurgical intervention in cerebral metastases of lung cancer consist in creation of the paled of carrying out combined therapy. Ideally, a neurosurgical operation should be carried out with clearcut observance of oncological principles of ablasty.Adequate comprehensive approach to treatment or patients with cerebral metastases of various forms of lung cancer with the developed of optimal tactics of and stages of treatment would make it possible to increase duration and quality of life of patients.

  7. Treatment of brain metastases from primary lung cancer

    International Nuclear Information System (INIS)

    Ryan, Gail F.; Ball, David L.; Smith, Jennifer G.

    1995-01-01

    Purpose: A retrospective study of patients treated at the Peter MacCallum Cancer Institute for brain metastases from primary carcinoma of the lung is presented. Methods and Materials: The medical records of 416 patients with the diagnosis of primary carcinoma of the lung who presented with, or subsequently developed, brain metastases during the period January 1984 to December 1987 were reviewed. Information on a number of factors of potential prognostic significance (sex, age, histology, performance status and interval between diagnosis of the primary and brain metastases) was collected. Details of surgery, radiation and steroid usage were recorded, and any steroid side effects documented. Survival was calculated from the date of diagnosis of brain metastases. Stepwise regression based on Cox's proportional hazards model was used to determine significant prognostic factors affecting survival. Patients with and without steroid side effects were compared using Yate's corrected chi-square test. Results: The overall estimated median survival was only 3.3 months (95% confidence interval 2.9-3.7 months). Only two factors were found to be associated with a significantly improved survival--surgical intervention and good performance status. After taking these two factors into account, the dose of radiation used (< 30 Gy or ≥ 30 Gy) did not influence survival. There was a 3% incidence of gastric bleeding or perforation in patients taking steroids, with a 40% fatality rate. Predisposing factors to gastric side effects were a prior history of peptic ulcer and/or aspirin or nonsteroidal anti-inflammatory drug consumption. Conclusion: Radiation of brain metastases from primary lung cancer results in modest survival benefit. Radiation dose (< 30 Gy or ≥ 30 Gy) is not a significant determinant of survival. Other treatment modifications, such as concurrent radiation and chemotherapy, should be explored. Steroids should be used with caution as fatal side effects can occur

  8. Computed tomography in evaluation of regional metastases of lung cancer

    International Nuclear Information System (INIS)

    Frolova, I.G.; Velichko, S.A.; Zyryanov, B.N.

    1999-01-01

    The rate of metastatic spread of different groups of intrathoracic lymph nodes has been studied in depending on localization of the tumor by the nodes using CT method. CT-semiotic of metastatic lymph nodes was studied. The indices of the efficiency of diagnostic imaging when using CT were analyzed as well. The analysis of data obtained has shown that CT has great possibilities in evaluation of regional metastases of lung cancer

  9. Outcome after Radiofrequency Ablation of Sarcoma Lung Metastases

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    Koelblinger, Claus, E-mail: claus.koelblinger@bhs.at [KH Barmherzige Schwestern Ried, Department of Radiology (Austria); Strauss, Sandra, E-mail: s.strauss@ucl.ac.uk [UCL and UCLH, Department of Medical Oncology (United Kingdom); Gillams, Alice, E-mail: alliesorting@gmail.com [The London Clinic, Department of Radiology (United Kingdom)

    2013-05-14

    PurposeResection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA).MethodsThis is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded.ResultsTwenty-two patients [15 women; median age 48 (range 10–78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5–2) cm, and 2.5 and 1 (1–7) respectively. Median CT and clinical follow-up were 12 (4–54) and 20 (8–63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival.ConclusionRFA is a safe and effective treatment for patients with small-volume sarcoma metastases.

  10. Outcome after Radiofrequency Ablation of Sarcoma Lung Metastases

    International Nuclear Information System (INIS)

    Koelblinger, Claus; Strauss, Sandra; Gillams, Alice

    2014-01-01

    PurposeResection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA).MethodsThis is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded.ResultsTwenty-two patients [15 women; median age 48 (range 10–78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5–2) cm, and 2.5 and 1 (1–7) respectively. Median CT and clinical follow-up were 12 (4–54) and 20 (8–63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival.ConclusionRFA is a safe and effective treatment for patients with small-volume sarcoma metastases

  11. Diffuse lung disease: Pneumoconioses

    International Nuclear Information System (INIS)

    McLoud, T.C.

    1987-01-01

    This paper begins with a discussion of the 1980 International Labour Organization classification of the pneumoconioses. Emphasis is on the common pneumoconioses, that is, silicosis, coalworker's pneumoconiosis, and asbestos-related pleural and parenchymal disease. Examples of the five radiographic forms of silicosis-simple and complicated silicosis, Caplan syndrome, silicotuberculosis, and acute silicosis- are presented, and the differential diagnoses are discussed. Discussion of asbestos-related disease included pleural manifestations such as plaques, diffuse pleural thickening, and asbestos pleural effusion as well as asbestosis and malignancies associated with asbestos exposure, such as bronchogenic carcinoma and malignant mesothelioma. Although the standard radiographic findings are stressed, the use of CT in the diagnosis of pneumoconiosis and the staging of dust-related malignancies is also discussed

  12. Hilar and mediastinal lymph node metastases from lung cancer

    International Nuclear Information System (INIS)

    Koganemaru, Michihiko; Fujimoto, Kiminori; Nishimura, Hiroshi; Tabuchi, Akinori; Ohtake, Hisashi; Nishimura, Yutaka

    1990-01-01

    Sixty-one patients with primary lung cancer, who had CT and MR imaging before surgery, were studied. MR imaging used spin-echo sequences with T1 weighted image and T2 weighted image (C-MRI), and included STIR technique (Stir-MRI). The accuracy of diagnosis of mediastinal lymphadenopathy (regarding 10 mm or larger in short transverse diameter as positive) was 89% by CT, 84% by C-MRI and 89% by Stir-MRI. The accuracy of diagnosis of hilar lymphadenopathy was 42% by CT, 67% by C-MRI, and 75% by Stir-MRI. The accuracy of diagnosis of mediastinal lymph node metastases was 89% by CT, 94% by C-MRI and 96% by Stir-MRI. The accuracy of diagnosis of hilar lymph node metastases was 78% by CT, 87% by C-MRI and 89% by Stir-MRI. The possibility of enhancement of diagnostic accuracy of lymph node metastases from lung cancer was suggested by combining MR imaging including STIR technique, with CT. (author)

  13. Boron Neutron Capture Therapy (BNCT) in an experimental model of lung metastases in BDIX rats

    International Nuclear Information System (INIS)

    Trivillin, V.A.; Garabalino, M.A.; Colombo, L.L.

    2013-01-01

    Boron Neutron Capture Therapy (BNCT) in an experimental model of lung metastases in BDIX rats Introduction: Boron Neutron Capture Therapy (BNCT) is based on selective tumor uptake of boron compounds, followed by neutron irradiation. BNCT was proposed for the treatment of unresectable, diffuse lung metastases. The aim of the present study was to perform BNCT studies in an experimental model of lung metastases. Materials and Methods: 3 x 106/0.5 ml colon carcinoma cells (DHD/K12/TRb) were injected iv in syngeneic BDIX rats. Three weeks post-inoculation, rats with diffuse lung metastases were used for in vivo BNCT studies in the RA-3 Nuclear Reactor. Based on previous biodistribution studies and computational dosimetry with Monte Carlo simulation, 2 doses were prescribed, i.e. 4 Gy and 8 Gy minimum absorbed dose to tumor. The animals were assigned to 5 experimental groups (n= 4 to 8) at each dose level: T0 (euthanized pre-treatment), BPA-BNCT, Comb-BNCT (BPA+GB-10), Beam only (background dose) and Sham (same manipulation, no treatment). Boron concentration was measured in a blood sample taken pre-irradiation to verify that the value was in the range established in previous biodistribution studies. The animals were followed clinically for 2 weeks after neutron irradiation and then euthanized to assess the response of tumor and normal lung, macroscopically and histologically. To date we have evaluated the end-point weight of lung (normal lung + metastases) and % lung weight/body weight as an indicator of tumor growth. Results: The statistical analysis (ANOVA) of % lung weight/body weight showed statistically significant differences (p<0.05) between groups T0 (0.79 ± 0.38) and Sham (1.87 ± 0.91). No statistically significant differences were observed between the Beam only groups (at both dose levels) and Sham. Similar and statistically significant tumor control was induced in the groups BPA-BNCT Low dose (LD) (0.56 ± 0.11), BPA-BNCT High dose (HD) (0.80 ± 0.16), Comb

  14. Localized leiomyosarcoma of the uterine cervix with rapid lung metastases

    Directory of Open Access Journals (Sweden)

    Joao Casanova

    2015-08-01

    Full Text Available Cervical sarcomas are extremely rare tumors associated with a poor prognosis. We report the case of a 63-year-old woman who was admitted to our institution due to abnormal vaginal bleeding and abdominal pain. Physical examination revealed a large cervical mass that was biopsied. Pathological features were compatible with a leiomyosarcoma of the uterine cervix. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. All histological and Immunohistochemical findings confirmed the diagnosis of leiomyosarcoma of the cervix. Adjuvant chemotherapy was started but unfortunately the disease progressed and 1 year after completion of the chemotherapy the patient developed lung metastases and eventually died.

  15. High resolution CT in diffuse lung disease

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    High resolution CT (computerized tomography) was discussed in detail. The conclusions were HRCT is able to define lung anatomy at the secondary lobular level and define a variety of abnormalities in patients with diffuse lung diseases. Evidence from numerous studies indicates that HRCT can play a major role in the assessment of diffuse infiltrative lung disease and is indicate clinically (95 refs.)

  16. High resolution CT in diffuse lung disease

    Energy Technology Data Exchange (ETDEWEB)

    Webb, W R [California Univ., San Francisco, CA (United States). Dept. of Radiology

    1996-12-31

    High resolution CT (computerized tomography) was discussed in detail. The conclusions were HRCT is able to define lung anatomy at the secondary lobular level and define a variety of abnormalities in patients with diffuse lung diseases. Evidence from numerous studies indicates that HRCT can play a major role in the assessment of diffuse infiltrative lung disease and is indicate clinically (95 refs.).

  17. Systemic Chemotherapy for Progression of Brain Metastases in Extensive-Stage Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Nagla Abdel Karim

    2015-01-01

    Full Text Available Lung cancer is the most common cause of cancer related mortality in men and women. Approximately 15% of lung cancers are small cell type. Chemotherapy and radiation are the mainstay treatments. Currently, the standard chemotherapy regimen includes platinum/etoposide. For extensive small cell lung cancer, irinotecan and cisplatin have also been used. Patients with relapsed small cell lung cancer have a very poor prognosis, and the morbidity increases with brain metastases. Approximately 10%–14% of small cell lung cancer patients exhibit brain metastases at the time of diagnosis, which increases to 50%–80% as the disease progresses. Mean survival with brain metastases is reported to be less than six months, thus calling for improved regimens. Here we present a case series of patients treated with irinotecan for progressive brain metastases in small cell lung cancer, which serves as a reminder of the role of systemic chemotherapy in this setting.

  18. An unusual presentation of multiple cavitated lung metastases from colon carcinoma

    Directory of Open Access Journals (Sweden)

    Iannace Alessandro

    2011-05-01

    Full Text Available Abstract Background Consolidation with or without ground-glass opacity is the typical radiologic finding of lung metastases of adenocarcinoma from the gastrointestinal tract. Lung excavated metastases from gastrointestinal carcinoma are very rare. Case presentation The authors describe an unusual presentation of multiple cavitated lung metastases from colon adenocarcinoma and discuss the outcome of a patient. The absence both of symptoms and other disease localizations, the investigations related to different diagnostic hypotheses and the empirical treatments caused a delay in correct diagnosis. Only a transparietal biopsy revealed the neoplastic origin of nodules. Conclusions This report demonstrates that although lung excavated metastases are described in literature, initial failure to reach a diagnosis is common. We would like to alert clinicians and radiologists to the possibility of unusual atypical features of pulmonary metastases from colon adenocarcinoma.

  19. Advances in Diagnosis and Treatment of Brain Metastases from the Primary Lung Cancer

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    Yi LIU

    2013-07-01

    Full Text Available Lung cancer with brain metastasis was 23% to 65%, and is the most common type in brain metastasis tumors with the poor prognosis. At present, diagnosis and treatment of brain metastases from lung carcinoma and its molecular mechanism have become one hot spot of amount researches. Here, we made a systematic review of the progress of the clinical features, diagnosis and treatment of brain metastases from lung and its molecular mechanism.

  20. Treatment of Sarcoma Lung Metastases with Stereotactic Body Radiotherapy

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    Adam D. Lindsay

    2018-01-01

    Full Text Available Background. The most common site of sarcoma metastasis is the lung. Surgical resection of pulmonary metastases and chemotherapy are treatment options that have been employed, but many patients are poor candidates for these treatments for multiple host or tumor-related reasons. In this group of patients, radiation might provide a less morbid treatment alternative. We sought to evaluate the efficacy of radiotherapy in the treatment of metastatic sarcoma to the lung. Methods. Stereotactic body radiotherapy (SBRT was used to treat 117 pulmonary metastases in 44 patients. Patients were followed with serial computed tomography imaging of the chest. The primary endpoint was failure of control of a pulmonary lesion as measured by continued growth. Radiation-associated complications were recorded. Results. The majority of patients (84% received a total dose of 50 Gy per metastatic nodule utilizing an image-guided SBRT technique. The median interval follow-up was 14.2 months (range 1.6–98.6 months. Overall survival was 82% at two years and 50% at five years. Of 117 metastatic nodules treated, six nodules showed failure of treatment (95% control rate. Twenty patients (27% developed new metastatic lesions and underwent further SBRT. The side effects of SBRT included transient radiation pneumonitis n=6, cough n=2, rib fracture n=1, chronic pain n=1, dermatitis n=1, and dyspnea n=1. Conclusion. Stereotactic body radiotherapy is an effective and safe treatment for the ablation of pulmonary metastasis from sarcoma. Further work is needed to evaluate the optimal role of SBRT relative to surgery or chemotherapy for treatment of metastatic sarcoma.

  1. Remission of Unresectable Lung Metastases from Rectal Cancer After Herbal Medicine Treatment: A Case Report.

    Science.gov (United States)

    Kim, Kyungsuk; Lee, Sanghun

    2016-01-01

    Lung metastasis is frequent in rectal cancer patients and has a poor prognosis, with an expected three-year survival rate of about 10%. Though western medicine has made great strides in the curative resection of liver metastases, resection of lung metastases has lagged far behind. Many preclinical studies have suggested that herbal treatments block metastasis, but few clinical studies have addressed this topic. We present the case of a 57-year-old Asian male with lung metastases from rectal cancer. He first underwent resection of the primary lesion (stage IIA, T3N0M0) and six cycles of adjuvant chemotherapy. Unfortunately, lung metastases were confirmed about one year later. Palliative chemotherapy was begun, but his disease continued to progress after three cycles and chemotherapy was halted. The patient was exclusively treated with herbal medicine-standardized allergen-removed Rhus verniciflua stokes extract combined with Dokhwaljihwang-tang (Sasang constitutional medicine in Korea). After seven weeks of herbal medicine treatment, the lung metastases were markedly improved. Regression of lung metastases has continued; also, the patient's rectal cancer has not returned. He has been receiving herbal medicine for over two years and very few side effects have been observed. We suggest that the herbal regimen used in our patient is a promising candidate for the treatment of lung metastases secondary to rectal cancer, and we hope that this case stimulates further investigation into the efficacy of herbal treatments for metastatic colorectal cancer patients. Copyright © 2016. Published by Elsevier Inc.

  2. Video-Assisted Laser Resection of Lung Metastases-Feasibility of a New Surgical Technique.

    Science.gov (United States)

    Meyer, Christian; Bartsch, Detlef; Mirow, Nikolas; Kirschbaum, Andreas

    2017-08-01

    Background  Our pilot study describes our initial experience to do a laser resection of lung metastases under video-assisted thoracoscopic control via a minithoracotomy. With this approach, if needed, mediastinal lymphadenectomy is also possible. Methods  In this study, 15 patients (11 men and 4 women, mean age: 60 years) with resectable lung metastases of different solid primary tumors (colorectal cancer in seven patients, melanoma in three patients, renal cell carcinoma in two patients, and one each with oropharyngeal cancer, breast cancer, and seminoma) were included. An anterior minithoracotomy incision (approximately 5-7 cm length) was created in the fifth intercostal space and a soft tissue retractor (Alexis Protector; Applied Medical) was positioned. Two additional working ports were inserted. The entire lung was palpated via the minithoracotomy. All detected lung metastases were removed under thoracoscopic control. Nonanatomic resections were performed using a diode-pumped neodymium-doped yttrium aluminium garnet laser (LIMAX120; KLS Martin GmbH & Co KG) with a laser power of 80 W in a noncontact modus. Deeper parenchymal lesions were sutured. Results  A total of 29 lung metastases up to 30 mm in size were resected and all metastases diagnosed on preoperative imaging were detected. All diagnosed lung metastases were completely resected (R0). The median operation time was 102 (range: 85-120) minutes. Median blood loss was 47.6 mL and no postoperative complications occurred. Neither local recurrences nor new lung metastases were observed within 6 months after the procedures. Conclusion  Video-assisted laser resection of lung metastases is safe, effective, and fulfills the requirements of modern lung metastases surgery. Georg Thieme Verlag KG Stuttgart · New York.

  3. Detection of occult bone metastases of lung cancer with fluorine-18 fluorodeoxyglucose positron emission tomography

    International Nuclear Information System (INIS)

    Ramdave, Shankar; Berlangieri, Salvatore U.

    2004-01-01

    Accurate staging of cancer has a critical role in optimal patient management. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with non-small cell lung cancer. Although Tc-99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X-rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans Copyright (2004) Blackwell Publishing Asia Pty Ltd

  4. Progressive multiple cystic changes in both lungs in a patient treated with gefitinib for lung adenocarcinoma with multiple lung metastases

    International Nuclear Information System (INIS)

    Ryu, Yon Ju; Chun, Eun Mi; Lee, Soon Nam; Shim, Sung Shin

    2014-01-01

    Gefitinib is regarded as a relatively safe agent for the treatment of an advanced non-small cell lung cancer (NSCLC). Pulmonary toxicity such as interstitial lung disease associated with gefitinib is uncommon with an estimated all time incidence around 1% worldwide. Moreover, a case of gefitinib associated with pulmonary cystic changes has not been reported yet. In this report we present a case of progressive multiple air cystic changes in both lungs in a patient with NSCLC and intrapulmonary metastases who underwent a gefitinib therapy.

  5. Brain metastases in lung cancer. Impact of prognostic factors on patient survival

    International Nuclear Information System (INIS)

    Smrdel, U.; Zwitter, M.; Kovac, V.

    2003-01-01

    Background. Brain metastases are common patterns of dissemination in lung cancer patients. In this paper we would like to assess the pattern of brain metastases in lung cancer patients and the impact of prognostic factors on the survival of lung cancer patients with brain metastases. Patients and methods. In the year 1998 there were 974 registered patients with lung cancer in Slovenia, six hundred and fifteen of them were treated at the Institute of Oncology Ljubljana and we analyzed them. Among 615 patients 137 (22.3 %) of them have had brain metastases during a natural course of disease. Results. For 12 patients presenting with solitary brain metastases (most of them were undertaken metastasectomy) median survival was 7.6 months, while in patients with multiple brain metastases the median survival was 2.8 months (p 0.0018). Of the 137 patients 45 (32.8 %) were small cell lung cancer patients, 43 (31.4 %) were adenocarcinoma patients and 19 (13.9 %) were squamous cell carcinoma patients. Patients with performance status (WHO scale) less than 2 had the median survival time 3.7 months while patients with performance status 2 or more had median survival time 2.7 moths (p=0.0448). Conclusions. Patients with solitary brain metastases had better survival comparing with those who had multiple metastases. It is surprisingly that the portion of brain metastases patients with adenocarcinoma is almost equal to those with small-call lung cancer therefore, the prophylactic cranial radiation becomes actual for both groups of patients. The performance status of patients with brain metastases remains very important prognostic factor. (author)

  6. A case of rectal cancer successfully treated with surgery and stereotactic radiotherapy for metachronous lung metastases

    International Nuclear Information System (INIS)

    Oshima, Yu; Hosoda, Yohei; Tachi, Hidekazu

    2016-01-01

    A 64-year-old woman underwent polypectomy for a rectal polyp (Isp). Pathological findings were invasion of the submucosa (3,500 μm diameter), and she underwent anterior resection for rectal cancer (RS, pT1b, pN0, cM0, Stage I ) without adjuvant chemotherapy. Lung masses were found in her right (8 mm) and left lung (7 mm). The tumors enlarged during the 4 month follow-up period. We decided to perform left partial pneumonectomy. The tumor was diagnosed as a lung metastasis from colon cancer by pathology. Because the right tumor was located towards the center, performing right pneumonectomy would have been quite invasive and we feared occult metastases. We decided to apply SRT (50 Gy) to the right tumor. The tumor shrunk and became a scar after treatment. There were no complications such as radiation pneumonitis. The patient was in good health without any recurrence for 12 months after SRT. Surgical resection is an optimal method to control lung metastasis from colon cancer if the lesion is operable. However, in the case of a tumor centrally located, surgical resection may cause deterioration of lung function. There are also cases with contraindications for surgery due to co-morbidities. In addition, there is no consensus on observation periods to exclude occult metastases. SRT can be an effective treatment for lung metastases from colon cancer when there are bilateral lung metastases and no metastases outside the lungs. (author)

  7. Dynamic Contrast Enhanced MRI in Patients With Advanced Breast or Pancreatic Cancer With Metastases to the Liver or Lung

    Science.gov (United States)

    2014-05-28

    Acinar Cell Adenocarcinoma of the Pancreas; Duct Cell Adenocarcinoma of the Pancreas; Liver Metastases; Lung Metastases; Recurrent Breast Cancer; Recurrent Pancreatic Cancer; Stage IV Breast Cancer; Stage IV Pancreatic Cancer

  8. Concurrent radiotherapy and fotemustine for brain metastases of non small cell cancer of the lung

    International Nuclear Information System (INIS)

    Pignon, T.; Ruggieri, S.; Orabona, P.; Muracciole, X.; Juin, P.; Astoul, P.; Vialette, J.P.; Boutin, C.

    1994-01-01

    The radiotherapy is the most employed in the treatment of cerebral metastases, even if results are deceptive. The tests with chemotherapy are not better and the nitrosoureas remain the most employed drugs. The fotemustin is a new one which can give good results for bearing cerebral metastases patients's response. The associations radiotherapy and chemotherapy are developing to potentiate radiotherapy action but are still a little studied in the cases of cerebral metastases; that is why we choose to treat in an open study the patients bearers of cerebral metastases in lungs cancers with no little cells. 18 refs

  9. Prevention of lung metastases by irradiation alone or combined with chemotherapy in an animal model

    International Nuclear Information System (INIS)

    Wondergem, J.; Haveman, J.

    1986-01-01

    Clinical observations indicate that the results of elective radiotherapy are disappointing when the subclinical metastases supposedly contain a large number of tumor cells. Experimental data confirm this indication: a rapid decrease in the effectiveness of radiation treatment of experimental metastases was observed with increasing number of tumor cells in the lung. Apart from the increase in cell number also the development of hypoxia during growth of subclinical metastases might explain part of the decrease in the effectiveness of elective radiation treatment. Experiments with the hypoxic cell sensitizer misonidazole in transplantable tumors in rodents indicate that this latter possibility might be relevant too for the clinical situation. Improvement of the results of an elective treatment might either be obtained by a reduction of the cell number to be treated with radiation, by prior treatment with a cytostatic drug or be dealing with the problem of hypoxia. Therefore in the present study the authors investigate the effectiveness of thorax irradiation combined with the treatment with cytostatic drugs (Actinomycin-D or 5-Fluorouracil) or the hypoxic cell sensitizer misonidazole in a mouse model with artificial lung metastases. The artificial lung metastases were obtained by intravenous injection of tumor cells in the tail vein of mice. The influence of thorax irradiation on the development of lung metastases was evaluated not only by recording the number of mice dying from lung metastases as parameter but also registered the pattern of lung metastases found at autopsy of animals which died from their disease. The response of lung tissue following combined therapy was also investigated

  10. The level of serum tumor makers and bone metastases of lung cancer correlation

    International Nuclear Information System (INIS)

    Li Li; Jin Jianhua

    2014-01-01

    Objective: To study the correlation between the level of serum tumor makers and bone metastases of lung cancer. Method: In 128 diagnosed patients with lung cancer, small cell lung cancer were 26 cases, non-small cell lung cancer were 102 cases which included 44 cases of adenocarcinoma, 50 cases of squamous cell carcinoma, 4 cases of large cell carcinoma, 4 cases of squamous adenocarcinoma. "9"9"mTc-MDP whole-body bone scanning was performed in 128 patients with lung cancer. over the same period, the serum samples were collected in these patients and 30 comparison controls. CEA, CA125, CA199, SCC, NSE, CA15-3, and AFP were measured by ELISA technique. Bone imaging findings analysis used t-test, and serum levels of tumor markers analysis used χ"2 test. Results: The diagnostic of 53 cases of lung cancer with bone metastasis was subject to clinical criteria of lung cancer with bone metastases. The positive ratio of patients with osseous metastasis was confirmed by "9"9"mTc-MDP whole-body bone scanning was 23.44% (30/128), including 16 cases of lung adenocarcinoma, 9 cases of squamous cell carcinoma, 3 cases of small cell lung cancer , 1 case of large cell lung cancer, 1 case of squamous adenocarcinoma and multiple bone metastases accounted for 66.67% (20/30). The levels of serum CEA, CA125, CA199, SCC, NSE and CA15-3 were higher than the control group (P < O.05). 29 cases of CEA positive and 21 cases of CA125 positive were included in 30 cases of lung cancer with bone metastasis. There was a significant difference between the levels of CEA, CA125, CA199, NSE in lung cancer with bone metastases and without bone metastases (P < 0.05). The sensitivity of "9"9"mTc-MDP whole-body bone scanning in diagnosis of lung cancer with bone metastasis was 84.91%. Conclusion: The average value of CEA, CA125, and CA199, SCC, NSE and CA15-3 in lung cancer patients were significantly higher than the control group. In addition, there is a significantly correlation between the occurrence

  11. Detection of occult bone metastases of lung cancer with Fluorine-18 fluorodeoxyglucose positron emission tomography

    International Nuclear Information System (INIS)

    Foo, S.S.; Ramdave, S.; Berlangieri, S.U.; Scott, A.M.

    2004-01-01

    Accurate staging of cancer has a critical role in optimal patient management. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastasesin patients with non-small cell lung cancer. Although Tc-99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X-rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans. Copyright (2004) Blackwell Science Pty Ltd

  12. Cannonball lung metastases as a presenting feature of ectopic hCG expression

    Directory of Open Access Journals (Sweden)

    Rong-Hsin Yang

    2016-08-01

    Full Text Available Cannonball metastases refer to well-defined spherical nodules scattered over both lungs, being a classical presentation of hematogenous tumor spreading. Striking progression of lung metastases without established primary malignancy can raise a diagnostic challenge. We herein report three cases with cannonball metastases at initial presentation. Two patients ended up having a choriocarcinoma but no awareness of the presence of primary tumors, and the third had abrupt lung metastases of endometrial cancer while she was being asymptomatic. Relentless progression was illustrated by clinical and radiographic changes. Ectopic expression of human chorionic gonadotropin (hCG would seemingly go some way responsible for fulminant cancer spreading associated with poor prognosis in our patients. The goal of this presentation is to raise awareness of ectopic hCG expression in patients presenting with similar astonishing scenarios.

  13. Influence of thorax irradiation on the survival of mice with spontaneous or artificial lung metastases from a transplantable mammary adenocarcinoma

    International Nuclear Information System (INIS)

    Wondergem, J.; Haveman, J.; van der Schueren, E.

    1985-01-01

    The effect of thorax irradiation on lung metastases, either occurring spontaneously from a primary mammary adenocarcinoma (M8013X) transplanted on the leg or artificially induced by intravenous injection of tumor cells was studied. Increasing the interval between the moment at which lung metastases are supposed to originate and the thorax irradiation resulted in a rapid decrease of the effectiveness of this treatment in preventing the development of lung metastases. Increasing the radiation dose led to an increased number of cures; however, an increased number of mice dying of lethal lung damage was also observed. Irradiation of the lungs of mice with 5 or 10 Gy, 24 hours, 7 days or 14 days prior to i.v. injection with tumor cells, did not significantly increase the number of mice with lung metastases. Immunological resistance against the tumor played a role in our experiments with both spontaneous and artificial lung metastases

  14. Survival after Radiofrequency Ablation in 122 Patients with Inoperable Colorectal Lung Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Gillams, Alice, E-mail: alliesorting@gmail.com [The London Clinic, Radiology Department (United Kingdom); Khan, Zahid [Countess of Chester Hospital (United Kingdom); Osborn, Peter [Queen Alexandra Hospital (United Kingdom); Lees, William [University College London Medical School (United Kingdom)

    2013-06-15

    Purpose. To analyze the factors associated with favorable survival in patients with inoperable colorectal lung metastases treated with percutaneous image-guided radiofrequency ablation. Methods. Between 2002 and 2011, a total of 398 metastases were ablated in 122 patients (87 male, median age 68 years, range 29-90 years) at 256 procedures. Percutaneous CT-guided cool-tip radiofrequency ablation was performed under sedation/general anesthesia. Maximum tumor size, number of tumors ablated, number of procedures, concurrent/prior liver ablation, previous liver or lung resection, systemic chemotherapy, disease-free interval from primary resection to lung metastasis, and survival from first ablation were recorded prospectively. Kaplan-Meier analysis was performed, and factors were compared by log rank test. Results. The initial number of metastases ablated was 2.3 (range 1-8); the total number was 3.3 (range 1-15). The maximum tumor diameter was 1.7 (range 0.5-4) cm, and the number of procedures was 2 (range 1-10). The major complication rate was 3.9 %. Overall median and 3-year survival rate were 41 months and 57 %. Survival was better in patients with smaller tumors-a median of 51 months, with 3-year survival of 64 % for tumors 2 cm or smaller versus 31 months and 44 % for tumors 2.1-4 cm (p = 0.08). The number of metastases ablated and whether the tumors were unilateral or bilateral did not affect survival. The presence of treated liver metastases, systemic chemotherapy, or prior lung resection did not affect survival. Conclusion. Three-year survival of 57 % in patients with inoperable colorectal lung metastases is better than would be expected with chemotherapy alone. Patients with inoperable but small-volume colorectal lung metastases should be referred for ablation.

  15. Significance of bacterial flora in abdominal irradiation-induced inhibition of lung metastases

    International Nuclear Information System (INIS)

    Matsumoto, T.; Ando, K.; Koike, S.

    1988-01-01

    We have previously reported that abdominal irradiation prior to i.v. injection of syngeneic tumor cells reduced metastases in lung. Our report described an investigation of the significance of intestinal organisms in the radiation effect. We found that eliminating intestinal organisms with antibiotics totally abolished the radiation effect. Monoassociation of germ-free mice revealed that the radiation effect was observable only for Enterobacter cloacae, never for Streptococcus faecium, Bifidobacterium adlesentis, or Escherichia coli. After abdominal irradiation of regular mice, E. cloacae multiplied in cecal contents, adhered to mucous membranes, invaded the cecal wall, and translocated to mesenteric lymph nodes. Intravenous administration of E. cloacae in place of abdominal irradiation inhibited metastases. E. cloacae-monoassociated mice developed fewer metastases than germ-free mice, and the reduction was further enhanced by abdominal irradiation. We concluded that abdominal irradiation caused the invasion of E. cloacae from the mucous membrane of the intestine and inhibited formation of lung metastases

  16. Benign Metastasizing Leiomyoma of the Lung: Clinicopathologic, Immunohistochemical, and Micro-RNA Analyses

    OpenAIRE

    Nuovo, Gerard J.; Schmittgen, Thomas D.

    2008-01-01

    Benign metastasizing leiomyomas are rare tumors, which are typically found in the lungs and, thus, might be confused with leiomyosarcomas. Further, it is not clear whether the term “benign metastasizing leiomyoma” is a misnomer and whether these lesions actually represent low-grade malignant tumors that have a low proliferation index. Micro-RNAs (miRNAs) are small noncoding RNAs, which repress translation. The altered expression of miRNAs has been strongly correlated with the malignant phenot...

  17. An analysis of the relationship between metastases and cachexia in lung cancer patients.

    Science.gov (United States)

    Shiono, Masatoshi; Huang, Kan; Downey, Robert J; Consul, Nikita; Villanueva, Nicolas; Beck, Kristen; Fenn, Kathleen; Dietz, Donald; Yamaguchi, Takuhiro; Kato, Shunsuke; Divgi, Chaitanya; Kalinsky, Kevin; Wei, Ying; Zhang, Yuan; Borczuk, Alain C; Inoue, Akira; Halmos, Balazs; Acharyya, Swarnali

    2016-09-01

    Weight loss and hematogenous metastases are poor prognosis factors in lung cancer patients that can but do not necessarily co-occur. We retrospectively investigated the clinical association between cachexia, tumor characteristics (such as metastatic burden and mutational status), and treatment in lung cancer patients. The medical records of 394 lung cancer patients from two institutions (Columbia University, USA and Tohoku University, Japan) were reviewed. Information collected included the presence of cachexia, histologic subtype, tumor stage, number of metastases, mutation status, treatment, and survival. Descriptive statistics were performed. Only stage IV patients exhibited >5% weight loss (0.8%, 2.2%, 3.6%, and 5.1%, for stages I to IV; P = 0.0001). Patients with metastases developed cachexia more often than patients without metastases independent of treatment (6.0% and 7.1% weight loss in patients with metastases vs. 2.5% and 2.0% in patients without metastases, before [P = 0.0001] and after [P cachexia had worse survival than patients without cachexia (hazard ratio, 2.94; 95% confidence interval, 2.08-4.16; P cachexia might be linked intrinsically and are independent of treatments administered. KRAS-mutated tumors were more commonly associated with cachexia. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  18. Unusual fatty metamorphosis observed in diffuse liver metastases of stage 4S neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Tazoe, Jun; Okuyama, Chio; Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto City (Japan); Iehara, Tomoko; Hosoi, Hajime [Kyoto Prefectural University of Medicine, Department of Paediatrics, Graduate School of Medical Science, Kyoto City (Japan)

    2010-05-15

    We report a case of stage 4S neuroblastoma in which CT showed diffuse liver metastases containing a geographical fatty area in the periportal region. MRI showed this abnormality to correspond to an area with an unusual pattern of fatty change. {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy demonstrated increased accumulation throughout the liver, except for the region showing fatty change. To the best of our knowledge, this is the first report of liver metastases from neuroblastoma with geographical fatty infiltration. (orig.)

  19. Unusual fatty metamorphosis observed in diffuse liver metastases of stage 4S neuroblastoma

    International Nuclear Information System (INIS)

    Tazoe, Jun; Okuyama, Chio; Nishimura, Tsunehiko; Iehara, Tomoko; Hosoi, Hajime

    2010-01-01

    We report a case of stage 4S neuroblastoma in which CT showed diffuse liver metastases containing a geographical fatty area in the periportal region. MRI showed this abnormality to correspond to an area with an unusual pattern of fatty change. 123 I-metaiodobenzylguanidine (MIBG) scintigraphy demonstrated increased accumulation throughout the liver, except for the region showing fatty change. To the best of our knowledge, this is the first report of liver metastases from neuroblastoma with geographical fatty infiltration. (orig.)

  20. Metabolic and hemodynamic evaluation of brain metastases from small cell lung cancer with positron emission tomography

    DEFF Research Database (Denmark)

    Lassen, U; Andersen, P; Daugaard, G

    1998-01-01

    for studies of metabolic and hemodynamic features. This study was performed to determine regional cerebral metabolic rate of glucose (rCMRglu), regional cerebral blood flow (rCBF), and regional cerebral blood volume (rCBV) in brain metastases from small cell lung cancer and the surrounding brain. Tumor r......Brain metastases from small cell lung cancer respond to chemotherapy, but response duration is short and the intracerebral concentration of chemotherapy may be too low because of the characteristics of the blood-brain barrier. Positron emission tomography has been applied in a variety of tumors...

  1. Lung Metastases from Bile Duct Adenocarcinoma Mimicking Chronic Airway Infection and Causing Diagnostic Difficulty.

    Science.gov (United States)

    Sato, Mitsuo; Okachi, Shotaro; Fukihara, Jun; Shimoyama, Yoshie; Wakahara, Keiko; Sakakibara, Toshihiro; Hase, Tetsunari; Onishi, Yasuharu; Ogura, Yasuhiro; Maeda, Osamu; Hasegawa, Yoshinori

    2018-05-15

    We herein report a case of lung metastases with unusual radiological appearances that mimicked those of chronic airway infection, causing diagnostic difficulty. A 60-year-old woman who underwent liver transplantation from a living donor was incidentally diagnosed with bile duct adenocarcinoma after a histopathological analysis of her explanted liver. Six months later, chest computed tomography (CT) revealed bilateral bronchogenic dissemination that had gradually worsened, suggesting chronic airway infection. A biopsy with bronchoscopy from a mass lesion beyond a segmental bronchus revealed adenocarcinoma identical to that of her bile duct adenocarcinoma, leading to the diagnosis of multiple lung metastases from bile duct adenocarcinoma.

  2. Whole Lung Irradiation for Adults With Pulmonary Metastases From Ewing Sarcoma

    International Nuclear Information System (INIS)

    Casey, Dana L.; Alektiar, Kaled M.; Gerber, Naamit K.; Wolden, Suzanne L.

    2014-01-01

    Purpose: To evaluate feasibility and patterns of failure in adult patients with Ewing sarcoma (ES) treated with whole lung irradiation (WLI) for pulmonary metastases. Methods and Materials: Retrospective review of all ES patients treated at age 18 or older with 12-15 Gy WLI for pulmonary metastases at a single institution between 1990 and 2014. Twenty-six patients met the study criteria. Results: The median age at WLI was 23 years (range, 18-40). The median follow-up time of the surviving patients was 3.8 years (range, 1.0-9.6). The 3-year cumulative incidence of pulmonary relapse (PR) was 55%, with a 3-year cumulative incidence of PR as the site of first relapse of 42%. The 3-year event-free survival (EFS) and overall survival (OS) were 38 and 45%, respectively. Patients with exclusively pulmonary metastases had better outcomes than did those with extrapulmonary metastases: the 3-year PR was 45% in those with exclusively lung metastases versus 76% in those with extrapulmonary metastases (P=.01); the 3-year EFS was 49% versus 14% (P=.003); and the 3-year OS was 61% versus 13% (P=.009). Smoking status was a significant prognostic factor for EFS: the 3-year EFS was 61% in nonsmokers versus 11% in smokers (P=.04). Two patients experienced herpes zoster in the radiation field 6 and 12 weeks after radiation. No patients experienced pneumonitis or cardiac toxicity, and no significant acute or late sequelae were observed among the survivors. Conclusion: WLI in adult patients with ES and lung metastases is well tolerated and is associated with freedom from PR of 45% at 3 years. Given its acceptable toxicity and potential therapeutic effect, WLI for pulmonary metastases in ES should be considered for adults, as it is in pediatric patients. All patients should be advised to quit smoking before receiving WLI

  3. Whole Lung Irradiation for Adults With Pulmonary Metastases From Ewing Sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Casey, Dana L.; Alektiar, Kaled M.; Gerber, Naamit K.; Wolden, Suzanne L., E-mail: woldens@mskcc.org

    2014-08-01

    Purpose: To evaluate feasibility and patterns of failure in adult patients with Ewing sarcoma (ES) treated with whole lung irradiation (WLI) for pulmonary metastases. Methods and Materials: Retrospective review of all ES patients treated at age 18 or older with 12-15 Gy WLI for pulmonary metastases at a single institution between 1990 and 2014. Twenty-six patients met the study criteria. Results: The median age at WLI was 23 years (range, 18-40). The median follow-up time of the surviving patients was 3.8 years (range, 1.0-9.6). The 3-year cumulative incidence of pulmonary relapse (PR) was 55%, with a 3-year cumulative incidence of PR as the site of first relapse of 42%. The 3-year event-free survival (EFS) and overall survival (OS) were 38 and 45%, respectively. Patients with exclusively pulmonary metastases had better outcomes than did those with extrapulmonary metastases: the 3-year PR was 45% in those with exclusively lung metastases versus 76% in those with extrapulmonary metastases (P=.01); the 3-year EFS was 49% versus 14% (P=.003); and the 3-year OS was 61% versus 13% (P=.009). Smoking status was a significant prognostic factor for EFS: the 3-year EFS was 61% in nonsmokers versus 11% in smokers (P=.04). Two patients experienced herpes zoster in the radiation field 6 and 12 weeks after radiation. No patients experienced pneumonitis or cardiac toxicity, and no significant acute or late sequelae were observed among the survivors. Conclusion: WLI in adult patients with ES and lung metastases is well tolerated and is associated with freedom from PR of 45% at 3 years. Given its acceptable toxicity and potential therapeutic effect, WLI for pulmonary metastases in ES should be considered for adults, as it is in pediatric patients. All patients should be advised to quit smoking before receiving WLI.

  4. Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl

    International Nuclear Information System (INIS)

    Hebestreit, Helge; Burkhardt, Antje; Biko, Johannes; Reiners, Christoph; Drozd, Valentina; Demidchik, Yuri; Trusen, Andreas; Beer, Meinrad

    2011-01-01

    The objective of this project was to systematically determine the prevalence and consequences of pulmonary fibrosis in youth with thyroid carcinoma and lung metastases from Belarus who were treated with radioiodine ( 131 I). A total of 69 patients treated for juvenile thyroid carcinoma and lung metastasis with 131 I were assessed. A group of 29 patients without lung metastases and prior 131 I treatment served as controls. The assessments included a CT scan of the lungs, extensive pulmonary function testing and an incremental cycle test to volitional fatigue with measurements of oxygen uptake (V. O 2 ), oxygen saturation and alveolar-arterial difference in oxygen partial pressure (ΔaaO 2 ). Five patients with lung metastases showed advanced pulmonary fibrosis on CT scans and also had poorer lung functions compared with the 62 patients with none or minor signs of fibrosis and the 29 controls. Furthermore, these five patients showed lower peak V.O 2 , lower oxygen saturation at peak exercise and higher exercise ΔaaO 2 . They were younger at the time of cancer diagnosis and had received chemotherapy more frequently than youth with pulmonary metastases who did not develop fibrosis. One of the five patients subsequently died from pulmonary fibrosis. Following the Chernobyl catastrophe, about 7% of children treated with radioiodine for thyroid carcinoma and lung metastases displayed pulmonary fibrosis which was associated with functional impairments. Based on the characteristics of affected individuals, the number of radioiodine courses may have to be limited, especially in young children, and chemotherapy should be avoided. (orig.)

  5. Cold metastases detected by bone scintigraphy in aggressive lung cancer

    International Nuclear Information System (INIS)

    Martinez Carsi, C.; Perales Vila, A.; Ruiz Hernandez, G.; Sanchez Marchori, C.; Oro Camps, J.

    1998-01-01

    A case of a 55-year-old man was remitted to Traumatology Department to present back pain of two weeks of evolution. The results of bone scintigraphy and the patient's evolution allowed the diagnosis. This case report and a literature review showed the importance of using a routine bone scan in diagnosis of bone metastases. (orig.) [de

  6. Efficacy and safety of icotinib in patients with brain metastases from lung adenocarcinoma

    OpenAIRE

    Xu, Jianping; Liu, Xiaoyan; Yang, Sheng; Zhang, Xiangru; Shi, Yuankai

    2016-01-01

    Jianping Xu, Xiaoyan Liu, Sheng Yang, Xiangru Zhang, Yuankai Shi Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: The objective of this study was to evaluate the efficacy and safety of icotinib in patients with brain metastases (BMs) from lung adenocarcinoma.Patients and methods: Clinical data of 28 cases with BMs from lung adenocarcinoma were retrospectively analyzed. All the patients took 125&am...

  7. Discrimination of different brain metastases and primary CNS lymphomas using morphologic criteria and diffusion tensor imaging

    Energy Technology Data Exchange (ETDEWEB)

    Bette, S.; Wiestler, B.; Huber, T.; Boeckh-Behrens, T.; Zimmer, C.; Kirschke, J. [Technical University Munich, Klinikum rechts der Isar (Germany). Dept. of Neuroradiology; Delbridge, C. [Technical University Munich, Klinikum rechts der Isar (Germany). Dept. of Neuropathology; Meyer, B.; Gempt, J. [Technical University Munich, Klinikum rechts der Isar (Germany). Dept. of Neurosurgery

    2016-12-15

    Brain metastases are a common complication of cancer and occur in about 15-40% of patients with malignancies. The aim of this retrospective study was to differentiate between metastases from different primary tumors/CNS lymphyomas using morphologic criteria, fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Morphologic criteria such as hemorrhage, cysts, pattern of contrast enhancement and location were reported in 200 consecutive patients with brain metastases/primary CNS lymphomas. FA and ADC values were measured in regions of interest (ROIs) placed in the contrast-enhancing tumor part, the necrosis and the non-enhancing peritumoral region (NEPTR). Differences between histopathological subtypes of metastases were analyzed using non-parametric tests, decision trees and hierarchical clustering analysis. Significant differences were found in morphologic criteria such as hemorrhage or pattern of contrast enhancement. In diffusion measurements, significant differences between the different tumor entities were only found in ADC analyzed in the contrast-enhancing tumor part. Among single tumor entities, primary CNS lymphomas showed significantly lower median ADC values in the contrast-enhancing tumor part (ADC{sub lymphoma} 0.92 [0.83-1.07] vs. ADC{sub no} {sub lymphoma} 1.35 [1.10-1.64] P=0.001). Further differentiation between types of metastases was not possible using FA and ADC. There were morphologic differences among the main subtypes of brain metastases/CNS lymphomas. However, due to a high variability of common types of metastases and low specificity, prospective differentiation remained challenging. DTI including FA and ADC was not a reliable tool for differentiation between different histopathological subtypes of brain metastases except for CNS lymphomas showing lower ADC values. Biopsy, surgery and staging remain essential for diagnosis.

  8. Breast Cancer-Derived Lung Metastases Show Increased Pyruvate Carboxylase-Dependent Anaplerosis

    Directory of Open Access Journals (Sweden)

    Stefan Christen

    2016-10-01

    Full Text Available Cellular proliferation depends on refilling the tricarboxylic acid (TCA cycle to support biomass production (anaplerosis. The two major anaplerotic pathways in cells are pyruvate conversion to oxaloacetate via pyruvate carboxylase (PC and glutamine conversion to α-ketoglutarate. Cancers often show an organ-specific reliance on either pathway. However, it remains unknown whether they adapt their mode of anaplerosis when metastasizing to a distant organ. We measured PC-dependent anaplerosis in breast-cancer-derived lung metastases compared to their primary cancers using in vivo 13C tracer analysis. We discovered that lung metastases have higher PC-dependent anaplerosis compared to primary breast cancers. Based on in vitro analysis and a mathematical model for the determination of compartment-specific metabolite concentrations, we found that mitochondrial pyruvate concentrations can promote PC-dependent anaplerosis via enzyme kinetics. In conclusion, we show that breast cancer cells proliferating as lung metastases activate PC-dependent anaplerosis in response to the lung microenvironment.

  9. Spirometry, Static Lung Volumes, and Diffusing Capacity.

    Science.gov (United States)

    Vaz Fragoso, Carlos A; Cain, Hilary C; Casaburi, Richard; Lee, Patty J; Iannone, Lynne; Leo-Summers, Linda S; Van Ness, Peter H

    2017-09-01

    Spirometric Z-scores from the Global Lung Initiative (GLI) rigorously account for age-related changes in lung function and are thus age-appropriate when establishing spirometric impairments, including a restrictive pattern and air-flow obstruction. However, GLI-defined spirometric impairments have not yet been evaluated regarding associations with static lung volumes (total lung capacity [TLC], functional residual capacity [FRC], and residual volume [RV]) and gas exchange (diffusing capacity). We performed a retrospective review of pulmonary function tests in subjects ≥40 y old (mean age 64.6 y), including pre-bronchodilator measures for: spirometry ( n = 2,586), static lung volumes by helium dilution with inspiratory capacity maneuver ( n = 2,586), and hemoglobin-adjusted single-breath diffusing capacity ( n = 2,508). Using multivariable linear regression, adjusted least-squares means (adj LS Means) were calculated for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity. The adj LS Means were expressed with and without height-cubed standardization and stratified by GLI-defined spirometry, including normal ( n = 1,251), restrictive pattern ( n = 663), and air-flow obstruction (mild, [ n = 128]; moderate, [ n = 150]; and severe, [ n = 394]). Relative to normal spirometry, restrictive-pattern had lower adj LS Means for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity ( P ≤ .001). Conversely, relative to normal spirometry, mild, moderate, and severe air-flow obstruction had higher adj LS Means for FRC and RV ( P < .001). However, only mild and moderate air-flow obstruction had higher adj LS Means for TLC ( P < .001), while only moderate and severe air-flow obstruction had higher adj LS Means for RV/TLC ( P < .001) and lower adj LS Means for hemoglobin-adjusted single-breath diffusing capacity ( P < .001). Notably, TLC (calculated as FRC + inspiratory capacity) was not increased in severe air-flow obstruction ( P ≥ .11

  10. Lung diffusion of soluble radioaerosols in scleroderma

    International Nuclear Information System (INIS)

    Chopra, S.K.; Taplin, G.V.; Tashkin, D.P.; Elam, D.

    1978-01-01

    Diffusion rates of soluble radioaerosols of sodium pertechnetate (/sup 99m/TcO 4 ; mol. wt. 163) and diethylentriaminepentaacetate (/sup 99m/Tc-DTPA; mol. wt. 492) were determined in ten normal subjects and ten patients with scleroderma having lung involvement. Twenty millicuries (mCi) each of /sup 99m/TcO 4 and /sup 99m/Tc-DTPA in 5 ml saline were aerosolized and inhaled on two different days. Initial lung retention after three minutes of administration was approximately 2 mCi. Two regions of interest over each posterior lung field were monitored with a scintillation camera and data were stored on magnetic tape. Decreasing levels of radioactivity were plotted semilogarithmically and half time (T 1 / 2 ) removal rates were calculated

  11. Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

    International Nuclear Information System (INIS)

    Lekic, Mirko; Kovac, Viljem; Triller, Nadja; Knez, Lea; Sadikov, Aleksander; Cufer, Tanja

    2012-01-01

    Small cell lung cancer (SCLC) represents approximately 13 to 18% of all lung cancers. It is the most aggressive among lung cancers, mostly presented at an advanced stage, with median survival rates of 10 to12 months in patients treated with standard chemotherapy and radiotherapy. In approximately 15-20% of patients brain metastases are present already at the time of primary diagnosis; however, it is unclear how much it influences the outcome of disease according the other metastatic localisation. The objective of this analysis was to evaluate the median survival of SCLC patients treated by specific therapy (chemotherapy and/or radiotherapy) with regard to the presence or absence of brain metastases at the time of diagnosis. All SCLC patients have been treated in a routine clinical practice and followed up at the University Clinic Golnik in Slovenia. In the retrospective study the medical files from 2002 to 2007 were review. All patients with cytological or histological confirmed disease and eligible for specific oncological treatment were included in the study. They have been treated according to the guidelines valid at the time. Chemotherapy and regular followed-up were carried out at the University Clinic Golnik and radiotherapy at the Institute of Oncology Ljubljana. We found 251 patients eligible for the study. The median age of them was 65 years, majority were male (67%), smokers or ex-smokers (98%), with performance status 0 to 1 (83%). At the time of diagnosis no metastases were found in 64 patients (25.5%) and metastases outside the brain were presented in 153 (61.0%). Brain metastases, confirmed by a CT scan, were present in 34 patients (13.5%), most of them had also metastases at other localisations. All patients received chemotherapy and all patients with confirmed brain metastases received whole brain irradiation (WBRT). The radiotherapy with radical dose at primary tumour was delivered to 27 patients with limited disease and they got 4–6 cycles of

  12. Diffusion-weighted imaging of brain metastases: their potential to be misinterpreted as focal ischaemic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Geijer, B. [Department of Radiology, University Hospital, Lund (Sweden); Holtaas, S. [Department of Diagnostic Imaging, King Fahd Hospital, Riyadh (Saudi Arabia)

    2002-07-01

    Small focal ischaemic brain lesions are said to be easy to identify in the acute stage and to differentiate from older lesions using diffusion-weighted imaging (DWI). Brain metastases are common and the aim of this study was to evaluate the risk of misinterpretation as ischaemic lesions in a standard MRI protocol for clinical stroke. Of 26 patients investigated with MRI for possible metastases, 12 did have metastatic brain lesions, including most of the common tumours. On a 1.5 tesla imager, we obtained DWI, plus T2- and T1-weighted images, the latter before and after triple-dose contrast medium. Well-circumscribed brain lesions with a decreased apparent diffusion coefficient and a slightly or moderately increased signal on T2-weighted images were found in patients with metastases from a small-cell bronchial carcinoma and a pulmonary adenocarcinoma. The same features were also found in metastases from a breast carcinoma but the lesions were surrounded by oedema. With a standard DWI protocol, the features of common brain metastases may overlap with those of small acute and subacute ischaemic lesions. (orig.)

  13. Pneumomediastinum as a complication of SABR for lung metastases

    International Nuclear Information System (INIS)

    Rodríguez-Ruiz, María Esperanza; Arévalo, Estefanía; Gil-Bazo, Ignacio; García, Alicia Olarte; Valtueña, German; Moreno-Jiménez, Marta; Arbea-Moreno, Leire; Aristu, Javier

    2015-01-01

    Stereotactic ablative body radiation (SABR) is a novel and sophisticated radiation modality that involves the irradiation of extracranial tumors through precise and very high doses in patients with oligometastatic lung disease and primary lung tumors. A 52-year-old female with subclinical idiopathic interstitial lung disease (ILD) and oligometastatic lung disease from squamous urethral cancer who was treated with SABR for a metastatic lesion located in the right lower pulmonary lobe. The patient received a hypo-fractionated course of SABR. A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A 48 Gy total dose in three fractions over six days was prescribed to the 95% of the PTV. The presence of idiopathic ILD and other identifiable underlying lung conditions were not taken into account as a constraint to prescribe a different than standard total dose or fractionation schedule. Six months after the SABR treatment, a CT-scan showed the presence of a pneumomediastinum with air outside the bronchial tree and within the subcutaneous tissue without co-existing pneumothorax. To our knowledge, this is the first case of pneumomediastinum appearing 6 months after SABR treatment for a lung metastasis located in the perihiliar/central tumors region as defined by the RTOG protocols as the proximal bronchial tree. Radiation oncologist should be aware of the potential risk of severe lung toxicity caused by SABR in patients with ILD, especially when chemotherapy-induced pulmonary toxicity is administered in a short time interval

  14. Isolated lung perfusion with gemcitabine for the treatment of pulmonary metastases : Experimental study in a rat model

    NARCIS (Netherlands)

    Putte, B.P. van

    2003-01-01

    Isolated lung perfusion is an experimental surgical technique for the treatment of pulmonary metastases in order to improve the current 5-year survival of approximately 40 % after surgical resection of manually palpable metastases. Several drugs have been tested in animals models and five phase I

  15. Invasive ductal carcinoma within fibroadenoma and lung metastases

    Science.gov (United States)

    Abu-Rahmeh, Zuhair; Nseir, William; Naroditzky, Inna

    2012-01-01

    Fibroadenomas are one of the most common benign tumors of the breast. Malignant transformation from fibroadenoma to cancer is rare. We present a case of an invasive ductal carcinoma within an otherwise benign fibroadenoma with lung metastasis in a 69-year-old woman. PMID:22259257

  16. Cerebral metastases from lung carcinoma: neurological and CT correlation: work in progress

    International Nuclear Information System (INIS)

    Tarver, R.D.; Richmond, B.D.; Klatte, E.C.

    1984-01-01

    To determine the role of brain CT in neurologically asymptomatic lung cancer patients a review was made of the CT and clinical findings in 279 patients. Brain metastases were found in 94.5% of patients with specific abnormal neurological findings, 26.6% of patients with vague neurological signs and symptoms, 11% of patients with oat cell carcinoma and a normal neurological examination, and 40% of patients with adenocarcinoma and a normal neurological examination. Brain metastasis was not seen on CT in the 29 patients with squamous cell carcinoma and a normal neurological examination. It is concluded that brain CT is useful for the detection of occult brain metastases, particularly oat cell carcinoma and adenocarcinoma, in neurologically asymptomatic lung cancer patients

  17. Microwave Ablation and Immune Activation in the Treatment of Recurrent Colorectal Lung Metastases: A Case Report

    Directory of Open Access Journals (Sweden)

    Magnus Bäcklund

    2017-04-01

    Full Text Available We present a patient with colorectal metastases confined to the lungs and treated with multiple resections until this was not an option anymore, followed by stereotactic body radiation therapy until this option was drained. Then, the patient was successfully treated with multiple microwave ablations combined with immunological activation targeting the programmed cell death 1 receptor (PD-1, possibly instigating a powerful abscopal effect. Techniques, doses, and radiological findings are presented.

  18. FDG-PET/CT finding of benign metastasizing leiomyoma of the lung

    International Nuclear Information System (INIS)

    Nakajo, Masatoyo; Nakayama, Hirofumi; Sato, Masayuki; Fukukura, Yoshihiko; Nakajo, Masayuki; Kajiya, Yoriko; Yanagi, Masakazu; Tabata, Kazuhiro; Higashi, Michiyo

    2012-01-01

    We report a case of multiple benign metastasizing leiomyoma (BML) lung nodules showing faint or non-avid uptake of F-18 fluorodeoxyglucose (FDG) (respective 1-hour early and 2-hour delayed maximum standardized uptake values; 1.3 or less and 1.2 or less) in a 50-year-old woman with a history of hysterectomy for uterine leiomyoma at the age of 38 years. When multiple lung nodules show faint or non-avid FDG uptake in a patient with a history of hysterectomy for uterine leiomyoma, BML should be included in the differential diagnosis

  19. Blocking Surgically Induced Lysyl Oxidase Activity Reduces the Risk of Lung Metastases

    Directory of Open Access Journals (Sweden)

    Chen Rachman-Tzemah

    2017-04-01

    Full Text Available Surgery remains the most successful curative treatment for cancer. However, some patients with early-stage disease who undergo surgery eventually succumb to distant metastasis. Here, we show that in response to surgery, the lungs become more vulnerable to metastasis due to extracellular matrix remodeling. Mice that undergo surgery or that are preconditioned with plasma from donor mice that underwent surgery succumb to lung metastases earlier than controls. Increased lysyl oxidase (LOX activity and expression, fibrillary collagen crosslinking, and focal adhesion signaling contribute to this effect, with the hypoxic surgical site serving as the source of LOX. Furthermore, the lungs of recipient mice injected with plasma from post-surgical colorectal cancer patients are more prone to metastatic seeding than mice injected with baseline plasma. Downregulation of LOX activity or levels reduces lung metastasis after surgery and increases survival, highlighting the potential of LOX inhibition in reducing the risk of metastasis following surgery.

  20. Quantitative stratification of diffuse parenchymal lung diseases.

    Directory of Open Access Journals (Sweden)

    Sushravya Raghunath

    Full Text Available Diffuse parenchymal lung diseases (DPLDs are characterized by widespread pathological changes within the pulmonary tissue that impair the elasticity and gas exchange properties of the lungs. Clinical-radiological diagnosis of these diseases remains challenging and their clinical course is characterized by variable disease progression. These challenges have hindered the introduction of robust objective biomarkers for patient-specific prediction based on specific phenotypes in clinical practice for patients with DPLD. Therefore, strategies facilitating individualized clinical management, staging and identification of specific phenotypes linked to clinical disease outcomes or therapeutic responses are urgently needed. A classification schema consistently reflecting the radiological, clinical (lung function and clinical outcomes and pathological features of a disease represents a critical need in modern pulmonary medicine. Herein, we report a quantitative stratification paradigm to identify subsets of DPLD patients with characteristic radiologic patterns in an unsupervised manner and demonstrate significant correlation of these self-organized disease groups with clinically accepted surrogate endpoints. The proposed consistent and reproducible technique could potentially transform diagnostic staging, clinical management and prognostication of DPLD patients as well as facilitate patient selection for clinical trials beyond the ability of current radiological tools. In addition, the sequential quantitative stratification of the type and extent of parenchymal process may allow standardized and objective monitoring of disease, early assessment of treatment response and mortality prediction for DPLD patients.

  1. Quantitative Stratification of Diffuse Parenchymal Lung Diseases

    Science.gov (United States)

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A.; Maldonado, Fabien; Peikert, Tobias; Moua, Teng; Ryu, Jay H.; Bartholmai, Brian J.; Robb, Richard A.

    2014-01-01

    Diffuse parenchymal lung diseases (DPLDs) are characterized by widespread pathological changes within the pulmonary tissue that impair the elasticity and gas exchange properties of the lungs. Clinical-radiological diagnosis of these diseases remains challenging and their clinical course is characterized by variable disease progression. These challenges have hindered the introduction of robust objective biomarkers for patient-specific prediction based on specific phenotypes in clinical practice for patients with DPLD. Therefore, strategies facilitating individualized clinical management, staging and identification of specific phenotypes linked to clinical disease outcomes or therapeutic responses are urgently needed. A classification schema consistently reflecting the radiological, clinical (lung function and clinical outcomes) and pathological features of a disease represents a critical need in modern pulmonary medicine. Herein, we report a quantitative stratification paradigm to identify subsets of DPLD patients with characteristic radiologic patterns in an unsupervised manner and demonstrate significant correlation of these self-organized disease groups with clinically accepted surrogate endpoints. The proposed consistent and reproducible technique could potentially transform diagnostic staging, clinical management and prognostication of DPLD patients as well as facilitate patient selection for clinical trials beyond the ability of current radiological tools. In addition, the sequential quantitative stratification of the type and extent of parenchymal process may allow standardized and objective monitoring of disease, early assessment of treatment response and mortality prediction for DPLD patients. PMID:24676019

  2. Spontaneous pneumothorax in diffuse cystic lung diseases.

    Science.gov (United States)

    Cooley, Joseph; Lee, Yun Chor Gary; Gupta, Nishant

    2017-07-01

    Diffuse cystic lung diseases (DCLDs) are a heterogeneous group of disorders with varying pathophysiologic mechanisms that are characterized by the presence of air-filled lung cysts. These cysts are prone to rupture, leading to the development of recurrent spontaneous pneumothoraces. In this article, we review the epidemiology, clinical features, and management DCLD-associated spontaneous pneumothorax, with a focus on lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome, and pulmonary Langerhans cell histiocytosis. DCLDs are responsible for approximately 10% of apparent primary spontaneous pneumothoraces. Computed tomography screening for DCLDs (Birt-Hogg-Dubé syndrome, lymphangioleiomyomatosis, and pulmonary Langerhans cell histiocytosis) following the first spontaneous pneumothorax has recently been shown to be cost-effective and can help facilitate early diagnosis of the underlying disorders. Patients with DCLD-associated spontaneous pneumothorax have a very high rate of recurrence, and thus pleurodesis should be considered following the first episode of spontaneous pneumothorax in these patients, rather than waiting for a recurrent episode. Prior pleurodesis is not a contraindication to future lung transplant. Although DCLDs are uncommon, spontaneous pneumothorax is often the sentinel event that provides an opportunity for diagnosis. By understanding the burden and implications of pneumothoraces in DCLDs, clinicians can facilitate early diagnosis and appropriate management of the underlying disorders.

  3. Differential diagnosis and cancer staging of a unique case with multiple nodules in the lung - lung adenocarcinoma, metastasis of colon adenocarcinoma, and colon adenocarcinoma metastasizing to lung adenocarcinoma.

    Science.gov (United States)

    Bai, Yun; Qiu, Jianxing; Shang, Xueqian; Liu, Ping; Zhang, Ying; Wang, Ying; Xiong, Yan; Li, Ting

    2015-05-01

    Lung cancer is the most common cancer in the world. Despite this, there have been few cases of simultaneous primary and metastatic cancers in the lung reported, let alone coexisting with tumor-to-tumor metastasis. Herein, we describe an extremely unusual case. A 61-year-old man with a history of colon adenocarcinoma was revealed as having three nodules in the lung 11 months after colectomy. The nodule in the left upper lobe was primary lung adenocarcinoma, the larger one in the right upper lobe was a metastasis of colon adenocarcinoma, and the smaller one in the right upper lobe was colon adenocarcinoma metastasizing to lung adenocarcinoma. Our paper focused on the differential diagnosis and cancer staging of this unique case, and discussed the uncommon phenomenon of the lung acting as a recipient in tumor-to-tumor metastasis.

  4. Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch® patient registry

    International Nuclear Information System (INIS)

    Davis, Joanne N.; Medbery, Clinton; Sharma, Sanjeev; Pablo, John; Kimsey, Frank; Perry, David; Muacevic, Alexander; Mahadevan, Anand

    2015-01-01

    The purpose of this study was to evaluate treatment patterns and outcomes of stereotactic body radiotherapy (SBRT) for centrally located primary non-small cell lung cancer (NSCLC) or lung metastases from the RSSearch ® Patient Registry, an international, multi-center patient registry dedicated to radiosurgery and SBRT. Eligible patients included those with centrally located lung tumors clinically staged T1-T2 N0, M0, biopsy-confirmed NSCLC or lung metastases treated with SBRT between November 2004 and January 2014. Descriptive analysis was used to report patient demographics and treatment patterns. Overall survival (OS) and local control (LC) were determined using Kaplan-Meier method. Toxicity was reported using the Common Terminology Criteria for Adverse Events version 3.0. In total, 111 patients with 114 centrally located lung tumors (48 T1-T2,N0,M0 NSCLC and 66 lung metastases) were treated with SBRT at 19 academic and community-based radiotherapy centers in the US and Germany. Median follow-up was 17 months (range, 1–72). Median age was 74 years for primary NSCLC patients and 65 years for lung metastases patients (p < 0.001). SBRT dose varied from 16 – 60 Gy (median 48 Gy) delivered in 1–5 fractions (median 4 fractions). Median dose to centrally located primary NSCLC was 48 Gy compared to 37.5 Gy for lung metastases (p = 0.0001) and median BED 10 was 105.6 Gy for primary NSCLC and 93.6 Gy for lung metastases (p = 0.0005). Two-year OS for T1N0M0 and T2N0M0 NSCLC was 79 and 32.1 %, respectively (p = 0.009) and 2-year OS for lung metastases was 49.6 %. Two-year LC was 76.4 and 69.8 % for primary NSCLC and lung metastases, respectively. Toxicity was low with no Grade 3 or higher acute or late toxicities. Overall, patients with centrally located primary NSCLC were older and received higher doses of SBRT than those with lung metastases. Despite these differences, LC and OS was favorable for patients with central lung tumors treated with SBRT. Reported toxicity

  5. Intracrainal metastases of lung cancer -CT and histopathologic correlation-

    International Nuclear Information System (INIS)

    Park, Hyun Ju; Kim, Myung Soon; Kang, Myung Jae

    1991-01-01

    The authors retrospectively analyzed high resolution (HR) CT scans of the brain in 23 patients with surgically proved primary lung cancer and intracranial metastatic lesions from April 1986 to March 1990. The purpose of this study was to evaluate the relationship between histopathologic types of primary lung cancer and HRCT findings of brain. The results were as follows: The locations of metastatic lesion were intraaxial in 93% and extraaxial in 7%. In the intraaxial lesions, most were in the supratentorial area (83%) and the remainer in the infratentorial area (10%). Among the supratentorial lesions, the parietal lobe was the most commonly involved (33%), while the second most common location was frontal lobe (22%). The HRCT showed multiple lesions in 52% and solitary lesions in 48%. All cell types except for squamous cell carcinoma showed the same incidence in multiplicity, and the squamous cell carcinoma showed slightly more multiple lesions rather than solitary ones. The degree of peritumoral edema was none in 4%, mild in 25%, moderate in 46%, and severe in 25%. All cell types except for squamous cell carcinoma in general showed a moderate degree of edema, and the squamous cell carcinoma mainly showed mild and severe edema. Precontrast CT scans showed mixed density in 52%, isodensity in 24%, low density in 19%, and high density in 5%. All cell types except for large cell carcinoma showed mixed density, the large cell carcinoma showed a low density unlike the others. Hemorrhages were seen in 24% and noted in all cell types except for large cell carcinoma. Postcontrast CT scans showed ring enhancement in 64%, nodular enhancement in 20%, and inhomogeneous enhancement in 16%. All cell types except for small cell carcinoma generally showed ring enhancement, and the small cell carcinoma showed a variable degree of enhancement

  6. Efficacy and safety of icotinib in patients with brain metastases from lung adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Xu J

    2016-05-01

    Full Text Available Jianping Xu, Xiaoyan Liu, Sheng Yang, Xiangru Zhang, Yuankai Shi Department of Internal Medicine, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: The objective of this study was to evaluate the efficacy and safety of icotinib in patients with brain metastases (BMs from lung adenocarcinoma.Patients and methods: Clinical data of 28 cases with BMs from lung adenocarcinoma were retrospectively analyzed. All the patients took 125 mg icotinib orally three times a day. Progression of disease, intolerable adverse reactions, and number of deaths were recorded.Results: For all the patients, the remission rate of icotinib was 67.8% and the disease control rate was 96.4%. The median overall survival time of patients was 21.2 months, and the median progression-free survival time of patients was 10.9 months. Only mild adverse events of grade 1/2 were observed during the treatment.Conclusion: Icotinib was an effective and safe strategy to treat patients with BMs from lung adenocarcinoma.Keywords: icotinib, lung adenocarcinoma, brain metastases 

  7. Argon-plasma treatment in benign metastasizing leiomyoma of the lung: A case report

    Directory of Open Access Journals (Sweden)

    A. Bugalho

    2010-11-01

    Full Text Available Benign metastasizing leiomyomas of the lung are rare smooth muscle cells tumours. We report the case of a 48 year-old female who was evaluated due to persistent cough, progressive dyspnoea and constitutional symptoms. Chest computed tomography revealed a left endobronchial mass, multiple parenchyma nodules and a pleural effusion. Bronchial biopsy histological features were consistent with benign metastasizing leiomyoma. The patient was successfully treated with argon-plasma and mechanical debulking. There was no disease relapse in the last four years. Resumo: Os leiomiomas benignos metastizantes pulmonares são tumores raros de células musculares lisas. Uma doente de 48 anos foi avaliada devido a tosse persistente, dispneia progressiva e sintomas constitucionais. A tomografia computorizada do tórax revelou uma massa endobrônquica à esquerda, múltiplos nódulos do parênquima pulmonar e derrame pleural. As características histológicas da biopsia brônquica foram consistentes com o diagnóstico de leiomioma benigno metastizante. A doente foi submetida a coagulação árgon-plasma e desobstrução mecânica com eficácia terapêutica. Verificou-se estabilidade clínica nos últimos quatro anos. Keywords: Benign metastasizing leiomyoma, Lung neoplasms, Diagnosis, Bronchoscopy, Management, Argon-plasma treatment, Palavras-chave: Leiomioma benigno metastizante, Neoplasias pulmonares, Diagnóstico, Broncoscopia, Tratamento, Tratamento árgon-plasma

  8. Lung volume reduction surgery for diffuse emphysema.

    Science.gov (United States)

    van Agteren, Joseph Em; Carson, Kristin V; Tiong, Leong Ung; Smith, Brian J

    2016-10-14

    Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to resect damaged emphysematous lung tissue, thereby increasing elastic properties of the lung. This treatment is hypothesised to improve long-term daily functioning and quality of life, although it may be costly and may be associated with risks of morbidity and mortality. Ten years have passed since the last version of this review was prepared, prompting us to perform an update. The objective of this review was to gather all available evidence from randomised controlled trials comparing the effectiveness of lung volume reduction surgery (LVRS) versus non-surgical standard therapy in improving health outcomes for patients with severe diffuse emphysema. Secondary objectives included determining which subgroup of patients benefit from LVRS and for which patients LVRS is contraindicated, to establish the postoperative complications of LVRS and its morbidity and mortality, to determine which surgical approaches for LVRS are most effective and to calculate the cost-effectiveness of LVRS. We identified RCTs by using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register, in addition to the online clinical trials registers. Searches are current to April 2016. We included RCTs that studied the safety and efficacy of LVRS in participants with diffuse emphysema. We excluded studies that investigated giant or bullous emphysema. Two independent review authors assessed trials for inclusion and extracted data. When possible, we combined data from more than one study in a meta-analysis using RevMan 5 software. We identified two new studies (89 participants) in this updated review. A total of 11 studies (1760 participants) met the entry criteria of the review, one of which accounted for 68% of recruited participants. The quality of evidence ranged from low to moderate owing to an unclear risk

  9. Stereotactic body radiotherapy for lung metastases as oligo-recurrence: a single institutional study.

    Science.gov (United States)

    Aoki, Masahiko; Hatayama, Yoshiomi; Kawaguchi, Hideo; Hirose, Katsumi; Sato, Mariko; Akimoto, Hiroyoshi; Miura, Hiroyuki; Ono, Shuichi; Takai, Yoshihiro

    2016-01-01

    The purpose of this study was to investigate clinical outcomes following stereotactic body radiotherapy (SBRT) for lung metastases as oligo-recurrence. From May 2003 to June 2014, records for 66 patients with 76 oligo-recurrences in the lungs treated with SBRT were retrospectively reviewed. Oligo-recurrence primary sites and patient numbers were as follows: lungs, 31; colorectal, 13; head and neck, 10; esophagus, 3; uterus, 3; and others, 6. The median SBRT dose was 50 Gy (range, 45-60 Gy) administered in a median of 5 (range, 5-9) fractions. All patients received SBRT, with no acute toxicity. Surviving patients had a median follow-up time of 36.5 months. The 3-year rates of local control, overall survival and disease-free survival were 90.6%, 76.0% and 53.7%, respectively. Longer disease-free interval from initial treatment to SBRT, and non-colorectal cancer were both associated with favorable outcomes. Disease progression after SBRT occurred in 31 patients, most with distant metastases (n = 24) [among whom, 87.5% (n = 21) had new lung metastases]. Among these 21 patients, 12 were judged as having a second oligo-recurrence. Additional SBRT was performed for these 12 patients, and all 12 tumors were controlled without disease progression. Three patients (4.5%) developed Grade 2 radiation pneumonitis. No other late adverse events of Grade ≥2 were identified. Thus, SBRT for oligo-recurrence achieved acceptable tumor control, with additional SBRT also effective for selected patients with a second oligo-recurrence after primary SBRT. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  10. Analysis of diffuse gallium lung uptake

    International Nuclear Information System (INIS)

    Harada, Masahumi; Sui, Osamu; Mukaijo, Toshihumi; Tokuyama, Noritami; Tanouchi, Miki; Kitsukawa, Kaoru

    1989-01-01

    Diffuse lung uptake of Ga-67 was observed on scintigrams in 56 patients. It was considered attributable to drugs in 21 patients. Only 7 patients complained of fever, cough, and dyspnea, 5 of whom spontaneously recovered without any treatment. This seemed to reflect clinically reversible cases, as well as to support the usefulness of Ga-67 scintigraphy in early detection of drug-induced pneumonitis. In one patient that died of acute pneumonitis, only a small amount of cyclophosphamide (3,400 mg) had been administered. Drug dosage seemed to be unrelated to the prognosis of drug-induced pneumonitis. Seventeen patients underwent Ga-67 scintigraphy within one month after the completion of chemotherapy. The most frequently given dosage of cyclophosphamide was 2,000 mg or less. In early detecting drug-induced pneumonitis, the optimum time of Ga-67 scintigraphy was considered to be the first one month after completion of chemotherapy. (Namekawa, K)

  11. Efficacy and safety of icotinib in patients with brain metastases from lung adenocarcinoma.

    Science.gov (United States)

    Xu, Jianping; Liu, Xiaoyan; Yang, Sheng; Zhang, Xiangru; Shi, Yuankai

    2016-01-01

    The objective of this study was to evaluate the efficacy and safety of icotinib in patients with brain metastases (BMs) from lung adenocarcinoma. Clinical data of 28 cases with BMs from lung adenocarcinoma were retrospectively analyzed. All the patients took 125 mg icotinib orally three times a day. Progression of disease, intolerable adverse reactions, and number of deaths were recorded. For all the patients, the remission rate of icotinib was 67.8% and the disease control rate was 96.4%. The median overall survival time of patients was 21.2 months, and the median progression-free survival time of patients was 10.9 months. Only mild adverse events of grade 1/2 were observed during the treatment. Icotinib was an effective and safe strategy to treat patients with BMs from lung adenocarcinoma.

  12. Analysis of outcome in patients irradiated for brain metastases of lung (no oatcell) cancer

    International Nuclear Information System (INIS)

    Lione, Marcelo; Tissera, Norberto

    2004-01-01

    Purpose: To correlate our findings with those of the international literature and identify the factors related to survival. Material and methods: Fifty patients with central nervous system metastases of non-small cell lung cancer were evaluated. Holocranial radiotherapy was performed with a daily dose of 1.8 Gy and a total dose of 50.4 Gy. Results: Overall survival of all patients at 6 months, 1 year and 2 years was 37%, 27% and 5% respectively. Mean survival was 5 months; 9 months for the group with a favorable outcome and 4 months for the group with an unfavorable outcome. Conclusion: The results are similar to those published in the international literature. Factors that relate to survival are: age, performance status, and the presence or absence of metastases in other sites. (author)

  13. Pathological vertebral fracture after stereotactic body radiation therapy for lung metastases. Case report and literature review.

    Directory of Open Access Journals (Sweden)

    Rodríguez-Ruiz María

    2012-03-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT is a radiation technique used in patients with oligometastatic lung disease. Lung and chest wall toxicities have been described in the patients but pathological vertebral fracture is an adverse effect no reported in patients treated with SBRT for lung metastases. Case presentation A 68-year-old woman with the diagnosis of a recurrence of a single lung metastatic nodule of urothelial carcinoma after third line of chemotherapy. The patient received a hypo-fractionated course of SBRT.A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A total dose of 48 Gy in three fractions over six days was prescribed to the 95% of the CTV. Ten months after the SBRT procedure, a CT scan showed complete response of the metastatic disease without signs of radiation pneumonitis. However, rib and vertebral bone toxicities were observed with the fracture-collapse of the 7th and 8th vertebral bodies and a fracture of the 7th and 8th left ribs. We report a unique case of pathological vertebral fracture appearing ten months after SBRT for an asymptomatic growing lung metastases of urothelial carcinoma. Conclusion Though SBRT allows for minimization of normal tissue exposure to high radiation doses SBRT tolerance for vertebral bone tissue has been poorly evaluated in patients with lung tumors. Oncologists should be alert to the potential risk of fatal bone toxicity caused by this novel treatment. We recommend BMD testing in all woman over 65 years old with clinical risk factors that could contribute to low BMD. If low BMD is demonstrated, we should carefully restrict the maximum radiation dose in the vertebral body in order to avoid intermediate or low radiation dose to the whole vertebral body.

  14. Clinical outcome of hypofractionated breath-hold image-guided SABR of primary lung tumors and lung metastases

    International Nuclear Information System (INIS)

    Boda-Heggemann, Judit; Wenz, Frederik; Lohr, Frank; Frauenfeld, Anian; Weiss, Christel; Simeonova, Anna; Neumaier, Christian; Siebenlist, Kerstin; Attenberger, Ulrike; Heußel, Claus Peter; Schneider, Frank

    2014-01-01

    Stereotactic Ablative RadioTherapy (SABR) of lung tumors/metastases has been shown to be an effective treatment modality with low toxicity. Outcome and toxicity were retrospectively evaluated in a unique single-institution cohort treated with intensity-modulated image-guided breath-hold SABR (igSABR) without external immobilization. The dose–response relationship is analyzed based on Biologically Equivalent Dose (BED). 50 lesions in 43 patients with primary NSCLC (n = 27) or lung-metastases of various primaries (n = 16) were consecutively treated with igSABR with Active-Breathing-Coordinator (ABC®) and repeat-breath-hold cone-beam-CT. After an initial dose-finding/-escalation period, 5x12 Gy for peripheral lesions and single doses of 5 Gy to varying dose levels for central lesions were applied. Overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC) and toxicity were analyzed. The median BED2 was 83 Gy. 12 lesions were treated with a BED2 of <80 Gy, and 38 lesions with a BED2 of >80 Gy. Median follow-up was 15 months. Actuarial 1- and 2-year OS were 67% and 43%; respectively. Cause of death was non-disease-related in 27%. Actuarial 1- and 2-year PFS was 42% and 28%. Progression site was predominantly distant. Actuarial 1- and 2 year LC was 90% and 85%. LC showed a trend for a correlation to BED2 (p = 0.1167). Pneumonitis requiring conservative treatment occurred in 23%. Intensity-modulated breath-hold igSABR results in high LC-rates and low toxicity in this unfavorable patient cohort with inoperable lung tumors or metastases. A BED2 of <80 Gy was associated with reduced local control

  15. Is diffusion-weighted MRI sufficient for follow-up of neuroendocrine tumour liver metastases?

    International Nuclear Information System (INIS)

    Lavelle, L.P.; O'Neill, A.C.; McMahon, C.J.; Cantwell, C.P.; Heffernan, E.J.; Malone, D.E.; Daly, L.; Skehan, S.J.

    2016-01-01

    Aim: To assess if diffusion-weighted imaging (DWI) alone could be used for follow-up of neuroendocrine hepatic metastases. Material and methods: This was a retrospective study, approved by the institutional review board. Twenty-two patients with neuroendocrine liver metastases who had undergone more than one liver magnetic resonance imaging (MRI) examination, (including DWI and using hepatocyte-specific contrast medium) were evaluated. Up to five metastases were measured at baseline and at each subsequent examination. The reference standard measurement was performed on the hepatocyte phase by one reader. Three independent readers separately measured the same lesions on DWI sequences alone, blinded to other sequences, and recorded the presence of any new lesions. Results: The longest diameters of 317 liver metastases (91 on 22 baseline examinations and a further 226 measurements on follow-up) were measured on the reference standard by one reader and on three b-values by three other readers. The mean difference between DWI measurements and the reference standard measurement was between 0.01–0.08 cm over the nine reader/b-value combinations. Based on the width of the Bland and Altman interval containing approximately 95% of the differences between the reader observation and the mean of reference standard and DWI measurement, the narrowest interval over the nine reader/b-value combinations was −0.6 to +0.7 cm and the widest was −0.9 to 1 cm. In the evaluation of overall response using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, the weighted kappa statistic was between 0.49 and 0.86, indicating moderate-to-good agreement between the reference standard and DWI. Conclusion: The visualisation and measurement of hepatic metastases using DWI alone are within acceptable limits for clinical use, allowing the use of this rapid technique to restage hepatic disease in patients with neuroendocrine metastases. - Highlights: • DWI showed excellent

  16. Icotinib as initial treatment in lung adenocarcinoma patients with brain metastases.

    Science.gov (United States)

    Xu, Jian-Ping; Liu, Xiao-Yan; Yang, Sheng; Zhang, Chang-Gong; Wang, Lin; Shi, Yuan-Kai

    2016-07-01

    To evaluate the antitumor activity and toxicity of icotinib as initial treatment in lung adenocarcinoma patients with brain metastases. Twenty-one patients with histologically or pathologically documented brain metastatic lung cancer were administered icotinib as initial treatment from 2011 to 2015 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences. Chemotherapy response was assessed by Response Evaluation Criteria in Solid Tumors and toxicity was evaluated according to National Cancer Institute-Common Toxicity Criteria. Icotinib was administered three times per day at a dose of 125mg. The median overall and progression-free survival rates were 15.2 (1.2-31.5 months, 95% confidence interval [CI] 6.6-23.7 months) and 8.9 months (0.6-30.5 months, 95% CI 3.4-14.3 months), respectively. The overall response and disease control rates were 61.9% and 90.5%, respectively. Icotinib was well tolerated, and no grade 3/4 adverse events were observed. The most common grade 1/2 adverse events included acneiform eruptions (38.1%), diarrhea (19.0%), and stomatitis (9.5%). Icotinib is effective and well tolerated as initial treatment in lung adenocarcinoma patients with brain metastases.

  17. Repeated diffusion MRI reveals earliest time point for stratification of radiotherapy response in brain metastases

    DEFF Research Database (Denmark)

    Mahmood, Faisal; Johannesen, Helle H; Geertsen, Poul

    2017-01-01

    An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later. In this prospect......An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later....... In this prospective study we investigated the apparent diffusion coefficient (ADC), perfusion fraction and pseudo diffusion coefficient derived from diffusion weighted MRI as potential early biomarkers for radiotherapy response of brain metastases. It was a particular aim to assess the optimal time point...

  18. Diffuse lung neoplasms. Correlation between high resolution computerized tomography and anatomopathology; Neoplasias pulmonares difusas: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia; Irion, Klaus L. [Complexo Hospitalar Santa Casa de Porto Alegre, RS (Brazil). Servico de Radiologia do Pavilhao Pereira Filho; Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto, SP (Brazil)]. E-mail: edmarchiori@zipmail.com.br

    2002-08-01

    A short comparative evaluation study between high resolution computerized tomography and anatomopathologic findings is presented. The association of these two diagnostic techniques is discussed as a factor to enhance the accuracy of diffuse lung diseases, such as carcinomatous lymphangitis, Kaposi's Sarcoma, lymphomas, hematogenic metastases, bronchiole-alveolar carcinoma and leukemia. (MAC)

  19. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease.

    Directory of Open Access Journals (Sweden)

    Jonathan A Kropski

    Full Text Available Although in some cases clinical and radiographic features may be sufficient to establish a diagnosis of diffuse parenchymal lung disease (DPLD, surgical lung biopsy is frequently required. Recently a new technique for bronchoscopic lung biopsy has been developed using flexible cryo-probes. In this study we describe our clinical experience using bronchoscopic cryobiopsy for diagnosis of diffuse lung disease.A retrospective study of subjects who had undergone bronchoscopic cryobiopsy for evaluation of DPLD at an academic tertiary care center from January 1, 2012 through January 15, 2013 was performed. The procedure was performed using a flexible bronchoscope to acquire biopsies of lung parenchyma. H&E stained biopsies were reviewed by an expert lung pathologist.Twenty-five eligible subjects were identified. With a mean area of 64.2 mm(2, cryobiopsies were larger than that typically encountered with traditional transbronchial forceps biopsy. In 19 of the 25 subjects, a specific diagnosis was obtained. In one additional subject, biopsies demonstrating normal parenchyma were felt sufficient to exclude diffuse lung disease as a cause of dyspnea. The overall diagnostic yield of bronchoscopic cryobiopsy was 80% (20/25. The most frequent diagnosis was usual interstitial pneumonia (UIP (n = 7. Three of the 25 subjects ultimately required surgical lung biopsy. There were no significant complications.In patients with suspected diffuse parenchymal lung disease, bronchoscopic cryobiopsy is a promising and minimally invasive approach to obtain lung tissue with high diagnostic yield.

  20. Recurrently Mutated Genes Differ between Leptomeningeal and Solid Lung Cancer Brain Metastases.

    Science.gov (United States)

    Li, Yingmei; Liu, Boxiang; Connolly, Ian David; Kakusa, Bina Wasunga; Pan, Wenying; Nagpal, Seema; Montgomery, Stephen B; Hayden Gephart, Melanie

    2018-03-29

    When compared with solid brain metastases from NSCLC, leptomeningeal disease (LMD) has unique growth patterns and is rapidly fatal. Patients with LMD do not undergo surgical resection, limiting the tissue available for scientific research. In this study we performed whole exome sequencing on eight samples of LMD to identify somatic mutations and compared the results with those for 26 solid brain metastases. We found that taste 2 receptor member 31 gene (TAS2R31) and phosphodiesterase 4D interacting protein gene (PDE4DIP) were recurrently mutated among LMD samples, suggesting involvement in LMD progression. Together with a retrospective review of the charts of an additional 44 patients with NSCLC LMD, we discovered a surprisingly low number of KRAS mutations (n = 4 [7.7%]) but a high number of EGFR mutations (n = 33 [63.5%]). The median interval for development of LMD from NSCLC was shorter in patients with mutant EGFR (16.3 months) than in patients with wild-type EGFR (23.9 months) (p = 0.017). Targeted analysis of recurrent mutations thus presents a useful complement to the existing diagnostic tool kit, and correlations of EGFR in LMD and KRAS in solid metastases suggest that molecular distinctions or systemic treatment pressure underpin the differences in growth patterns within the brain. Copyright © 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  1. An active treatment of lung adenocarcinoma cancer with brain metastases: icotinib

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-06-01

    Full Text Available Ying Zhang, Huaping Tang, Jun Li, Meng Li Department of Respiration Medicine, Municipal Hospital, Qingdao, People’s Republic of China Abstract: Lung cancer has the highest mortality rate of all cancers world­wide. A total of 70%–75% of all lung cancers are non-small cell lung cancer (NSCLC with two-thirds presenting with locally advanced or metastatic disease at diagnosis. Brain metastasis is one of the most common problems in the management of NSCLC, worsening the prognosis and quality of life of NSCLC patients. The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs gefitinib and erlotinib have been tested in patients with NSCLC and brain metastasis. Icotinib is a new type of oral EGFR-TKI. In this report, we describe a patient with lung adenocarcinoma cancer with brain metastases who received icotinib treatment and kept satisfactory health-related quality of life for 1 year. Keywords: EGFR, non-small cell lung cancer, tyrosine kinase inhibitor

  2. Thoracoscopic surgery for pulmonary metastases after chemotherapy using a tailor-made virtual lung

    International Nuclear Information System (INIS)

    Akiba, Tadashi; Marushima, Hideki; Kinoshita, Satoki; Kamiya, Noriteru; Odaka, Makoto; Takeyama, Hiroshi; Morikawa, Toshiaki

    2011-01-01

    Details with regard to the standard criteria for a therapeutic metastasectomy and the use of video-assisted thoracic surgery (VATS) remain elusive. To evaluate the feasibility of VATS using a tailor-made virtual lung for patients with pulmonary metastases after chemotherapy, we reviewed the following cases. Clinical data from October 2006 to April 2010 were obtained from patients who received chemotherapy before a pulmonary metastasectomy (lobectomy or segmentectomy). VATS was the primarily selected surgical approach except for treating hilar lesions. A lobectomy was performed when the metastasis was greater than 3.0 cm in diameter or located deeply in the lobe. Tailor-made virtual lungs were created using three-dimensional multidetector computed tomography before lobectomy on a routine basis. The virtual lung consisted of three-dimensional pulmonary vessels, a tracheobronchial tree, pulmonary parenchyma, and tumors. Twelve operations, consisting of 1 segmentectomy, 10 lobectomies, and 1 wedge bronchoplasty upper lobectomy, were performed on 11 patients during the study period. VATS was completed in 10 of these 12 operations. The mean operative time for the lobectomies was 257 min, and the mean operative bleeding volume was 215 ml. Two cases experienced postoperative transient atrial fibrillation, and no mortalities associated with these operations were reported. VATS was performed safely in instances of metastasectomy after chemotherapy, and the tailor-made virtual lung assisted in lung orientation during the operation. (author)

  3. [Benign Metastasizing Leiomyoma of the Lung;Report of a Case].

    Science.gov (United States)

    Sawada, Takahiro; Yamamoto, Satoshi; Sugihara, Hajime; Iwasaki, Akinori

    2017-02-01

    A 71-year-old woman, in whom computed tomography revealed a solitary mass shadow at the base of the left lung, underwent resection of the mass. Histopathological examination showed estrogen receptor-positive leiomyoma cells growing in cords and mixed with glandular structures composed of alveolar cells. These findings led to a diagnosis of benign metastatic leiomyoma. Benign metastatic leiomyoma is a rare disease in which histologically benign uterine leiomyoma cells metastasize to different sites of the body. However, in this patient, the presence of uterine myoma was not confirmed in the past or at present. She had a history of cervical conization, which suggests that a small amount of the leiomyoma component contained in cervical tissue may have been forced into blood vessels during surgical manipulation, causing lung metastasis.

  4. The role of 18F-FDG PET in the differentiation between lung metastases and synchronous second primary lung tumours

    International Nuclear Information System (INIS)

    Dijkman, Bernadette G.; Schuurbiers, Olga C.J.; Heijden, Henricus F.M. van der; Vriens, Dennis; Oyen, Wim J.G.; Geus-Oei, Lioe-Fee de; Looijen-Salamon, Monika; Bussink, Johan; Timmer-Bonte, Johanna N.H.; Snoeren, Miranda M.

    2010-01-01

    In lung cancer patients with multiple lesions, the differentiation between metastases and second primary tumours has significant therapeutic and prognostic implications. The aim of this retrospective study was to investigate the potential of 18 F-FDG PET to discriminate metastatic disease from second primary lung tumours. Of 1,396 patients evaluated by the thoracic oncology group between January 2004 and April 2009 at the Radboud University Nijmegen Medical Centre, patients with a synchronous second primary lung cancer were selected. Patients with metastatic disease involving the lungs served as the control group. Maximum standardized uptake values (SUVs) measured with 18 F-FDG PET were determined for two tumours in each patient. The relative difference between the SUVs of these tumours (∇SUV) was determined and compared between the second primary group and metastatic disease group. Receiver-operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of the ∇SUV for an optimal cut-off value. A total of 37 patients (21 metastatic disease, 16 second primary cancer) were included for analysis. The ∇SUV was significantly higher in patients with second primary cancer than in those with metastatic disease (58 vs 28%, respectively, p 18 F-FDG PET images can be helpful in differentiating metastatic disease from second primary tumours in patients with synchronous pulmonary lesions. Further studies are warranted to confirm the consistency of these results. (orig.)

  5. Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: An autopsy study

    Directory of Open Access Journals (Sweden)

    Ivana Savic Milovanovic

    2017-01-01

    Conclusions: While, overall, the most frequent hematogenous metastases occur in the liver and adrenal glands, various histological types of lung cancer show specific dissemination patterns. Knowing distribution of metastases is essential for making algorithms of treatment, as well as for improving clinical assessment of the patients with unclear clinical findings and suspicion on occult primary lung cancer.

  6. Prolonged survival after resection and radiotherapy for solitary brain metastases from non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Chee, R. J.; Bydder, S.; Cameron, F.

    2007-01-01

    Selected patients with brain metastases from non-small-cell lung cancer benefit from aggressive treatment. This report describes three patients who developed solitary brain metastases after previous resection of primary adenocarcinoma of the lung. Each underwent surgical resection of their brain metastasis followed by cranial irradiation and remain disease free 10 or more years later. Two patients developed cognitive impairment approximately 8 years after treatment of their brain metastasis, which was felt to be due to their previous brain irradiation. Here we discuss the treatment of solitary brain metastasis, particularly the value of combined method approaches in selected patients and dose-volume considerations

  7. Value of diffusion - weighted magnetic resonance imaging in the assessment of bone marrow in vertebral metastases

    International Nuclear Information System (INIS)

    Herneth, A.M.; Philipp, M.; Trattnig, S.; Imhof, H.; Naude, J.; Beichel, R.

    2000-01-01

    Aim of the study. The aim of the study was the evaluation of the diffusion coefficient (ADC) of vertebral metastasis and regular vertebral bodies with diffusion weighted MRI (DWI). DWI evaluates the tissue-specific molecular diffusion of protons. In tissues with high cell densities (neoplasm) a decreased ADC can be expected due to restricted diffusion according to an exaggerated amount of intra- and intercellular membranes (i.e. diffusion barriers). Methods. In 5 breast cancer patients the ADC of both known vertebral metastases and of adjacent regular vertebral bodies were measured with DWI (1.0 T; Phased-Array-Body-Coil; b: 880 and 440 s/mm 2 ). Results. The ADC of regular vertebral bodies (1.3±0.23x10 -3 s/mm 2 ) was significantly (p -3 s/mm 2 ). Conclusions. These data demonstrate that the ADC can be reliably measured in vertebral bodies. The quantitative evaluation of the ADC in vertebral bodies seems to be an objective and comparable parameter for differentiating malign from benign vertebral tissue. (orig.) [de

  8. Detection of skeletal muscle metastases on initial staging of lung cancer: a retrospective case series.

    Science.gov (United States)

    Bocchino, Marialuisa; Valente, Tullio; Somma, Francesco; de Rosa, Ilaria; Bifulco, Marco; Rea, Gaetano

    2014-03-01

    Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial staging of lung cancer. Retrospective evaluation of clinical charts and imaging data suggestive of SMMs of patients with histology-proved lung cancer over a 5-year period. SMMs were identified in 46 out of 1,754 patients. Single and multiple (62.9% of cases) SMMs were detected by total body multi-detector computed tomography (MDCT). They were associated with poorly differentiated (43%) and advanced adenocarcinomas (52%) without clinically relevant symptoms and/or signs. Psoas and buttock muscles were most frequently involved (33.3%). MDCT findings consisted of well-defined homogeneously hyperdense oval masses (31%), lesions with ring-like enhancement and central hypoattenuation (68%), or large abscess-like necrotic lesions (24%). Sonography revealed well-defined hypoechoic masses (41.6%), ill-defined hypoechoic lesions (33.3%), or anechoic areas with a necrotic centre (25%). Positron emission tomography revealed that all SMMs were metabolically active. SMMs are uncommon but not negligible in lung cancer, with an estimated prevalence of 2.62% in our series. Although histology remains the recommended method, use of high-performance imaging techniques and increased clinical suspicion may improve their early detection. Efforts addressing their effect on the natural history of lung cancer are needed.

  9. A case of lung adenocarcinoma with multiple intracranial hemorrhages of brain metastases after whole-brain radiation therapy

    International Nuclear Information System (INIS)

    Nakamichi, Shinji; Hirano, Satoshi; Asao, Tetsuhiko; Takeda, Yuichiro; Sugiyama, Haruhito; Kobayashi, Nobuyuki

    2011-01-01

    Whole-brain radiation therapy (WBRT) is widely applied in cases of brain metastases of non-small cell lung cancer (NSCLC). However, there are few case reports on hemorrhages of brain metastases occurring after WBRT. A 63-year-old woman was given a diagnosis of stage IV (T4N0M1b) lung adenocarcinoma about 4 years previously, and received chemotherapy regimens and gamma knife radiosurgery. However, her brain metastases exacerbated and she received WBRT in November 2010 and docetaxel monotherapy in December 2010. Two weeks after completing WBRT, she experienced dysarthria and an MRI showed multiple hemorrhages within brain metastases. Over a period of careful observation, these hemorrhages repeatedly alternated between improvement and exacerbation. Radiotherapy for metastatic brain tumors is considered to suppress hemorrhagic events of brain metastases. However, multiple intracranial hemorrhages of brain metastases occurred after WBRT in the present case. The accumulation of further studies of similar cases is necessary to identify the exact mechanism of these hemorrhages. (author)

  10. A Complete Response Case in a Patient with Multiple Lung Metastases of Rectal Cancer Treated with Bevacizumab plus XELIRI Therapy

    Directory of Open Access Journals (Sweden)

    Hiroki Hashida

    2017-01-01

    Full Text Available It has been reported that many patients with lung metastasis of colorectal cancer (CRC underwent chemotherapy with fluorouracil, folinic acid, oxaliplatin, irinotecan, or capecitabine. There is a small number of reports about the capecitabine and irinotecan (XELIRI plus bevacizumab (BV therapy for patients with metastatic CRC in Japan. We report a case of successful BV+XELIRI therapy for rectal cancer with multiple lung metastases as first-line chemotherapy. A 53-year-old female presented with advanced rectal cancer and metastatic lung tumors. Following surgery, the patient was treated with XELIRI+BV. After 6 courses, a computed tomography scan showed complete response of the lung metastases. No recurrence has occurred for 3 years after chemotherapy was stopped.

  11. Colorectal liver metastases: contrast agent diffusion coefficient for quantification of contrast enhancement heterogeneity at MR imaging.

    Science.gov (United States)

    Jia, Guang; O'Dell, Craig; Heverhagen, Johannes T; Yang, Xiangyu; Liang, Jiachao; Jacko, Richard V; Sammet, Steffen; Pellas, Theodore; Cole, Patricia; Knopp, Michael V

    2008-09-01

    To describe and determine the reproducibility of a simplified model to quantitatively measure heterogeneous intralesion contrast agent diffusion in colorectal liver metastases. This HIPAA-compliant retrospective study received institutional review board approval, and written informed consent was obtained from 14 patients (mean age, 61 years +/- 9 [standard deviation]; range, 41-78 years), including 10 men (mean age, 65 years +/- 8; range, 47-78 years) and four women (mean age, 54 years +/- 9; range, 41-59 years), with colorectal liver metastases. Magnetic resonance (MR) imaging was performed twice (first baseline MR image [B(1)] and second baseline MR image [B(2)]) in a single target lesion prior to therapy. Dynamic contrast material-enhanced MR imaging was performed by using a saturation-recovery fast gradient-echo sequence. A simplified contrast agent diffusion model was proposed, and a contrast agent diffusion coefficient (CDC) was calculated. The reproducibility of the CDC measurement was evaluated by using the Bland-Altman plot and a linear regression model. The mean CDC was 0.22 mm(2)/sec (range, 0.01-0.73 mm(2)/sec) on B(1) and 0.24 mm(2)/sec (range, 0.01-0.71 mm(2)/sec) on B(2), with an intraclass correlation coefficient of 0.91 (P < .0001). Bland-Altman plot showed good agreement, with a mean difference in measurement pairs of 0.017 mm(2)/sec +/- 0.096. The slope from the linear regression model was 0.89 (95% confidence interval: 0.63, 1.15) and the intercept was 0.01 (95% confidence interval: -0.08, 0.09). The CDC enables a quantitative description of contrast enhancement heterogeneity in lesions. Given the high reproducibility of the CDC metric, CDC appears promising for further qualification as an imaging biomarker of change measurement in response assessment. http://radiology.rsnajnls.org/cgi/content/full/248/3/901/DC1. RSNA, 2008

  12. What to choose as radical local treatment for lung metastases from colo-rectal cancer: surgery or radiofrequency ablation?

    NARCIS (Netherlands)

    Schlijper, R.C.; Grutters, J.P.C.; Houben, R.; Dingemans, A.M.; Wildberger, J.E.; Raemdonck, D. Van; Cutsem, E. van; Haustermans, K.; Lammering, G.; Lambin, P.; Ruysscher, D. de

    2014-01-01

    BACKGROUND: Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT). METHODS: A systematic review included 27 studies

  13. Creatine kinase BB and beta-2-microglobulin as markers of CNS metastases in patients with small-cell lung cancer

    DEFF Research Database (Denmark)

    Pedersen, A G; Bach, F W; Nissen, Mogens Holst

    1985-01-01

    Creatine kinase (CK) and its BB isoenzyme (CK-BB) were measured in CSF in 65 evaluable patients suspected of CNS metastases secondary to small-cell lung cancer (SCLC). In addition, CSF and plasma levels of beta-2-microglobulin (beta-2-m) were measured in a group of 73 evaluable patients. Of the 65...

  14. Therapeutic effects of protein kinase N3 small interfering RNA and doxorubicin combination therapy on liver and lung metastases

    Science.gov (United States)

    Hattori, Yoshiyuki; Kikuchi, Takuto; Nakamura, Mari; Ozaki, Kei-Ichi; Onishi, Hiraku

    2017-01-01

    It has been reported that suppression of protein kinase N3 (PKN3) expression in vascular and lymphatic endothelial cells results in the inhibition of tumor progression and lymph node metastasis formation. The present study investigated whether combination therapy of small interfering RNA (siRNA) against PKN3 and doxorubicin (DXR) could increase therapeutic efficacy against liver and lung metastases. In vitro transfection of PKN3 siRNA into PKN3-positive MDA-MB-231, LLC, and Colon 26 cells and PKN3-negative MCF-7 cells did not inhibit cell growth and did not increase sensitivity to DXR. However, following in vivo treatment, PKN3 siRNA suppressed the growth of liver MDA-MB-231 and lung LLC and MCF-7 metastases, although combination therapy with DXR did not increase the therapeutic efficacy. By contrast, in liver MCF-7 metastases, PKN3 siRNA or DXR alone did not exhibit significant inhibition of tumor growth, but their combination significantly improved therapeutic efficacy. Treatment of liver MDA-MB-231 metastases with PKN3 siRNA induced a change in vasculature structure via suppression of PKN3 mRNA expression. PKN3 siRNA may induce antitumor effects in lung and liver metastases by suppression of PKN3 expression in stroma cells, such as endothelial cells. From these findings, PKN3 siRNA alone or in combination with DXR may reduce the tumor growth of liver and lung metastases regardless of PKN3 expression in tumor cells. PMID:29098022

  15. Diffusion-weighted MR imaging of the normal fetal lung

    International Nuclear Information System (INIS)

    Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Hoermann, Marcus; Bankier, Alexander; Herold, Christian J.; Prayer, Daniela; Brugger, Peter C.; Csapo, Bence; Bammer, Roland

    2008-01-01

    To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20-37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 ± 0.44 μm 2 /ms (mean ± SD) in the apex, 1.99 ± 0.42 μm 2 /ms (mean ± SD) in the middle third, and 1.91 ± 0.41 μm 2 /ms (mean ± SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity. (orig.)

  16. Diffusion-weighted MR imaging of the normal fetal lung

    Energy Technology Data Exchange (ETDEWEB)

    Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Hoermann, Marcus; Bankier, Alexander; Herold, Christian J.; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria); Csapo, Bence [Medical University of Vienna, Department of Obstetrics and Gyneocology, Vienna (Austria); Bammer, Roland [University of Stanford, Department of Radiology, Stanford, CA (United States)

    2008-04-15

    To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20-37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 {+-} 0.44 {mu}m{sup 2}/ms (mean {+-} SD) in the apex, 1.99 {+-} 0.42 {mu}m{sup 2}/ms (mean {+-} SD) in the middle third, and 1.91 {+-} 0.41 {mu}m{sup 2}/ms (mean {+-} SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity. (orig.)

  17. Selection of optimal treatment scheme for brain metastases of non-small cell lung cancer

    International Nuclear Information System (INIS)

    Dong Mingxin; Zhao Tong; Huang Jingzi; Yu Shukun; Ma Yan; Tian Zhongcheng; Jin Xiangshun; Quan Jizhong; Liu Jin; Wang Dongxu

    2006-01-01

    Objective: To select the optimal treatment scheme for brain metastases of non-small cell lung cancers (NSCLCs). Methods: Seventy-two NSCLC cases diagnosesd by pathology with brain metastases were randomly classified into three groups, Group I, 24 cases with whole brain conventional external fractioned irradiation of D T 36-41 Gy/4-5 w, Group II, 22 eases with y-knife treatment plus whole brain conventional external fractioned irradiation, and Group III, 26 cases with γ-knife plus whole brain conventional external fractioned irradiation in combination with chemotherapy of Vm-26. The surrounding area of tumor was strictly covered with 50% para-central-dosal curve in γ-knife treatment (D T 16-25 Gy with a mean of 16 Gy). The muirleaf collimator was selected according to the volume of tumors. Chemotherapy of Vm-26 (60 mg/m 2 d1-3) was applied during the treatment with whole brain conventional external fractioned irradiation (D T 19-29 Gy/2-3 w), 21 days in a period, 2 periods in total. Results: The median survival time was estimated to be 6.0 months (ranged from 1.2 to 19.0 months) in the Group I, 9.2 months (4.4-30 months) in the Group II, and 10.8 months (5.2-42.2 months) in the Group III. The 1-year and 2-year survival rates were 34.6% and 12.6% , 62.2% and 30.2%, and 70.8% and 35.6% respectively in Group I, Group II, and Group III, respectively. Conclusion: For brain metastases of NSCLC, γ-knife plus whole brain conventional external fractioned irradiation combined with treatment of Vm-26 had a significantly beneficial influence on improvement of the local control and 1-year and 2-year survival. There was no complaint about the side-effects of the treatment. (authors)

  18. Gamma Knife Radiosurgery for Treatment of Cerebral Metastases From Non–Small-Cell Lung Cancer

    International Nuclear Information System (INIS)

    Motta, Micaela; Vecchio, Antonella del; Attuati, Luca; Picozzi, Piero; Perna, Lucia; Franzin, Alberto; Bolognesi, Angelo; Cozzarini, Cesare; Calandrino, Riccardo; Mortini, Pietro; Muzio, Nadia di

    2011-01-01

    Purpose: To evaluate clinical and physico-dosimetric variables affecting clinical outcome of patients treated with Gamma Knife radiosurgery (GKRS) for brain metastases from non–small cell lung cancer (NSCLC). Methods and Materials: Between 2001 and 2006, 373 patients (298 men and 75 women, median age 65 years) with brain metastases from NSCLC underwent GKRS. All of them had KPS ≥ 60%, eight or fewer brain metastases, confirmed histopathological diagnosis and recent work-up ( 3 . Median marginal dose was 22.5 Gy at 50% isodose.; median 10 Gy and 12 Gy isodose volumes were 30.8 cm 3 and 15.8 cm 3 , respectively. Follow-up with MRI was performed every 3 months. Overall survival data were collected from internal database, telephone interviews, and identifying registries. Results: Mean follow-up after GKRS was 51 months (range, 6 to 96 months); mean overall survival was 14.2 months. Of 373 patients, 29 were alive at time of writing, 104 had died of cerebral progression, and 176 had died of systemic progression. In 64 cases it was not possible to ascertain the cause. Univariate and multivariate analysis were adjusted for the following: RPA class, surgery, WBRT, age, gender, number of lesions, median tumor volume, median peripheral dose, and 10 Gy and 12 Gy volumes. Identified RPA class and overall tumor volume >5 cc were the only two covariates independently predictive of overall survival in patients who died of cerebral progression. Conclusions: Global volume of brain disease should be the main parameter to consider for performing GKRS, which is a first-line therapy for patient in good general condition and controlled systemic disease.

  19. Comparison of erlotinib and pemetrexed as second-/third-line treatment for lung adenocarcinoma patients with asymptomatic brain metastases

    Directory of Open Access Journals (Sweden)

    He YY

    2016-04-01

    Full Text Available Yayi He,1,* Wenwen Sun,2,* Yan Wang,3,* Shengxiang Ren,1 Xuefei Li,3 Jiayu Li,3 Christopher J Rivard,4 Caicun Zhou,1 Fred R Hirsch4 1Department of Oncology, Shanghai Pulmonary Hospital, 2Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, 3Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA *These authors contributed equally to this work Objective: Brain metastases occur in one-third of all non-small-cell lung cancer patients. Due to restrictive transport at the blood–brain barrier, many drugs provide poor control of metastases in the brain. The aim of this study was to compare erlotinib with pemetrexed as second-/third-line treatment in patients with lung adenocarcinoma with asymptomatic brain metastases.Methods: From January 2012 to June 2014, all lung adenocarcinoma patients with asymptomatic brain metastases who received treatment with erlotinib or pemetrexed as second-/third-line treatment were retrospectively reviewed. Chi-square and log-rank tests were used to perform statistical analysis.Results: The study enrolled 99 patients, of which 44 were positive for EGFR mutation. Median progression-free survival (PFS in months was not significantly different between the erlotinib- and pemetrexed-treated groups (4.2 vs 3.4 months; 95% confidence interval [CI]: 2.01–6.40 vs 2.80–5.00, respectively; P=0.635. Median PFS was found to be significantly longer in EGFR mutation–positive patients in the erlotinib-treated group (8.0 months; 95% CI 5.85–10.15 compared to the pemetrexed group (3.9 months; 95% CI: 1.25–6.55; P=0.032. The most common treatment-related side effect was mild-to-moderate rash and the most common drug-related side

  20. Lung metastases detection in CT images using 3D template matching

    International Nuclear Information System (INIS)

    Wang, Peng; DeNunzio, Andrea; Okunieff, Paul; O'Dell, Walter G.

    2007-01-01

    The aim of this study is to demonstrate a novel, fully automatic computer detection method applicable to metastatic tumors to the lung with a diameter of 4-20 mm in high-risk patients using typical computed tomography (CT) scans of the chest. Three-dimensional (3D) spherical tumor appearance models (templates) of various sizes were created to match representative CT imaging parameters and to incorporate partial volume effects. Taking into account the variability in the location of CT sampling planes cut through the spherical models, three offsetting template models were created for each appearance model size. Lung volumes were automatically extracted from computed tomography images and the correlation coefficients between the subregions around each voxel in the lung volume and the set of appearance models were calculated using a fast frequency domain algorithm. To determine optimal parameters for the templates, simulated tumors of varying sizes and eccentricities were generated and superposed onto a representative human chest image dataset. The method was applied to real image sets from 12 patients with known metastatic disease to the lung. A total of 752 slices and 47 identifiable tumors were studied. Spherical templates of three sizes (6, 8, and 10 mm in diameter) were used on the patient image sets; all 47 true tumors were detected with the inclusion of only 21 false positives. This study demonstrates that an automatic and straightforward 3D template-matching method, without any complex training or postprocessing, can be used to detect small lung metastases quickly and reliably in the clinical setting

  1. Targeting brain metastases in ALK-rearranged non-small-cell lung cancer.

    Science.gov (United States)

    Zhang, Isabella; Zaorsky, Nicholas G; Palmer, Joshua D; Mehra, Ranee; Lu, Bo

    2015-10-01

    The incidence of brain metastases has increased as a result of improved systemic control and advances in imaging. However, development of novel therapeutics with CNS activity has not advanced at the same rate. Research on molecular markers has revealed many potential targets for antineoplastic agents, and a particularly important aberration is translocation in the ALK gene, identified in non-small-cell lung cancer (NSCLC). ALK inhibitors have shown systemic efficacy against ALK-rearranged NSCLC in many clinical trials, but the effectiveness of crizotinib in CNS disease is limited by poor blood-brain barrier penetration and acquired drug resistance. In this Review, we discuss potential pathways to target ALK-rearranged brain metastases, including next generation ALK inhibitors with greater CNS penetration and mechanisms to overcome resistance. Other important mechanisms to control CNS disease include targeting pathways downstream of ALK phosphorylation, increasing the permeability of the blood-brain barrier, modifying the tumour microenvironment, and adding concurrent radiotherapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Relative significance of surgery and radiotherapy in treatment of brain metastases of lung cancer

    International Nuclear Information System (INIS)

    Yamashita, Junkoh; Ohtsuka, Sinichi; Yamasaki, Toshiki; Gi, Hidefuku; Ha, Young-Soo; Handa, Hajime

    1983-01-01

    One hundred and sixteen cases of brain metastases of lung cancer were retrospectively analysed with special reference to the relative significance of surgery and radiotherapy. The median survival time from diagnosis of brain metastases was 1.2 months in 27 cases without treatment, 2.5 months in 51 cases treated by surgery alone, 4.2 months in 31 cases treated by radiotherapy alone and 6.5 months in 7 cases treated by surgery and radiotherapy. The survival rate in patients treated by radiotherapy was significantly better than in those not treated by radiotherapy. However, the effect of surgery was not significant in prolongation of survival time. On the other hand, the rate of improvement in neurological symptoms assessed at one month after the initiation of treatment was 80.9% in 47 cases treated by surgery and 19.4 % in 31 cases treated by radiotherapy. The result suggested that surgery is superior to radiotherapy in alleviating neurological symptoms. It is important to understand the nature of effect of each treatment. A better result will be anticipated by proper selection or combination of these treatments. (author)

  3. The association between miR-34 dysregulation and distant metastases formation in lung adenocarcinoma

    DEFF Research Database (Denmark)

    Daugaard, Iben; Knudsen, Alice; Kjeldsen, Tina E

    2017-01-01

    Resolution Melting (MS-HRM) analysis. No difference in expression was observed for miR-34a when comparing metastasizing and non-metastasizing LACs (p=0.793). For both miR-34b and miR-34c, a significantly lower expression level was determined in metastasizing LACs compared to non-metastasizing LACs (p=0...

  4. Rare aggressive behavior of MDM2-amplified retroperitoneal dedifferentiated liposarcoma, with brain, lung and subcutaneous metastases

    Directory of Open Access Journals (Sweden)

    Imen Ben Salha

    2016-10-01

    Full Text Available Dedifferentiated liposarcoma (DDL is a histologically pleomorphic sarcoma, traditionally defined as well-differentiated liposarcoma with abrupt transition to high grade, nonlipogenic sarcoma. It can occur as part of recurrent well-differentiated liposarcoma, or may arise de novo. DDL most frequently occurs within the retroperitoneum, and while it is prone to local recurrence, it usually has a lower rate of metastasis than other pleomorphic sarcomas. We describe a case of retroperitoneal dedifferentiated liposarcoma in a 63-year-old male, who showed MDM2 amplification with fluorescence in situ hybridization, which displayed unusually aggressive behavior, with brain, lung and subcutaneous soft tissue metastases. As previous reports of metastatic liposarcoma have largely grouped DDL in with other (genetically and clinically distinct liposarcoma subtypes, we highlight and discuss the rare occurrence of brain metastasis in MDM2-amplified retroperitoneal liposarcoma.

  5. Concurrent radiotherapy and fotemustine for brain metastases of non small cell cancer of the lung. Association concomitante de radiotherapie et de fotemustine dans le traitement des metastases cerebrales des cancers du poumon non a petites cellules

    Energy Technology Data Exchange (ETDEWEB)

    Pignon, T.; Ruggieri, S.; Orabona, P.; Muracciole, X.; Juin, P. (Hopital de la Timone, 13 - Marseille (France)); Astoul, P.; Vialette, J.P.; Boutin, C. (Hopital de la Conception, 13 - Marseille (France))

    1994-01-01

    The radiotherapy is the most employed in the treatment of cerebral metastases, even if results are deceptive. The tests with chemotherapy are not better and the nitrosoureas remain the most employed drugs. The fotemustin is a new one which can give good results for bearing cerebral metastases patients's response. The associations radiotherapy and chemotherapy are developing to potentiate radiotherapy action but are still a little studied in the cases of cerebral metastases; that is why we choose to treat in an open study the patients bearers of cerebral metastases in lungs cancers with no little cells. 18 refs.

  6. 18F-FDG PET demonstrates previously unvisualised bony metastases in a lung cancer patient

    International Nuclear Information System (INIS)

    Bradley, J.; Rowe, C.; Scott, A.M.

    2002-01-01

    Full text: A 59-year-old male, presented to his local doctor with the trivial complaint of a persistent dry cough. On clinical examination he was found to have an enlarged right supraclavicular lymph node. He was investigated with chest X-ray, Computerised Tomography (CT) and Fine Needle Aspiration Cytology (FNAC) of the palpable node CT showed a right lung mass, bulky hilar, mediastinal, supraclavicular and cervical lymph nodes FNAC was inconclusive due to an insufficient tissue sample, but suggestive of non-Hodgkin's Lymphoma. Hence excisional node biopsy was required which revealed non-small cell lung cancer (NSCLC). Subsequent CT scans of the abdomen and pelvis for staging revealed no distant involvement. Therefore radical radiotherapy was planned to treat the locally advanced disease. Prior to treatment a Positron Emission Tomography (PET) scan was organised by his specialist as a baseline study to monitor therapy progress. Non-Attenuation corrected images of the chest, abdomen and pelvis were obtained 40 minutes post administration of 394 MBq 18 F-FDG, on a Siemens 951/3IR PET scanner. The images were reconstructed using both Filtered Back Projection (FBP) and Ordered Subsets-Expectation Maximization (OSEM) algorithms. The images revealed extensive metastases particularly in the spine and pelvis, besides the known locally advanced thoracic disease A 99m Tc MDP bone scan and plain film radiographs aimed at confirming bony metastases were negative, even though the bone scan noted a slight focus in the right fourth rib. The appearance suggested trauma, but a solitary bone metastasis could not be ruled out MRI of the spine confirmed the PET scan findings. Mr RD was to have curative radical radiotherapy, but after the PET results, it was decided to treat him palliatively. The value of 18 F-FDG PET in staging some cancers such as NSCLC is widely accepted, in this case it was pivotal in altering the patient's management. Copyright (2002) The Australian and New

  7. Carbon ion radiotherapy for oligo-recurrent lung metastases from colorectal cancer: a feasibility study

    International Nuclear Information System (INIS)

    Takahashi, Wataru; Nakajima, Mio; Yamamoto, Naoyoshi; Yamada, Shigeru; Yamashita, Hideomi; Nakagawa, Keiichi; Tsuji, Hiroshi; Kamada, Tadashi

    2014-01-01

    The purpose of this study was to evaluate the efficacy and feasibility of carbon ion radiotherapy (CIRT) for oligo-recurrent lung tumors from colorectal cancer (CRC). From May 1997 to October 2012, 34 consecutive patients with oligo-recurrent pulmonary metastases from CRC were treated with CIRT. The patients were not surgical candidates for medical reasons or patient refusal. Using a respiratory-gated technique, carbon ion therapy was delivered with curative intent using 4 coplanar beam angles. A median dose of 60 GyE (range, 44–64.8 GyE) was delivered to the planning target volume (PTV), with a median daily dose of 15 GyE (range, 3.6–44 GyE). Treatment outcome was analyzed in terms of local control rate (LCR), survival rate, and treatment-related complications. In total, 34 patients with 44 oligo-recurrent pulmonary lesions were treated with CIRT. Median follow-up period was 23.7 months. The 2- and 3-year actuarial LCRs of the treated patients were 85.4% ± 6.2% and 85.4% ± 6.2%, respectively. Overall survival was 65.1% ± 9.5% at 2 years, and 50.1% ± 10.5% at 3 years. Although survival rates were relatively worse in the subsets of patients aged < 63 years or with early metastasis (< 36 months after resection of primary site), these factors were not significantly correlated with overall survival (P = 0.13 and 0.19, respectively). All treatment-related complications were self-limited, without any grade 3–5 toxicity. CIRT is one of the most effective nonsurgical treatments for colorectal lung metastases, which are relatively resistant to stereotactic body radiotherapy. CIRT is considered to be the least invasive approach even in patients who have undergone repeated prior thoracic metastasectomies

  8. Temozolomide in patients with advanced non-small cell lung cancer with and without brain metastases. a phase II study of the EORTC Lung Cancer Group (08965).

    NARCIS (Netherlands)

    Dziadziuszko, R; Ardizzoni, A.; Postmus, P.E.; Smit, E.F.; Price, A; Debruyne, C.; Legrand, C; Giaccone, G.

    2003-01-01

    This study was performed to evaluate the activity of single-agent temozolomide in two groups of chemotherapy-naive non-small cell lung cancer (NSCLC) patients, with (12 patients) and without (13 patients) brain metastases (BM). Patients in both groups were treated with temozolomide 200 mg/m(2)/day,

  9. Diffusion on Networks and Diffusion Weighted NMR of the Human Lung

    DEFF Research Database (Denmark)

    Buhl, Niels

    2011-01-01

    of the diffusion propagator to general properties of the underlying graph. Diffusion weighted NMR of the human lung with hyperpolarized noble gases, which over the last decade has been demonstrated to be a very promising way of detecting and quantifying lung diseases like emphysema, represent an obvious...... application of the above mentioned theory, given that the human lung consists of a large network of bifurcating tube like airways. 90-95% of the gas in a human lung resides in the ~30000 pulmonary acini, each of these consists of ~500 airways, which are connected as the edges in a binary tree. We model...... diffusion in the pulmonary acini as diffusion on metric graphs with this structure. The metric graph for each individual pulmonary acinus is embedded in three dimensional space via line segments. By considering an isotropic distribution of acini and a symmetric branching geometry for the line segments...

  10. Validation of the RTOG recursive partitioning analysis (RPA) classification for small-cell lung cancer-only brain metastases

    International Nuclear Information System (INIS)

    Videtic, Gregory M.M.; Adelstein, David J.; Mekhail, Tarek M.; Rice, Thomas W.; Stevens, Glen H.J.; Lee, S.-Y.; Suh, John H.

    2007-01-01

    Purpose: Radiation Therapy Oncology Group (RTOG) developed a prognostic classification based on a recursive partitioning analysis (RPA) of patient pretreatment characteristics from three completed brain metastases randomized trials. Clinical trials for patients with brain metastases generally exclude small-cell lung cancer (SCLC) cases. We hypothesize that the RPA classes are valid in the setting of SCLC brain metastases. Methods and Materials: A retrospective review of 154 SCLC patients with brain metastases treated between April 1983 and May 2005 was performed. RPA criteria used for class assignment were Karnofsky performance status (KPS), primary tumor status (PT), presence of extracranial metastases (ED), and age. Results: Median survival was 4.9 months, with 4 patients (2.6%) alive at analysis. Median follow-up was 4.7 months (range, 0.3-40.3 months). Median age was 65 (range, 42-85 years). Median KPS was 70 (range, 40-100). Number of patients with controlled PT and no ED was 20 (13%) and with ED, 27 (18%); without controlled PT and ED, 34 (22%) and with ED, 73 (47%). RPA class distribution was: Class I: 8 (5%); Class II: 96 (62%); Class III: 51 (33%). Median survivals (in months) by RPA class were: Class I: 8.6; Class II: 4.2; Class III: 2.3 (p = 0.0023). Conclusions: Survivals for SCLC-only brain metastases replicate the results from the RTOG RPA classification. These classes are therefore valid for brain metastases from SCLC, support the inclusion of SCLC patients in future brain metastases trials, and may also serve as a basis for historical comparisons

  11. Comparison of manual and automated size measurements of lung metastases on MDCT images: Potential influence on therapeutic decisions

    Energy Technology Data Exchange (ETDEWEB)

    Pauls, Sandra [Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: sandra.pauls@uni-ulm.de; Kuerschner, Christian [Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: chris.kuerschner@web.de; Dharaiya, Ekta [CT-Clinical Science, Philips Medical Systems, Highland Heights, OH 44143 (United States)], E-mail: ekta.shah@philips.com; Muche, Rainer [Institute of Biometrics, University of Ulm, Schwabstrasse 13, 89075 Ulm (Germany)], E-mail: rainer.muche@uni-ulm.de; Schmidt, Stefan A. [Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: stefan-a.schmidt@gmx.de; Krueger, Stefan [Department of Internal Medicine II, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: s.krueger@uniklinik-ulm.de; Brambs, Hans-Juergen [Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: hans-juergen.brambs@uniklinik-ulm.de; Aschoff, Andrik J. [Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm (Germany)], E-mail: andrik.aschoff@uni-ulm.de

    2008-04-15

    Purpose: The goal of this study was to evaluate the influence of automated measurement of diameter, area, and volume from chest CT scans on therapeutic decisions of lung nodules as compared to manual 2-D measurements. Patients and method: The retrospective study involved 25 patients with 75 lung metastases. Contrast enhanced CT scans (16 row) of the lung were performed three times during chemotherapy with a mean time interval of 67.9 days between scans. In each patient, three metastases were evaluated (n = 225). Automatic measurements were compared to manual assessment for the following parameters: diameter, area, and density. The influence on the therapeutic decisions was evaluated using the RECIST criteria. Results: The maximum diameter measured by the automatic application was on an average 27% (S.D. 39; CI: 0.22-0.32; p < 0.0001) higher than the maximum diameter with manual assessment, and the differences depended on metastases size. Based on diameter calculation, manual and automated assessment disagreed in up to 32% of therapeutic decisions. Volumetric assessment tended towards more changes in therapy as compared to diameter calculation. The calculation of mean transversal area of metastases was 36% (S.D. 0.305; CI: -0.40 to -0.32; p < 0.0001) less with automated measurement. Therapeutic strategy would be changed in up to 25.7% of nodules using automated area calculation. Automated assessment of nodules' area and volume could influence the therapeutic decisions in up to 51.4% of all nodules. Density of the nodules was not validated to determine the influence on therapeutic decisions. Conclusion: There is a discrepancy between the manual and automated size measurement of lung metastases which could be significant.

  12. Comparison of manual and automated size measurements of lung metastases on MDCT images: Potential influence on therapeutic decisions

    International Nuclear Information System (INIS)

    Pauls, Sandra; Kuerschner, Christian; Dharaiya, Ekta; Muche, Rainer; Schmidt, Stefan A.; Krueger, Stefan; Brambs, Hans-Juergen; Aschoff, Andrik J.

    2008-01-01

    Purpose: The goal of this study was to evaluate the influence of automated measurement of diameter, area, and volume from chest CT scans on therapeutic decisions of lung nodules as compared to manual 2-D measurements. Patients and method: The retrospective study involved 25 patients with 75 lung metastases. Contrast enhanced CT scans (16 row) of the lung were performed three times during chemotherapy with a mean time interval of 67.9 days between scans. In each patient, three metastases were evaluated (n = 225). Automatic measurements were compared to manual assessment for the following parameters: diameter, area, and density. The influence on the therapeutic decisions was evaluated using the RECIST criteria. Results: The maximum diameter measured by the automatic application was on an average 27% (S.D. 39; CI: 0.22-0.32; p < 0.0001) higher than the maximum diameter with manual assessment, and the differences depended on metastases size. Based on diameter calculation, manual and automated assessment disagreed in up to 32% of therapeutic decisions. Volumetric assessment tended towards more changes in therapy as compared to diameter calculation. The calculation of mean transversal area of metastases was 36% (S.D. 0.305; CI: -0.40 to -0.32; p < 0.0001) less with automated measurement. Therapeutic strategy would be changed in up to 25.7% of nodules using automated area calculation. Automated assessment of nodules' area and volume could influence the therapeutic decisions in up to 51.4% of all nodules. Density of the nodules was not validated to determine the influence on therapeutic decisions. Conclusion: There is a discrepancy between the manual and automated size measurement of lung metastases which could be significant

  13. Hierarchy of treatment variables affecting outcome of 131I therapy in thyroid cancer patients with lung metastases.

    Science.gov (United States)

    Kozak, Oksana V; Sukach, Georgiy G; Korchinskaya, Oksana I; Trembach, Alexander M; Turicina, Viktoria L; Voit, Natalia U

    2005-06-01

    To assess the correlations between the first 131I activity value, time interval between the courses of radioiodine treatment and the overall number of courses required for total destruction of lung metastases in patients with differentiated thyroid cancer with metastatic lesions in lungs. 27 patients with differentiated thyroid cancer with metastases in lungs have been treated with radioiodine after surgical intervention. Activities administered amounted from 1600 to 7980 MBq. The number of radioiodine courses before total ablation of all metastatic lesions amounted from 1 to 10. Time interval between the 1st and the 2nd courses amounted from 3.5 to 11.5 months (6 months in average). The regression analysis of the data has been made. The exponential model fits the actual number of courses as a function of the first-second activity value and time interval between the courses. The first activity has a decisive influence on the number of courses required for total metastases ablation. The greater was the first activity value, the lesser was the overall number of courses. Increasing time interval between 1st and 2nd courses to 10 months seems to result in reducing the number of courses. Nevertheless even in the case of high activities the probability to undergone less then 3 courses is low. According to the proposed model in thyroid cancer patients with metastases in lungs the first activity should be not lesser than 6000 MBq, time interval between treatments--approximately 10 months. The results of our study suggest that individual factors such as histology, the number and the size of metastases in lymph nodes could not contribute more to the final outcome than the treatment variables, namely the first-second activity and time interval, nor could they affect the hierarchy of the effects revealed for the treatment variables.

  14. Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times.

    Directory of Open Access Journals (Sweden)

    Anna Sophie Berghoff

    Full Text Available BACKGROUND: MRI-based diffusion-weighted imaging (DWI visualizes the local differences in water diffusion in vivo. The prognostic value of DWI signal intensities on the source images and apparent diffusion coefficient (ADC maps respectively has not yet been studied in brain metastases (BM. METHODS: We included into this retrospective analysis all patients operated for single BM at our institution between 2002 and 2010, in whom presurgical DWI and BM tissue samples were available. We recorded relevant clinical data, assessed DWI signal intensity and apparent diffusion coefficient (ADC values and performed histopathological analysis of BM tissues. Statistical analyses including uni- and multivariate survival analyses were performed. RESULTS: 65 patients (34 female, 31 male with a median overall survival time (OS of 15 months (range 0-99 months were available for this study. 19 (29.2% patients presented with hyper-, 3 (4.6% with iso-, and 43 (66.2% with hypointense DWI. ADCmean values could be determined in 32 (49.2% patients, ranged from 456.4 to 1691.8*10⁻⁶ mm²/s (median 969.5 and showed a highly significant correlation with DWI signal intensity. DWI hyperintensity correlated significantly with high amount of interstitial reticulin deposition. In univariate analysis, patients with hyperintense DWI (5 months and low ADCmean values (7 months had significantly worse OS than patients with iso/hypointense DWI (16 months and high ADCmean values (30 months, respectively. In multivariate survival analysis, high ADCmean values retained independent statistical significance. CONCLUSIONS: Preoperative DWI findings strongly and independently correlate with OS in patients operated for single BM and are related to interstitial fibrosis. Inclusion of DWI parameters into established risk stratification scores for BM patients should be considered.

  15. Metachronous brain and intramedullary spinal cord metastases from nonsmall-cell lung cancer: A case report

    Directory of Open Access Journals (Sweden)

    Wen-Chih Liu

    2012-05-01

    Full Text Available A 44-year-old man had a brain tumor secondary to lung adenocarcinoma and underwent craniectomy to remove the brain tumor. After postoperative whole-brain radiation therapy, he underwent pneumonectomy followed by chemotherapy, mediastinal radiotherapy, and target therapy for lung cancer. Thirty-six months after the initial brain surgery, he suffered from neck pain and right upper limb numbness that rapidly progressed to upper extremity weakness and paralysis in 2 months. Magnetic resonance imaging demonstrated an intramedullary spinal cord lesion at the C4 level. Laminectomy and gross intramedullary tumor removal were performed. The patient’s neurological function improved after the operation. Nevertheless, 4 months after the intramedullary tumor removal, he began to show multiple metastases. Unfortunately, the patient died from respiratory failure 8 months after diagnosis with intramedullary spinal cord metastasis. In this case, early diagnosis and aggressive surgical treatment combined with postoperative radiotherapy and chemotherapy might have provided this patient with a prolonged survival and better quality of life.

  16. Two unusual cases of brain metastases from lung primary malignant melanoma

    International Nuclear Information System (INIS)

    Rodríguez, A.; Mañana, G.; Panuncio, A.; Rodríguez, R.; Roldán, G.; Sosa, A.

    2004-01-01

    Start with two cases of brain metastases from lung melanoma are presented who were diagnosed in the Neuropathology Laboratory of the Department of Anatomy Pathology, Institute of Neurology, Hospital de Clinicas, Montevideo, emphasizing the pathological diagnostic criteria and their evolution clinic. Both patients presented at the time of the initial consultation injuries amelánica respectively pigmented single brain. In both cases ruled by the morphology and the use of complementary techniques metastasis carcinoma. The main differential diagnosis of these lesions is whether is a primitive brain tumor, pigmented or not, or of a secondary tumor melanin: metastatic malignant melanoma. In both cases the patients had been studied one being in an unresectable lung injury, and in the other showed a single pulmonary nodule was resected in its entirety. the pulmonary lesions were for malignant melanoma, one with ample pigment and the other for the most part amelánico, with few areas retained pigment. He studied dermatologist, discarded the presence of a cutaneous malignant melanoma primitive. Other locations were also excluded

  17. Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long-term follow-up.

    Science.gov (United States)

    Sohn, Seo Young; Kim, Hye In; Kim, Young Nam; Kim, Tae Hyuk; Kim, Sun Wook; Chung, Jae Hoon

    2018-02-01

    Distant metastases, although uncommon, represent maximum disease-related mortality in differentiated thyroid carcinoma (DTC). Lungs are the most frequent sites of metastases. We aimed to evaluate long-term outcomes and identify prognostic factors in metastatic DTC limited to the lungs. This retrospective study included 89 patients with DTC and metastases limited to the lungs, who were treated between 1996 and 2012 at Samsung Medical Center. Progression-free survival (PFS) and cancer-specific survival (CSS) rates were evaluated according to clinicopathologic factors. Cox regression analysis was used to identify independent factors associated with structural progressive disease (PD) and cancer-specific death. With a median follow-up of 84 months, the 5- and 10-year CSS rates were 78% and 73%, respectively. Older age at diagnosis (≥55 years), radioactive iodine (RAI) nonavidity, preoperative or late diagnosis of metastasis and macro-nodular metastasis (≥1 cm) were predictive of decreased PFS and CSS. Multivariate analysis identified older age (P = .002), RAI nonavidity (P = .045) and preoperative (P = .030) or late diagnosis (P = .026) as independent predictors of structural PD. RAI avidity was also independent predictor of cancer-specific death (P = .025). Patients with DTC and metastatic disease limited to the lungs had favourable long-term outcomes. Age, RAI avidity and timing of metastasis were found to be major factors for predicting prognosis. © 2017 John Wiley & Sons Ltd.

  18. Prognostic indices in stereotactic radiotherapy of brain metastases of non-small cell lung cancer.

    Science.gov (United States)

    Kaul, David; Angelidis, Alexander; Budach, Volker; Ghadjar, Pirus; Kufeld, Markus; Badakhshi, Harun

    2015-11-26

    Our purpose was to analyze the long-term clinical outcome and to identify prognostic factors after Linac-based stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) on patients with brain metastases (BM) from non-small cell lung cancer (NSCLC). We performed a retrospective analysis of survival on 90 patients who underwent SRS or FSRT of intracranial NSCLC metastases between 04/2004 and 05/2014 that had not undergone prior surgery or whole brain radiotherapy (WBRT) for BM. Follow-up data was analyzed until May 2015. Potential prognostic factors were examined in univariable and multivariable analyses. The Golden Grading System (GGS), the disease-specific graded prognostic assessment (DS-GPA), the RADES II prognostic index as well as the NSCLC-specific index proposed by Rades et al. in 2013 (NSCLC-RADES) were calculated and their predictive values were tested in univariable analysis. The median follow-up time of the surviving patients was 14 months. The overall survival (OS) rate was 51 % after 6 months and 29.9 % after 12 months. Statistically significant factors of better OS after univariable analysis were lower International Union Against Cancer (UICC) stage at first diagnosis, histology of adenocarcinoma, prior surgery of the primary tumor and lower total BM volume. After multivariable analysis adenocarcinoma histology remained a significant factor; higher Karnofsky Performance Score (KPS) and the presence of extracranial metastases (ECM) were also significant. The RADES II and the NSCLC-RADES indices were significant predictors of OS. However, the NSCLC-RADES failed to differentiate between intermediate- and low-risk patients. The DS-GPA and GGS were not statistically significant predictors of survival in univariable analysis. The ideal prognostic index has not been defined yet. We believe that more specific indices will be developed in the future. Our results indicate that the histologic subtype of NSCLC could add to the prognostic

  19. Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases.

    Science.gov (United States)

    Shimada, Kotaro; Isoda, Hiroyoshi; Hirokawa, Yuusuke; Arizono, Shigeki; Shibata, Toshiya; Togashi, Kaori

    2010-11-01

    To compare the accuracy of gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI with that of diffusion-weighted MRI (DWI) in the detection of small hepatic metastases (2 cm or smaller). Forty-five patients underwent abdominal MRI at 3 T, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), heavily T2WI (HASTE), DWI with a b-value of 500 s/mm(2) and contrast-enhanced MRI with Gd-EOB-DTPA. Two groups were assigned and compared: group A (T1WI, T2WI, HASTE and contrast-enhanced study with Gd-EOB-DTPA), and group B (T1WI, T2WI, HASTE and DWI). Two observers independently interpreted the images obtained in a random order. For all hepatic metastases, the diagnostic performance using each imaging set was evaluated by receiver-operating characteristic (ROC) curve analysis. A total of 51 hepatic metastases were confirmed. The area under the ROC curve (Az) of group A was larger than that of group B, and the difference in the mean Az values between the two image sets was statistically significant, whereas, there were three metastases that lay near thin vessels or among multiple cysts and were better visualised in group B than in group A. Gd-EOB-DTPA-enhanced MRI showed higher accuracy in the detection of small metastases than DWI.

  20. The stability of osseous metastases of the spine in lung cancer – a retrospective analysis of 338 cases

    International Nuclear Information System (INIS)

    Rief, Harald; Bischof, Marc; Bruckner, Thomas; Welzel, Thomas; Askoxylakis, Vasileios; Rieken, Stefan; Lindel, Katja; Combs, Stephanie; Debus, Jürgen

    2013-01-01

    The objective of this retrospective analysis is to systematically assess osseous lesions on the basis of a validated scoring system in terms of stability and fractures prior to and following radiotherapy in 338 lung cancer patients with bone metastases in the vertebral column. The stability of 338 patients with 981 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of the Taneichi-Score between January 2000 and January 2012. 64% (215 patients) were classified stable prior to radiotherapy. Of the stable osseous metastases, none were rated unstable in the further course (p < 0.001, McNemar test). Of the 123 patients in whom the metastases were classified unstable prior to radiotherapy, 21 patients (17%) were classified stable after three months, and 30 patients (24%) stable after six months. A pathological fracture was diagnosed in 62 patients (18%) prior to radiotherapy. Regarding cases of osteolytic metastases of the vertebral bodies in which no fractures could be detected prior to the start of therapy, fractures occurred in 2% of all patients (n = 7) within six months following radiotherapy. Our analysis demonstrated that pathological fractures following radiotherapy occur in the very minority of vertebral lesions for patients with a favorable outcome. The use of a systematic radiological scoring system to classify osteolytic metastases of the vertebral column has shown to be feasible in daily routine. Prospective clinical trials are warranted in order to analyse, to what extent patients with osseous metastases can be mobilized by physiotherapy for strengthening the paravertebral muscles before radiotherapy effects can be measured by means of radiological recalcification

  1. Hazy increased density in diffuse lung disease

    International Nuclear Information System (INIS)

    Klein, J.S.; Webb, W.R.; Gamsu, G.; Warnock, M.; Park, C.K.

    1989-01-01

    In order to determine the significance of ground glass density on high-resolution CT scans of patients with idiopathic pulmonary fibrosis and other lung disorders, the authors have reviewed 200 high-resolution CT studies and found 50 cases demonstrating areas of hazy increased lung density. Disease entities most often associated with this finding included DIP, UIP, alveolar proteinosis, sarcoidosis, and bronchiolitis obliterans/ organizing pneumonia. Pathologic examination revealed either cellular or fluid material lining terminal air spaces, often associated with alveolar wall infiltration and an absence of fibrosis. Gallium scans and bronchoalveolar lavage in some cases showed active inflammation Follow-up high-resolution CT studies in 10 patients showed either change or resolution of the hazy densities, confirming the presence of a reversible parenchymal lesion

  2. CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Single Peripheral Lung Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Snider, James W.; Oermann, Eric K.; Chen, Viola; Rabin, Jennifer; Suy, Simeng; Yu, Xia [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); Vahdat, Saloomeh [Department of Pathology, Georgetown University Hospital, Washington, DC (United States); Collins, Sean P. [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); Banovac, Filip [Department of Radiology, Georgetown University Hospital, Washington, DC (United States); Anderson, Eric [Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Hospital, Washington, DC (United States); Collins, Brian T., E-mail: collinsb@gunet.georgetown.edu [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States)

    2012-06-29

    Standard treatment for operable patients with single peripheral lung metastases is metastasectomy. We report mature CyberKnife outcomes for high-risk surgical patients with biopsy proven single peripheral lung metastases. Twenty-four patients (median age 73 years) with a mean maximum tumor diameter of 2.5 cm (range, 0.8–4.5 cm) were treated over a 6-year period extending from September 2004 to September 2010 and followed for a minimum of 1 year or until death. A mean dose of 52 Gy (range, 45–60 Gy) was delivered to the prescription isodose line in three fractions over a 3–11 day period (mean, 7 days). At a median follow-up of 20 months, the 2-year Kaplan–Meier local control and overall survival rates were 87 and 50%, respectively. CyberKnife with fiducial tracking is an effective treatment for high-risk surgical patients with single small peripheral lung metastases. Trials comparing CyberKnife with metastasectomy for operable patients are necessary to confirm equivalence.

  3. Clinical applications of 153Sm-EDTMP in treatment of multiple bone metastases in 78 patients with lung cancer

    International Nuclear Information System (INIS)

    Xiao Guoyou; Li Dangsheng; Liang Yihua; Yao Xinjuan

    2001-01-01

    Objective: To evaluate the effect of 153 Sm-EDTMP in treating patients with lung cancer and multiple bone metastases. Methods: A dose of 18.5-25.9 MBq/Kg 153 Sm-EDTMP was administered once a month to each patient through vein injection according to disease severity and body weight. 3 injections made up one therapy cycle. Results: Pain relieves were obtained in 65 patients, with an effective rate of 83.3%. Pain relief of grade I was observed in 19 patients (24.3%), grade II in 46 patients (59%) and grade III in 13 patients (16.7%), respectively. Lesions of bone metastases disappeared or shrunk in 9 patients, with a positive rate of 11.5%, which included 3 cases of grade I and 6 cases of grade II, respectively. Better effects were obtained in adenocarcinoma and squamous carcinoma than in small cell lung cancer. Conclusion: 153 Sm-EDTMP is safe and effective in treating patients with lung cancer and multiple bone metastases

  4. Cure in a patient with multiple osseus metastases in non-small cell lung cancer: a case report

    International Nuclear Information System (INIS)

    Hawighorst, H.; Gademann, G.

    1993-01-01

    Purpose: This case was reported to describe a case of cure in a 61-year old patient with squamous cell lung cancer and multiple extrathoracic metastasis. Methods and materials: A left upper lobectomy of lung for a squamous cell carcinoma was performed on a 61-year old man with curative intent. Fourt months later two osseous metastases were irradiated with Cobalt 60 up to 40 Gy. Results: The two irradiated lesions showed continuously shrinkage as well as signs of recalcification. Eleven years later the patient shows clinically absolut well being and on CT there are no signs of recurrent disease of the lung or bone anymore. Discussion: To our knowledge has nobody so far reported of a case of a squamous cell lung cancer which was operated and irradiated on thus resulting in cure. Furtheron the authors discuss that it might well be worthwile to define subgroups in stage 4 non-small cell lung cancer (presence of extrathoracic metastases) which might benefit from a more aggressive treatment approach than pure palliation. (orig.) [de

  5. Cure in a patient with multiple osseus metastases in non-small cell lung cancer: a case report.

    Science.gov (United States)

    Hawighorst, H; Gademann, G

    1993-10-01

    This case was reported to describe a case of cure in a 61-year old patient with squamous cell lung cancer and multiple extrathoracic metastasis. A left upper lobectomy of lung for a squamous cell carcinoma was performed on a 61-year old man with curative intent. Four months later two osseus metastases were irradiated with Cobalt 60 up to 40 Gy. The two irradiated lesions showed continuously shrinkage as well as signs of recalcification. Eleven years later the patient shows clinically absolute well being and on CT there are no signs of recurrent disease of the lung or bone anymore. To our knowledge has nobody so far reported of a case of as squamous cell lung cancer which was operated and irradiated on thus resulting in cure. Further on the authors discuss that it might well be worthwhile to define subgroups in stage 4 non-small cell lung cancer (presence of extrathoracic metastases) which might benefit from a more aggressive treatment approach than pure palliation.

  6. Erlotinib Versus Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Lung Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Naamit K.; Yamada, Yoshiya; Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shi, Weiji [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Riely, Gregory J. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beal, Kathryn [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yu, Helena A. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Timothy A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wu, Abraham J., E-mail: wua@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-06-01

    Purpose/Objectives: Radiation therapy (RT) is the principal modality in the treatment of patients with brain metastases (BM). However, given the activity of EGFR tyrosine kinase inhibitors in the central nervous system, it is uncertain whether upfront brain RT is necessary for patients with EGFR-mutant lung adenocarcinoma with BM. Methods and Materials: Patients with EGFR-mutant lung adenocarcinoma and newly diagnosed BM were identified. Results: 222 patients were identified. Exclusion criteria included prior erlotinib use, presence of a de novo erlotinib resistance mutation, or incomplete data. Of the remaining 110 patients, 63 were treated with erlotinib, 32 with whole brain RT (WBRT), and 15 with stereotactic radiosurgery (SRS). The median overall survival (OS) for the whole cohort was 33 months. There was no significant difference in OS between the WBRT and erlotinib groups (median, 35 vs 26 months; P=.62), whereas patients treated with SRS had a longer OS than did those in the erlotinib group (median, 64 months; P=.004). The median time to intracranial progression was 17 months. There was a longer time to intracranial progression in patients who received WBRT than in those who received erlotinib upfront (median, 24 vs 16 months, P=.04). Patients in the erlotinib or SRS group were more likely to experience intracranial failure as a component of first failure, whereas WBRT patients were more likely to experience failure outside the brain (P=.004). Conclusions: The survival of patients with EGFR-mutant adenocarcinoma with BM is notably long, whether they receive upfront erlotinib or brain RT. We observed longer intracranial control with WBRT, even though the WBRT patients had a higher burden of intracranial disease. Despite the equivalent survival between the WBRT and erlotinib group, this study underscores the role of WBRT in producing durable intracranial control in comparison with a targeted biologic agent with known central nervous system activity.

  7. Stereotactic Radiotherapy in the Treatment of Lung Metastases from Bone and Soft-tissue Sarcomas.

    Science.gov (United States)

    Frakulli, Rezarta; Salvi, Fabrizio; Balestrini, Damiano; Parisi, Alessandro; Palombarini, Marcella; Cammelli, Silvia; Rocca, Michele; Salone, Mariacristina; Longhi, Alessandra; Ferrari, Stefano; Morganti, Alessio G; Frezza, Giovanni

    2015-10-01

    The purpose of this study was to evaluate local control and toxicity in a group of patients treated with stereotactic body radiotherapy (SBRT) for lung metastases (LM) from bone and soft tissue sarcomas. From October 2010 to July 2014, patients with LM from sarcomas not suitable for surgery were treated with daily cone-beam computed tomography-guided SBRT. The dose administered ranged from 30 to 60 Gy in 3-8 fractions. Acute and late toxicity were scored according to Common Terminology Criteria for Adverse Events version 4.0. A total of 24 patients with 68 LM from sarcomas were treated with SBRT. The median follow-up after SBRT was 17 months (range=11-51 months). Two-year actuarial lesion local control and overall survival were 85.9% and 66.4%, respectively. No G3 or greater acute and late toxicities were observed. SBRT is a safe and effective treatment for LM from sarcoma and might be used as an alternative option in patients unfit for surgery. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  8. Advanced Mesodermal (Müllerian Adenosarcoma of the Ovary: Metastases to the Lungs, Mouth, and Brain

    Directory of Open Access Journals (Sweden)

    A. Daskalaki

    2015-01-01

    Full Text Available Background. A malignant mixed Müllerian tumor (MMMT is a malignant neoplasm found in the uterus, the ovaries, the fallopian tubes, and other parts of the body that contains both carcinomatous (epithelial tissue and sarcomatous (connective tissue components. Outcome of MMMTs is determined primarily by depth of invasion and stage. The metastatic background of these lesions is controversial and unknown. Case Report. A 75-year-old woman was admitted to the hospital with anorexia, weakness, and persistent coughing. The imaging exams revealed a solid, promiscuous lesion of 16 × 14 cm in dimensions located into the small pelvis, surrounding the uterus and the ovaries. The patient underwent exploratory laparotomy. The mass was removed and the histological examination of the specimen revealed an advanced mesodermal adenocarcinoma of the ovary (MMMT. Nine days after the operation the patient presented with metastatic lesions in the mouth as well as the lungs. Within a month after the discharge from the hospital metastatic lesions of the MMMT were also depicted in the CT brain scan. Conclusion. Despite the fact that sarcomas have a long-term metastatic potential, to our knowledge this is the first case of Müllerian adenosarcoma presenting with such extraperitoneal metastases.

  9. Low Accuracy of Computed Tomography and Positron Emission Tomography to Detect Lung and Lymph Node Metastases of Colorectal Cancer.

    Science.gov (United States)

    Guerrera, Francesco; Renaud, Stéphane; Schaeffer, Mickaël; Nigra, Victor; Solidoro, Paolo; Santelmo, Nicola; Filosso, Pier Luigi; Falcoz, Pierre-Emmanuel; Ruffini, Enrico; Oliaro, Alberto; Massard, Gilbert

    2017-10-01

    Minimally invasive surgery, stereotactic radiotherapy, and radiofrequency ablation are commonly proposed in the case of pulmonary colorectal-metastasis as alternatives to conventional open surgery. Preoperative imaging assessment by computed tomography (CT) scan and fluorodeoxyglucose positron emission tomography (FDG-PET) are critical to guide oncologic radical treatment. Our aim was to investigate the accuracy of CT and FDG-PET for the evaluation of the number of pulmonary colorectal metastases and thoracic lymph nodal involvement (LNI). Patients who underwent lung surgical resection for pulmonary colorectal metastases from 2004 to 2014 were analyzed. Concordance between histology, CT scan, and FDG-PET findings were assessed. Data of 521 patients were analyzed. Of those, FDG-PET was performed in 435 (83.5%). A moderate agreement between both CT scan (kappa index: 0.42) and FDG-PET (kappa index: 0.42) findings and the histologically proven number of metastases was observed. The number of histologically proven metastases was correctly discriminated in 61.7% of cases with CT scan and in 61.8% of cases with FDG-PET. Multiple metastases were discovered in 20.9% of clinical single metastasis cases with CT scan, and in 24.4% of those cases with FDG-PET. One hundred fifty patients (29.1%) presented with pathologic LNI. A poor agreement was observed between LNI and CT scan findings (kappa index: 0.02), and a weak agreement was observed concerning LNI and FDG-PET findings (kappa index: 0.39). Computed tomography and FDG-PET have limitations if the objective is to detect all malignant nodules and to discriminate the LNI in cases of pulmonary metastases of colorectal cancer. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Percutaneous radiofrequency ablation of lung metastases from colorectal carcinoma under C-arm cone beam CT guidance.

    Science.gov (United States)

    Amouyal, G; Pernot, S; Déan, C; Cholley, B; Scotté, F; Sapoval, M; Pellerin, O

    2017-11-01

    The aim of this study was to assess the feasibility, safety and efficacy of percutaneous radiofrequency ablation of lung metastases from colorectal carcinoma using C-arm cone beam computed tomography (CBCT) guidance. This single-center prospective observational study was performed from August 2013 to August 2016, and included consecutive patients referred for radiofrequency ablation of lung metastases from colorectal cancer. Radiofrequency ablation procedures were performed under C-arm CBCT guidance. Feasibility was assessed by probe accuracy placement, time to accurate placement and number of C-arm CBCT acquisitions to reach the target lesion. Safety was assessed by the report of adverse event graded using the common terminology criteria for adverse events (CTCAE-V4.0). Efficacy was assessed by metastases response rate using RECIST 1.1 and 18 FDG-PET-CT tumor uptake at 6months. Fifty-four consecutive patients (32 men, 22 women) with a mean age of 63±8 (SD) years (range: 51-81years) with a total of 56 lung metastasis from colorectal metastases were treated in a single session. The mean tumor diameter was 25.6±4.5 (SD)mm (range: 17-31mm). Median time to insert the needle into the target lesion was 10min (range: 5-25min). Median number of needles repositioning and C-arm CBCT acquisition per patient was 1 (range: 0-3) and 4 (range: 3-6) respectively. The accuracy for radiofrequency ablation probe placement was 2±0.2 (SD)mm (range: 0-9mm). Pneumothorax requiring chest tube placement occurred in one patient (CTCAE-V4.0 grade 3). At 6months, all patients were alive with tumor response rate of -27% and had no significant activity on the 18 FDG-PET CT follow-up. Percutaneous radiofrequency ablation of lung metastases from colorectal cancer under C-arm CBCT guidance is feasible and safe, with immediate and short-term results similar to those obtained using conventional CT guidance. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS

  11. Diagnostic performance of [18F] FDG PET-CT compared to bone scintigraphy for the detection of bone metastases in lung cancer patients

    International Nuclear Information System (INIS)

    RODRIGUES, Margarida; STARK, Hannes; RENDL, Gundula; RETTENBACHER, Lukas; PIRICH, Christian; DATZ, Lidwina; STUDNICKA, Michael

    2016-01-01

    Accurate staging of lung cancer is essential for effective patient management and selection of appropriate therapeutic strategy. The aim of this paper was to compare the value of bone scintigraphy and FDG PET-CT for detecting bone metastases in lung cancer patients and the impact of these modalities in disease staging. One hundred sixty-four lung cancer patients who had undergone both FDG PET-CT and bone scintigraphy within 14 days were included into this study. The analysis of FDG PET-CT and bone scintigraphy was carried out patient- and lesion-based. One hundred twenty-one patients were negative and 43 patients positive for bone metastases. FDG PET-CT found bone metastases in 42/43 patients and bone scintigraphy in 38/43 patients. Sensitivity, specificity and accuracy of FDG PET-CT and bone scintigraphy for detecting bone metastases were 97.7%, 100% and 99.4%, and 87.8%, 97.5% and 94.2%, respectively. FDG PET-CT identified 430 bone metastases and bone scintigraphy 246 bone metastases. Skull was the only region where bone scintigraphy identified more lesions than FDG PET-CT. Based on both scintigraphic modalities disagreement concerning disease stage was found in 3 patients. In conclusion, FDG PET-CT yielded a higher sensitivity, specificity and accuracy than bone scintigraphy for identifying bone metastases in lung cancer patients. FDG PET-CT thus can be recommended for initial staging of lung cancer patients without applying bone scintigraphy for the detection of bone metastases.

  12. Use of Stereotactic Radiosurgery for Brain Metastases From Non-Small Cell Lung Cancer in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Halasz, Lia M., E-mail: lhalasz@uw.edu [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts (United States); Weeks, Jane C.; Neville, Bridget A.; Taback, Nathan [Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Punglia, Rinaa S. [Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2013-02-01

    Purpose: The indications for treatment of brain metastases from non-small cell lung cancer (NSCLC) with stereotactic radiosurgery (SRS) remain controversial. We studied patterns, predictors, and cost of SRS use in elderly patients with NSCLC. Methods and Materials: Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we identified patients with NSCLC who were diagnosed with brain metastases between 2000 and 2007. Our cohort included patients treated with radiation therapy and not surgical resection as initial treatment for brain metastases. Results: We identified 7684 patients treated with radiation therapy within 2 months after brain metastases diagnosis, of whom 469 (6.1%) cases had billing codes for SRS. Annual SRS use increased from 3.0% in 2000 to 8.2% in 2005 and varied from 3.4% to 12.5% by specific SEER registry site. After controlling for clinical and sociodemographic characteristics, we found SRS use was significantly associated with increasing year of diagnosis, specific SEER registry, higher socioeconomic status, admission to a teaching hospital, no history of participation in low-income state buy-in programs (a proxy for Medicaid eligibility), no extracranial metastases, and longer intervals from NSCLC diagnosis. The average cost per patient associated with radiation therapy was 2.19 times greater for those who received SRS than for those who did not. Conclusions: The use of SRS in patients with metastatic NSCLC increased almost 3-fold from 2000 to 2005. In addition, we found significant variations in SRS use across SEER registries and socioeconomic quartiles. National practice patterns in this study suggested both a lack of consensus and an overall limited use of the approach among elderly patients before 2008.

  13. Use of Stereotactic Radiosurgery for Brain Metastases From Non-Small Cell Lung Cancer in the United States

    International Nuclear Information System (INIS)

    Halasz, Lia M.; Weeks, Jane C.; Neville, Bridget A.; Taback, Nathan; Punglia, Rinaa S.

    2013-01-01

    Purpose: The indications for treatment of brain metastases from non-small cell lung cancer (NSCLC) with stereotactic radiosurgery (SRS) remain controversial. We studied patterns, predictors, and cost of SRS use in elderly patients with NSCLC. Methods and Materials: Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we identified patients with NSCLC who were diagnosed with brain metastases between 2000 and 2007. Our cohort included patients treated with radiation therapy and not surgical resection as initial treatment for brain metastases. Results: We identified 7684 patients treated with radiation therapy within 2 months after brain metastases diagnosis, of whom 469 (6.1%) cases had billing codes for SRS. Annual SRS use increased from 3.0% in 2000 to 8.2% in 2005 and varied from 3.4% to 12.5% by specific SEER registry site. After controlling for clinical and sociodemographic characteristics, we found SRS use was significantly associated with increasing year of diagnosis, specific SEER registry, higher socioeconomic status, admission to a teaching hospital, no history of participation in low-income state buy-in programs (a proxy for Medicaid eligibility), no extracranial metastases, and longer intervals from NSCLC diagnosis. The average cost per patient associated with radiation therapy was 2.19 times greater for those who received SRS than for those who did not. Conclusions: The use of SRS in patients with metastatic NSCLC increased almost 3-fold from 2000 to 2005. In addition, we found significant variations in SRS use across SEER registries and socioeconomic quartiles. National practice patterns in this study suggested both a lack of consensus and an overall limited use of the approach among elderly patients before 2008.

  14. Improved differentiation between hepatic hemangioma and metastases on diffusion-weighted MRI by measurement of standard deviation of apparent diffusion coefficient.

    Science.gov (United States)

    Hardie, Andrew D; Egbert, Robert E; Rissing, Michael S

    2015-01-01

    Diffusion-weighted magnetic resonance imaging (DW-MR) can be useful in the differentiation of hemangiomata from liver metastasis, but improved methods other than by mean apparent diffusion coefficient (mADC) are needed. A retrospective review identified 109 metastatic liver lesions and 86 hemangiomata in 128 patients who had undergone DW-MR. For each lesion, mADC and the standard deviation of the mean ADC (sdADC) were recorded and compared by receiver operating characteristic analysis. Mean mADC was higher in benign hemangiomata (1.52±0.12 mm(2)/s) than in liver metastases (1.33±0.18 mm(2)/s), but there was significant overlap in values. The mean sdADC was lower in hemangiomata (101±17 mm(2)/s) than metastases (245±25 mm(2)/s) and demonstrated no overlap in values, which was significantly different (P<.0001). Hemangiomata may be better able to be differentiated from liver metastases on the basis of sdADC than by mADC, although further studies are needed. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Colorectal Histology Is Associated With an Increased Risk of Local Failure in Lung Metastases Treated With Stereotactic Ablative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Binkley, Michael S. [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Trakul, Nicholas [Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California (United States); Jacobs, Lisa Rose; Eyben, Rie von; Le, Quynh-Thu; Maxim, Peter G.; Loo, Billy W. [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Shultz, David Benjamin, E-mail: DavidS4@Stanford.edu [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Diehn, Maximilian, E-mail: Diehn@Stanford.edu [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California (United States)

    2015-08-01

    Purpose: Stereotactic ablative radiation therapy (SABR) is increasingly used to treat lung oligometastases. We set out to determine the safety and efficacy of this approach and to identify factors associated with outcomes. Methods and Materials: We conducted a retrospective study of patients treated with SABR for metastatic lung tumors at our institution from 2003 to 2014. We assessed the association between various patient and treatment factors with local failure (LF), progression, subsequent treatment, systemic treatment, and overall survival (OS), using univariate and multivariate analyses. Results: We identified 122 tumors in 77 patients meeting inclusion criteria for this study. Median follow-up was 22 months. The 12- and 24-month cumulative incidence rates of LF were 8.7% and 16.2%, respectively; the 24-month cumulative incidence rates of progression, subsequent treatment, and subsequent systemic treatment were 75.2%, 64.5%, and 35.1%, respectively. Twenty-four-month OS was 74.6%, and median OS was 36 months. Colorectal metastases had a significantly higher cumulative incidence of LF at 12 and 24 months (25.5% and 42.2%, respectively), than all other histologies (4.4% and 9.9%, respectively; P<.0004). The 24-month cumulative incidences of LF for colorectal metastases treated with a biologically effective dose at α/β = 10 (BED{sub 10}) of <100 Gy versus BED{sub 10} of ≥100 Gy were 62.5% and 16.7%, respectively (P=.08). Toxicity was minimal, with only a single grade 3 or higher event observed. Conclusions: SABR for metastatic lung tumors appears to be safe and effective with excellent local control, treatment-free intervals, and OS. An exception is metastases from colorectal cancer, which have a high LF rate consistent with a radioresistant phenotype, suggesting a potential role for dose escalation.

  16. Preoperative scintigraphic detection of lung metastases of a follicular thyroid carcinoma associated with hyperthyroidism

    International Nuclear Information System (INIS)

    Biyi, A.; Oufroukhi, Y.; Doudouh, A.; Baizri, H.; El Quatni, M.; Al Bouzidi, A.

    2009-01-01

    Preoperative accumulation of radioiodine in metastases of thyroid carcinoma and its association with hyperthyroidism are uncommon. We report a case of 58-year-old woman with follicular thyroid carcinoma revealed by thyrotoxicosis caused by a hot nodule, and bilateral pulmonary uptake of I-131 before total thyroidectomy. Despite four ablative doses of I-131, bone metastases were identified and the patient died 42 month after the initial diagnosis. (authors)

  17. Metastatic tumors of lungs

    International Nuclear Information System (INIS)

    Rozenshtraukh, L.C.; Rybakova, N.I.; Vinner, M.G.

    1987-01-01

    Roentgenologic semiotics of lung metastases and their complications, as well as peculiarities of lung metastases of separate localization tumours are presented. Definition table for primary tumour by roentgenologic aspect of lung metastases is given

  18. Diffusion-weighted imaging and dynamic contrast-enhanced MRI of experimental breast cancer bone metastases – A correlation study with histology

    Energy Technology Data Exchange (ETDEWEB)

    Merz, Maximilian [Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg (Germany); Seyler, Lisa; Bretschi, Maren; Semmler, Wolfhard [Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Bäuerle, Tobias, E-mail: tobias.baeuerle@uk-erlangen.de [Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Institute of Radiology, University Medical Center Erlangen, Palmsanlage 5, 90154 Erlangen (Germany)

    2015-04-15

    Purpose: To validate imaging parameters from diffusion-weighted imaging and dynamic contrast-enhanced MRI with immunohistology and to non-invasively assess microstructure of experimental breast cancer bone metastases. Materials and methods: Animals bearing breast cancer bone metastases were imaged in a clinical 1.5 T MRI scanner. HASTE sequences were performed to calculate apparent diffusion coefficients. Saturation recovery turbo FLASH sequences were conducted while infusing 0.1 mmol/l Gd–DTPA for dynamic contrast-enhanced MRI to quantify parameters amplitude A and exchange rate constant k{sub ep}. After imaging, bone metastases were analyzed immunohistologically. Results: We found correlations of the apparent diffusion coefficients from diffusion-weighted imaging with tumor cellularity as assessed with cell nuclei staining. Histological vessel maturity was correlated negatively with parameters A and k{sub ep} from dynamic contrast-enhanced MRI. Tumor size correlated inversely with cell density and vessel permeability as well as positively with mean vessel calibers. Parameters from the rim of bone metastases differed significantly from values of the center. Conclusion: In vivo diffusion-weighted imaging and dynamic contrast-enhanced MRI in experimental bone metastases provide information about tumor cellularity and vascularity and correlate well with immunohistology.

  19. Lung function study and diffusion capacity in anorexia nervosa.

    Science.gov (United States)

    Pieters, T; Boland, B; Beguin, C; Veriter, C; Stanescu, D; Frans, A; Lambert, M

    2000-08-01

    In humans, malnutrition alters the respiratory system in different ways. It impairs the ventilatory drive, decreases respiratory muscle strength and reduces immune competence. In addition, typical emphysema-like changes were demonstrated in starved animals. The presence of emphysema has never been demonstrated in starved humans. Our objective was to investigate whether pulmonary emphysema occurs in anorexia nervosa by means of a pulmonary function study. We examined 24 women aged between 14 and 38 years (nine smokers). We studied the lung function including lung volumes, ventilatory capacity, maximal respiratory pressures and transfer factor, as well as PaO2. All respiratory tests were within normal limits with the exception of decreased maximal inspiratory (59% of predicted values) and expiratory pressures (35%), and increased residual volume (162%). Diffusion capacity (98.1 +/- 16.2%) and transfer coefficient (98.4 +/- 16.2%) were also normal. The diffusion coefficient was lower in current smokers than in those who had never smoked (P anorexia nervosa, pulmonary function tests are within normal limits with the exception of maximal pressures and residual volume. Diffusion capacity is not decreased. The present results within the limitations of the used method are not compatible with the hypothesis of starvation-induced pulmonary emphysema.

  20. Detecting lung cancer symptoms with analogic CNN algorithms based on a constrained diffusion template

    International Nuclear Information System (INIS)

    Hirakawa, Satoshi; Nishio, Yoshifumi; Ushida, Akio; Ueno, Junji; Kasem, I.; Nishitani, Hiromu; Rekeczky, C.; Roska, T.

    1997-01-01

    In this article, a new type of diffusion template and an analogic CNN algorithm using this diffusion template for detecting some lung cancer symptoms in X-ray films are proposed. The performance of the diffusion template is investigated and our CNN algorithm is verified to detect some key lung cancer symptoms, successfully. (author)

  1. Lung, liver and lymph node metastases in follow-up MSCT. Comprehensive volumetric assessment of lesion size changes

    Energy Technology Data Exchange (ETDEWEB)

    Wulff, A.M.; Fischer, S.; Biederer, J.; Heller, M.; Fabel, M. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Klinik fuer Diagnostische Radiologie; Bolte, H. [Universitaetsklinikum Muenster (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Freitag-Wolf, S. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Inst. fuer Medizinische Informatik und Statistik; Soza, G.; Tietjen, C. [Siemens AG (Germany). Imaging and IT Div. Computed Tomography

    2012-09-15

    Purpose: To investigate measurement accuracy in terms of precision and inter-rater variability in the simultaneous volumetric assessment of lung, liver and lymph node metastasis size change over time in comparison to RECIST 1.1. Materials and Methods: Three independent readers evaluated multislice CT data from clinical follow-up studies (chest/abdomen) in 50 patients with metastases. A total of 117 lung, 77 liver and 97 lymph node metastases were assessed manually (RECIST 1.1) and by volumetry with semi-automated software. The quality of segmentation and need for manual adjustments were recorded. Volumes were converted to effective diameters to allow comparison to RECIST. For statistical assessment of precision and interobserver agreement, the Wilcoxon-signed rank test and Bland-Altman plots were utilized. Results: The quality of segmentation after manual correction was acceptable to excellent in 95 % of lesions and manual corrections were applied in 21 - 36 % of all lesions, most predominantly in lymph nodes. Mean precision was 2.6 - 6.3 % (manual) with 0.2 - 1.5 % (effective) relative measurement deviation (p <.001). Inter-reader median variation coefficients ranged from 9.4 - 12.8 % (manual) and 2.9 - 8.2 % (volumetric) for different lesion types (p <.001). The limits of agreement were {+-} 9.8 to {+-} 11.2 % for volumetric assessment. Conclusion: Superior precision and inter-rater variability of volumetric over manual measurement of lesion change over time was demonstrated in a whole body setting. (orig.)

  2. Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Sundaresan, P.; Yeghiaian, R.; Gebski, V.

    2010-01-01

    Full text: Palliative whole brain radiotherapy (WBRT) is often recommended in the management of multiple brain metastases. Allowing for WBRT waiting time, duration of the WBRT course and time to clinical response, it may take 6 weeks from the point of initial assessment for a benefit from WBRT to manifest. Patients who die within 6 weeks ('early death') may not benefit from WBRT and may instead experience a decline in quality of life. This study aimed to develop a prognostic index (PI) that identifies the subset of patients with lung cancer with multiple brain metastases who may not benefit from WBRT because of'early death'. The medical records of patients with lung cancer who had WBRT recommended for multiple brain metastases over a 10-year period were retrospectively reviewed. Patients were classified as either having died within 6 weeks or having lived beyond 6 weeks. Potential prognostic indicators were evaluated for correlation with 'early death'. A PI was constructed by modelling the survival classification to determine the contribution of these factors towards shortened survival. Of the 275 patients recommended WBRT, 64 (23.22%) died within 6 weeks. The main prognostic factor predicting early death was Eastern Cooperative Oncology Group (ECOG) status >2. Patients with a high PI score (>13) were at higher risk of'early death'. Twenty-three per cent of patients died prior to benefit from WBRT. ECOG status was the most predictive for 'early death'. Other factors may also contribute towards a poor outcome. With further refinement and validation, the PI could be a valuable clinical decision tool.

  3. The value of diffusion weighted imaging in differentiating intracranial tuberculomas from high-grade astrocytomas and metastases

    International Nuclear Information System (INIS)

    Peng Juan; Luo Tianyou; Lv Fajin; Fang Weidong; Wu Jingquan; Ouyang Yu; Li Yongmei

    2007-01-01

    Objective: To explore the value of diffusion weighted imaging (DWI) in differentiating intracranial tuberculomas from high-grade astrocytomas and metastases. Methods: The conventional MR imaging and DWI were performed in 50 eases (14 cases with intracranial tuberculomas, 15 cases with high- grade astrocytomas, and 21 cases with metastases) before treatment or operation. The mean apparent diffusion coefficient (ADC) values and relative apparent diffusion coefficient (rADC) values were calculated from the mass as well as from the peripheral edema regions of intracranial lesions. Results: The mean ADC values and rADC values were (1.2±0.2) x 10 -3 mm 2 ·s -1 and 1.6±0.3 in the mass of intracranial tuberculomas respectively; (0.8±0.1) x 10 -3 mm 2 ·s -1 and 1.1±0.1 in the parenehyma of high-grade astrocytomas; (0.8±0.1) x 10 -3 mm 2 ·s -1 and 1.0±0.2 in the parenchyma of metastases. There was significant difference of the mean ADC values (F=33.57, P -3 mm 2 ·s -1 and 2.5±0.2 in the peripheral edema regions of intracranial tuberculomas respectively; (1.4±0.2) x 10 -3 mm 2 ·s -1 and 1.8±0.3 in the peripheral edema regions of high-grade astrocytomas; and (1.9±0.2) x 10 -3 mm 2 ·s -1 and 2.3±0.5 in the peripheral edema regions of metastases. There was also significant difference in the mean ADC values (F23.17, P<0.01) or rADC values (F=5.94, P<0.01) among the peripheral edema regions of the three groups. Conclusion: The ADC values and rADC values are quite effective in differentiating intracranial tuberculoma from high-grade astrocytoma and metastasis. (authors)

  4. Airway surface irregularities promote particle diffusion in the human lung

    International Nuclear Information System (INIS)

    Martonen, T.; North Carolina Univ., Chapel Hill, NC; Zhang, Z.; Yang, Y.; Bottei, G.

    1995-01-01

    Current NCRP and ICRP particle deposition models employed in risk assessment analyses treat the airways of the human lung as smooth-walled tubes. However, the upper airways of the tracheobronchial (TB) tree are line with cartilaginous rings. Recent supercomputer simulations of in vivo conditions (cited herein), where cartilaginous ring morphologies were based upon fibre-optic bronchoscope examinations, have clearly demonstrated their profound effects upon fluid dynamics. A physiologically based analytical model of fluid dynamics is presented, focusing upon applications to particle diffusion within the TB tree. The new model is the first to describe particle motion while simultaneously simulating effects of wall irregularities, entrance conditions and tube curvatures. This study may explain the enhanced deposition by particle diffusion detected in replica case experiments and have salient implications for the clinically observed preferential distributions of bronchogenic carcinomas associated with inhaled radionuclides. (author)

  5. Use of diffusion-weighted MRI to modify radiosurgery planning in brain metastases may reduce local recurrence.

    Science.gov (United States)

    Zakaria, Rasheed; Pomschar, Andreas; Jenkinson, Michael D; Tonn, Jörg-Christian; Belka, Claus; Ertl-Wagner, Birgit; Niyazi, Maximilian

    2017-02-01

    Stereotactic radiosurgery (SRS) is an effective and well tolerated treatment for selected brain metastases; however, local recurrence still occurs. We investigated the use of diffusion weighted MRI (DWI) as an adjunct for SRS treatment planning in brain metastases. Seventeen consecutive patients undergoing complete surgical resection of a solitary brain metastasis underwent image analysis retrospectively. SRS treatment plans were generated based on standard 3D post-contrast T1-weighted sequences at 1.5T and then separately using apparent diffusion coefficient (ADC) maps in a blinded fashion. Control scans immediately post operation confirmed complete tumour resection. Treatment plans were compared to one another and with volume of local recurrence at progression quantitatively and qualitatively by calculating the conformity index (CI), the overlapping volume as a proportion of the total combined volume, where 1 = identical plans and 0 = no conformation whatsoever. Gross tumour volumes (GTVs) using ADC and post-contrast T1-weighted sequences were quantitatively the same (related samples Wilcoxon signed rank test = -0.45, p = 0.653) but showed differing conformations (CI 0.53, p recurrence than the standard plan (median 3.53 cm 3 vs. 3.84 cm 3 , p = 0.002). ADC maps may be a useful tool in addition to the standard post-contrast T1-weighted sequence used for SRS planning.

  6. TH-E-BRF-07: Raman Spectroscopy for Radiation Treatment Response Assessment in a Lung Metastases Mouse Model

    International Nuclear Information System (INIS)

    Devpura, S; Barton, K; Brown, S; Siddiqui, F; Chetty, I; Sethi, S; Klein, M

    2014-01-01

    Purpose: Raman spectroscopy is an optical spectroscopic method used to probe chemical information about a target tissue. Our goal was to investigate whether Raman spectroscopy is able to distinguish lung tumors from normal lung tissue and whether this technique can identify the molecular changes induced by radiation. Methods: 4T1 mouse breast cancer cells were implanted subcutaneously into the flanks of 6 Balb/C female mice. Four additional mice were used as “normal lung” controls. After 14 days, 3 mice bearing tumors received 6Gy to the left lung with 6MV photons and the other three were treated as “unirradiated tumor” controls. At a 24-hour time point, lungs were excised and the specimens were sectioned using a cryostat; alternating sections were either stained with hematoxylin and eosin (H and E) for evaluation by a pathologist or unstained for Raman measurements. 240 total Raman spectra were collected; 84 from normal lung controls; 63 from unirradiated tumors and 64 from tumors irradiated with 6Gy in a single fraction. Raman spectra were also collected from normal lung tissues of mice with unirradiated tumors. Principal component analysis (PCA) and discriminant function analysis (DFA) were performed to analyze the data. Results: Raman bands assignable to DNA/RNA showed prominent contributions in tumor tissues while Raman bands associated with hemoglobin showed strong contributions in normal lung tissue. PCA/DFA analysis identified normal lung tissue and tumor with 100% and 98.4% accuracy, respectively, relative to pathologic scoring. Additionally, normal lung tissues from unirradiated mice bearing tumors were classified as normal with 100% accuracy. In a model consisting of unirradiated and irradiated tumors identification accuracy was 79.4% and 93.8% respectively, relative to pathologic assessment. Conclusion: Initial results demonstrate the promise for Raman spectroscopy in the diagnosis normal vs. lung metastases as well as the assessment of

  7. TH-E-BRF-07: Raman Spectroscopy for Radiation Treatment Response Assessment in a Lung Metastases Mouse Model

    Energy Technology Data Exchange (ETDEWEB)

    Devpura, S; Barton, K; Brown, S; Siddiqui, F; Chetty, I [Henry Ford Health System, Detroit, MI (United States); Sethi, S [Karmanos Cancer Center, Detroit, MI (United States); Klein, M [Children' s Hospital of Michigan, Detroit, MI (United States)

    2014-06-15

    Purpose: Raman spectroscopy is an optical spectroscopic method used to probe chemical information about a target tissue. Our goal was to investigate whether Raman spectroscopy is able to distinguish lung tumors from normal lung tissue and whether this technique can identify the molecular changes induced by radiation. Methods: 4T1 mouse breast cancer cells were implanted subcutaneously into the flanks of 6 Balb/C female mice. Four additional mice were used as “normal lung” controls. After 14 days, 3 mice bearing tumors received 6Gy to the left lung with 6MV photons and the other three were treated as “unirradiated tumor” controls. At a 24-hour time point, lungs were excised and the specimens were sectioned using a cryostat; alternating sections were either stained with hematoxylin and eosin (H and E) for evaluation by a pathologist or unstained for Raman measurements. 240 total Raman spectra were collected; 84 from normal lung controls; 63 from unirradiated tumors and 64 from tumors irradiated with 6Gy in a single fraction. Raman spectra were also collected from normal lung tissues of mice with unirradiated tumors. Principal component analysis (PCA) and discriminant function analysis (DFA) were performed to analyze the data. Results: Raman bands assignable to DNA/RNA showed prominent contributions in tumor tissues while Raman bands associated with hemoglobin showed strong contributions in normal lung tissue. PCA/DFA analysis identified normal lung tissue and tumor with 100% and 98.4% accuracy, respectively, relative to pathologic scoring. Additionally, normal lung tissues from unirradiated mice bearing tumors were classified as normal with 100% accuracy. In a model consisting of unirradiated and irradiated tumors identification accuracy was 79.4% and 93.8% respectively, relative to pathologic assessment. Conclusion: Initial results demonstrate the promise for Raman spectroscopy in the diagnosis normal vs. lung metastases as well as the assessment of

  8. Classification of diffuse lung diseases: why and how.

    Science.gov (United States)

    Hansell, David M

    2013-09-01

    The understanding of complex lung diseases, notably the idiopathic interstitial pneumonias and small airways diseases, owes as much to repeated attempts over the years to classify them as to any single conceptual breakthrough. One of the many benefits of a successful classification scheme is that it allows workers, within and between disciplines, to be clear that they are discussing the same disease. This may be of particular importance in the recruitment of individuals for a clinical trial that requires a standardized and homogeneous study population. Different specialties require fundamentally different things from a classification: for epidemiologic studies, a classification that requires categorization of individuals according to histopathologic pattern is not usually practicable. Conversely, a scheme that simply divides diffuse parenchymal disease into inflammatory and noninflammatory categories is unlikely to further the understanding about the pathogenesis of disease. Thus, for some disease groupings, for example, pulmonary vasculopathies, there may be several appropriate classifications, each with its merits and demerits. There has been an interesting shift in the past few years, from the accepted primacy of histopathology as the sole basis on which the classification of parenchymal lung disease has rested, to new ways of considering how these entities relate to each other. Some inventive thinking has resulted in new classifications that undoubtedly benefit patients and clinicians in their endeavor to improve management and outcome. The challenge of understanding the logic behind current classifications and their shortcomings are explored in various examples of lung diseases.

  9. Predictors of Individual Tumor Local Control After Stereotactic Radiosurgery for Non-Small Cell Lung Cancer Brain Metastases

    International Nuclear Information System (INIS)

    Garsa, Adam A.; Badiyan, Shahed N.; DeWees, Todd; Simpson, Joseph R.; Huang, Jiayi; Drzymala, Robert E.; Barani, Igor J.; Dowling, Joshua L.; Rich, Keith M.; Chicoine, Michael R.; Kim, Albert H.; Leuthardt, Eric C.; Robinson, Clifford G.

    2014-01-01

    Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS). Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant. Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index. Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective

  10. Survival and prognostic factors in non-small cell lung cancer patients with spinal bone metastases. A retrospective analysis of 303 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rief, H.; Welzel, T.; Rieken, S.; Bischof, M.; Lindel, K.; Combs, S.E.; Debus, J. [University Hospital of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Muley, T. [University Hospital of Heidelberg, Thorax Clinic, Department of Thoracic Oncology, Heidelberg (Germany); Bruckner, T. [University Hospital of Heidelberg, Department of Medical Biometry, Heidelberg (Germany)

    2014-01-15

    For palliative care of spinal bone metastases, stability assessment is of crucial importance. Pathological fractures, instability-related patient immobility and the extent of bone metastasis have been reported to affect patient outcome and these parameters have therefore been used for treatment stratification. We report on stability-dependent fracture and survival rates in over 300 non-small cell lung cancer (NSCLC) patients. Data from 303 patients with 868 osteolytic metastases treated with radiotherapy (RT) between 2000 and 2012 were evaluated retrospectively. In NSCLC patients with bone metastases only, the retrospective 6- and 12-month overall survival (OS) rates were 76.7 and 47.2%, respectively. In patients with additional non-bone distant metastases, these values were 60.0 and 34.0%, respectively. Survival rates were significantly lower in patients with multiple bone metastases and in those suffering pathological fractures (p=0.017). No significant impact of histological type, location of spinal lesions or treatment regime was detected. Furthermore, stability assessment revealed no influence of vertebral column stability on patient outcome (p=0.739). Our analysis demonstrated a correlation between the pathological fractures of bone lesions, the number of bone metastases, additional distant metastases and survival. The results offer a rationale for future prospective investigations. (orig.)

  11. Sex Differences and Bone Metastases of Breast, Lung, and Prostate Cancers: Do Bone Homing Cancers Favor Feminized Bone Marrow?

    Directory of Open Access Journals (Sweden)

    Mary C. Farach-Carson

    2017-08-01

    Full Text Available Sex-associated differences in bone metastasis formation from breast, lung, and prostate cancer exist in clinical studies, but have not been systematically reviewed. Differences in the bone marrow niche can be attributed to sexual dimorphism, to genetic variations that affect sex hormone levels, or to the direct effects of sex hormones, natural or exogenously delivered. This review describes the present understanding of sex-associated and sex hormone level differences in the marrow niche and in formation of bone metastasis during the transition of these three cancers from treatable disease to an often untreatable, lethal metastatic one. Our purpose is to provide insight into some underlying molecular mechanisms for hormonal influence in bone metastasis formation, and to the potential influence of sexual dimorphism, genetic differences affecting sex assignment, and sex hormone level differences on the bone niche and its favorability for metastasis formation. We reviewed publications in PubMed and EMBASE, including full length manuscripts, case reports, and clinical studies of relevance to our topic. We focused on bone metastasis formation in breast, lung, and prostate cancer because all three commonly present with bone metastases. Several clear observations emerged. For breast cancer bone metastasis formation, estrogen receptor (ER signaling pathways indicate a role for ER beta (ERβ. Estrogen influences the bone microenvironment, creating and conditioning a favorable niche for colonization and breast cancer progression. For lung cancer, studies support the hypothesis that females have a more favorable bone microenvironment for metastasis formation. For prostate cancer, a decrease in the relative androgen to estrogen balance or a “feminization” of bone marrow favors bone metastasis formation, with a potentially important role for ERβ that may be similar to that in breast cancer. Long-term estrogen administration or androgen blockade in males

  12. Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, R.F.; Yu, B.; Zhang, R.Q.; Wang, X.H.; Li, C.; Wang, P.; Zhang, Y.; Han, B.; Gao, X.X.; Zhang, L. [Taian City Central Hospital, Taian, Shandong (China); Jiang, Z.M., E-mail: dmyh2436@126.com [Qianfoshan Hospital of Shandong Province, Shandong University, Ji’nan, Shandong (China)

    2018-02-01

    Non-small-cell lung cancer (NSCLC) patients who experience brain metastases are usually associated with poor prognostic outcomes. This retrospective study proposed to assess whether bevacizumab or gefitinib can be used to improve the effectiveness of whole brain radiotherapy (WBRT) in managing patients with brain metastases. A total of 218 NSCLC patients with multiple brain metastases were retrospectively included in this study and were randomly allocated to bevacizumab-gefitinibWBRT group (n=76), gefitinib-WBRT group (n=77) and WBRT group (n=75). Then, tumor responses were evaluated every 2 months based on Response Evaluation Criteria in Solid Tumors version 1.0. Karnofsky performance status and neurologic examination were documented every 6 months after the treatment. Compared to the standard WBRT, bevacizumab and gefitinib could significantly enhance response rate (RR) and disease control rate (DCR) of WBRT (Po0.001). At the same time, RR and DCR of patients who received bevacizumab-gefitinib-WBRT were higher than those who received gefitinib-WBRT. The overall survival (OS) rates and progression-free survival (PFS) rates also differed significantly among the bevacizumab-gefitinib-WBRT (48.6 and 29.8%), gefitinib-WBRT (36.7 and 29.6%) and WBRT (9.8 and 14.6%) groups (Po0.05). Although bevacizumabgefitinib-WBRT was slightly more toxic than gefitinib-WBRT, the toxicity was tolerable. As suggested by prolonged PFS and OS status, bevacizumab substantially improved the overall efficacy of WBRT in the management of patients with NSCLC. (author)

  13. Risk factors for brain metastases after definitive chemoradiation for locally advanced non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Petrović Marina

    2009-01-01

    Full Text Available Background/Aim. As therapy for locally advanced nonsmall cell lung carcinoma (NSCLC improves, brain metastases (BM still remain a great problem. The aim of the study was to analyze risk factors for BM in patients with locally advanced NSCLC after chemoradiation therapy. Methods. Records for 150 patients with non-resectable stage IIIA/IIIB NSCLC treated with combined chemoradiation therapy were analyzed. All of them had negative brain metastases imaging result before the treatment. Incidence of BM was examined in relation to age, sex, histological type, stage, performance status scale of wellbeing of cancer patients, weight loss, chemotherapy regimen and chemotherapy timing. Results. One- and 2-year incidence rates of BM were 19 and 31%, respectively. Among pretreatment parameters, stage IIIB was associated with a higher risk of BM (p < 0.004 vs stage IIIA. Histologically, the patients with nonsquamous tumors had an exceptionally high 2-year BM risk rate of 32% (p < 0.02. Examining treatment-related parameters, 1-year and 2-year actuarial risk of BM were 27 and 39%, respectively, in the patients receiving chemotherapy before radiotherapy and 15 and 20%, respectively, when radiotherapy was not delayed (p < 0.03. On multivariate analysis, timing of chemotherapy (p < 0.05 and stage IIIA vs IIIB (p < 0.01 remained statistically significant. Conclusion. Patients with IIIB stage, nonsquamous NSCLC, particularly those receiving sequential chemotherapy, had significantly high BM rates.

  14. Diagnostic Value of Early-Phase-Enhanced Computed Tomography for the Differentiation of Pulmonary Metastases from Hepatocellular Carcinoma and Primary Lung Cancer

    International Nuclear Information System (INIS)

    Choi, Joon-Il; Jung, Dae Chul; Kim, Min-Ju; Hong, Eun Kyung; Park, Joong-Won; Kim, Chang-Min; Choi, Hyuck Jae; Jang, Yun-Jin

    2009-01-01

    Background: The lung is the most common site of distant metastases from hepatocellular carcinoma. Correct differentiation between metastatic hepatocellular carcinoma of the lung and primary lung cancer is sometimes difficult without biopsy. Purpose: To evaluate the usefulness of measuring the attenuations of pulmonary nodules on early-phase contrast-enhanced computed tomography (CT) for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer. Material and Methods: Thirteen patients with pulmonary metastases from hepatocellular carcinoma (nine men, four women; age 53.9±14.2 years, range 16-70 years) and 25 patients with primary lung cancer (14 men, 11 women; age 62.2±9.4 years, range 43-72 years) were retrospectively evaluated. Contrast-enhanced scans were obtained 35 s after commencing intravenous injection of contrast medium. Attenuation values and the size of the pulmonary nodules were measured on contrast-enhanced CT scans. CT and clinical features were analyzed with regard to age, sex, body surface area of the patients, the attenuation values and size of the nodules, and CT machines using univariate analysis (Fisher's exact test for binary data sets and the Mann-Whitney U test for continuous data sets). Multiple linear regression analysis was used to eliminate confounding factors. Results: The mean attenuation value of metastatic pulmonary nodules from hepatocellular carcinoma (75.7±24.9 HU) was higher than that of primary lung cancer nodules (45.8±14.4 HU) (P<0.01). Other variables such as age, sex, body surface area of the patients, CT device, and nodule size were not significant variables on multiple regression analysis. When a cut-off value of 75 HU was applied, the positive predictive value for diagnosing metastatic nodules from hepatocellular carcinoma was 100%. Conclusion: Pending confirmation in a large study, our findings suggest that there is a difference in contrast enhancement between pulmonary

  15. Lung, liver and lymph node metastases in follow-up MSCT. Comprehensive volumetric assessment of lesion size changes

    International Nuclear Information System (INIS)

    Wulff, A.M.; Fischer, S.; Biederer, J.; Heller, M.; Fabel, M.; Bolte, H.; Freitag-Wolf, S.; Soza, G.; Tietjen, C.

    2012-01-01

    Purpose: To investigate measurement accuracy in terms of precision and inter-rater variability in the simultaneous volumetric assessment of lung, liver and lymph node metastasis size change over time in comparison to RECIST 1.1. Materials and Methods: Three independent readers evaluated multislice CT data from clinical follow-up studies (chest/abdomen) in 50 patients with metastases. A total of 117 lung, 77 liver and 97 lymph node metastases were assessed manually (RECIST 1.1) and by volumetry with semi-automated software. The quality of segmentation and need for manual adjustments were recorded. Volumes were converted to effective diameters to allow comparison to RECIST. For statistical assessment of precision and interobserver agreement, the Wilcoxon-signed rank test and Bland-Altman plots were utilized. Results: The quality of segmentation after manual correction was acceptable to excellent in 95 % of lesions and manual corrections were applied in 21 - 36 % of all lesions, most predominantly in lymph nodes. Mean precision was 2.6 - 6.3 % (manual) with 0.2 - 1.5 % (effective) relative measurement deviation (p <.001). Inter-reader median variation coefficients ranged from 9.4 - 12.8 % (manual) and 2.9 - 8.2 % (volumetric) for different lesion types (p <.001). The limits of agreement were ± 9.8 to ± 11.2 % for volumetric assessment. Conclusion: Superior precision and inter-rater variability of volumetric over manual measurement of lesion change over time was demonstrated in a whole body setting. (orig.)

  16. Combined human papillomavirus typing and TP53 mutation analysis in distinguishing second primary tumors from lung metastases in patients with head and neck squamous cell carcinoma.

    Science.gov (United States)

    Daher, Tamas; Tur, Mehmet Kemal; Brobeil, Alexander; Etschmann, Benjamin; Witte, Biruta; Engenhart-Cabillic, Rita; Krombach, Gabriele; Blau, Wolfgang; Grimminger, Friedrich; Seeger, Werner; Klussmann, Jens Peter; Bräuninger, Andreas; Gattenlöhner, Stefan

    2018-06-01

    In head and neck squamous cell carcinoma (HNSCC), the occurrence of concurrent lung malignancies poses a significant diagnostic challenge because metastatic HNSCC is difficult to discern from second primary lung squamous cell carcinoma (SCC). However, this differentiation is crucial because the recommended treatments for metastatic HNSCC and second primary lung SCC differ profoundly. We analyzed the origin of lung tumors in 32 patients with HNSCC using human papillomavirus (HPV) typing and targeted next generation sequencing of all coding exons of tumor protein 53 (TP53). Lung tumors were clearly identified as HNSCC metastases or second primary tumors in 29 patients, thus revealing that 16 patients had received incorrect diagnoses based on clinical and morphological data alone. The HPV typing and mutation analysis of all TP53 coding exons is a valuable diagnostic tool in patients with HNSCC and concurrent lung SCC, which can help to ensure that patients receive the most suitable treatment. © 2018 Wiley Periodicals, Inc.

  17. Outcome and prognostic factors in single brain metastases from small-cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bernhardt, Denise; Koenig, Laila [University Hospital Heidelberg, Department of Radiation Oncology, INF 400, Heidelberg (Germany); Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg (Germany); Adeberg, Sebastian; Debus, Juergen [University Hospital Heidelberg, Department of Radiation Oncology, INF 400, Heidelberg (Germany); Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Heidelberg (Germany); Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg (Germany); Bozorgmehr, Farastuk; Thomas, Michael; Steins, Martin [Heidelberg University, Department of Thoracic Oncology, Thoraxklinik, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany); German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany); Opfermann, Nils; Hoerner-Rieber, Juliane; Rieken, Stefan [University Hospital Heidelberg, Department of Radiation Oncology, INF 400, Heidelberg (Germany); Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); Kappes, Jutta [Heidelberg University, Department of Pneumology, Thoraxklinik, Heidelberg (Germany); Unterberg, Andreas [University Hospital Heidelberg, Department of Neurosurgery, INF 400, Heidelberg (Germany); Herth, Felix [Heidelberg University, Department of Pneumology, Thoraxklinik, Heidelberg (Germany); German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany); Heussel, Claus Peter [German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany); University of Heidelberg, Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg (Germany); University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg (Germany); Warth, Arne [German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (DE); Heidelberg University, Institute of Pathology, Heidelberg (DE)

    2018-02-15

    Whole brain radiation therapy (WBRT) is historically the standard of care for patients with brain metastases (BM) from small-cell lung cancer (SCLC), although locally ablative treatments are the standard of care for patients with 1-4 BM from other solid tumors. The objective of this analysis was to find prognostic factors influencing overall survival (OS) and intracranial progression-free survival (iPFS) in SCLC patients with single BM (SBM) treated with WBRT. A total of 52 patients were identified in the authors' cancer center database with histologically confirmed SCLC and contrast-enhanced magnet resonance imaging (MRI) or computed tomography (CT), which confirmed SBM between 2006 and 2015 and were therefore treated with WBRT. A Kaplan-Meier survival analysis was performed for OS analyses. The log-rank (Mantel-Cox) test was used to compare survival curves. Univariate Cox proportional-hazards ratios (HRs) were used to assess the influence of cofactors on OS and iPFS. The median OS after WBRT was 5 months and the median iPFS after WBRT 16 months. Patients that received surgery prior to WBRT had a significantly longer median OS of 19 months compared to 5 months in the group receiving only WBRT (p = 0.03; HR 2.24; 95% confidence interval [CI] 1.06-4.73). Patients with synchronous disease had a significantly longer OS compared to patients with metachronous BM (6 months vs. 3 months, p = 0.005; HR 0.27; 95% CI 0.11-0.68). Univariate analysis for OS revealed a statistically significant effect for metachronous disease (HR 2.25; 95% CI 1.14-4.46; p = 0.019), initial response to first-line chemotherapy (HR 0.58; 95% CI 0.35-0.97; p = 0.04), and surgical resection (HR 0.36; 95% CI 0.15-0.88; p = 0.026). OS was significantly affected by metachronous disease in multivariate analysis (HR 2.20; 95% CI 1.09-4.45; p = 0.028). Univariate analysis revealed that surgery followed by WBRT can improve OS in patients with SBM in SCLC. Furthermore, synchronous disease and response

  18. Evaluation of Biomarkers Predictive of Benefit from the PD-1 Inhibitor MK-3475 in Patients with Non-Small Cell Lung Cancer and Brain Metastases

    Science.gov (United States)

    2017-07-01

    Small Cell Lung Cancer and Brain Metastases PRINCIPAL INVESTIGATOR: Sarah B. Goldberg, MD CONTRACTING ORGANIZATION: Yale University New Haven, CT...benefit in patients with non- small cell lung cancer (NSCLC). However, the overall response rate is only 20-30% and there is no clearly-defined...9. Appendices……………………………………………………………14 4 1. INTRODUCTION: Lung cancer is the leading cause of cancer death in the United States, resulting in more

  19. Sarcomatoid Carcinoma of Male Urethra with Bone and Lung Metastases Presenting as Urethral Stricture

    Directory of Open Access Journals (Sweden)

    Niraj Badhiwala

    2013-01-01

    Full Text Available A 57-year-old man who presented with urinary retention was found to have a sarcomatoid carcinoma of the urethra. Evaluation with CT scan of the abdomen and pelvis revealed multiple pulmonary nodules and osteolytic lesions of left posterior ribs. After external beam radiation therapy and six cycles of systemic chemotherapy, patient underwent a surgical resection of the urethral cancer. After his surgery, patient was also found to have multiple brain metastases and underwent whole brain radiation therapy, nine months after his initial diagnosis. Sarcomatoid carcinomas of the genitourinary tract are extremely rare tumors that require a very aggressive, multimodal treatment approach.

  20. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases

    Energy Technology Data Exchange (ETDEWEB)

    Vilgrain, Valerie; Ronot, Maxime [University Hospitals Paris Nord Val de Seine, Beaujon, Department of Radiology, Assistance Publique - Hopitaux de Paris, Clichy, Hauts-de-Seine (France); University Paris Diderot, Sorbonne Paris Cite, Paris (France); INSERM U1149, Centre de Recherche Biomedicale Bichat-Beaujon, CRB3, Paris (France); Esvan, Maxime; Caumont-Prim, Aurore [Hopital europeen Georges-Pompidou, Unite d' Epidemiologie et de Recherche Clinique, Paris (France); INSERM, Centre d' Investigation Clinique 1418, module Epidemiologie Clinique, Paris (France); Aube, Christophe [CHU d' Angers, Department of Radiology, Angers (France); Universite d' Angers, Laboratoire HIFIH, LUNAM, Angers (France); Chatellier, Gilles [Hopital europeen Georges-Pompidou, Unite d' Epidemiologie et de Recherche Clinique, Paris (France); INSERM, Centre d' Investigation Clinique 1418, module Epidemiologie Clinique, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Faculte de Medecine, Paris (France)

    2016-12-15

    To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. (orig.)

  1. Role of Transbronchial Lung Cryobiopsies in Diffuse Parenchymal Lung Diseases: Interest of a Sequential Approach

    Directory of Open Access Journals (Sweden)

    Benjamin Bondue

    2017-01-01

    Full Text Available Background. Transbronchial lung cryobiopsies (TBLCs are a promising diagnostic tool in the setting of diffuse parenchymal lung diseases (DPLDs. However, no comparison with surgical lung biopsy (SLB in the same patient is available. Methods. The diagnostic yield and safety data of TBLCs, as well as the result of SLB performed after TBLCs, were analysed in a multicentric Belgian study. A SLB was performed after TBLCs in absence of a definite pathological diagnosis or if a NSIP pattern was observed without related condition identified following multidisciplinary discussion. Results. Between April 2015 and November 2016, 30 patients were included. Frequent complications included pneumothorax (20% and bleeding (severe 7%, moderate 33%, and mild 53%. There was no mortality. The overall diagnostic yield was 80%. A SLB was performed in six patients (three without definite histological pattern and three with an NSIP. The surgical biopsy changed the pathological diagnosis into a UIP pattern in five patients and confirmed a NSIP pattern in one patient. Conclusion. TBLCs are useful in the diagnostic work-up of DPLDs avoiding a SLB in 80% of the patients. However, surgical biopsies, performed as a second step after TBLCs because of an indefinite diagnosis or a NSIP pattern, provide additional information supporting the interest of a sequential approach in these patients.

  2. Differential expression profiling of circulation microRNAs in PTC patients with non-131I and 131I-avid lungs metastases: a pilot study

    International Nuclear Information System (INIS)

    Qiu, Zhong-Ling; Shen, Chen-Tian; Song, Hong-Jun; Wei, Wei-Jun; Luo, Quan-Yong

    2015-01-01

    Introduction: Loss of the ability to concentrate 131 I is one of the important causes of radioiodine-refractory disease in papillary thyroid carcinoma (PTC). Recent advantages of serum microRNAs (miRNAs) open a new realm of possibilities for noninvasive diagnosis and prognosis of many cancers. The aim of the current study was to identify differential expression profiling of circulation miRNAs in PTC patients with non- 131 I and 131 I-avid lungs metastases. Methods: The expressions of miRNAs were examined using miRNA microarray chip. The most significantly changed miRNAs from microarray were verified by using qRT-PCR. The potential miRNAs regulating target genes and their preliminary biological functions were forecasted by Bioinformatic analysis. Results: Compared to 131 I-avid lung metastases, 13 kinds of significantly differential serum miRNAs including 5 upregulated miRNAs (miR-1249, miR-106a, miR-503, miR-34c-5p, miR-1281) and 8 downregulated miRNAs (miR-1915, miR-2861, miR-3196, miR-500, miR-572, miR-33b, miR-554, miR-18a) in PTC patients with non- 131 I-avid lung metastases were identified. Bioinformatic analysis demonstrated that miR-106a was the core miRNA regulating 193 genes in the network. The results of validation confirmed the up-regulation of miR-106a in non- 131 I-avid lungs metastatic PTC patients. Conclusion: Differentially expressed serum miRNA profiles between PTC patients with non- 131 I and 131 I-avid lungs metastases were analyzed. These findings in our present study could represent new clues for the diagnostic and therapeutic strategy in PTC patients with non- 131 I-avid metastatic disease

  3. Vorinostat and Concurrent Stereotactic Radiosurgery for Non-Small Cell Lung Cancer Brain Metastases: A Phase 1 Dose Escalation Trial.

    Science.gov (United States)

    Choi, Clara Y H; Wakelee, Heather A; Neal, Joel W; Pinder-Schenck, Mary C; Yu, Hsiang-Hsuan Michael; Chang, Steven D; Adler, John R; Modlin, Leslie A; Harsh, Griffith R; Soltys, Scott G

    2017-09-01

    To determine the maximum tolerated dose (MTD) of vorinostat, a histone deacetylase inhibitor, given concurrently with stereotactic radiosurgery (SRS) to treat non-small cell lung cancer (NSCLC) brain metastases. Secondary objectives were to determine toxicity, local failure, distant intracranial failure, and overall survival rates. In this multicenter study, patients with 1 to 4 NSCLC brain metastases, each ≤2 cm, were enrolled in a phase 1, 3 + 3 dose escalation trial. Vorinostat dose levels were 200, 300, and 400 mg orally once daily for 14 days. Single-fraction SRS was delivered on day 3. A dose-limiting toxicity (DLT) was defined as any Common Terminology Criteria for Adverse Events version 3.0 grade 3 to 5 acute nonhematologic adverse event related to vorinostat or SRS occurring within 30 days. From 2009 to 2014, 17 patients were enrolled and 12 patients completed study treatment. Because no DLTs were observed, the MTD was established as 400 mg. Acute adverse events were reported by 10 patients (59%). Five patients discontinued vorinostat early and withdrew from the study. The most common reasons for withdrawal were dyspnea (n=2), nausea (n=1), and fatigue (n=2). With a median follow-up of 12 months (range, 1-64 months), Kaplan-Meier overall survival was 13 months. There were no local failures. One patient (8%) at the 400-mg dose level with a 2.0-cm metastasis developed histologically confirmed grade 4 radiation necrosis 2 months after SRS. The MTD of vorinostat with concurrent SRS was established as 400 mg. Although no DLTs were observed, 5 patients withdrew before completing the treatment course, a result that emphasizes the need for supportive care during vorinostat administration. There were no local failures. A larger, randomized trial may evaluate both the tolerability and potential local control benefit of vorinostat concurrent with SRS for brain metastases. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The value of diffusion tensor imaging in differentiating high-grade gliomas from brain metastases: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Rui Jiang

    Full Text Available Differentiation of high-grade gliomas and solitary brain metastases is an important clinical issue because the treatment strategies differ greatly. Our study aimed to investigate the potential value of diffusion tensor imaging (DTI in differentiating high-grade gliomas from brain metastases using a meta-analytic approach.We searched Pubmed, Embase and the Cochrane Library for relevant articles published in English. Studies that both investigated high-grade gliomas and brain metastases using DTI were included. Random effect model was used to compare fractional anisotropy (FA and mean diffusivity (MD values in the two tumor entities.Nine studies were included into the meta-analysis. In the peritumoral region, compared with brain metastases, high-grade gliomas had a significant increase of FA (SMD  = 0.47; 95% CI, 0.22-0.71; P<0.01 and a significant decrease of MD (SMD  = -1.49; 95% CI, -1.91 to -1.06; P<0.01. However, in the intratumoral area, no significant change in FA (SMD  = 0.16; 95% CI, -0.49 to 0.82; P = 0.73 or MD (SMD  = 0.34; 95% CI, -0.91 to 1.60; P = 0.59 was detected between gliomas and metastases.High-grade gliomas may be distinguished from brain metastases by comparing the peritumoral FA and MD values. DTI appears to be a promising tool in diagnosing solitary intracranial lesions.

  5. Presence of lung metastases in bitches affected by malignant mammary neoplasms in Medellin (Colombia

    Directory of Open Access Journals (Sweden)

    Brigitte Gómez J.

    2012-08-01

    Full Text Available Objective. To define the presence of lung metastasis in bitches with malignant mammary neoplasms. Materials and methods. Thirty female dogs that were attended at Veterinary Hospital (University of Antioquia, Medellin, Colombia were selected for the study. At consultation clinical variables and grade of mammary and inguinal lymph node compromise were registered. Latero-lateral and ventral-dorsal radiographic images of thorax were done for identification of radiographic lesions suggestive of lung metastasis. At surgery biopsies of affected mammary glands were taken for histopathological study and classification of tumors. Data were analyzed by descriptive statistics. Results. The average (± standard error age at clinical diagnosis was 10.87±2.65 year old. French poodle (46.6% cross-breed (13.3% and Schnauzer (10% were the breeds most frequently affected by mammary tumors. The most frequent tumor found was carcinoma (81%, followed by adenoma (8.1%, and other types (10.8%. The most frequently affected mammary glands by tumors were the right and the left inguinal glands (70% and 66.6%, respectively. Five out of 30 bitches (16.6% had lung metastasis according to radiographic examination. From this group of dogs, 4 out of 5 neoplasms (80% were diagnosed as complex carcinoma by histopathology diagnosis. Conclusions. We provide evidence suggesting that complex carcinoma is the most frequent mammary tumor in bitches in our city and it is highly related to lung metastasis.

  6. Inhibition of checkpoint kinase 1 sensitizes lung cancer brain metastases to radiotherapy

    International Nuclear Information System (INIS)

    Yang, Heekyoung; Yoon, Su Jin; Jin, Juyoun; Choi, Seung Ho; Seol, Ho Jun; Lee, Jung-Il

    2011-01-01

    Research highlights: → The most important therapeutic tool in brain metastasis is radiation therapy. → Radiosensitivity of cancer cells was enhanced with treatment of Chk1 inhibitor. → Depletion of Chk1 in cancer cells showed an enhancement of sensitivity to radiation. → Chk1 can be a good target for enhancement of radiosensitivity. -- Abstract: The most important therapeutic tool in brain metastasis is radiation therapy. However, resistance to radiation is a possible cause of recurrence or treatment failure. Recently, signal pathways about DNA damage checkpoints after irradiation have been noticed. We investigated the radiosensitivity can be enhanced with treatment of Chk1 inhibitor, AZD7762 in lung cancer cell lines and xenograft models of lung cancer brain metastasis. Clonogenic survival assays showed enhancement of radiosensitivity with AZD7762 after irradiation of various doses. AZD7762 increased ATR/ATM-mediated Chk1 phosphorylation and stabilized Cdc25A, suppressed cyclin A expression in lung cancer cell lines. In xenograft models of lung cancer (PC14PE6) brain metastasis, AZD7762 significantly prolonged the median survival time in response to radiation. Depletion of Chk1 using shRNA also showed an enhancement of sensitivity to radiation in PC14PE6 cells. The results of this study support that Chk1 can be a good target for enhancement of radiosensitivity.

  7. Long-Term Survival in a Patient with Multiple Brain Metastases from Small-Cell Lung Cancer Treated with Gamma Knife Radiosurgery on Four Occasions: A Case Report

    Science.gov (United States)

    Elaimy, Ameer L.; Thumma, Sudheer R.; Lamm, Andrew F.; Mackay, Alexander R.; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Demakas, John J.; Cooke, Barton S.; Lee, Christopher M.

    2012-01-01

    Brain metastases are the most common cancerous neoplasm in the brain. The treatment of these lesions is challenging and often includes a multimodality management approach with whole-brain radiation therapy, stereotactic radiosurgery, and neurosurgery options. Although advances in biomedical imaging technologies and the treatment of extracranial cancer have led to the overall increase in the survival of brain metastases patients, the finding that select patients survive several years remains puzzling. For this reason, we present the case of a 70-year-old patient who was diagnosed with multiple brain metastases from small-cell lung cancer five years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and Gamma Knife radiosurgery on four separate occasions for the neurological cancer. Since the diagnosis of brain metastases five years ago, the patient's primary cancer has remained controlled. Furthermore, multiple repeat GKRS procedures provided this patient with high levels of local tumor control, which in combination with a stable primary cancer led to an extended period of survival and a highly functional life. Further analysis and clinical research will be valuable in assessing the durability of multiple GKRS for brain metastases patients who experience long-term survival. PMID:23091748

  8. Contribution of computed tomography in patients with lung metastases of differentiated thyroid carcinoma not apparent on plain radiography who were treated with radioiodine

    International Nuclear Information System (INIS)

    Rosario, Pedro W.S.; Purisch, Saulo; Barroso, Alvarao L.; Rezende, Leonardo L.; Padrao, Eduardo L.

    2008-01-01

    Computed tomography (CT or CAT Scan) of the chest is more sensitive than radiography in the detection of lung metastases of differentiated thyroid cancer (DTC), but little information is available regarding the aggregated value of this method. The present study evaluated the response of patients with lung metastases of DTC not apparent on radiography to treatment with 131 I and the value of CT in these cases. Twenty-five patients with lung metastases not apparent on radiography, who initially received 100-200 mCi I 151 , were evaluated and those presenting pulmonary uptake on post-therapy WBS were submitted to a new treatment after 6 to 12 months, and so on. The chance of detection of pulmonary uptake on post-therapy WBS did not differ between patients with negative and positive CT (100% versus 91.5%). Mean serum Tg levels were higher in patients with positive CT (108 ng/ml versus 52 ng/ml). Negative post-therapy WBS was achieved in 82% of patients with positive CT and in 92.3% with negative CT and the cumulative I 131 activity necessary to achieve this outcome did not differ between the two groups (mean = 300 mCi). Stimulated Tg was undetectable in 47% of patients with negative CT at the end of treatment, but in none of the patients whose CT continued to be positive. In patients with elevated Tg, the CT result apparently did not change the indication of therapy or the I 131 activity to be administered. In cases with lung metastases, the persistence of micronodules on CT was associated with the persistence of detectable Tg in patients presenting negative post-therapy WBS. (author)

  9. Dosimetric selection for helical tomotherapy based stereotactic ablative radiotherapy for early-stage non-small cell lung cancer or lung metastases.

    Directory of Open Access Journals (Sweden)

    Alexander Chi

    Full Text Available BACKGROUND: No selection criteria for helical tomotherapy (HT based stereotactic ablative radiotherapy (SABR to treat early stage non-small cell lung cancer (NSCLC or solitary lung metastases has been established. In this study, we investigate the dosimetric selection criteria for HT based SABR delivering 70 Gy in 10 fractions to avoid severe toxicity in the treatment of centrally located lesions when adequate target dose coverage is desired. MATERIALS AND METHODS: 78 HT-SABR plans for solitary lung lesions were created to prescribe 70 Gy in 10 fractions to the planning target volume (PTV. The PTV was set to have ≥95% PTV receiving 70 Gy in each case. The cases for which dose constraints for ≥1 OAR could not be met without compromising the target dose coverage were compared with cases for which all target and OAR dose constraints were met. RESULTS: There were 23 central lesions for which OAR dose constraints could not be met without compromising PTV dose coverage. Comparing to cases for which optimal HT-based SABR plans were generated, they were associated with larger tumor size (5.72±1.96 cm vs. 3.74±1.49 cm, p<0.0001, higher lung dose, increased number of immediately adjacent OARs ( 3.45±1.34 vs. 1.66±0.81, p<0.0001, and shorter distance to the closest OARs (GTV: 0.26±0.22 cm vs. 0.88±0.54 cm, p<0.0001; PTV 0.19±0.18 cm vs. 0.48±0.36 cm, p = 0.0001. CONCLUSION: Delivery of 70 Gy in 10 fractions with HT to meet all the given OAR and PTV dose constraints are most likely when the following parameters are met: lung lesions ≤3.78 cm (11.98 cc, ≤2 immediately adjacent OARs which are ≥0.45 cm from the gross lesion and ≥0.21 cm from the PTV.

  10. Multisystem Langerhans cell histiocytosis coexisting with metastasizing adenocarcinoma of the lung: A case report

    Directory of Open Access Journals (Sweden)

    Lovrenski Aleksandra

    2013-01-01

    Full Text Available Introduction. Langerhans cell histiocytosis (LCH is an uncommon disease of unknown etiology characterized by uncontrolled proliferation and infiltration of various organs by Langerhans cells. Case report. We presented a 54-year-old man, heavy smoker, with dyspnea, cough, hemoptysis, headache and ataxia, who died shortly after admission to our hospital. On the autopsy, tumor was found in the posterior segment of the right upper pulmonary lobe as well as a right-sided occipitoparietal lesion which penetrated into the right ventricle resulting in internal and external hematocephalus. Histologically and immunohistohemically, the diagnosis of primary lung adenocarcinoma with brain metastasis was made (tumor cells showed positivity for CK7 and TTF-1 which confirmed the diagnosis. In the lung parenchyma around the tumor, as well as in brain tissue around the metastatic adenocarcinoma histiocytic lesions were found. Light microscopic examination of the other organs also showed histiocytic lesions involving the pituitary gland, hypothalamus, spleen and mediastinal lymph nodes. Immunohistochemical studies revealed CD68, S-100 and CD1a immunoreactivity within the histiocytes upon which the diagnosis of Langerhans' cells histiocytosis was made. Conclusion. The multisystem form of LCH with extensive organ involvement was an incidental finding, while metastatic lung adenocarcinoma to the brain that led to hematocephalus was the cause of death.

  11. Comparison of EGFR and KRAS Status between Primary Non-small Cell Lung Cancer and Corresponding Metastases: A Systematic Review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Chengbo HAN

    2010-09-01

    Full Text Available Background and objective Epidermal growth factor receptor (EGFR and KRAS status were particularly critical for the choice of first-line targeted therapy of non-small cell lung cancer (NSCLC, while the primary tumor and metastases might be different in the EGFR and KRAS gene status. The aim of this pooled analysis is to compare EGFR and KRAS status in matching primary NSCLC and metastases and further to guide clinical practice. Methods Systematic computerized searches of the Pubmed and Medline databases (up to May 10, 2010 meeting specified search criteria were performed, followed by a further screening according to inclusive and exclusive criteria. Results Fourteen articles were selected into the final meta-analysis with paired primary and metastatic cases of 598. Expression level of EGFR protein and mutation frequency of KRAS gene in primary tumors were higher than that in metastases, relative risk (RR=1.13 (95%CI: 0.98-1.31, P=0.09 and RR=1.39 (95%CI: 0.95-2.03, P=0.09, respectively. EGFR gene copy number in metastases was higher than that in primary tumor, RR=0.74 (95%CI: 0.53-1.02, P=0.06. There was no statistically significant difference of EGFR mutation frequency in primary tumors and metastases (P=0.31. The discordant rate in primary and metastases was 17.09% for EGFR mutation, 27.07% for EGFR amplification, 27.84% for EGFR protein expression and 25.91% for KRAS mutation. Conclusion The systematic analysis showed that the EGFR mutation status in primary lung cancer and corresponding metastases was more stable than KRAS gene. KRAS mutation in primary lung cancerous foci seems to better reflect systemically cancerous genetic characteristics of KRAS gene. Determination of KRAS gene status based merely on metastatic foci might lead to more resistant selections of EGFR tyrosine kinase inhibitor (TKI therapy. Combined detection of EGFR and KRAS mutation from primary NSCLC foci might serve as a better predictive biomarker for anti-EGFR targeted

  12. Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Yu, Mi Hye; Lee, Jeong Min; Han, Joon Koo; Choi, Byung-Ihn; Hur, Bo Yun; Kim, Tae-You; Jeong, Seung-Yong; Yi, Nam-Joon; Suh, Kyung-Suk

    2015-01-01

    To investigate the diagnostic performance of gadoxetic acid-enhanced MRI including diffusion-weighted imaging (DWI) for the detection of colorectal liver metastases (CRLMs) after neoadjuvant chemotherapy (NAC). Our study population comprised 77 patients with 140 CRLMs who underwent gadoxetic acid-enhanced MRI within 1 month prior to surgery: group A (without NAC, n = 38) and group B (with NAC, n = 39). Two radiologists independently assessed all MR images and graded their diagnostic confidence for CRLM on a 5-point scale. Diagnostic accuracy, sensitivity and positive predictive values (PPV) were calculated and compared between the two groups. Diagnostic accuracy of gadoxetic acid-enhanced MRI in group B was slightly lower than in group A, but a statistically significant difference was not observed (observer 1: A z , 0.926 in group A, 0.905 in group B; observer 2: A z , 0.944 in group A, 0.885 in group B; p > 0.05). Sensitivity and PPV of group B were comparable to those of group A (observer 1: sensitivity = 93.5 % vs. 93.6 %, PPV = 95.1 % vs. 86.9 %; observer 2: sensitivity = 96.8 % vs. 91.0 %; PPV = 90.0 % vs. 89.7 %; all p > 0.05). Gadoxetic acid-enhanced MRI including DWI provided good diagnostic performance with high sensitivity (>90 %) for the detection of CRLMs, regardless of the influence of NAC. (orig.)

  13. The diffuse interstitial lung disease - with emphasis in the idiopathic interstitial pneumonias

    International Nuclear Information System (INIS)

    Bustillo P, Jose G; Pacheco, Pedro M; Matiz, Carlos; Ojeda, Paulina; Carrillo B, Jorge A.

    2003-01-01

    The term diffuse interstitial lung disease, it refers to those diseases that commit the interstice basically, the space between the membrane basal epithelial and endothelial, although the damage can also commit the outlying air spaces and the vessels; the supplement is centered in the diffuse interstitial lung illness of unknown cause; well-known as idiopathic interstitial pneumonias, making emphasis in the more frequents, the pulmonary fibrosis idiopathic or cryptogenic fibrosant alveolitis

  14. The value of the abnormalities of bronchovascular bundles in the diagnosis of diffused lung diseases

    International Nuclear Information System (INIS)

    Li Tieyi; Ji Jingling

    1997-01-01

    To evaluate the abnormalities of bronchovascular bundles in the differential diagnosis of the diffuse lung disease, seventy-two patients with diffuse lung diseases were evaluated, 15 of 72 patients were pathologically proven and the others clinically proven. Of these 72 patients, there were 33 patients with diffuse pulmonary interstitial disease, 5 patients with pulmonary parenchymal disease, 14 patients with bronchial disease, and 20 patients with disseminated disease. All patients had conventional CT scan of the chest, some also had HRCT scan. All CT images were jointly reviewed by two radiologists. The features of the abnormalities of bronchovascular bundles included: (1) Thinning of bronchovascular bundles, predominantly seen in diffuse interstitial disease of lung and chronic bronchitis; (2) thickening of bronchovascular bundles, predominantly seen in interstitial diseases and disseminated lung diseases such as sarcoidosis and lymphangitis carcinomatosis with beaded appearance of bronchovascular bundles; (3) Increased visibility of bronchovascular bundles, predominantly seen in bronchiolitis and disseminated lung diseases. CT features of the abnormalities of bronchovascular bundles are present in 80% of diffuse lung diseases. The features are not specific, but the beaded bronchovascular bundles are always seen in sarcoidosis and lymphangitis carcinomatosis. In making a distinction between idiopathic pulmonary fibrosis and chronic bronchitis complicated with interstitial fibrosis, the position of diaphragm is of value in differential diagnosis, normal or elevated diaphragm is usually seen in the former, while low and flattened diaphragm in the latter. Change of the appearance of bronchovascular bundles from normality to abnormality reflects the process of development of the lung disease

  15. Local cytokine treatment of HPV16-associated tumours results in inhibition of their lung metastases

    Czech Academy of Sciences Publication Activity Database

    Mikyšková, Romana; Bubeník, Jan; Mendoza, Luis; Vonka, V.; Šmahel, M.; Šímová, Jana; Jandlová, Táňa

    2001-01-01

    Roč. 18, č. 7 (2001), s. 581-587 ISSN 0262-0898 R&D Projects: GA MZd NC5526; GA MZd NC5900; GA ČR GA312/99/0542; GA ČR GA301/01/0985; GA ČR GA301/00/0114; GA AV ČR IAA7052002 Institutional research plan: CEZ:AV0Z5052915 Keywords : HPV 16 * cytokines * lung metastasis Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 1.966, year: 2001

  16. Brain Metastases from Lung Cancer Show Increased Expression of DVL1, DVL3 and Beta-Catenin and Down-Regulation of E-Cadherin

    Directory of Open Access Journals (Sweden)

    Anja Kafka

    2014-06-01

    Full Text Available The susceptibility of brain to secondary formation from lung cancer primaries is a well-known phenomenon. In contrast, the molecular basis for invasion and metastasis to the brain is largely unknown. In the present study, 31 brain metastases that originated from primary lung carcinomas were analyzed regarding over expression of Dishevelled-1 (DVL1, Dishevelled-3 (DVL3, E-cadherin (CDH1 and beta-catenin (CTNNB1. Protein expressions and localizations were analyzed by immunohistochemistry. Genetic alterations of E-cadherin were tested by polymerase chain reaction (PCR/loss of heterozygosity (LOH. Heteroduplex was used to investigate mutations in beta-catenin. DVL1 and DVL3 showed over expression in brain metastasis in 87.1% and 90.3% of samples respectively. Nuclear staining was observed in 54.8% of cases for DVL1 and 53.3% for DVL3. The main effector of the Wnt signaling, beta-catenin, was up-regulated in 56%, and transferred to the nucleus in 36% of metastases. When DVL1 and DVL3 were up-regulated the number of cases with nuclear beta-catenin significantly increased (p = 0.0001. Down-regulation of E-cadherin was observed in 80% of samples. Genetic analysis showed 36% of samples with LOH of the CDH1. In comparison to other lung cancer pathologies, the diagnoses adenocarcinoma and small cell lung cancer (SCLC were significantly associated to CDH1 LOH (p = 0.001. Microsatellite instability was detected in one metastasis from adenocarcinoma. Exon 3 of beta-catenin was not targeted. Altered expression of Dishevelled-1, Dishevelled-3, E-cadherin and beta-catenin were present in brain metastases which indicates that Wnt signaling is important and may contribute to better understanding of genetic profile conditioning lung cancer metastasis to the brain.

  17. A Rare Case of Intussusception Associated with Metastasize Small Cell Carcinoma of Lung

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    Razrim Rahim

    2012-11-01

    Full Text Available Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, The diagnosis may be difficult because of asymptomatic nature of thisbowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness,loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he wastransfused with packed cells. On gastrointestinal (GI endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CTscan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed,‘Whipple’s procedure’ was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.

  18. Importance of diffusion imaging in liver metastases; Bedeutung der Diffusionsbildgebung bei Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Riffel, P.; Schoenberg, S.O.; Krammer, J. [Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Institut fuer Klinische Radiologie und Nuklearmedizin, Universitaetsmedizin Mannheim, Mannheim (Germany)

    2017-05-15

    Detection and characterization of focal liver lesions. Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response. (orig.) [German] Detektion und Charakterisierung fokaler Leberlaesionen. Die MRT ist aufgrund des exzellenten Weichteilkontrasts, der Verfuegbarkeit leberspezifischer Kontrastmittel und der Moeglichkeit funktioneller Bildgebung die Methode der Wahl zur Abklaerung fokaler Leberlaesionen. Die diffusionsgewichtete Bildgebung (''diffusion-weighted imaging'', DWI) ermoeglicht es, neben den rein morphologischen auch funktionelle Informationen ueber die Mikrostruktur eines Gewebes zu

  19. The importance of balanced pro-inflammatory and anti-inflammatory mechanisms in diffuse lung disease

    Directory of Open Access Journals (Sweden)

    Strieter Robert

    2002-01-01

    Full Text Available Abstract The lung responds to a variety of insults in a remarkably consistent fashion but with inconsistent outcomes that vary from complete resolution and return to normal to the destruction of normal architecture and progressive fibrosis. Increasing evidence indicates that diffuse lung disease results from an imbalance between the pro-inflammatory and anti-inflammatory mechanisms, with a persistent imbalance that favors pro-inflammatory mediators dictating the development of chronic diffuse lung disease. This review focuses on the mediators that influence this imbalance.

  20. Diffusion of gases into the lung: How physics can help to understand ...

    Indian Academy of Sciences (India)

    In the human lung, the gas transfer between air and blood is achieved in terminal units that are called `acini'. Whereas convection is still the predominant transport phenomenon at the acinus entrance, most of the acinar surface is in fact accessed by diffusion. The transition between convection and diffusion, and thus the ...

  1. [Timing of Brain Radiation Therapy Impacts Outcomes in Patients with 
Non-small Cell Lung Cancer Who Develop Brain Metastases].

    Science.gov (United States)

    Wang, Yang; Fang, Jian; Nie, Jun; Dai, Ling; Hu, Weiheng; Zhang, Jie; Ma, Xiangjuan; Han, Jindi; Chen, Xiaoling; Tian, Guangming; Wu, Di; Han, Sen; Long, Jieran

    2016-08-20

    Radiotherapy combined with chemotherapy or molecular targeted therapy remains the standard of treatment for brain metastases from non-small cell lung cancer (NSCLC). The aim of this study is to determine if the deferral of brain radiotherapy impacts patient outcomes. Between May 2003 and December 2015, a total of 198 patients with brain metastases from NSCLC who received both brain radiotherapy and systemic therapy (chemotherapy or targeted therapy) were identified. The rate of grade 3-4 adverse reactions related to chemotherapy and radiotherapy had no significant difference between two groups. 127 patients received concurrent brain radiotherapy and systemic therapy, and 71 patients received deferred brain radiotherapy after at least two cycles of chemotherapy or targeted therapy. Disease specific-graded prognostic assessment was similar in early radiotherapy group and deferred radiotherapy group. Median overall survival (OS) was longer in early radiotherapy group compared to deferred radiotherapy group (17.9 months vs 12.6 months; P=0.038). Progression free survival (PFS) was also improved in patients receiving early radiotherapy compared to those receiving deferred radiotherapy (4.0 months vs 3.0 months; Pbrain metastases as any line therapy improved the OS (20.0 months vs 10.7 months; Pbrain radiotherapy may resulted in inferior OS in patients with NSCLC who develop brain metastases. A prospective multi-central randomized study is imminently needed.

  2. Lung Cancer Mortality among Uranium Gaseous Diffusion Plant Workers: A Cohort Study 1952–2004

    Directory of Open Access Journals (Sweden)

    LW Figgs

    2013-07-01

    Full Text Available Background: 9%–15% of all lung cancers are attributable to occupational exposures. Reports are disparate regarding elevated lung cancer mortality risk among workers employed at uranium gaseous diffusion plants. Objective: To investigate whether external radiation exposure is associated with lung cancer mortality risk among uranium gaseous diffusion workers. Methods: A cohort of 6820 nuclear industry workers employed from 1952 to 2003 at the Paducah uranium gaseous diffusion plant (PGDP was assembled. A job-specific exposure matrix (JEM was used to determine likely toxic metal exposure categories. In addition, radiation film badge dosimeters were used to monitor cumulative external ionizing radiation exposure. International Classification for Disease (ICD codes 9 and 10 were used to identify 147 lung cancer deaths. Logistic and proportional hazards regression were used to estimate lung cancer mortality risk. Results: Lung cancer mortality risk was elevated among workers who experienced external radiation >3.5 mrem and employment duration >12 years. Conclusion: Employees of uranium gaseous diffusion plants carry a higher risk of lung cancer mortality; the mortality is associated with increased radiation exposure and duration of employment.

  3. Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years

    Directory of Open Access Journals (Sweden)

    M. Blanco

    2013-03-01

    Full Text Available Introduction: Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society and ERS (European Respiratory Society for Idiopathic Pulmonary Fibrosis (IPF. Patients and methods: We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002 and group 2 (operated between 2003 and 2011. Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed. Results: Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84% deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70% of 10 cases, alveolar haemorrhage in 2 (20% and heart failure in 1 (10%. Conclusions: Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality. Resumo: Introdução: A biópsia pulmonar cirúrgica é uma técnica com uma morbimortalidade não negligenciável. Este trabalho resulta da experiência adquirida na realização de biópsias pulmonares cirúrgicas para o diagnóstico da doença pulmonar intersticial difusa, bem como pelo efeito provocado sobre as indicações da biópsia cirúrgica nesta entidade, após a publicação do consenso da ATS (American Thoracic Society e da ERS (European

  4. 23 Lung Metastases Treated by Radiofrequency Ablation Over 10 Years in a Single Patient: Successful Oncological Outcome of a Metastatic Cancer Without Altered Respiratory Function

    Energy Technology Data Exchange (ETDEWEB)

    Crombé, Amandine, E-mail: amandine.crombe@ens-lyon.fr; Buy, Xavier [Institut Bergonié, Department of Radiology (France); Godbert, Yann [Institut Bergonié, Department of Nuclear Medicine (France); Alberti, Nicolas [Centre Hospitalier Alpes-Léman, Department of Radiology (France); Kind, Michèle [Institut Bergonié, Department of Radiology (France); Bonichon, Françoise [Institut Bergonié, Department of Nuclear Medicine (France); Palussière, Jean [Institut Bergonié, Department of Radiology (France)

    2016-12-15

    An 82-year-old man, who was diagnosed in 2002 with an oncocytic (Hürthle cell) thyroid carcinoma, was initially treated by local surgery and was refractory to radioiodine treatment. The patient had successive secondary recurrences from 2006 onwards. Metastases were suspected due to an elevation of thyroglobulin in serum. Hypermetabolic nodules were targeted using FDG PET as well as CT-guided radiofrequency ablations. Thyroglobulin levels decreased following each procedure. 10 years later, tolerance and efficacy are excellent; 23 lung metastases have been treated during 11 sessions without current relapse. Respiratory function and quality of life are not altered. This report illustrates how radiofrequency ablation can be efficiently integrated into the long-term management of poorly aggressive oligometastatic cancer, in combination with other local and/or systemic therapies.

  5. 23 Lung Metastases Treated by Radiofrequency Ablation Over 10 Years in a Single Patient: Successful Oncological Outcome of a Metastatic Cancer Without Altered Respiratory Function

    International Nuclear Information System (INIS)

    Crombé, Amandine; Buy, Xavier; Godbert, Yann; Alberti, Nicolas; Kind, Michèle; Bonichon, Françoise; Palussière, Jean

    2016-01-01

    An 82-year-old man, who was diagnosed in 2002 with an oncocytic (Hürthle cell) thyroid carcinoma, was initially treated by local surgery and was refractory to radioiodine treatment. The patient had successive secondary recurrences from 2006 onwards. Metastases were suspected due to an elevation of thyroglobulin in serum. Hypermetabolic nodules were targeted using FDG PET as well as CT-guided radiofrequency ablations. Thyroglobulin levels decreased following each procedure. 10 years later, tolerance and efficacy are excellent; 23 lung metastases have been treated during 11 sessions without current relapse. Respiratory function and quality of life are not altered. This report illustrates how radiofrequency ablation can be efficiently integrated into the long-term management of poorly aggressive oligometastatic cancer, in combination with other local and/or systemic therapies.

  6. Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases.

    Science.gov (United States)

    Magnuson, William J; Yeung, Jacky T; Guillod, Paul D; Gettinger, Scott N; Yu, James B; Chiang, Veronica L

    2016-06-01

    To perform a retrospective analysis of patients with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma who developed brain metastases (BM) to evaluate our hypothesis that the use of upfront EGFR-tyrosine kinase inhibitors (TKIs), and deferral of radiation therapy (RT), would result in inferior intracranial progression-free survival but similar overall survival (OS). Of 202 patients diagnosed with EGFR-mutant NSCLC between July 1, 2008, and December 31, 2014, 71 developed BM. Twenty-one patients were excluded owing to prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after whole-brain radiation therapy (WBRT)/stereotactic radiosurgery (SRS) or develop brain metastases. A prospective, multi-institutional, randomized trial of upfront EGFR-TKI with RT at intracranial progression versus upfront RT followed by EGFR-TKI is urgently needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Assessment of the residual tumour of colorectal liver metastases after chemotherapy: diffusion-weighted MR magnetic resonance imaging in the peripheral and entire tumour

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Mathilde; Doblas, Sabrina; Giraudeau, Celine [Paris Diderot University, INSERM, UMR 1149, Clichy (France); Ronot, Maxime; Van Beers, Bernard; Vilgrain, Valerie [Paris Diderot University, INSERM, UMR 1149, Clichy (France); Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hopitaux de Paris, APHP, Clichy (France); Belghiti, Jacques [Hepatobiliary Surgery Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hopitaux de Paris, APHP, Clichy (France); Paradis, Valerie [Pathology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hopitaux de Paris, APHP, Clichy (France)

    2016-01-15

    To evaluate the value of diffusion-weighted imaging (DWI) in detecting residual tumours (RTs) in colorectal liver metastases (CLMs) following chemotherapy, with a focus on tumour periphery. From January 2009-January 2012, 57 patients who underwent liver resection for CLMs with preoperative MRI (<3 months) including DWI were retrospectively included. CLMs were classified into three response groups on pathology: (1) major histological (MHR, RTs ≤ 10 %), (2) partial histological (PHR, RT = 10-49 %), and (3) no histological (NHR, RT ≥ 50 %). On DWI, regions of interest (ROIs) were drawn around the entire tumour and tumour periphery. Apparent diffusion (ADC) and pure diffusion (D) coefficients were calculated using a monoexponential fit, and compared using Kruskal-Wallis test on a lesion-per-lesion analysis. 111 CLMs were included. Fourteen (12.5 %), 42 (38 %) and 55 (49.5 %) CLMs presented a MHR, PHR and NHR, respectively. ADC and D of the peripheral ROIs were significantly higher in the MHR group (P = 0.013/P = 0.013). ADC and D from the entire tumour were not significantly different among the groups (P = 0.220/P = 0.103). In CLM treated with chemotherapy, ADC and D values from the entire tumour are not related to the degree of RT, while peripheral zone diffusion parameters could help identify metastases with MHR. (orig.)

  8. How does iliac crest bone marrow biopsy compare with imaging in the detection of bone metastases in small cell lung cancer?

    International Nuclear Information System (INIS)

    Perrin-Resche, I.; Bizais, Y.; Buhe, T.; Fiche, M.

    1993-01-01

    Iliac crest bone marrow biopsy (BMB) has often been used as the gold standard for the detection of bone marrow metastases in small cell lung cancer (SCLC). However, it is likely to lead to numerous false-negative results. For this reason, we compared the results of bone scintigraphy (BS), magnetic resonance imaging (MRI), and BMB in 48 sequential patients affected with pathologically confirmed SCLC (47 were evaluable; mean age, 58.4 years). The three procedures were carried out within 1 week, no treatment being performed during this period. Whole-body scans and spot views were obtained in the anterior and posterior projections. For MRI, only the thoracolumbar spine, the sternum and the pelvis were scanned, using spin-echo T1-weighted sequences, resulting in an acquisition time of less than 45 min. Only five BMBs were rated as positive. In these cases, both BS and MRI were also positive. The other 42 biopsies were negative. Among them, in ten cases both BS and MRI were positive. In 21 cases, both BS and MRI were negative. In five cases MRI was positive while BS was negative. Finally, in six cases MRI was negative whilst BS was positive. In most cases in which either BS or MRI was positive, follow-up scans confirmed the initial findings. This study suggests that BMB is more invasive and less sensitive than BS or MRI in detecting bone metastases. MRI seems to be more sensitive than BS in detecting small spinal or pelvic metastases. Whole-body bone scintigraphy is more sensitive in detecting skull, costal or peripheral metastases. BS and MRI should be used in combination and may replace BMB in the detection of bone metastases in SCLC. (orig.)

  9. Phase I Study of Concurrent Whole Brain Radiotherapy and Erlotinib for Multiple Brain Metastases From Non-Small-Cell Lung Cancer

    International Nuclear Information System (INIS)

    Lind, Joline S.W.; Lagerwaard, Frank J.; Smit, Egbert F.; Senan, Suresh

    2009-01-01

    Purpose: Erlotinib has shown activity in patients with brain metastases from non-small-cell lung cancer. The present dose-escalation Phase I trial evaluated the toxicity of whole brain radiotherapy (WBRT) with concurrent and maintenance erlotinib in this patient group. Methods and Materials: Erlotinib (Cohort 1, 100 mg/d; Cohort 2, 150 mg/d) was started 1 week before, and continued during, WBRT (30 Gy in 10 fractions). Maintenance erlotinib (150 mg/d) was continued until unacceptable toxicity or disease progression. Results: A total of 11 patients completed WBRT, 4 in Cohort 1 and 7 in Cohort 2. The median duration of erlotinib treatment was 83 days. No treatment-related neurotoxicity was observed. No treatment-related Grade 3 or greater toxicity occurred in Cohort 1. In Cohort 2, 1 patient developed a Grade 3 acneiform rash and 1 patient had Grade 3 fatigue. Two patients in Cohort 2 developed erlotinib-related interstitial lung disease, contributing to death during maintenance therapy. The median overall survival and interval to progression was 133 and 141 days, respectively. Six patients developed extracranial progression; only 1 patient had intracranial progression. In 7 patients with follow-up neuroimaging at 3 months, 5 had a partial response and 2 had stable disease. Conclusion: WBRT with concurrent erlotinib is well tolerated in patients with brain metastases from non-small-cell lung cancer. The suggestion of a high intracranial disease control rate warrants additional study.

  10. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao [Shandong Provincial Hospital Affiliated to Shandong University, Department of Oncology, Jinan, Shandong Province (China); Zhang, Kaixian [Teng Zhou Central People' s Hospital Affiliated to Jining Medical College, Department of Oncology, Tengzhou, Shandong Province (China)

    2015-10-15

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  11. Dynamic contrast-enhanced MR imaging pharmacokinetic parameters as predictors of treatment response of brain metastases in patients with lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kuchcinski, Gregory; Duhal, Romain; Lalisse, Maxime; Dumont, Julien; Lopes, Renaud; Pruvo, Jean-Pierre; Leclerc, Xavier; Delmaire, Christine [University of Lille, CHU Lille, Department of Neuroradiology, Lille (France); Le Rhun, Emilie [University of Lille, CHU Lille, Department of Neurosurgery, Lille (France); Oscar Lambret Center, Department of Medical Oncology, Lille (France); Inserm U1192-PRISM-Laboratoire de Proteomique, Reponse Inflammatoire, Spectrometrie de Masse, Lille (France); Cortot, Alexis B. [University of Lille, CHU Lille, Department of Thoracic Oncology, Lille (France); Drumez, Elodie [University of Lille, CHU Lille, Department of Biostatistics, Lille (France)

    2017-09-15

    To determine the diagnostic accuracy of pharmacokinetic parameters measured by dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in predicting the response of brain metastases to antineoplastic therapy in patients with lung cancer. Forty-four consecutive patients with lung cancer, harbouring 123 newly diagnosed brain metastases prospectively underwent conventional 3-T MRI at baseline (within 1 month before treatment), during the early (7-10 weeks) and midterm (5-7 months) post-treatment period. An additional DCE MRI sequence was performed during baseline and early post-treatment MRI to evaluate baseline pharmacokinetic parameters (K{sup trans}, k{sub ep}, v{sub e}, v{sub p}) and their early variation (∇K{sup trans}, ∇k{sub ep}, ∇v{sub e}, ∇v{sub p}). The objective response was judged by the volume variation of each metastasis from baseline to midterm MRI. ROC curve analysis determined the best DCE MRI parameter to predict the objective response. Baseline DCE MRI parameters were not associated with the objective response. Early ∇K{sup trans}, ∇v{sub e} and ∇v{sub p} were significantly associated with the objective response (p = 0.02, p = 0.001 and p = 0.02, respectively). The best predictor of objective response was ∇v{sub e} with an area under the curve of 0.93 [95% CI = 0.87, 0.99]. DCE MRI and early ∇v{sub e} may be a useful tool to predict the objective response of brain metastases in patients with lung cancer. (orig.)

  12. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    International Nuclear Information System (INIS)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao; Zhang, Kaixian

    2015-01-01

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  13. Predictive Value of Early Tumor Shrinkage and Density Reduction of Lung Metastases in Patients With Metastatic Colorectal Cancer Treated With Regorafenib.

    Science.gov (United States)

    Vanwynsberghe, Hannes; Verbeke, Xander; Coolen, Johan; Van Cutsem, Eric

    2017-12-01

    The benefit of regorafenib in colorectal cancer is not very pronounced. At present, there is lack of predictive biological or radiological markers. We studied if density reduction or small changes in size of lung metastases could be a predictive marker. We retrospectively measured density in size of lung metastases of all patients included in the CORRECT and CONSIGN trials at our center. Contrast-enhanced CT scan at baseline and at week 8 were compared. Data of progressive-free survival and overall survival were collected from the CORRECT and CONSIGN trials. A significant difference in progressive-free survival was seen in 3 groups: response or stable disease in size (5.36 vs. 3.96 months), response in density (6.03 vs. 2.72 months), and response in corrected density (6.14 vs. 3.08 months). No difference was seen for response in size versus stable disease or progressive disease in size. For overall survival, a difference was observed in the same 3 groups: response or stable disease in size (9.89 vs. 6.44 months), response in density (9.59 vs. 7.04 months), and response in corrected density (9.09 vs. 7.16 months). No difference was seen for response in size versus stable disease or progressive disease in size. Density reduction in lung metastases might be a good predictive parameter to predict outcome for regorafenib. Early tumor progression might be a negative predictive factor. If further validated, density reduction and early tumor progression might be useful to ameliorate the cost-benefit of regorafenib. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Cortical bone metastases

    International Nuclear Information System (INIS)

    Davis, T.M. Jr.; Rogers, L.F.; Hendrix, R.W.

    1986-01-01

    Twenty-five cases of bone metastases involving the cortex alone are reviewed. Seven patients had primary lung carcinoma, while 18 had primary tumors not previously reported to produce cortical bone metastases (tumors of the breast, kidney, pancreas, adenocarcinoma of unknown origin, multiple myeloma). Radiographically, these cortical lesions were well circumscribed, osteolytic, and produced soft-tissue swelling and occasional periosteal reaction. A recurrent pattern of metadiaphyseal involvement of the long bones of the lower extremity (particularly the femur) was noted, and is discussed. Findings reported in the literature, review, pathophysiology, and the role of skeletal radiographs, bone scans, and CT scans in evaluating cortical bone metastases are addressed

  15. [New toxicity of fotemustine: diffuse interstitial lung disease].

    Science.gov (United States)

    Bertrand, M; Wémeau-Stervinou, L; Gauthier, S; Auffret, M; Mortier, L

    2012-04-01

    Fotemustine is an alkylating cytostatic drug belonging to the nitrosourea family and is used in particular in the treatment of disseminated malignant melanoma. Herein, we report a case of interstitial lung disease associated with fotemustine. An 81-year-old man treated with fotemustine for metastatic melanoma presented acute interstitial lung disease 20 days after a fourth course of fotemustine monotherapy. The condition regressed spontaneously, with the patient returning to the clinical, radiological and blood gas status that had preceded fotemustine treatment. After other potential aetiologies had been ruled out, acute fotemustine-induced lung toxicity was considered and this treatment was definitively withdrawn. Other cytostatic agents belonging to the nitrosourea family can cause similar pictures, with a number of cases of interstitial lung disease thus being ascribed to fotemustine and dacarbazine. To our knowledge, this is the first case of interstitial lung disease induced by fotemustine monotherapy. This diagnosis should be considered where respiratory signs appear in melanoma patients undergoing fotemustine treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  16. Improvement of dosimetry for I-131 therapy of lung metastases with special regard to children with thyroid cancer from Belarus following the Chernobyl accident. Final report 1997-1999

    International Nuclear Information System (INIS)

    Lassmann, M.; Reiners, C.; Allen, S.

    2000-01-01

    The main problem in treating disseminated pulmonary metastases in children with papillary thyroid cancer is to find a balance between an insufficient dose for the ablation of metastatic tissue and unnecessary high radiation exposure to the lungs and the bone marrow. This can hardly be achieved without quantitative dosimetry for the more or less inhomogeneously distributed 1-131 in high dosed radioiodine therapy. The major goal of this project is to improve the concept for treating patients with lung metastases induced by thyroid carcinoma. Almost all of the patients with lung metastases are treated in more than one therapy course. After each course the knowledge of the doses to the tumor tissue, the lung, and the bone marrow is of crucial importance for a well funded decision about further treatment. In the cases of either the tumor doses being inefficient for ablation or substantial impairment of residuing pulmonary metastases or the cumulated doses to lung and bone marrow exceeds empirically defined ''critical'' limits the fractionated radioiodine treatment has to be stopped to avoid side effects such as lung fibrosis or leukemia in patients with papillary thyroid cancer. The decision which has to be taken must consider that prognosis with respect to mortality and quality of life even in the case of persisting lung metastases may be better than after the induction of progressive pulmonary fibrosis. Up to now, patients are treated more or less empirically until complete remission is achieved and no tumor uptake is visible in post-therapeutic scans with a gamma camera or the cumulative activity of 1-131 taken up by the lungs exceeds 3 GBq (80 mCi) according to recommendations given by Benua and Leaper in 1962. This project combines empirical approaches with theoretical research at cellular level to optimize the dose to the tumor cells with protection of healthy lung tissue. (orig.)

  17. Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature.

    Science.gov (United States)

    Plonczak, Agata M; DiMarco, Aimee N; Dina, Roberto; Gujral, Dorothy M; Palazzo, Fausto F

    2017-09-22

    Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature. A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy. A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally

  18. Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease

    Directory of Open Access Journals (Sweden)

    Natália Melo

    2009-07-01

    Full Text Available Background: While open lung biopsy (OLB performed in patients on mechanical ventilation (MV with diffuse lung diseases (DLD can be extremely important in establishing the diagnosis, the associated risk of this procedure should be taken into account. Aim: To determine the diagnostic yield, therapeutic changes, complications and mortality in patients with DLD on MV submitted to OLB. Methods: Retrospective study of 19 patients admitted to S. João Hospital between January 1999 and July 2007 (8.5 years. Data analysed included demographic data, ventilation variables before and after biopsy, diagnostic yield, effect on subsequent treatment changes and complications of OLB. Statistical analysis was performed using SPSS 14.0. Results: The mean age of patients was 58 ± 16.3 years old and 53% were male. The mean duration of hospital stay in Intensive Care Unit before performing OLB was 13 ± 7 days. All biopsies were performed by thoracotomy. The diagnostic yield was 95%. There were no significant differences in partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2 ratio and the positive end expiratory pressure (PEEP before and after OLB. Postoperative complications occurred in 4 patients (21%; persistent air leak. Alteration in the diagnosis occurred in 14 patients (74% and in 8 patients (42% there was a modification in the treatment regimen. Global mortality was 47% (9 patients but there were no biopsyrelated deaths. Conclusion: The high diagnostic yield and the low incidence of complications make OLB a useful procedure in patients on MV with DLD of unknown aetiology. However, early OLB may lead to even better results in some patients. Resumo: Introdução: A realização de biópsia pulmonar cirúrgica (BPC em doentes sob ventilação invasiva (VI no contexto de doenças difusas do pulmão (DPD poderá revelar-se necessária em circunstâncias em que se torne fundamental a precis

  19. Mixed Herbal Medicine Induced Diffuse Infiltrative Lung Disease: The HRCT and Histopathologic Findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Gyu; Shin, Eun A [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Kim, Joung Sook [Mokdong Hospital, Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2010-12-15

    The purpose of this study was to evaluate the high-resolution CT (HRCT) and pathologic findings of mixed herbal medicine-induced diffuse interstitial lung disease. Eight patients (6 women and 2 men, age range: 31 to 81 years, mean age: 51.4 years) who presented with cough or dyspnea after taking mixed herbal medicine were included in this study. All the patients underwent plain chest radiography and HRCT. We obtained pathologic specimens from 7 patients via fluoroscopy guided large bore cutting needle biopsy and transbronchial lung biopsy. All the patients were treated with steroid therapy. The most common HRCT finding was bilateral diffuse ground glass opacity (n=7), followed by peribronchial consolidation (n=5) and inter- or intralobular septal thickening (n=2). For the disease distribution, the lower lung zone was dominantly involved. The pathologic results of 7 patients were nonspecific interstitial pneumonia (n=3), bronchiolitis obliterans organizing pneumonia (n=2), hypersensitivity pneumonitis (n=1) and eosinophilic pneumonia (n=1). Irrespective of the pathologic results, all 8 patients improved clinically and radiologically after steroid treatment. The HRCT findings of mixed herbal medicine-induced diffuse infiltrative lung disease were mainly bilateral diffuse ground glass opacity, peribronchial consolidation and dominant involvement of the lower lung zone. Those pathologic findings were nonspecific and the differential diagnosis could include interstitial pneumonia, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis and eosinophilic pneumonia

  20. Mixed Herbal Medicine Induced Diffuse Infiltrative Lung Disease: The HRCT and Histopathologic Findings

    International Nuclear Information System (INIS)

    Kim, Tae Gyu; Shin, Eun A; Kim, Joung Sook

    2010-01-01

    The purpose of this study was to evaluate the high-resolution CT (HRCT) and pathologic findings of mixed herbal medicine-induced diffuse interstitial lung disease. Eight patients (6 women and 2 men, age range: 31 to 81 years, mean age: 51.4 years) who presented with cough or dyspnea after taking mixed herbal medicine were included in this study. All the patients underwent plain chest radiography and HRCT. We obtained pathologic specimens from 7 patients via fluoroscopy guided large bore cutting needle biopsy and transbronchial lung biopsy. All the patients were treated with steroid therapy. The most common HRCT finding was bilateral diffuse ground glass opacity (n=7), followed by peribronchial consolidation (n=5) and inter- or intralobular septal thickening (n=2). For the disease distribution, the lower lung zone was dominantly involved. The pathologic results of 7 patients were nonspecific interstitial pneumonia (n=3), bronchiolitis obliterans organizing pneumonia (n=2), hypersensitivity pneumonitis (n=1) and eosinophilic pneumonia (n=1). Irrespective of the pathologic results, all 8 patients improved clinically and radiologically after steroid treatment. The HRCT findings of mixed herbal medicine-induced diffuse infiltrative lung disease were mainly bilateral diffuse ground glass opacity, peribronchial consolidation and dominant involvement of the lower lung zone. Those pathologic findings were nonspecific and the differential diagnosis could include interstitial pneumonia, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis and eosinophilic pneumonia

  1. Case Report HOT TUB LUNG: AN INTRIGUING DIFFUSE ...

    African Journals Online (AJOL)

    www.ghanamedj.org Volume 51 Number 3 September 2017. 143. HOT TUB LUNG: AN ... We report a case of HTL to increase the awareness of this rare and enigmatic disease ..... Taylor RH, Falkinham JO III, Norton CD,. LeChevallier MW.

  2. Predictors of quality of life and survival following Gamma Knife surgery for lung cancer brain metastases: a prospective study.

    Science.gov (United States)

    Bragstad, Sidsel; Flatebø, Marianne; Natvig, Gerd Karin; Eide, Geir Egil; Skeie, Geir Olve; Behbahani, Maziar; Pedersen, Paal-Henning; Enger, Per Øyvind; Skeie, Bente Sandvei

    2017-08-18

    OBJECTIVE Lung cancer (LC) patients who develop brain metastases (BMs) have a poor prognosis. Estimations of survival and risk of treatment-related deterioration in quality of life (QOL) are important when deciding on treatment. Although we know of several prognostic factors for LC patients with BMs, the role of QOL has not been established. Authors of this study set out to evaluate changes in QOL following Gamma Knife surgery (GKS) for BMs in LC patients and QOL as a prognostic factor for survival. METHODS Forty-four of 48 consecutive LC patients with BMs underwent GKS in the period from May 2010 to September 2011, and their QOL was prospectively assessed before and 1, 3, 6, 9, and 12 months after GKS by using the Functional Assessment of Cancer Therapy-Brain (FACT-BR) questionnaire. A mixed linear regression model was used to identify potential predictive factors for QOL and to assess the effect of GKS and the disease course on QOL at follow-up. RESULTS Mean QOL as measured by the brain cancer subscale (BRCS) of the FACT-BR remained stable from baseline (score 53.0) up to 12 months post-GKS (57.1; p = 0.624). The BRCS score improved for 32 patients (72.3%) with a total BM volume ≤ 5 cm 3 . Mean improvement in these patients was 0.45 points each month of follow-up, compared to a decline of 0.50 points each month despite GKS treatment in patients with BM volumes > 5 cm 3 (p = 0.04). Asymptomatic BMs (p = 0.01), a lower recursive partitioning analysis (RPA) classification (p = 0.04), and a higher Karnofsky Performance Scale (KPS) score (p Knife surgery is a safe and effective therapeutic modality that improves QOL for LC patients with a BM volume ≤ 5 cm 3 at treatment. Careful follow-up and salvage therapy on demand seem to prevent worsening of QOL due to relapse of BMs.

  3. Risk Factors for Brain Metastases in Locally Advanced Non-Small Cell Lung Cancer With Definitive Chest Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Zhe; Bi, Nan; Wang, Jingbo; Hui, Zhouguang; Xiao, Zefen; Feng, Qinfu; Zhou, Zongmei; Chen, Dongfu; Lv, Jima; Liang, Jun; Fan, Chengcheng; Liu, Lipin; Wang, Luhua, E-mail: wlhwq@yahoo.com

    2014-06-01

    Purpose: We intended to identify risk factors that affect brain metastases (BM) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiation therapy, which may guide the choice of selective prevention strategies. Methods and Materials: The characteristics of 346 patients with stage III NSCLC treated with thoracic radiation therapy from January 2008 to December 2010 in our institution were retrospectively reviewed. BM rates were analyzed by the Kaplan-Meier method. Multivariate Cox regression analysis was performed to determine independent risk factors for BM. Results: The median follow-up time was 48.3 months in surviving patients. A total of 74 patients (21.4%) experienced BM at the time of analysis, and for 40 (11.7%) of them, the brain was the first site of failure. The 1-year and 3-year brain metastasis rates were 15% and 28.1%, respectively. In univariate analysis, female sex, age ≤60 years, non-squamous cell carcinoma, T3-4, N3, >3 areas of lymph node metastasis, high lactate dehydrogenase and serum levels of tumor markers (CEA, NSE, CA125) before treatment were significantly associated with BM (P<.05). In multivariate analysis, age ≤60 years (P=.004, hazard ratio [HR] = 0.491), non-squamous cell carcinoma (P=.000, HR=3.726), NSE >18 ng/mL (P=.008, HR=1.968) and CA125 ≥ 35 U/mL (P=.002, HR=2.129) were independent risk factors for BM. For patients with 0, 1, 2, and 3 to 4 risk factors, the 3-year BM rates were 7.3%, 18.9%, 35.8%, and 70.3%, respectively (P<.001). Conclusions: Age ≤60 years, non-squamous cell carcinoma, serum NSE >18 ng/mL, and CA125 ≥ 35 U/mL were independent risk factors for brain metastasis. The possibilities of selectively using prophylactic cranial irradiation in higher-risk patients with LA-NSCLC should be further explored in the future.

  4. Disappearing or residual tiny (≤5 mm) colorectal liver metastases after chemotherapy on gadoxetic acid-enhanced liver MRI and diffusion-weighted imaging: Is local treatment required?

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Cheonan Hospital, Department of Radiology, Soonchunhyang University College of Medicine, Cheonan-si, Chungcheongnam-do (Korea, Republic of); Song, Kyoung Doo; Kim, Young Kon [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Hee Cheol; Huh, Jung Wook [Sungkyunkwan University School of Medicine, Department of Surgery, Samsung Medical Center, Seoul (Korea, Republic of); Park, Young Suk; Park, Joon Oh; Kim, Seung Tae [Sungkyunkwan University School of Medicine, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul (Korea, Republic of)

    2017-07-15

    To evaluate the clinical course of disappearing colorectal liver metastases (DLM) or residual tiny (≤5 mm) colorectal liver metastases (RTCLM) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in patients who had colorectal liver metastases (CLM) and received chemotherapy. Among 137 patients who received chemotherapy for CLM and underwent gadoxetic acid-enhanced MRI and DWI between 2010 and 2012, 43 patients with 168 DLMs and 48 RTCLMs were included. The cumulative in situ recurrence rate of DLM and progression rate of RTCLM and their predictive factors were evaluated. A total of 150 DLMs and 26 RTCLMs were followed up without additional treatment. At 1 and 2 years, respectively, the cumulative in situ recurrence rates for DLM were 10.9 % and 15.7 % and the cumulative progression rates for RTCLM were 27.2 % and 33.2 %. The in situ recurrence rate at 2 years was 4.9 % for the DLM group that did not show reticular hypointensity of liver parenchyma on hepatobiliary phase. DLM on gadoxetic acid-enhanced liver MRI and DWI indicates a high possibility of clinical complete response, especially in patients without chemotherapy-induced sinusoidal obstruction syndrome. Thirty-three percent of RTCLMs showed progression at 2 years. (orig.)

  5. Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination

    International Nuclear Information System (INIS)

    Koh, D.M.; Brown, G.; Riddell, A.M.; Scurr, E.; Allen, S.D.; Husband, J.E.; Collins, D.J.; Souza, N.M. de; Leach, M.O.; Chau, I.; Cunningham, D.

    2008-01-01

    To compare the diagnostic accuracy of MnDPDP MR imaging and diffusion-weighted imaging (DWI), alone and in combination, for detecting colorectal liver metastases in patients with suspected metastatic disease. Thirty-three consecutive patients with suspected colorectal liver metastases underwent MR imaging. Three image sets (MnDPDP, DWI and combined MnDPDP and DWI) were reviewed independently by two observers. Lesions were scored on a five-point scale for malignancy and the areas (Az) under the receiver operating characteristic curves were calculated for each observer and image set. The sensitivity and specificity for lesion detection were calculated for each image set and compared. There were 83 metastases, 49 cysts and 1 haemangioma. Using the combined set resulted in the highest diagnostic accuracy for both observers (Az = 0.94 and 0.96), with improved averaged sensitivity of lesion detection compared with the DWI set (p = 0.01), and a trend towards improved sensitivity compared with the MnDPDP set (p = 0.06). There was no difference in the averaged specificity using any of the three image sets (p > 0.5). Combination of MnDPDP MR imaging and DWI resulted in the highest diagnostic accuracy and can increase sensitivity without loss in specificity. (orig.)

  6. Phase II clinical trial of whole-brain irradiation plus three-dimensional conformal boost with concurrent topotecan for brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Ge, Xiao-hui; Liu, Miao-ling; Lin, Qiang; Ren, Xiao-cang; Liu, Yue-e; Chen, Xue-ji; Wang, Dong-ying; Wang, Yong-qiang; Cao, Bin; Li, Zhi-gang

    2013-01-01

    Patients with brain metastases from lung cancer have poor prognoses and short survival time, and they are often excluded from clinical trials. Whole-cranial irradiation is considered to be the standard treatment, but its efficacy is not satisfactory. The purpose of this phase II clinical trial was to evaluate the preliminary efficacy and safety of the treatment of whole-brain irradiation plus three-dimensional conformal boost combined with concurrent topotecan for the patients with brain metastases from lung cancer. Patients with brain metastasis from lung cancer received concurrent chemotherapy and radiotherapy: conventional fractionated whole-brain irradiation, 2 fields/time, 1 fraction/day, 2 Gy/fraction, 5 times/week, and DT 40 Gy/20 fractions; for the patients with ≤ 3 lesions with diameter ≥ 2 cm, a three-dimensional (3-D) conformal localised boost was given to increase the dosage to 56–60 Gy; and during radiotherapy, concurrent chemotherapy with topotecan was given (the chemoradiotherapy group, CRT). The patients with brain metastasis from lung cancer during the same period who received radiotherapy only were selected as the controls (the radiotherapy-alone group, RT). From March 2009 to March 2012, both 38 patients were enrolled into two groups. The median progression-free survival(PFS) time , the 1- and 2-year PFS rates of CRT group and RT group were 6 months, 42.8%, 21.6% and 3 months, 11.6%, 8.7% (χ 2 = 6.02, p = 0.014), respectively. The 1- and 2-year intracranial lesion control rates of CRT and RT were 75.9% , 65.2% and 41.6% , 31.2% (χ 2 = 3.892, p = 0.049), respectively. The 1- and 2-year overall survival rates (OS) of CRT and RT were 50.8% , 37.9% and 40.4% , 16.5% (χ 2 = 1.811, p = 0.178), respectively. The major side effects were myelosuppression and digestive toxicities, but no differences were observed between the two groups. Compared with radiotherapy alone, whole-brain irradiation plus 3-D conformal boost irradiation and concurrent

  7. Selected Arterial Infusion Chemotherapy Combined with Target Drugs 
for Non-small Cell Lung Cancer with Multiple Brain Metastase

    Directory of Open Access Journals (Sweden)

    Jinduo LI

    2012-05-01

    Full Text Available Background and objective The aim of this study is to evaluate the efficacy of selected arterial infusion chemotherapy in treating non-small cell lung cancer (NSCLC with multiple brain metastases and corresponding factors to influencing prognosis. Methods From September 2008 to October 2011, a total of 31 patients of NSCLC with multiple brain metastases (≥3 received selected incranial, bronchial and corresponding target arterial infusion chemotherapy combined with EGFR-TKIs. Interventional treatment was performed every four weeks, two-six cycles with synchronized or sequential targeted drugs (erlotinib, gefitinib or icotinib. Follow-up CT and MRI were regularly finished at interval of four weeks after two cycles of interventional treatment were finished or during taking targeted drugs in order to evaluate efficacy of the therapy. The procedure was stopped for the tumor disease was worse or the patient could not tolerate the toxity of drugs any longer. Results 31 patients was performed two to six cycles of interventional therapy, 3cycles at average. Response assessment showed that 5 (16.1% patients got a complete response (CR, 7 (22.6% had a partial response (PR, 11 (35.5% had a stable disease (SD and 8 (25.8% had a progressive disease (PD. The objective response rate (ORR was 38.7%, and the disease control rate was 74.2%. The median progression free survival (PFS and overall survival (OS were 13.1 months and 15.1 months. The 6-month survival rate, one-year survival rate and two-year survival rate were 79%, 61.1%, and 31.1%, respectively. The patients’ OS and PFS were influenced by smoking state, tumor pathology, extracranial metastases, period of targeted drug taking and performance status, not by sex, age, before therapy and the total of brain metastases. Conclusion Selected arterial infusion chemotherapy with targeted drugs is one of the most effective and safe treatment to NSCLC with multiple brain metastases. Smoking status, tumor

  8. Operative and scientific set-up to treat diffused and multi-focal metastases in the explanted liver. Preliminary indications from the first case

    International Nuclear Information System (INIS)

    Pinelli, T.; Altieri, S.; Bruschi, P.; Fossati, F.; Zonta, A.; Ferrari, C.; Prati, U.; Roveda, L.; Barni, S.; Chiari, P.; Nano, R.

    2002-01-01

    A new method has been developed for the therapy of human liver affected with multi-focal and diffused metastases. The therapeutic concept is based on the neutron irradiation of the explanted organ which, soon after such a treatment, is re-implanted according to the self-transplant procedure. Metastases are generally numerous and not completely detectable by the current diagnostic methodologies: so it is necessary to irradiate the whole organ in a thermal neutron field to treat all metastases and to minimize the recurrence probability. The irradiation position into the thermal column of the Triga Mark II reactor of University of Pavia was designed by means of neutron transport code MCNP. The neutron flux components in air at the irradiation position are shown. During the irradiation, to have a neutron flux inside the liver as flat as possible (in the longitudinal axis of the irradiation channel), we rotate the liver of an angle of 180 deg around the vertical axis. The irradiation of the liver is performed putting the organ inside a two teflon bags and than in another rigid teflon container equipped with two thermocouples to monitor the liver temperature. The first clinical trial consist in the treatment of a male 48 years old made on December 19th 2001. The self-graft procedure and the neutron therapy were performed at S. Matteo Polyclinic and inside the thermal column of Triga Mark II reactor of the University of Pavia respectively. The patient's liver contained more than 20 metastases following the removal of a colon-adenocarcinoma few months before. Six months after treatment all radiological and clinical checks indicated a positive and hopeful trend of the patient's condition

  9. Stromal expression of heat-shock protein 27 is associated with worse clinical outcome in patients with colorectal cancer lung metastases.

    Directory of Open Access Journals (Sweden)

    Thomas Schweiger

    Full Text Available Pulmonary metastases are common in patients with primary colorectal cancer (CRC. Heat-shock protein 27 (Hsp27 is upregulated in activated fibroblasts during wound healing and systemically elevated in various diseases. Cancer-associated fibroblasts (CAFs are also thought to play a role as prognostic and predictive markers in various malignancies including CRC. Surprisingly, the expression of Hsp27 has never been assessed in CAFs. Therefore we aimed to investigate the expression level of Hsp27 in CAFs and its clinical implications in patients with CRC lung metastases.FFPE tissue samples from 51 pulmonary metastases (PMs and 33 paired primary tumors were evaluated for alpha-SMA, CD31, Hsp27 and vimentin expression by immunohistochemistry and correlated with clinicopathological variables. 25 liver metastases served as control group. Moreover, serum samples (n=10 before and after pulmonary metastasectomy were assessed for circulating phospho-Hsp27 and total Hsp27 by ELISA.Stromal expression of Hsp27 was observed in all PM and showed strong correlation with alpha-SMA (P<0.001 and vimentin (P<0.001. Strong stromal Hsp27 was associated with higher microvessel density in primary CRC and PM. Moreover, high stromal Hsp27 and αSMA expression were associated with decreased recurrence-free survival after pulmonary metastasectomy (P=0.018 and P=0.008, respectively and overall survival (P=0.031 and P=0.017, respectively. Serum levels of phospho- and total Hsp27 dropped after metastasectomy to levels comparable to healthy controls.Herein we describe for the first time that Hsp27 is highly expressed in tumor stroma of CRC. Stromal α-SMA and Hsp27 expressions correlate with the clinical outcome after pulmonary metastasectomy. Moreover, serum Hsp27 might pose a future marker for metastatic disease in CRC.

  10. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  11. Additional value of integrated PET-CT in the detection and characterization of lung metastases: correlation with CT alone and PET alone

    International Nuclear Information System (INIS)

    Wever, W. de; Meylaerts, L.; Verschakelen, J.A.; Ceuninck, L. de; Stroobants, S.

    2007-01-01

    The purpose was evaluating retrospectively the additional value of integrated positron emission tomography (PET) and computed tomography (CT) in the detection of pulmonary metastases in comparison with CT and PET alone. Fifty-six lung nodules, divided into three groups according their size, detected in 24 consecutive patients with a known primary tumor were retrospectively evaluated with integrated PET-CT, CT and PET. The nature of these nodules was determined by either histopathology or a follow-up of at least 6 months. The CT and PET images of the integrated PET-CT were evaluated separately by a radiologist and a nuclear medicine physician, the integrated PET-CT images were evaluated by a chest radiologist and nuclear medicine physician in consensus. The investigators were asked to search lung nodules and to determine whether these nodules were metastases or not. Sensitivity and accuracy for CT, PET and integrated PET-CT for characterization of all pulmonary nodules were, respectively: 100%, 90%, 100% and 57%, 55%, 55%. There was no significant difference in the characterization of pulmonary nodules between integrated PET-CT and CT alone (P=1.000) and PET alone (P=0.1306). An accurate evaluation is only possible for lesions larger than 1 cm. (orig.)

  12. Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non-small-cell lung cancer: A Cochrane Review

    International Nuclear Information System (INIS)

    Lester, Jason Francis; MacBeth, Fergus R.; Coles, Bernadette

    2005-01-01

    Purpose: To investigate whether prophylactic cranial irradiation (PCI) has a role in the management of patients with non-small-cell lung cancer (NSCLC) treated with curative intent. Methods and Materials: A search strategy was designed to identify randomized controlled trials (RCTs) comparing PCI with no PCI in NSCLC patients treated with curative intent. The electronic databases MEDLINE, EMBASE, LILACS, and Cancerlit were searched, along with relevant journals, books, and review articles to identify potentially eligible trials. Four RCTs were identified and reviewed. A total of 951 patients were randomized in these RCTs, of whom 833 were evaluable and reported. Forty-two patients with small-cell lung cancer were excluded, leaving 791 patients in total. Because of the small patient numbers and trial heterogeneity, no meta-analysis was attempted. Results: Prophylactic cranial irradiation did significantly reduce the incidence of brain metastases in three trials. No trial reported a survival advantage with PCI over observation. Toxicity data were poorly collected and no quality of life assessments were carried out in any trial. Conclusion: Prophylactic cranial irradiation may reduce the incidence of brain metastases, but there is no evidence of a survival benefit. It was not possible to evaluate whether any radiotherapy regimen is superior, and the effect of PCI on quality of life is not known. There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial

  13. Chromogenic in situ hybridization to detect EGFR gene copy number in cell blocks from fine-needle aspirates of non small cell lung carcinomas and lung metastases from colo-rectal cancer

    Directory of Open Access Journals (Sweden)

    Terrenato Irene

    2010-09-01

    Full Text Available Abstract Background Several studies demonstrated that epidermal growth factor receptor (EGFR gene copy number (GCN correlates to the response to tyrosine kinase inhibitors in non small cell lung cancer (NSCLC and to anti-EGFR monoclonal antibodies (MoAbs in metastatic colorectal cancer (CRC. In the presence of lung nodules, cytology is often the only possible diagnostic approach. Chromogenic in situ hybridization (CISH is an alternative technique to fluorescence in situ hybridization (FISH, but its feasibility in detecting EGFR GCN in cell blocks from fine-needle aspiration cytology (FNAC of lung nodules has not yet been established. Methods We evaluated the feasibility of CISH on 33 FNAC from 20 primary NSCLC (5 squamous carcinomas, 8 large cell carcinomas and 7 adenocarcinomas and 13 lung metastases from CRC. Results Of the 33 FNAC analyzed by CISH, 27 (82% presented a balanced increase in EGFR gene and chromosome 7 number: 10 cases (30% showed a low polysomy, 15 (45% a high polysomy and 2 (6% NSCLC were amplified. No significant differences between NSCLC and CRC lung metastases were found in relation to disomic or polysomic status. In addition, no correlation between EGFR GCN and EGFR immunohistochemical overexpression was found. Furthermore, we compared CISH results with those obtained by FISH on the same samples and we found 97% overall agreement between the two assays (k = 0.78, p Conclusions Our study shows that CISH is a valid method to detect EGFR GCN in cell blocks from FNAC of primary NSCLC or metastatic CRC to the lung.

  14. Multiple metastases from ovarian cancer

    African Journals Online (AJOL)

    Ovarian cancer affects women in the age group >60 years much ... ovarian cancer presenting with liver and thoracic vertebral metastases 4 months after ... manifested by parenchymal liver or lung ... categorised as stage Ic as per International.

  15. Establishment of an experimental human lung adenocarcinoma cell line SPC-A-1BM with high bone metastases potency by 99mTc-MDP bone scintigraphy

    International Nuclear Information System (INIS)

    Yang Shunfang; Dong Qianggang; Yao Ming; Shi Meiping; Ye Jianding; Zhao Langxiang; Su Jianzhong; Gu Weiyong; Xie Wenhui; Wang Kankan; Du Yanzhi; Li Yao; Huang Yan

    2009-01-01

    Background: Bone metastasis is one of the most common clinical phenomena of late stage lung cancer. A major impediment to understanding the pathogenesis of bone metastasis has been the lack of an appropriate animal and cell model. This study aims to establish human lung adenocarcinoma cell line with highly bone metastases potency with 99m Tc-MDP bone scintigraphy. Methods: The human lung adenocarcinoma cancer cells SPC-A-1 were injected into the left cardiac ventricle of NIH-Beige-Nude-XID (NIH-BNX) immunodeficient mice. The metastatic lesions of tumor-bearing mice were imaged with 99m Tc-MDP bone scintigraphy on a Siemens multi-single photon emission computed tomography. Pinhole images were acquired on a GZ-B conventional gamma camera with a self-designed pinhole collimator. The mice with bone metastasis were sacrificed under deep anesthesia, and the lesions were resected. Bone metastatic cancer cells in the resected lesions were subjected for culture and then reinoculated into the NIH-BNX mice through left cardiac ventricle. The process was repeated for eight cycles to obtain a novel cell subline SPC-A-1BM. Real-time polymerase chain reaction (PCR) was used to compare the gene expression differences in the parental and SPC-A-1BM cells. Results: The bone metastasis sites were successfully revealed by bone scintigraphy. The established bone metastasis cell line SPC-A-1BM had a high potential to metastasize in bone, including mandible, humerus, thoracic vertebra, lumbar, femur, patella, ilium and cartilage rib. The expression level of vascular endothelial growth factor gene family, Bcl-2 and cell adhesion-related genes ECM1, ESM1, AF1Q, SERPINE2 and FN1 were examined. Gene expression difference was found between parental and bone-seeking metastasis cell SPC-A-1BM, which indicates SPC-A-1BM has metastatic capacity vs. its parental cells. Conclusion: SPC-A-1BM is a bone-seeking metastasis human lung adenocarcinoma cell line. Bone scintigraphy may be used as an

  16. Combination of icotinib, surgery, and internal-radiotherapy of a patient with lung cancer severely metastasized to the vertebrae bones with EGFR mutation: a case report

    Directory of Open Access Journals (Sweden)

    Qu LL

    2015-06-01

    Full Text Available Li-Li Qu, Hai-Feng Qin, Hong-Jun Gao, Xiao-Qing Liu Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Science, Beijing, People’s Republic of China Abstract: A 48-year-old Chinese female was referred to us regarding EGFR-mutated advanced non-small cell lung cancer, and metastasis to left scapula and vertebrae bones which caused pathological fracture at T8 and T10 thoracic vertebrae. An aggressive combined therapy with icotinib, vertebrae operation, and radioactive particle implantation and immunotherapy was proposed to prevent paraplegia, relieve pain, and control the overall and local tumor lesions. No postoperative symptoms were seen after surgery, and the pain was significantly relieved. Icotinib merited a 31-month partial response with grade 1 diarrhea as its drug-related adverse event. High dose of icotinib was administered after pelvis lesion progression for 3 months with good tolerance. Combination therapy of icotinib, surgery, and internal radiation for metastases of the vertebrae bones from non-small cell lung cancer seems to be a very promising technique both for sufficient pain relief and for local control of the tumor, vertebrae operation can be an encouraging option for patients with EFGR positive mutation and good prognosis indicator. Keywords: lung cancer, spinal metastasis, pathological fracture, spinal canal stenosis, icotinib

  17. Metastasizing leiomyoma to heart.

    Science.gov (United States)

    Consamus, Erin N; Reardon, Michael J; Ayala, Alberto G; Schwartz, Mary R; Ro, Jae Y

    2014-01-01

    Cardiac smooth muscle tumors are rare. Three different clinical settings for these tumors have been reported, including benign metastasizing leiomyoma from the uterus, primary cardiac leiomyoma and leiomyosarcoma, and intravenous cardiac extension of pelvic leiomyoma, which is the most common. We present a case of a 55-year-old woman with a benign metastasizing leiomyoma to the heart 17 years after hysterectomy and 16 years after metastasis to the lung. Immunohistochemical stains for smooth muscle actin, desmin, and estrogen and progesterone receptors were positive, indicating a smooth muscle tumor of uterine origin. To our knowledge, this is only the fourth reported case of benign metastasizing leiomyoma to the heart and the first case of long-delayed cardiac metastasis after successful treatment of pulmonary metastasis. It illustrates that benign metastasizing leiomyoma should be included in the differential diagnosis of cardiac tumors in patients with a history of uterine leiomyoma, especially when associated with pulmonary metastasis.

  18. Transbronchial Lung Cryobiopsy and Video-assisted Thoracoscopic Lung Biopsy in the Diagnosis of Diffuse Parenchymal Lung Disease. A Meta-analysis of Diagnostic Test Accuracy.

    Science.gov (United States)

    Iftikhar, Imran H; Alghothani, Lana; Sardi, Alejandro; Berkowitz, David; Musani, Ali I

    2017-07-01

    Transbronchial lung cryobiopsy is increasingly being used for the assessment of diffuse parenchymal lung diseases. Several studies have shown larger biopsy samples and higher yields compared with conventional transbronchial biopsies. However, the higher risk of bleeding and other complications has raised concerns for widespread use of this modality. To study the diagnostic accuracy and safety profile of transbronchial lung cryobiopsy and compare with video-assisted thoracoscopic surgery (VATS) by reviewing available evidence from the literature. Medline and PubMed were searched from inception until December 2016. Data on diagnostic performance were abstracted by constructing two-by-two contingency tables for each study. Data on a priori selected safety outcomes were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy. The pooled diagnostic yield, pooled sensitivity, and pooled specificity of transbronchial lung cryobiopsy were 83.7% (76.9-88.8%), 87% (85-89%), and 57% (40-73%), respectively. The pooled diagnostic yield, pooled sensitivity, and pooled specificity of VATS were 92.7% (87.6-95.8%), 91.0% (89-92%), and 58% (31-81%), respectively. The incidence of grade 2 (moderate to severe) endobronchial bleeding after transbronchial lung cryobiopsy and of post-procedural pneumothorax was 4.9% (2.2-10.7%) and 9.5% (5.9-14.9%), respectively. Although the diagnostic test accuracy measures of transbronchial lung cryobiopsy lag behind those of VATS, with an acceptable safety profile and potential cost savings, the former could be considered as an alternative in the evaluation of patients with diffuse parenchymal lung diseases.

  19. Fusion positron emission/computed tomography underestimates the presence of hilar nodal metastases in patients with resected non-small cell lung cancer.

    Science.gov (United States)

    Carrillo, Sergio A; Daniel, Vincent C; Hall, Nathan; Hitchcock, Charles L; Ross, Patrick; Kassis, Edmund S

    2012-05-01

    The 5-year survival for patients with resected stage II (N1) non-small cell lung cancer ranges from 40% to 55%. No data exist addressing the benefit of neoadjuvant therapy for patients with stage II disease. This is largely in part due to the lack of a reliable, minimally invasive method to assess hilar nodes. This study is aimed at determining the ability of fusion positron emission/computed tomography (PET/CT) to identify hilar metastases in patients with resected non-small cell lung cancer. A retrospective review of surgically resected patients with fusion PET/CT within 30 days of resection was performed. The sensitivity, specificity, positive predictive value, and negative predictive value for PET/CT in detecting hilar nodal metastases was calculated for a range of maximum standardized uptake values (SUVmax). Hilar nodes from patients with falsely positive PET/CT scans were analyzed for the presence of histoplasmosis. Additionally, the impact of hilar node size greater than 1 centimeter on the calculated values was assessed. There were 119 patients evaluated. The number of lymph nodes resected ranged from 1 to 12 (X=2.98). There was decreased sensitivity and increased specificity with higher SUVmax cutoff values. At the standard SUVmax value of 2.5, the sensitivity and specificity were only 48.5% and 80.2%. The addition of size of hilar node by CT led to a modest improvement in sensitivity at all SUVmax cutoff values. Fusion PET/CT lacks sensitivity and specificity in identifying hilar nodal metastasis in patients with resected non-small cell lung cancer. Further prospective studies assessing the utility of PET/CT versus alternative sampling techniques are warranted. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. EGFR-TKI therapy for patients with brain metastases from non-small-cell lung cancer: a pooled analysis of published data

    Directory of Open Access Journals (Sweden)

    Fan Y

    2014-11-01

    Full Text Available Yun Fan,1,2 Xiaoling Xu,3 Conghua Xie4 1Zhongnan Hospital of Wuhan University, Department of Radiation Oncology, Wuhan, People's Republic of China; 2Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, People’s Republic of China; 3Zhejiang Cancer Hospital, Hangzhou, People’s Republic of China; 4Zhongnan Hospital of Wuhan University, Department of Radiation Oncology, Wuhan, People’s Republic of China Introduction: Brain metastases are one of the leading causes of death from non-small-cell lung cancer (NSCLC. The use of epidermal growth factor receptor (EGFR tyrosine kinase inhibitors (TKIs to treat brain metastases remains controversial. Thus, we performed a pooled analysis of published data to evaluate the efficacy of EGFR-TKIs in NSCLC patients with brain metastases, particularly for tumors with activating EGFR mutations. Methods: Several data sources were searched, including PubMed, Web of Science, and ASCO Annual Meetings databases. The end points were intracranial overall response rate (ORR, disease control rate (DCR, progression-free survival (PFS, overall survival (OS, and adverse events. The pooled ORR, DCR, PFS, and OS with 95% confidence intervals (CIs were calculated employing fixed- or random-effect models, depending on the heterogeneity of the included studies. Results: Sixteen published studies were included in this analysis, with a total of 464 enrolled patients. The EGFR mutational status was unknown for 362 (unselected group, and 102 had activating EGFR mutations. The pooled intracranial ORR and DCR were 51.8% (95% CI: 45.8%–57.8% and 75.7% (95% CI: 70.3%–80.5%, respectively. A higher ORR was observed in the EGFR mutation group than in the unselected group (85.0% vs 45.1%; a similar trend was observed for the DCR (94.6% vs 71.3%. The pooled median PFS and OS were 7.4 months (95% CI, 4.9–9.9 and 11.9 months (95% CI, 7.7–16.2, respectively, with longer PFS (12.3 months vs 5.9 months and OS (16.2 months vs

  1. [Efficacy of zoledronic acid combined with chemotherapy in treatment of skeletal metastases of non-small cell lung cancer and the bone metabolic markers].

    Science.gov (United States)

    Hu, Xiao-ye; Zou, Qing-feng; Jin, Chuan; Li, Wei-dong; Chen, Wen-sheng; Ma, Lei

    2010-06-01

    To evaluate the clinical efficacy of zoledronic acid combined with chemotherapy in the management of skeletal metastasis of non-small cell lung cancer (NSCLC) and investigate the value in urine amino-terminal telopeptide of type I collagen (uNTX) and serum bone specific alkaline phosphatase (sBALP) in monitoring skeletal metastasis of NSCLC. From February, 2007 to January, 2009, 32 NSCLC patients with bone metastases received treatment with zoledronic acid at the dose of 4 mg given every 3 weeks and platinum-based chemotherapy (each cycle lasting for 3 weeks). Before and during the treatments, uNTX and sBALP were measured in these patients using ELISA and precipitation with wheat germ lectin, respectively. The patients were followed up for skeletal-related events (SREs) and status of survival. A significant decrease occurred in the pain scores and analgesic use in the patients after the therapy. SREs were not observed during the treatment. Serum creatinine and calcium levels underwent no significant variation during the treatment. Eleven patients reported 14 possible zoledronic acid-related adverse events. The concentration of uNTX and sBALP in patients with bone metastases was above the upper limit of the normal range. A positive correlation was observed between the levels of the markers and the extent of bone metastases. At the third month, uNTX and sBALP were significantly lowered, but radionuclide whole-body bone imaging showed no obvious changes. Of the 32 patients, 24 had elevated uNTX values, which became normal after the treatment in 15 patients and remained elevated in the other 9 patients. SREs occurred in these two subgroups at the rates of 53% and 89% (P=0.039), respectively. Twenty-six patients had elevated sBALP level, and 16 of them exhibited normal sBALP level after the treatment. The incidences of SREs in the patients with elevated and normal sBALP level were 50% and 90% (P=0.038), respectively. The levels of uNTX/Cr and sBALP were not correlated

  2. Breast Metastases from Extramammary Malignancies: Typical and Atypical Ultrasound Features

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Sung Hee [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Department of Radiology, Catholic University of Daegu College of Medicine, Daegu 712-702 (Korea, Republic of); Ko, Eun Young; Han, Boo-Kyung; Shin, Jung Hee [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, Suk Jung [Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan 614-735 (Korea, Republic of); Cho, Eun Yoon [Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2014-07-01

    Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast.

  3. Breast Metastases from Extramammary Malignancies: Typical and Atypical Ultrasound Features

    International Nuclear Information System (INIS)

    Mun, Sung Hee; Ko, Eun Young; Han, Boo-Kyung; Shin, Jung Hee; Kim, Suk Jung; Cho, Eun Yoon

    2014-01-01

    Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast

  4. Lung Metastases in Neuroblastoma at Initial Diagnosis: A Report from the International Neuroblastoma Risk Group (INRG) Project

    Science.gov (United States)

    DuBois, Steven G.; London, Wendy B.; Zhang, Yang; Matthay, Katherine K.; Monclair, Tom; Ambros, Peter F.; Cohn, Susan L.; Pearson, Andrew; Diller, Lisa

    2009-01-01

    Background Neuroblastoma is the most common extracranial pediatric solid cancer. Lung metastasis is rarely detected in children with newly diagnosed neuroblastoma. We aimed to describe the incidence, clinical characteristics, and outcome of patients with lung metastasis at initial diagnosis using a large international database. Procedure The subset of patients from the International Neuroblastoma Risk Group database with INSS stage 4 neuroblastoma and known data regarding lung metastasis at diagnosis was selected for analysis. Clinical and biological characteristics were compared between patients with and without lung metastasis. Survival for patients with and without lung metastasis was estimated by Kaplan-Meier methods. Cox proportional hazards methods were used to determine the independent prognostic value of lung metastasis at diagnosis. Results Of the 2,808 patients with INSS stage 4 neuroblastoma diagnosed between 1990 and 2002, 100 patients (3.6%) were reported to have lung metastasis at diagnosis. Lung metastasis was more common among patients with MYCN amplified tumors, adrenal primary tumors, or elevated lactate dehydrogenase (LDH) levels (p < 0.02 in each case). Five-year overall survival ± standard error for patients with lung metastasis was 34.5% ± 6.8% compared to 44.7% ± 1.3% for patients without lung metastasis (p=0.0002). However, in multivariable analysis, the presence of lung metastasis was not independently predictive of outcome. Conclusions Lung metastasis at initial diagnosis of neuroblastoma is associated with MYCN amplification and elevated LDH levels. Although lung metastasis at diagnosis was not independently predictive of outcome in this analysis, it remains a useful prognostic marker of unfavorable outcome. PMID:18649370

  5. Gender, Race, and Survival: A Study in Non-Small-Cell Lung Cancer Brain Metastases Patients Utilizing the Radiation Therapy Oncology Group Recursive Partitioning Analysis Classification

    International Nuclear Information System (INIS)

    Videtic, Gregory M.M.; Reddy, Chandana A.; Chao, Samuel T.; Rice, Thomas W.; Adelstein, David J.; Barnett, Gene H.; Mekhail, Tarek M.; Vogelbaum, Michael A.; Suh, John H.

    2009-01-01

    Purpose: To explore whether gender and race influence survival in non-small-cell lung cancer (NSCLC) in patients with brain metastases, using our large single-institution brain tumor database and the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) brain metastases classification. Methods and materials: A retrospective review of a single-institution brain metastasis database for the interval January 1982 to September 2004 yielded 835 NSCLC patients with brain metastases for analysis. Patient subsets based on combinations of gender, race, and RPA class were then analyzed for survival differences. Results: Median follow-up was 5.4 months (range, 0-122.9 months). There were 485 male patients (M) (58.4%) and 346 female patients (F) (41.6%). Of the 828 evaluable patients (99%), 143 (17%) were black/African American (B) and 685 (83%) were white/Caucasian (W). Median survival time (MST) from time of brain metastasis diagnosis for all patients was 5.8 months. Median survival time by gender (F vs. M) and race (W vs. B) was 6.3 months vs. 5.5 months (p = 0.013) and 6.0 months vs. 5.2 months (p = 0.08), respectively. For patients stratified by RPA class, gender, and race, MST significantly favored BFs over BMs in Class II: 11.2 months vs. 4.6 months (p = 0.021). On multivariable analysis, significant variables were gender (p = 0.041, relative risk [RR] 0.83) and RPA class (p < 0.0001, RR 0.28 for I vs. III; p < 0.0001, RR 0.51 for II vs. III) but not race. Conclusions: Gender significantly influences NSCLC brain metastasis survival. Race trended to significance in overall survival but was not significant on multivariable analysis. Multivariable analysis identified gender and RPA classification as significant variables with respect to survival.

  6. Bone metastases from gastric cancer

    International Nuclear Information System (INIS)

    Seto, Mikito; Tonami, Norihisa; Koizumi, Kiyoshi; Sui, Osamu; Hisada, Kinichi

    1983-01-01

    We have studied bone scintigrams in 60 patients with gastric cancer. Of these 60 patients, bone metastases were found in 15 patients (25 %). There were no evidence of bone metastases in polypoid lesions, cancers of the antrum, carcinomas in situ, advanced cancers without invasion to serosa, cancer with N 0 or N 1 regional lymph node metastases, highly deferenciated adenocarcinomas and papillary adenocarcinomas. On the contrary, high rates of bone metastases were seen in cancers of the corpus, advanced cancers with invasion to neighbouring structures and tubular adenocarcinomas. Of these 15 patients with bone metastasis, 3 patients showed very similar clinical features and the findings of ''diffuse bone metastases on bone scintigrams.'' Cancer of the antrum showed high rates of liver metastases, while cancers of the corpus showed high rates of bone stastases. Sixty percent of the patients with bone metastases did not have liver metastases and there seemed to be no significant relationship between liver metastases and bone metastases. From these results we suppose that non-portal tract through the vertebral venous plexus instead of portal tract may be the other route of bone metastases from gastric cancer. (author)

  7. Lung injury induced by secondhand smoke exposure detected with hyperpolarized helium-3 diffusion MR.

    Science.gov (United States)

    Wang, Chengbo; Mugler, John P; de Lange, Eduard E; Patrie, James T; Mata, Jaime F; Altes, Talissa A

    2014-01-01

    To determine whether helium-3 diffusion MR can detect the changes in the lungs of healthy nonsmoking individuals who were regularly exposed to secondhand smoke. Three groups were studied (age: 59 ± 9 years): 23 smokers, 37 exposure-to-secondhand-smoke subjects, and 29 control subjects. We measured helium-3 diffusion values at diffusion times from 0.23 to 1.97 s. One-way analysis of variance revealed that the mean area under the helium-3 diffusion curves (ADC AUC) of the smokers was significantly elevated compared with the controls and to the exposure-to-secondhand-smoke subjects (P exposure-to-secondhand-smoke subjects and that of the controls was found (P = 0.115). However, application of a receiver operator characteristic-derived rule to classify subjects as either a "control" or a "smoker," based on ADC AUC, revealed that 30% (11/37) of the exposure-to-secondhand subjects were classified as "smokers" indicating an elevation of the ADC AUC. Using helium-3 diffusion MR, elevated ADC values were detected in 30% of nonsmoking healthy subjects who had been regularly exposed to secondhand smoke, supporting the concept that, in susceptible individuals, secondhand smoke causes mild lung damage. Copyright © 2013 Wiley Periodicals, Inc.

  8. Sticky siRNAs targeting survivin and cyclin B1 exert an antitumoral effect on melanoma subcutaneous xenografts and lung metastases

    International Nuclear Information System (INIS)

    Kedinger, Valerie; Erbacher, Patrick; Bolcato-Bellemin, Anne-Laure; Meulle, Aline; Zounib, Omar; Bonnet, Marie-Elise; Gossart, Jean-Baptiste; Benoit, Elodie; Messmer, Melanie; Shankaranarayanan, Pattabhiraman; Behr, Jean-Paul

    2013-01-01

    Melanoma represents one of the most aggressive and therapeutically challenging malignancies as it often gives rise to metastases and develops resistance to classical chemotherapeutic agents. Although diverse therapies have been generated, no major improvement of the patient prognosis has been noticed. One promising alternative to the conventional therapeutic approaches currently available is the inactivation of proteins essential for survival and/or progression of melanomas by means of RNA interference. Survivin and cyclin B1, both involved in cell survival and proliferation and frequently deregulated in human cancers, are good candidate target genes for siRNA mediated therapeutics. We used our newly developed sticky siRNA-based technology delivered with linear polyethyleneimine (PEI) to inhibit the expression of survivin and cyclin B1 both in vitro and in vivo, and addressed the effect of this inhibition on B16-F10 murine melanoma tumor development. We confirm that survivin and cyclin B1 downregulation through a RNA interference mechanism induces a blockage of the cell cycle as well as impaired proliferation of B16-F10 cells in vitro. Most importantly, PEI-mediated systemic delivery of sticky siRNAs against survivin and cyclin B1 efficiently blocks growth of established subcutaneaous B16-F10 tumors as well as formation and dissemination of melanoma lung metastases. In addition, we highlight that inhibition of survivin expression increases the effect of doxorubicin on lung B16-F10 metastasis growth inhibition. PEI-mediated delivery of sticky siRNAs targeting genes involved in tumor progression such as survivin and cyclin B1, either alone or in combination with chemotherapeutic drugs, represents a promising strategy for melanoma treatment

  9. Predicting Treatment Response of Colorectal Cancer Liver Metastases to Conventional Lipiodol-Based Transarterial Chemoembolization Using Diffusion-Weighted MR Imaging: Value of Pretreatment Apparent Diffusion Coefficients (ADC) and ADC Changes Under Therapy

    International Nuclear Information System (INIS)

    Lahrsow, Maximilian; Albrecht, Moritz H.; Bickford, Matthew W.; Vogl, Thomas J.

    2017-01-01

    PurposeTo use absolute pretreatment apparent diffusion coefficients (ADC) derived from diffusion-weighted MR imaging (DWI) to predict response to repetitive cTACE for unresectable liver metastases of colorectal carcinoma (CRLM) at 1 and 3 months after start of treatment.Materials and MethodsFifty-five metastases in 34 patients were examined with DWI prior to treatment and 1 month after initial cTACE. Treatment was performed in 4-week intervals. Response was evaluated at 1 and 3 months after start of therapy. Metastases showing a decrease of ≥30% in axial diameter were classified as responding lesions.ResultsOne month after initial cTACE, seven lesions showed early response. There was no significant difference in absolute pretreatment ADC values between responding and non-responding lesions (p = 0.94). Three months after initial cTACE, 17 metastases showed response. There was a significant difference (p = 0.021) between absolute pretreatment ADC values of lesions showing response (median 1.08 × 10 −3  mm 2 /s) and no response (median 1.30 × 10 −3  mm 2 /s). Pretreatment ADC showed fair diagnostic value to predict response (AUC 0.7). Lesions showing response at 3 months also revealed a significant increase in ADC between measurements before treatment and at one month after initial cTACE (p < 0.001). Applying an increase in ADC of 12.17%, response at 3 months after initial cTACE could be predicted with a sensitivity and specificity of 77 and 74%, respectively (AUC 0.817). Furthermore, there was a strong and significant correlation (r = 0.651, p < 0.001) between percentage change in size after third cTACE and percentage change in ADC.ConclusionIn patients with CRLM, ADC measurements are potential biomarkers for assessing response to cTACE.

  10. Predicting Treatment Response of Colorectal Cancer Liver Metastases to Conventional Lipiodol-Based Transarterial Chemoembolization Using Diffusion-Weighted MR Imaging: Value of Pretreatment Apparent Diffusion Coefficients (ADC) and ADC Changes Under Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lahrsow, Maximilian, E-mail: mlahrsow@gmail.com; Albrecht, Moritz H. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology (Germany); Bickford, Matthew W. [Medical University of South Carolina, Department of Radiology and Radiological Science (United States); Vogl, Thomas J. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology (Germany)

    2017-06-15

    PurposeTo use absolute pretreatment apparent diffusion coefficients (ADC) derived from diffusion-weighted MR imaging (DWI) to predict response to repetitive cTACE for unresectable liver metastases of colorectal carcinoma (CRLM) at 1 and 3 months after start of treatment.Materials and MethodsFifty-five metastases in 34 patients were examined with DWI prior to treatment and 1 month after initial cTACE. Treatment was performed in 4-week intervals. Response was evaluated at 1 and 3 months after start of therapy. Metastases showing a decrease of ≥30% in axial diameter were classified as responding lesions.ResultsOne month after initial cTACE, seven lesions showed early response. There was no significant difference in absolute pretreatment ADC values between responding and non-responding lesions (p = 0.94). Three months after initial cTACE, 17 metastases showed response. There was a significant difference (p = 0.021) between absolute pretreatment ADC values of lesions showing response (median 1.08 × 10{sup −3} mm{sup 2}/s) and no response (median 1.30 × 10{sup −3} mm{sup 2}/s). Pretreatment ADC showed fair diagnostic value to predict response (AUC 0.7). Lesions showing response at 3 months also revealed a significant increase in ADC between measurements before treatment and at one month after initial cTACE (p < 0.001). Applying an increase in ADC of 12.17%, response at 3 months after initial cTACE could be predicted with a sensitivity and specificity of 77 and 74%, respectively (AUC 0.817). Furthermore, there was a strong and significant correlation (r = 0.651, p < 0.001) between percentage change in size after third cTACE and percentage change in ADC.ConclusionIn patients with CRLM, ADC measurements are potential biomarkers for assessing response to cTACE.

  11. Predicting Treatment Response of Colorectal Cancer Liver Metastases to Conventional Lipiodol-Based Transarterial Chemoembolization Using Diffusion-Weighted MR Imaging: Value of Pretreatment Apparent Diffusion Coefficients (ADC) and ADC Changes Under Therapy.

    Science.gov (United States)

    Lahrsow, Maximilian; Albrecht, Moritz H; Bickford, Matthew W; Vogl, Thomas J

    2017-06-01

    To use absolute pretreatment apparent diffusion coefficients (ADC) derived from diffusion-weighted MR imaging (DWI) to predict response to repetitive cTACE for unresectable liver metastases of colorectal carcinoma (CRLM) at 1 and 3 months after start of treatment. Fifty-five metastases in 34 patients were examined with DWI prior to treatment and 1 month after initial cTACE. Treatment was performed in 4-week intervals. Response was evaluated at 1 and 3 months after start of therapy. Metastases showing a decrease of ≥30% in axial diameter were classified as responding lesions. One month after initial cTACE, seven lesions showed early response. There was no significant difference in absolute pretreatment ADC values between responding and non-responding lesions (p = 0.94). Three months after initial cTACE, 17 metastases showed response. There was a significant difference (p = 0.021) between absolute pretreatment ADC values of lesions showing response (median 1.08 × 10 -3  mm 2 /s) and no response (median 1.30 × 10 -3  mm 2 /s). Pretreatment ADC showed fair diagnostic value to predict response (AUC 0.7). Lesions showing response at 3 months also revealed a significant increase in ADC between measurements before treatment and at one month after initial cTACE (p < 0.001). Applying an increase in ADC of 12.17%, response at 3 months after initial cTACE could be predicted with a sensitivity and specificity of 77 and 74%, respectively (AUC 0.817). Furthermore, there was a strong and significant correlation (r = 0.651, p < 0.001) between percentage change in size after third cTACE and percentage change in ADC. In patients with CRLM, ADC measurements are potential biomarkers for assessing response to cTACE.

  12. Computerized detection of diffuse lung disease in MDCT: the usefulness of statistical texture features

    International Nuclear Information System (INIS)

    Wang Jiahui; Li Qiang; Li Feng; Doi Kunio

    2009-01-01

    Accurate detection of diffuse lung disease is an important step for computerized diagnosis and quantification of this disease. It is also a difficult clinical task for radiologists. We developed a computerized scheme to assist radiologists in the detection of diffuse lung disease in multi-detector computed tomography (CT). Two radiologists selected 31 normal and 37 abnormal CT scans with ground glass opacity, reticular, honeycombing and nodular disease patterns based on clinical reports. The abnormal cases in our database must contain at least an abnormal area with a severity of moderate or severe level that was subjectively rated by the radiologists. Because statistical texture features may lack the power to distinguish a nodular pattern from a normal pattern, the abnormal cases that contain only a nodular pattern were excluded. The areas that included specific abnormal patterns in the selected CT images were then delineated as reference standards by an expert chest radiologist. The lungs were first segmented in each slice by use of a thresholding technique, and then divided into contiguous volumes of interest (VOIs) with a 64 x 64 x 64 matrix size. For each VOI, we determined and employed statistical texture features, such as run-length and co-occurrence matrix features, to distinguish abnormal from normal lung parenchyma. In particular, we developed new run-length texture features with clear physical meanings to considerably improve the accuracy of our detection scheme. A quadratic classifier was employed for distinguishing between normal and abnormal VOIs by the use of a leave-one-case-out validation scheme. A rule-based criterion was employed to further determine whether a case was normal or abnormal. We investigated the impact of new and conventional texture features, VOI size and the dimensionality for regions of interest on detecting diffuse lung disease. When we employed new texture features for 3D VOIs of 64 x 64 x 64 voxels, our system achieved the

  13. Combination of icotinib, surgery, and internal-radiotherapy of a patient with lung cancer severely metastasized to the vertebrae bones with EGFR mutation: a case report.

    Science.gov (United States)

    Qu, Li-Li; Qin, Hai-Feng; Gao, Hong-Jun; Liu, Xiao-Qing

    2015-01-01

    A 48-year-old Chinese female was referred to us regarding EGFR-mutated advanced non-small cell lung cancer, and metastasis to left scapula and vertebrae bones which caused pathological fracture at T8 and T10 thoracic vertebrae. An aggressive combined therapy with icotinib, vertebrae operation, and radioactive particle implantation and immunotherapy was proposed to prevent paraplegia, relieve pain, and control the overall and local tumor lesions. No postoperative symptoms were seen after surgery, and the pain was significantly relieved. Icotinib merited a 31-month partial response with grade 1 diarrhea as its drug-related adverse event. High dose of icotinib was administered after pelvis lesion progression for 3 months with good tolerance. Combination therapy of icotinib, surgery, and internal radiation for metastases of the vertebrae bones from non-small cell lung cancer seems to be a very promising technique both for sufficient pain relief and for local control of the tumor, vertebrae operation can be an encouraging option for patients with EFGR positive mutation and good prognosis indicator.

  14. Validity of two recently-proposed prognostic grading indices for lung, gastro-intestinal, breast and renal cell cancer patients with radiosurgically-treated brain metastases.

    Science.gov (United States)

    Yamamoto, Masaaki; Serizawa, Toru; Sato, Yasunori; Kawabe, Takuya; Higuchi, Yoshinori; Nagano, Osamu; Barfod, Bierta E; Ono, Junichi; Kasuya, Hidetoshi; Urakawa, Yoichi

    2013-02-01

    We tested the validity of two prognostic indices for stereotactic radiosurgically (SRS)-treated patients with brain metastases (BMs) from five major original cancer categories. The two indices are Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) and our Modified Recursive Partitioning Analysis (RPA). Forty-six hundred and eight BM patients underwent gamma knife SRS during the 1998-2011 period. Primary cancer categories were non-small cell lung cancer (NSCLC, 2827 patients), small cell lung cancer (SCLC, 460), gastro-intestinal cancer (GIC, 582), breast cancer (BC, 547) and renal cell cancer (RCC, 192). There were statistically significant survival differences among patients stratified into four groups based on the DS-GPA systems (p failed to reach statistical significance with this system. There were, however, statistically significant MST differences (p < 0.001) among the three groups without overlapping of 95 % CIs between any two pairs of groups with the Modified RPA system in all five categories. The DS-GPA system is applicable to our set of patients with NSCLC only. However, the Modified RPA system was shown to be applicable to patients with five primary cancer categories. This index should be considered when designing future clinical trials involving BM patients.

  15. Intravascular pulmonary metastases

    International Nuclear Information System (INIS)

    Shepard, J.A.O.; Moore, E.H.; Templeton, P.A.; McLoud, T.C.

    1988-01-01

    The diagnosis of intravascular metastatic tumor emboli to the lungs is rarely made. The authors present a characteristic radiographic finding of intravascular lung metastases that they observed in four patients with diagnoses or right atrial myoxoma, invasive renal cell carcinoma, invasive pelvic osteosarcoma, and recurrent pelvic chondrosarcoma. Substantiation of intravascular pulmonary metastases was achieved by means of autopsy, pulmonary artery biopsy, and surgical documentation of tumor invasion of the inferior vena cava or pelvic veins. In all four cases, chest computed tomography (CT) demonstrated branching, beaded opacities extending from the hila into the periphery of the lung in the distribution of pulmonary arteries. In one case, similar findings were observed in magnetic resonance (MR) images of the chest. Follow-up studies in three cases showed progressive enlargement and varicosity of the abnormal pulmonary artery consistent with proliferation of intravascular tumor. In the case of metastatic osteosarcoma, intraluminal ossification was also observed at CT. In three of four cases, pulmonary infarction was demonstrated in the distribution of the abnormal pulmonary arteries seen at CT as small, peripheral, wedge-shaped opacities. The demonstration of progressively dilated and beaded pulmonary arteries in patients with extrathoracic malignancies is suggestive of intravascular lung metastases, particularly when accompanied by peripheral infarction

  16. An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma

    Directory of Open Access Journals (Sweden)

    Matthew J. Iott

    2013-02-01

    Full Text Available In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.

  17. Presentation of a salivary tumour si mil primitive lung with metastases of carcinoid tumour of the colon

    International Nuclear Information System (INIS)

    Cataldi, S.; Ximenez; Carzoglio, J.

    2010-01-01

    Introduction: Colon carcinoid tumors are primary tumors in the colon, a rare histology. The lung tumour Si mil - Amyloid is within primary lung tumours, infrequent histology and often behaves like a benign tumour. In this paper we present the case of a patient with a history of having undergone colon surgery for a malignant carcinoid. Two years after developing a lung salivary tumour simile initially presented as metastasis Colonic carcinoid lung tumour. Clinical case: It is about a female patient of 64 years, who in September 2008 he makes a right hemicolectomy extended by an occlusive syndrome sub. Anatomic Pathology (A P) accounted for Carcinoid Tumor Malignant one that committed the entire wall and 50 lymph nodes are resected, all free metastasis. The patient does not receive complementary treatments and an imaging over in December 2009 is evident in a tomographic study a bulky upper lobe pulmonary parenchymal process right. The fiberoptic bronchoscopy (Fob) showed complete obstruction of the right upper lobe bronchus by a vegetating process whose biopsy reported a malignant lung tumor commitment carcinoid support primitive colonic confirmed by immunohistochemistry (IHC). The March 23, 2010 takes place the right upper lobectomy with lymphadenectomy. The A P and IHC study confirmed adenosquamous carcinoma with stroma simile amiloide low degree of malignancy. This injury can be approved to a salivary tumour early lung simile. Bronchial compromised by tumor margin and 22 negative lymph nodes. The patient is referred for additional radiation treatment. Discussion: Tumours of salivary gland type of primitive lung is a very rare condition and diagnosis is a r arity . Usually they originate in the bronchial epithelium submucosal gland. Endo luminal lesions usually occur as infrequently and develop in outlying areas. The development of lung tumours unrelated bronchial structure has been explained by a possible origin from a primitive stem cell that can differentiate a

  18. The role of chemotherapy in brain metastases

    International Nuclear Information System (INIS)

    Ohori, Hisatsugu; Takahashi, Shin; Ishioka, Chikashi

    2007-01-01

    Brain metastases are the most common intracranial tumors and their incidence is increasing. Untreated brain metastases have a very poor prognosis with a median survival of 1-2 months. Despite the use of surgery and radiotherapy including whole-brain radiation and stereotactic radiosurgery to locally control brain metastases, survival times for those patients has not improved. Although chemotherapy plays a limited role in the treatment of brain metastases, metastases from lung or breast cancer are often well-controlled by chemotherapy. Accumulating evidence suggest that brain metastases are equally sensitive to chemotherapy as are metastases elsewhere in the body in particular chemotherapy-naive cases. Finally, since nearly a half of patients with brain metastases die from progression of systemic disease, control of systemic disease as well as intracranial disease are both important. (author)

  19. Causes of death of patients with lung cancer.

    Science.gov (United States)

    Nichols, Larry; Saunders, Rachel; Knollmann, Friedrich D

    2012-12-01

    The causes of death for patients with lung cancer are inadequately described. To categorize the immediate and contributing causes of death for patients with lung cancer. The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.

  20. Reference Data for Standardized Quality of Life Questionnaires in Indian Patients with Brain Metastases from Non-small Cell Lung Cancer: Results from a Prospective Study.

    Science.gov (United States)

    Aggarwal, Jaiprakash; Chakraborty, Santam; Ghosh Laskar, Sarbani; Patil, Vijay M; Prabhash, Kumar; Bhattacharya, Atanu; Noronha, Vanita; Purandare, Nilendu C; Joshi, Amit; Mummudi, Naveen; Arora, Jitendra; Badhe, Rupali

    2017-04-10

    Reference data for European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires do not include studies from the Indian subcontinent. The objective of the current study was to establish a reference dataset for Indian patients of non-small cell lung cancer (NSCLC) presenting with brain metastases (BM). One hundred forty patients with NSCLC with BM treated between 2012-2015 were registered in a prospective cohort study (CTRI/2013/01/003299). The baseline quality of life was evaluated using the EORTC general quality of life questionnaire QLQ-C30 and lung cancer specific module LC13. Minimum important difference (MID) scores for individual domains of the EORTC QLQ-C30 and LC13 questionnaires were derived (MID = 0.2 x standard deviation) from the reference data for patients with recurrent/metastatic lung cancers. In addition, a systematic review was conducted to identify studies reporting baseline quality of life scores for recurrent/metastatic NSCLC. Scores of several functional as well as symptom scales in the current NSCLC population differed by more than the MID from the baseline mean scores in the reference EORTC population as well as that reported from other studies. Differences in mean score from the EORTC reference data ranged from 6.2 and 9.4 points for the role functioning and cognitive functioning domains. In the symptom scales, the largest differences were observed for the financial difficulties (23.9) scores for the QLQ-C30 and peripheral neuropathy (21.7) for LC13 questionnaires. The current study demonstrates that baseline reference scores need to be established for patients from the Indian subcontinent. The findings from the current study have important implications for studies employing quality of life (QOL) assessment in the Indian NSCLC patient population.

  1. The potential role of respiratory motion management and image guidance in the reduction of severe toxicities following stereotactic ablative radiation therapy for patients with centrally located early stage non-small cell lung cancer or lung metastases

    Directory of Open Access Journals (Sweden)

    Alexander eChi

    2014-06-01

    Full Text Available Image guidance allows delivery of very high doses of radiation over a few fractions, known as stereotactic ablative radiotherapy (SABR. This treatment is associated with excellent outcome for early stage non-small cell lung cancer and metastases to the lungs. In the delivery of SABR, central location constantly poses a challenge due to the difficulty of adequately sparing critical thoracic structures that are immediately adjacent to the tumor if an ablative dose of radiation is to be delivered to the tumor target. As of current, various respiratory motion management and image guidance strategies can be used to ensure accurate tumor target localization prior and/ or during daily treatment, which allows for maximal and safe reduction of set up margins. The incorporation of both may lead to the most optimal normal tissue sparing and the most accurate SABR delivery. Here, the clinical outcome, treatment related toxicities, and the pertinent respiratory motion management/image guidance strategies reported in the current literature on SABR for central lung tumors are reviewed.

  2. Extra-corporeal liver BNCT for the treatment of diffuse metastases: What was learned and what is still to be learned

    Energy Technology Data Exchange (ETDEWEB)

    Zonta, A. [Department of Surgery, University of Pavia, Pavia (Italy)], E-mail: aris.zonta@pv.infn.it; Pinelli, T. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy); Prati, U.; Roveda, L. [Oncologic Surgery, Cancer Center of Excellence Fond. ' T. Campanella' , Catanzaro (Italy); Ferrari, C.; Clerici, A.M.; Zonta, C. [Department of Surgery, University of Pavia, Pavia (Italy); Mazzini, G. [Department of Animal Biol., IGM-CNR Histochemistry and Cytometry Section, Pavia (Italy); Dionigi, P. [Department of Surgery, University of Pavia, Pavia (Italy); Altieri, S.; Bortolussi, S. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy); Bruschi, P. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); Fossati, F. [Department of Nuclear and Theoretical Physics, University of Pavia, Pavia (Italy); National Institute of Nuclear Physics (INFN) Pavia Section, Pavia (Italy)

    2009-07-15

    Almost eight years ago, in December 2001, we performed for the first time in the world thermal neutron irradiation on an isolated liver of a patient. The organ was affected by diffuse metastases of a colon carcinoma and had been previously loaded with a {sup 10}B compound. In July 2003, the same procedure was applied again on a patient for the treatment of unresectable and incurable hepatic metastases of a carcinoma of the rectum. Both patients are dead at present. Now we can analyze in depth the clinical history of these patients and evaluate the effectiveness of this therapy. From this exciting experience we learned much, and we also found out about complications till then unknown, which need to be studied and addressed experimentally. Unfortunately we can base our conclusions just on the experience we had with these two patients. We could have been much more detailed and firm in our statements if the number of clinical cases was larger. The BNCT Pavia project has been suspended, but it is more than likely to resume in a short time. Good findings were many. The procedure is feasible; the original concept of complete immersion of the diseased liver in a homogeneous neutron field proved effective and winning. The tumor masses resulted completely necrotic and unknown metastases too appeared radically treated; healthy hepatic tissue was preserved from both morphological and functional points of view; no symptoms of cirrhosis appeared even four years after treatment. For the long term surviving patient, quality of life was excellent. Other findings require to be tackled in depth. The 'post-irradiation syndrome' we observed in both patients, with identical symptoms and biochemical derangements, creates a dramatic-even though totally reversible-clinical condition, that is the probable cause of death for our second patient, suffering from cardiomyopathy, 33 days after treatment. For the first patient, recurrences were a late yet fatal complication, for which

  3. Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma

    International Nuclear Information System (INIS)

    Gutzeit, Andreas; Doert, Aleksis; Froehlich, Johannes M.; Eckhardt, Boris P.; Meili, Andreas; Scherr, Patrick; Schmid, Daniel T.; Weymarn, Constantin A. von; Willemse, Edwin M.M.; Binkert, Christoph A.; Graf, Nicole

    2010-01-01

    To prospectively compare the diagnostic accuracy of diffusion-weighted whole body imaging with background whole body signal suppression (DWIBS) with skeletal scintigraphy for the diagnosis and differentiation of skeletal lesions in patients suffering from prostate or breast cancer. A diagnostic cohort of 36 patients was included in skeletal scintigraphy and 1.5 T DWIBS MRI. Based on morphology and signal intensity patterns, two readers each identified and classified independently, under blinded conditions, all lesions into three groups: (1) malignant, (2) unclear if malignant or benign and (3) benign. Finally, for the definition of the gold standard all available imaging techniques and follow-up over a minimum of 6 months were considered. Overall, 45 circumscribed bone metastases and 107 benign lesions were found. DWIBS performed significantly better in detecting malignant skeletal lesions in patients with more than 10 lesions (sensitivity: 0.97/0.91) compared to skeletal scintigraphy (sensitivity: 0.48/0.42). No statistical difference could be found between DWIBS (0.58/0.33) and skeletal scintigraphy (0.67/0.58) in the sensitivity values for malignant skeletal lesions in patients with less than 5 lesions. For benign lesions, scintigraphy scored best with a sensitivity of 0.93/0.87 compared to 0.20/0.13 for DWIBS. Interobserver agreement with Cohen's kappa coefficient was calculated as 0.784 in the case of scintigraphy and 0.663 for DWIBS. With respect to staging, in prostate and breast carcinoma, the DWIBS technique is not superior to skeletal scintigraphy, but ranks equally. However, in the cases with many bone lesions, markedly more metastases could be discovered using the DWIBS technique than skeletal scintigraphy. (orig.)

  4. Comparison of plain radiography, conventional tomography, and computed tomography in detecting intrathoracic lymph node metastases from lung carcinoma

    International Nuclear Information System (INIS)

    Osborne, D.R.; Korobkin, M.; Ravin, C.E.

    1982-01-01

    Forty-two patients with T2 bronchogenic carcinoma were evaluated with plain radiography, conventional 55 0 oblique hilar and anteroposterior mediastinal tomography, and computed tomography (CT) to compare their accuracy in assessing mediastinal and hilar nodal metastases. Definitive staging was achieved by thoracotomy and histopathological evaluation of resected specimens. All modalities demonstrated about the same accuracy, however, in the 25 patients with hilar and/or mediastinal lymphadenopathy, CT of the mediastinum was more sensitive but not more specific than the other two and conventional tomography was no more accurate than CT for hilar evaluation. Overall, no technicue was accurate enough for routine staging; their value may lie in directing biopsy or in treatment planning in patients with inoperable disease

  5. Tumor-Like Liver Abscess Mimicking Malignancy With Lung Metastases in a Patient With Acute Renal Failure: A Case Report.

    Science.gov (United States)

    Wang, Chih Hsin; Sun, Cheuk-Kay; Jiang, Jiunn-Song; Tsai, Ming Hsien

    2016-03-01

    The worldwide incidence of Klebsiella pneumoniae liver abscess (KLA) is increasing. It is important to accurately diagnose this life-threatening disease to provide timely and appropriate treatment. Here we report the case of a 38-year-old man with acute renal failure and a tumor-like liver abscess and septic pulmonary embolism. Initially, his clinical symptoms, laboratory tests, and radiological findings presented equivocal results of malignancy with metastases. Fine needle aspiration of liver tumor was performed, which showed purulent material with a culture positive for K pneumoniae. KLA symptoms are atypical, and radiological findings may mimic a malignancy with tumor necrosis. In some circumstances, liver aspiration biopsy may be necessary to confirm the real etiology, leading to prompt and timely treatment. Moreover, we should be alert for the impression of KLA when facing a diabetic patient with liver mass lesion and acute renal failure.

  6. Contribution of computed tomography in patients with lung metastases of differentiated thyroid carcinoma not apparent on plain radiography who were treated with radioiodine; Contribuicao da tomografia computadorizada em pacientes com metastases pulmonares de carcinoma diferenciado de tireoide nao-aparentes na radiografia e tratados com radioiodo

    Energy Technology Data Exchange (ETDEWEB)

    Rosario, Pedro W.S.; Purisch, Saulo [Santa Casa Belo Horizonte, MG (Brazil). Dep. de Tireoide. Servico de Endocrinologia]. E-mail: pedrorosario@globo.com; Tavares, Wilson C. [Instituto Alpha de Gastroenterologia, Belo Horizonte, MG (Brazil); Barroso, Alvarao L.; Rezende, Leonardo L.; Padrao, Eduardo L. [Santa Casa Belo Horizonte, MG (Brazil). Servico de Medicina Nuclear

    2008-02-15

    Computed tomography (CT or CAT Scan) of the chest is more sensitive than radiography in the detection of lung metastases of differentiated thyroid cancer (DTC), but little information is available regarding the aggregated value of this method. The present study evaluated the response of patients with lung metastases of DTC not apparent on radiography to treatment with {sup 131}I and the value of CT in these cases. Twenty-five patients with lung metastases not apparent on radiography, who initially received 100-200 mCi I{sup 151}, were evaluated and those presenting pulmonary uptake on post-therapy WBS were submitted to a new treatment after 6 to 12 months, and so on. The chance of detection of pulmonary uptake on post-therapy WBS did not differ between patients with negative and positive CT (100% versus 91.5%). Mean serum Tg levels were higher in patients with positive CT (108 ng/ml versus 52 ng/ml). Negative post-therapy WBS was achieved in 82% of patients with positive CT and in 92.3% with negative CT and the cumulative I{sup 131} activity necessary to achieve this outcome did not differ between the two groups (mean = 300 mCi). Stimulated Tg was undetectable in 47% of patients with negative CT at the end of treatment, but in none of the patients whose CT continued to be positive. In patients with elevated Tg, the CT result apparently did not change the indication of therapy or the I{sup 131} activity to be administered. In cases with lung metastases, the persistence of micronodules on CT was associated with the persistence of detectable Tg in patients presenting negative post-therapy WBS. (author)

  7. Monte Carlo dose calculations for BNCT treatment of diffuse human lung tumours

    International Nuclear Information System (INIS)

    Altieri, S.; Bortolussi, S.; Bruschi, P.

    2006-01-01

    In order to test the possibility to apply BNCT in the core of diffuse lung tumours, dose distribution calculations were made. The simulations were performed with the Monte Carlo code MCNP.4c2, using the male computational phantom Adam, version 07/94. Volumes of interest were voxelized for the tally requests, and results were obtained for tissues with and without Boron. Different collimated neutron sources were tested in order to establish the proper energies, as well as single and multiple beams to maximize neutron flux uniformity inside the target organs. Flux and dose distributions are reported. The use of two opposite epithermal neutron collimated beams insures good levels of dose homogeneity inside the lungs, with a substantially lower radiation dose delivered to surrounding structures. (author)

  8. Diffuse lung uptake (DLU) on Ga-67 scintigraph: Clinical, radiologic and pathologic correlation

    International Nuclear Information System (INIS)

    Sy, W.M.; Seo, I.S.; Vieira, J.; Zaman, M.

    1985-01-01

    Review, analysis and correlation (clinical, radiologic and pathologic) of 29 consecutive adults (16 drug addicts and/or homosexuals) with DLU on Ga-67 scintigraph were made. Diffuse increased uptake of at least 75% of both lungs was considered as DLU. WFOF cameras were used to obtain 24 to 96 hr. scintigraphs after IV injection of 3-5 mCi of Ga-67 citrate. In 26, tissue diagnosis established: pneumocystis carinii (PC) 15, miliary tuberculosis (TB) 3, sarcoidosis (SR) 3, drug-induced toxicity 2, and toxoplasmosis (TX), primary hyperparathyroidism and nonspecific lymphocytic pneumonia-one each. In two with breast and one with esophageal carcinomas, no lung tissue diagnosis was sought. Concurrent chest x-rays were negative in 16, but in 7/16, lung infiltrate was later documented. An average of 31 days elapsed before x-rays became positive in four with PC, 7 days in two with TB, and 22 days in one with TX. In 13, concurrent x-rays showed lung infiltrate, but in 6, only subtle, localized rather than diffuse infiltrate was noted. Fourteen of 29 had at least two Ga-67 studies. In 12 (7 PC, 2 TB, 3 SR) of 14 whose repeat studies showed significant to total disappearance of DLU, all did well clinically. In two whose initial studies were negative or equivocal, they became clinically worse when the repeat study showed DLU. In three others (2 PC, 1 TX) who died, their single studies recorded intense DLU. DLU on gallium scintigraph indicated a variety of pathology. In 55.2%, gallium scintigraph predated x-ray findings by a few days to weeks. In 20.3%, x-ray findings were only subtle or localized. Scintigraphic changes correlated well with the clinical courses in various diseases

  9. Diffusion-weighted and T2-weighted MR imaging for colorectal liver metastases detection in a rat model at 7 T: a comparative study using histological examination as reference

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Mathilde; Ronot, Maxime; Vilgrain, Valerie; Beers, Bernard E. van [University Paris Diderot, Sorbonne Paris Cite, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique- Hopitaux de Paris, Laboratory of Physiological and Molecular Imaging of the Abdomen (IPMA) and Department of Radiology, Clichy Cedex (France); Maggiori, Leon; Panis, Yves [University Paris Diderot, Sorbonne Paris Cite, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hopitaux de Paris, Department of Colorectal Surgery, Clichy (France); Paradis, Valerie [University Paris Diderot, Sorbonne Paris Cite, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hopitaux de Paris, Department of Pathology, Clichy (France)

    2013-08-15

    To compare diffusion-weighted (DW) and T2-weighted MR imaging in detecting colorectal liver metastases in a rat model, using histological examination as a reference method. Eighteen rats had four liver injections of colon cancer cells. MR examinations at 7 T included FSE-T2-weighted imaging and SE-DW MR imaging (b = 0, 20 and 150 s/mm{sup 2}) and were analysed by two independent readers. Histological examination was performed on 0.4-mm slices. McNemar's test was used to compare the sensitivities and the Wilcoxon matched pairs test to compare the average number of false-positives per rat. One hundred and sixty-six liver metastases were identified on histological examination. The sensitivity in detecting liver metastases was significantly higher on DW MR than on T2-weighted images (99/166 (60 %) (reader 1) and 92/166 (55 %) (reader 2) versus 77/166 (46 %), P {<=} 0.001), without an increase in false-positives per rat (P = 0.773/P = 0.850). After stratification according to metastasis diameter, DW MR imaging had a significantly higher sensitivity than T2-weighted imaging only for metastases with a diameter (0.6-1.2 mm) similar to that of the spatial resolution of MR imaging in the current study. This MR study with histological correlations shows the higher sensitivity of DW relative to T2-weighted imaging at 7 T for detecting liver metastases, especially small ones. (orig.)

  10. Morphological respiratory diffusion capacity of the lungs of ball pythons (Python regius).

    Science.gov (United States)

    Starck, J Matthias; Aupperle, Heike; Kiefer, Ingmar; Weimer, Isabel; Krautwald-Junghanns, Maria-Elisabeth; Pees, Michael

    2012-08-01

    This study aims at a functional and morphological characterization of the lung of a boid snake. In particular, we were interested to see if the python's lungs are designed with excess capacity as compared to resting and working oxygen demands. Therefore, the morphological respiratory diffusion capacity of ball pythons (Python regius) was examined following a stereological, hierarchically nested approach. The volume of the respiratory exchange tissue was determined using computed tomography. Tissue compartments were quantified using stereological methods on light microscopic images. The tissue diffusion barrier for oxygen transport was characterized and measured using transmission electron micrographs. We found a significant negative correlation between body mass and the volume of respiratory tissue; the lungs of larger snakes had relatively less respiratory tissue. Therefore, mass-specific respiratory tissue was calculated to exclude effects of body mass. The volume of the lung that contains parenchyma was 11.9±5.0mm(3)g(-1). The volume fraction, i.e., the actual pulmonary exchange tissue per lung parenchyma, was 63.22±7.3%; the total respiratory surface was, on average, 0.214±0.129m(2); it was significantly negatively correlated to body mass, with larger snakes having proportionally smaller respiratory surfaces. For the air-blood barrier, a harmonic mean of 0.78±0.05μm was found, with the epithelial layer representing the thickest part of the barrier. Based on these findings, a median diffusion capacity of the tissue barrier ( [Formula: see text] ) of 0.69±0.38ml O(2)min(-1)mmHg(-1) was calculated. Based on published values for blood oxygen concentration, a total oxygen uptake capacity of 61.16mlO(2)min(-1)kg(-1) can be assumed. This value exceeds the maximum demand for oxygen in ball pythons by a factor of 12. We conclude that healthy individuals of P. regius possess a considerable spare capacity for tissue oxygen exchange. Copyright © 2012 Elsevier Gmb

  11. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial

    OpenAIRE

    Mulvenna, Paula; Nankivell, Matthew; Barton, Rachael; Faivre-Finn, Corinne; Wilson, Paula; McColl, Elaine; Moore, Barbara; Brisbane, Iona; Ardron, David; Holt, Tanya; Morgan, Sally; Lee, Caroline; Waite, Kathryn; Bayman, Neil; Pugh, Cheryl

    2016-01-01

    Summary Background Whole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from non-small cell lung cancer (NSCLC), although there have been no randomised clinical trials showing that WBRT improves either quality of life or overall survival. Even after treatment with WBRT, the prognosis of this patient group is poor. We aimed to establish whether WBRT could be omitted without a significant effect on survival or quality of life. Methods The Quality of Life a...

  12. [A case report-advanced pancreas cancer with liver and lung metastases well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting].

    Science.gov (United States)

    Hasuike, Yasunori; Tanigawa, Takahiko; Yamada, Masaharu; Minami, Yukiko; Ezumi, Koji; Kashiwazaki, Masaki; Fujimoto, Takayoshi

    2008-11-01

    We report a case of advanced pancreatic cancer with liver and lung metastases that was well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting. The patient was a 74-year-old woman. Chief complaints were back pain and anorexia. She was diagnosed with pancreas cancer with liver and lung metastases at the time of first visit. We started systemic chemotherapy with gemcitabine 1 g/body and 5-FU 1 g/body alternately every other week on an outpatient basis. At 1.5 months (M) after initiation of chemotherapy, we started radiation therapy to the main tumor at a total dose of 40 Gy. After radiation, chemotherapy was resumed. As a result, the size of the main tumor decreased but metastatic liver tumors got larger. Then we changed to combination therapy with systemic chemotherapy (gemcitabine and 5-FU) and hepatic arterial infusion (5-FU weekly). Liver metastases almost disappeared after 7.5 M. Despite all these treatments, however, the number of metastatic lung tumors increased. The patient was hospitalized for 15 M and died after 17 M. We focused on and succeeded in the prolongation of lifetime and maintenance of QOL by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion therapy.

  13. The Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Sperduto, Paul W., E-mail: psperduto@mropa.com [Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota (United States); Yang, T. Jonathan; Beal, Kathryn [Sloan Kettering Cancer Center, New York, New York (United States); Pan, Hubert; Brown, Paul D. [MD Anderson Cancer Center, Houston, Texas (United States); Bangdiwala, Ananta; Shanley, Ryan [University of Minnesota, Masonic Cancer Center, Biostatistics, Minneapolis, Minnesota (United States); Yeh, Norman; Gaspar, Laurie E. [University of Colorado–Denver, Denver, Colorado (United States); Braunstein, Steve; Sneed, Penny [University of California–San Francisco, San Francisco, California (United States); Boyle, John; Kirkpatrick, John P. [Duke University, Durham, North Carolina (United States); Mak, Kimberley S.; Shih, Helen A. [Massachusetts General Hospital, Boston, Massachusetts (United States); Engelman, Alex [University of Maryland, Baltimore, Maryland (United States); Roberge, David [CHUM, University of Montreal, Montreal, Quebec (Canada); Arvold, Nils D.; Alexander, Brian; Awad, Mark M. [Dana Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); and others

    2016-10-01

    Purpose: Lung cancer remains the most common cause of both cancer mortality and brain metastases (BM). The purpose of this study was to assess the effect of gene alterations and tyrosine kinase inhibition (TKI) on median survival (MS) and cause of death (CoD) in patients with BM from lung adenocarcinoma (L-adeno). Methods: A multi-institutional retrospective database of patients with L-adeno and newly diagnosed BM between 2006 and 2014 was created. Demographics, gene alterations, treatment, MS, and CoD were analyzed. The treatment patterns and outcomes were compared with those in prior trials. Results: Of 1521 L-adeno patients, 816 (54%) had known alteration status. The gene alteration rates were 29%, 10%, and 26% for EGFR, ALK, and KRAS, respectively. The time from primary diagnosis to BM for EGFR−/+ was 10/15 months (P=.02) and for ALK−/+ was 10/20 months (P<.01), respectively. The MS for the group overall (n=1521) was 15 months. The MS from first treatment for BM for EGFR and ALK−, EGFR+, ALK+ were 14, 23 (P<.01), and 45 (P<.0001) months, respectively. The MS after BM for EGFR+ patients who did/did not receive TKI before BM was 17/30 months (P<.01), respectively, but the risk of death was not statistically different between TKI-naïve patients who did/did not receive TKI after the diagnosis of BM (EGFR/ALK hazard ratios: 1.06 [P=.84]/1.60 [P=.45], respectively). The CoD was nonneurologic in 82% of patients with known CoD. Conclusion: EGFR and ALK gene alterations are associated with delayed onset of BM and longer MS relative to patients without these alterations. The CoD was overwhelmingly nonneurologic in patients with known CoD.

  14. Rectal Metastases from Squamous Cell Carcinoma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    S. Cedrés

    2012-01-01

    Full Text Available Non-small-cell lung cancer (NSCLC represents 85% of lung cancer. The most frequent sites of distant metastasis are the liver, adrenal glands, bones and brain. Gastrointestinal metastases are uncommon and rectal metastases are extremely rare. Here we report a case of squamous cell carcinoma of the lung with rectal metastases.

  15. Icotinib and whole-brain radiotherapy for the treatment in patients with brain metastases from EGFR-mutant nonsmall cell lung cancer: A retrospective study.

    Science.gov (United States)

    Jiang, Ai-Ying; Zhang, Jing; Luo, Hai-Long; Gao, Feng; Lv, Yu-Feng

    2018-04-01

    This study aimed to explore the effect and toxicity of icotinib and whole-brain radiotherapy (IWBRT) for the treatment of brain metastases from nonsmall cell lung cancer (BMNSCLC) with epidermal growth factor receptor (EGFR)-mutant among Chinese Han population.A total of 55 patients with EGFR-mutant BMNSCLC were included. They received orally icotinib (125 mg/tablet, 125 mg each time, 3 times daily) until disease progression. In addition, they also underwent whole-brain radiotherapy (3-Gy fractions once daily, 5 days weekly for a total dose of 30 Gy) in an attempt to extend their survival time. The outcomes consisted of complete response (CR), partial response (PR), stable disease (SD), progress disease (PD), overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). In addition, toxicity was also recorded in this study.The CR, PR, SD, PD, ORR, PFS, and OS were 38.2%, 52.8%, 5.4%, 3.6%, 90.1%, 12.5%, and 48.0% months, respectively. In addition, mild toxicity was observed in this study.This study demonstrated that IWBRT is efficacious with acceptable toxicity for patients with EGFR-mutant BMNSCLC among Chinese Han population.

  16. Icotinib and whole-brain radiotherapy for the treatment in patients with brain metastases from EGFR-mutant nonsmall cell lung cancer

    Science.gov (United States)

    Jiang, Ai-Ying; Zhang, Jing; Luo, Hai-Long; Gao, Feng; Lv, Yu-Feng

    2018-01-01

    Abstract This study aimed to explore the effect and toxicity of icotinib and whole-brain radiotherapy (IWBRT) for the treatment of brain metastases from nonsmall cell lung cancer (BMNSCLC) with epidermal growth factor receptor (EGFR)-mutant among Chinese Han population. A total of 55 patients with EGFR-mutant BMNSCLC were included. They received orally icotinib (125 mg/tablet, 125 mg each time, 3 times daily) until disease progression. In addition, they also underwent whole-brain radiotherapy (3-Gy fractions once daily, 5 days weekly for a total dose of 30 Gy) in an attempt to extend their survival time. The outcomes consisted of complete response (CR), partial response (PR), stable disease (SD), progress disease (PD), overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). In addition, toxicity was also recorded in this study. The CR, PR, SD, PD, ORR, PFS, and OS were 38.2%, 52.8%, 5.4%, 3.6%, 90.1%, 12.5%, and 48.0% months, respectively. In addition, mild toxicity was observed in this study. This study demonstrated that IWBRT is efficacious with acceptable toxicity for patients with EGFR-mutant BMNSCLC among Chinese Han population. PMID:29642161

  17. Evaluation of the optimal diagnostic criteria for regional lymph node metastases of lung cancer on MR imaging by receiver operating characteristic curve

    International Nuclear Information System (INIS)

    Iwai, Naomichi; Yamaguchi, Yutaka

    1991-01-01

    MRI was performed in 78 primary lung cancer cases to evaluate the optimal diagnostic criteria for regional lymph node metastases. Receiver operating characteristic (ROC) curve analysis for 262 lymph nodes of the hilar and mediastinal regions showed that the optimal size criterion is 10 mm in the mean axis of nodal diameter. Employing this criterion, the diagnostic rates for hilar and mediastinal lymph nodes had a sensitivity of 75%, a specificity of 82%, and an overall accuracy of 79%. However, the diagnostic rates for subaortic, paraaortic, and hilar lymph nodes using the same criterion showed lower specificities than those for other nodes. It was suggested that evaluation by coronal section made the diagnosis for subaortic lymph nodes more precise. In the ROC curve analysis for each histologic type, it was thought that the optimal criterion for adenocarcinoma was 10 mm in the mean axis, and that the criteria for squamous cell carcinoma were 11 mm in the mean axis and 10 mm in the sort axis. (author)

  18. MSCT multi-criteria: A novel approach in assessment of mediastinal lymph node metastases in non-small cell lung cancer

    International Nuclear Information System (INIS)

    Volterrani, Luca; Mazzei, Maria Antonietta; Banchi, Benedetta; Voltolini, Luca; La Sala, Filomena; Carbone, Salvatore Francesco; Ricci, Veronica; Gotti, Giuseppe; Zompatori, Maurizio

    2011-01-01

    Summary: Purpose: To evaluate the accuracy of multi-slice computed tomography (MSCT) in diagnosing mediastinal lymph node metastases in patients with non-small cell lung cancer (NSCLC) using a multi-criteria approach. Methods: We retrospectively reviewed contrast-enhanced MSCT of the chest in 86 consecutive patients with histopathologically proven NSCLC. All patients underwent surgical lymph node resection within 30 days from the CT examination. In all cases pathological and CT results were reviewed and correlated. Results: The sensitivity, specificity, positive and negative predictive values, and accuracy of MSCT using a multi-criteria approach in the detection of the N2 stage were 100%, 98.5%, 100%, 94.4% and 98.8% respectively, whereas using the size criterion alone 64%, 61%, 87%, 40%, and 62% respectively. Conclusions: To improve MSCT accuracy for diagnosing N staging other criteria can be associated with lymph node size. The use of different dimensional cut-offs for each mediastinal lymph node station, the matching of positive nodal stations with tumour location, the structural characteristics and the type of enhancement allow for a high accuracy of MSCT in the staging of mediastinal nodes in NSCLC.

  19. Radiolabeled cetuximab plus whole-brain irradiation (WBI) for the treatment of brain metastases from non-small cell lung cancer (NSCLC)

    International Nuclear Information System (INIS)

    Rades, Dirk; Nadrowitz, Roger; Buchmann, Inga; Meller, Birgit; Hunold, Peter; Noack, Frank; Schild, Steven E.

    2010-01-01

    Background and Purpose: The addition of systemic drugs to whole-brain irradiation has not improved the survival of patients with multiple brain metastases, most likely because the agents did not readily cross the blood-brain barrier (BBB). Radiolabeling of cetuximab was performed to investigate whether this antibody crosses the BBB. Case Report: A patient with multiple brain lesions from non-small cell lung cancer was investigated. The largest metastasis (40 x 33 x 27 mm) was selected the reference lesion. On day 1, 200 mg/m 2 cetuximab (0.25% hot and 99.75% cold antibody) were given. On day 3, 200 mg/m 2 cetuximab (cold antibody) were given. Weekly doses of 250 mg/m 2 cetuximab were administered for 3 months. Results: The reference lesion showed enhancement of radiolabeled cetuximab ( 123 I-Erbi) on scintigraphy; 123 I-Erbi crossed the BBB and accumulated in the lesion. The reference lesion measured 31 x 22 x 21 mm at 4 months. Enhancement of contrast medium was less pronounced. Conclusion: This is the first demonstration of cetuximab crossing the BBB and accumulating in brain metastasis. (orig.)

  20. Radiolabeled cetuximab plus whole-brain irradiation (WBI) for the treatment of brain metastases from non-small cell lung cancer (NSCLC)

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk; Nadrowitz, Roger [Dept. of Radiation Oncology, Univ. of Luebeck (Germany); Buchmann, Inga; Meller, Birgit [Section of Nuclear Medicine, Univ. of Luebeck (Germany); Hunold, Peter [Dept. of Radiology, Univ. of Luebeck (Germany); Noack, Frank [Inst. of Pathology, Univ. of Luebeck (Germany); Schild, Steven E. [Dept. of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2010-08-15

    Background and Purpose: The addition of systemic drugs to whole-brain irradiation has not improved the survival of patients with multiple brain metastases, most likely because the agents did not readily cross the blood-brain barrier (BBB). Radiolabeling of cetuximab was performed to investigate whether this antibody crosses the BBB. Case Report: A patient with multiple brain lesions from non-small cell lung cancer was investigated. The largest metastasis (40 x 33 x 27 mm) was selected the reference lesion. On day 1, 200 mg/m{sup 2} cetuximab (0.25% hot and 99.75% cold antibody) were given. On day 3, 200 mg/m{sup 2} cetuximab (cold antibody) were given. Weekly doses of 250 mg/m{sup 2} cetuximab were administered for 3 months. Results: The reference lesion showed enhancement of radiolabeled cetuximab ({sup 123}I-Erbi) on scintigraphy; {sup 123}I-Erbi crossed the BBB and accumulated in the lesion. The reference lesion measured 31 x 22 x 21 mm at 4 months. Enhancement of contrast medium was less pronounced. Conclusion: This is the first demonstration of cetuximab crossing the BBB and accumulating in brain metastasis. (orig.)

  1. Could new reconstruction CT techniques challenge MRI for the detection of brain metastases in the context of initial lung cancer staging?

    Energy Technology Data Exchange (ETDEWEB)

    Millon, Domitille; Byl, David; Coche, Emmanuel E. [Universite Catholique de Louvain, Department of Radiology and Medical Imaging, Cliniques Universitaires Saint Luc, Brussels (Belgium); Collard, Philippe [Universite Catholique de Louvain, Department of Pneumology, Cliniques Universitaires Saint Luc, Brussels (Belgium); Cambier, Samantha E.; Maanen, Aline G. van [Universite Catholique de Louvain, Statistic Unit, King Albert II Cancer Institute, Brussels (Belgium); Vlassenbroek, Alain [Philips Healthcare, Brussels (Belgium)

    2018-02-15

    To evaluate the diagnostic performance of brain CT images reconstructed with a model-based iterative algorithm performed at usual and reduced dose. 115 patients with histologically proven lung cancer were prospectively included over 15 months. Patients underwent two CT acquisitions at the initial staging, performed on a 256-slice MDCT, at standard (CTDIvol: 41.4 mGy) and half dose (CTDIvol: 20.7 mGy). Both image datasets were reconstructed with filtered back projection (FBP) and iterative model-based reconstruction (IMR) algorithms. Brain MRI was considered as the reference. Two blinded independent readers analysed the images. Ninety-three patients underwent all examinations. At the standard dose, eight patients presented 17 and 15 lesions on IMR and FBP CT images, respectively. At half-dose, seven patients presented 15 and 13 lesions on IMR and FBP CT images, respectively. The test could not highlight any significant difference between the standard dose IMR and the half-dose FBP techniques (p-value = 0.12). MRI showed 46 metastases on 11 patients. Specificity, negative and positive predictive values were calculated (98.9-100 %, 93.6-94.6 %, 75-100 %, respectively, for all CT techniques). No significant difference could be demonstrated between the two CT reconstruction techniques. (orig.)

  2. Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases: Single-Center Prospective Analysis

    International Nuclear Information System (INIS)

    Ludwig, Johannes M.; Ambinder, Emily McIntosh; Ghodadra, Anish; Xing, Minzhi; Prajapati, Hasmukh J.; Kim, Hyun S.

    2016-01-01

    ObjectiveTo investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival.MethodsA single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low ( 1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival.ConclusionsLSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.

  3. Preoperative scintigraphic detection of lung metastases of a follicular thyroid carcinoma associated with hyperthyroidism; Detection scintigraphique preoperatoire de metastases pulmonaires d'un carcinome vesiculaire de la thyroide associe a une hyperthyroidie

    Energy Technology Data Exchange (ETDEWEB)

    Biyi, A.; Oufroukhi, Y.; Doudouh, A. [Hopital Militaire d' Instruction Mohammed V, Rabat Instituts, Service de Medecine Nucleaire, Rabat (Morocco); Baizri, H.; El Quatni, M. [Hopital Militaire d' Instruction Mohammed V, Service d' Endocrinologie, Rabat (Morocco); Al Bouzidi, A. [Hopital Militaire d' Instruction Mohammed V, Service d' Anatomie Pathologique, Rabat (Morocco)

    2009-10-15

    Preoperative accumulation of radioiodine in metastases of thyroid carcinoma and its association with hyperthyroidism are uncommon. We report a case of 58-year-old woman with follicular thyroid carcinoma revealed by thyrotoxicosis caused by a hot nodule, and bilateral pulmonary uptake of I-131 before total thyroidectomy. Despite four ablative doses of I-131, bone metastases were identified and the patient died 42 month after the initial diagnosis. (authors)

  4. Prediction of Early Response to Chemotherapy in Lung Cancer by Using Diffusion-Weighted MR Imaging

    Directory of Open Access Journals (Sweden)

    Jing Yu

    2014-01-01

    Full Text Available Purpose. To determine whether change of apparent diffusion coefficient (ADC value could predict early response to chemotherapy in lung cancer. Materials and Methods. Twenty-five patients with advanced non-small cell lung cancer underwent chest MR imaging including DWI before and at the end of the first cycle of chemotherapy. The tumor’s mean ADC value and diameters on MR images were calculated and compared. The grouping reference was based on serial CT scans according to Response Evaluation Criteria in Solid Tumors. Logistic regression was applied to assess treatment response prediction ability of ADC value and diameters. Results. The change of ADC value in partial response group was higher than that in stable disease group (P=0.004. ROC curve showed that ADC value could predict treatment response with 100% sensitivity, 64.71% specificity, 57.14% positive predictive value, 100% negative predictive value, and 82.7% accuracy. The area under the curve for combination of ADC value and longest diameter change was higher than any parameter alone (P≤0.01. Conclusions. The change of ADC value may be a sensitive indicator to predict early response to chemotherapy in lung cancer. Prediction ability could be improved by combining the change of ADC value and longest diameter.

  5. A radiomics model from joint FDG-PET and MRI texture features for the prediction of lung metastases in soft-tissue sarcomas of the extremities

    International Nuclear Information System (INIS)

    Vallières, M; El Naqa, I; Freeman, C R; Skamene, S R

    2015-01-01

    This study aims at developing a joint FDG-PET and MRI texture-based model for the early evaluation of lung metastasis risk in soft-tissue sarcomas (STSs). We investigate if the creation of new composite textures from the combination of FDG-PET and MR imaging information could better identify aggressive tumours. Towards this goal, a cohort of 51 patients with histologically proven STSs of the extremities was retrospectively evaluated. All patients had pre-treatment FDG-PET and MRI scans comprised of T1-weighted and T2-weighted fat-suppression sequences (T2FS). Nine non-texture features (SUV metrics and shape features) and forty-one texture features were extracted from the tumour region of separate (FDG-PET, T1 and T2FS) and fused (FDG-PET/T1 and FDG-PET/T2FS) scans. Volume fusion of the FDG-PET and MRI scans was implemented using the wavelet transform. The influence of six different extraction parameters on the predictive value of textures was investigated. The incorporation of features into multivariable models was performed using logistic regression. The multivariable modeling strategy involved imbalance-adjusted bootstrap resampling in the following four steps leading to final prediction model construction: (1) feature set reduction; (2) feature selection; (3) prediction performance estimation; and (4) computation of model coefficients. Univariate analysis showed that the isotropic voxel size at which texture features were extracted had the most impact on predictive value. In multivariable analysis, texture features extracted from fused scans significantly outperformed those from separate scans in terms of lung metastases prediction estimates. The best performance was obtained using a combination of four texture features extracted from FDG-PET/T1 and FDG-PET/T2FS scans. This model reached an area under the receiver-operating characteristic curve of 0.984 ± 0.002, a sensitivity of 0.955 ± 0.006, and a specificity of 0.926 ± 0.004 in bootstrapping

  6. Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor–Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Magnuson, William J., E-mail: william.magnuson@yale.edu [Department of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Yeung, Jacky T. [Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut (United States); Guillod, Paul D. [Yale School of Medicine, New Haven, Connecticut (United States); Gettinger, Scott N. [Department of Medical Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B. [Department of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Chiang, Veronica L. [Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut (United States)

    2016-06-01

    Purpose: To perform a retrospective analysis of patients with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma who developed brain metastases (BM) to evaluate our hypothesis that the use of upfront EGFR–tyrosine kinase inhibitors (TKIs), and deferral of radiation therapy (RT), would result in inferior intracranial progression-free survival but similar overall survival (OS). Methods and Materials: Of 202 patients diagnosed with EGFR-mutant NSCLC between July 1, 2008, and December 31, 2014, 71 developed BM. Twenty-one patients were excluded owing to prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after whole-brain radiation therapy (WBRT)/stereotactic radiosurgery (SRS) or <6 months' follow-up. Of the remaining 50 patients, 17 received upfront EGFR-TKI followed by SRS or WBRT, 17 WBRT then EGFR-TKI, and 16 SRS followed by EGFR-TKI. Disease-specific-graded prognostic assessment was similar among all 3 groups. Results: The median OS was longer in the upfront RT group compared with the upfront EGFR-TKI group (34.1 vs 19.4 months; P=.01). On subgroup analysis, the SRS group had longer OS than the upfront EGFR-TKI group (58.4 vs 19.4 months; P=.01), but the WBRT group did not (29.9 vs 19.4 months; P=.09). Intracranial progression-free survival was improved in patients receiving upfront RT compared with those receiving upfront EGFR-TKI (37.9 vs 10.6 months; P<.001). Conclusions: The present study suggests that the use of upfront EGFR-TKI, and the deferral of SRS or WBRT, may result in inferior OS in patients with EGFR-mutant NSCLC who develop brain metastases. A prospective, multi-institutional, randomized trial of upfront EGFR-TKI with RT at intracranial progression versus upfront RT followed by EGFR-TKI is urgently needed.

  7. Metabolic Profiles of Brain Metastases

    Directory of Open Access Journals (Sweden)

    Tone F. Bathen

    2013-01-01

    Full Text Available Metastasis to the brain is a feared complication of systemic cancer, associated with significant morbidity and poor prognosis. A better understanding of the tumor metabolism might help us meet the challenges in controlling brain metastases. The study aims to characterize the metabolic profile of brain metastases of different origin using high resolution magic angle spinning (HR-MAS magnetic resonance spectroscopy (MRS to correlate the metabolic profiles to clinical and pathological information. Biopsy samples of human brain metastases (n = 49 were investigated. A significant correlation between lipid signals and necrosis in brain metastases was observed (p < 0.01, irrespective of their primary origin. The principal component analysis (PCA showed that brain metastases from malignant melanomas cluster together, while lung carcinomas were metabolically heterogeneous and overlap with other subtypes. Metastatic melanomas have higher amounts of glycerophosphocholine than other brain metastases. A significant correlation between microscopically visible lipid droplets estimated by Nile Red staining and MR visible lipid signals was observed in metastatic lung carcinomas (p = 0.01, indicating that the proton MR visible lipid signals arise from cytoplasmic lipid droplets. MRS-based metabolomic profiling is a useful tool for exploring the metabolic profiles of metastatic brain tumors.

  8. In vivo characterization of colorectal metastases in human liver using diffuse reflectance spectroscopy: toward guidance in oncological procedures

    Science.gov (United States)

    Spliethoff, Jarich W.; de Boer, Lisanne L.; Meier, Mark A. J.; Prevoo, Warner; de Jong, Jeroen; Kuhlmann, Koert; Bydlon, Torre M.; Sterenborg, Henricus J. C. M.; Hendriks, Benno H. W.; Ruers, Theo J. M.

    2016-09-01

    There is a strong need to develop clinical instruments that can perform rapid tissue assessment at the tip of smart clinical instruments for a variety of oncological applications. This study presents the first in vivo real-time tissue characterization during 24 liver biopsy procedures using diffuse reflectance (DR) spectroscopy at the tip of a core biopsy needle with integrated optical fibers. DR measurements were performed along each needle path, followed by biopsy of the target lesion using the same needle. Interventional imaging was coregistered with the DR spectra. Pathology results were compared with the DR spectroscopy data at the final measurement position. Bile was the primary discriminator between normal liver tissue and tumor tissue. Relative differences in bile content matched with the tissue diagnosis based on histopathological analysis in all 24 clinical cases. Continuous DR measurements during needle insertion in three patients showed that the method can also be applied for biopsy guidance or tumor recognition during surgery. This study provides an important validation step for DR spectroscopy-based tissue characterization in the liver. Given the feasibility of the outlined approach, it is also conceivable to make integrated fiber-optic tools for other clinical procedures that rely on accurate instrument positioning.

  9. Diffusion weighted imaging of liver lesions suspect for metastases: Apparent diffusion coefficient (ADC) values and lesion contrast are independent from Gd-EOB-DTPA administration

    International Nuclear Information System (INIS)

    Benndorf, Matthias; Schelhorn, Juliane; Dietzel, Matthias; Kaiser, Werner A.; Baltzer, Pascal A.T.

    2012-01-01

    Purpose: Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver MRI is widely used for detection and differentiation of focal liver lesions. Diffusion weighted imaging (DWI) including apparent diffusion coefficient (ADC) measurements is increasingly utilised as a fast and, with limitations, quantitative method for liver lesion detection and characterisation. Herein we investigate whether the administration of Gd-EOB-DTPA affects DWI. Materials and methods: 31 consecutive patients referred to standardised liver MRI (1.5 T, Gd-EOB-DTPA, 0.025 mmol/kg) were retrospectively reviewed. All underwent a breathhold DWI sequence before and after contrast agent administration (EPI-DWI, TR/TE (effective): 2100/62 ms, b-values: 0 and 800 s/mm 2 ). Patients with previously treated liver lesions were excluded. Signal intensity of lesion, parenchyma and noise on DWI images as well as the ADC value were measured after identification by two observers in consensus using manually placed regions of interest. The reference standard was imaging follow-up determined separately by two radiologists. Data analysis included signal-to-noise (SNR) ratio and contrast-to-noise ratio (CNR) calculations, comparisons were drawn by employing multiple Bonferroni corrected Wilcoxon signed-rank tests. Results: 50 malignant and 39 benign lesions were identified. Neither SNR, CNR nor ADC values showed significant differences between pre- and postcontrast DWI. Both pre- and postcontrast ADC values differed significantly between benign and malignant lesions (P < 0.001). Conclusion: We did not identify a significant influence of Gd-EOB-DTPA on DWI of liver lesions. This allows for individual tailoring of imaging protocols according to clinical needs.

  10. Diffusion Lung Capacity Changes in Hodgkin Lymphoma Patients Before and After ABVD Chemotherapy

    International Nuclear Information System (INIS)

    Abdullah, M.; Alam, S.; Majid, A.; Zafar, W.

    2016-01-01

    Background: Chemotherapy consisting of Adriamycin, Bleomycin, Vinblastine, and Doxorubicin (ABVD), which is the mainstay of treatment in Hodgkins Lymphoma (HL), is associated with both acute and long-term pulmonary toxicity primarily due to Bleomycin. Bleomycin induced pulmonary toxicity (BPT) is clinically detected using diffusing lung capacity for carbon monoxide (DLCO). The objective of this study was to evaluate changes in DLCO in HL patients before and after ABVD chemotherapy. Methods: Medical records of all adult HL patients treated with ABVD chemotherapy at a single centre in Lahore, Pakistan during the entire calendar year 2012 were analysed. Patients with pre-existing pulmonary dysfunction, history of thoracic surgery and smokers were excluded. Results: A total of 179 HL patients were identified during the study period who received ABVD chemotherapy. Out of these, 93 (51.95 percent) patients had undergone both a pre- and post-chemotherapy DLCO measurements. The remaining patients had only one DLCO reading available and were not included in the analysis. The mean percentage difference between pre- and post-chemotherapy values for DLCO (5.49 percent; 95 percent confidence interval [CI] 1.56-9.43 percent) and for Haemoglobin-adjusted DLCO (8.24 percent; 95 percent CI 3.90-12.57 percent) were statistically significant at p<0.01. Diffusing lung capacity for carbon (DLCO) values declined from pre-treatment to post-treatment by 1-10 percent in 23 (24.7 percent) patients, by 10-20 percent in 19 (20.4 percent) patients, by 20-30 percent in 10 (10.8 percent) patients and >30 percent in 10 (10.8 percent) patients. After adjusting for age, a 1mg/m/sup 2/ increase in dose of Bleomycin was significantly associated with 0.14 percent (95 percent CI: 0.03-0.25 percent) decline in DLCO and 0.13 percent (95 percent CI: 0.10-0.26 percent) decline in haemoglobin-adjusted DLCO from pre-treatment value. Conclusions: Mild to moderate dysfunction in diffusion lung capacity is

  11. Apparent diffusion coefficient values of diffusion-weighted imaging for distinguishing focal pulmonary lesions and characterizing the subtype of lung cancer: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Guohua; Jia, Zhiyun; Deng, Houfu [Sichuan University, Department of Nuclear Medicine, West China Hospital, Chengdu, Sichuan (China)

    2016-02-15

    The potential performance of apparent diffusion coefficient (ADC) values for distinguishing malignant and benign pulmonary lesions, further characterizing the subtype of lung cancer was assessed. PubMed, EMBASE, Cochrane Library, EBSCO, and three Chinese databases were searched to identify eligible studies on diffusion-weighted imaging (DWI) of focal pulmonary lesions. ADC values of malignant and benign lesions were extracted by lesion type and statistically pooled based on a linear mixed model. Further analysis for subtype of lung cancer was also performed. The methodological quality was assessed using the quality assessment of diagnostic accuracy studies tool. Thirty-four articles involving 2086 patients were included. Malignant pulmonary lesions have significantly lower ADC values than benign lesions [1.21 (95 % CI, 1.19-1.22) mm{sup 2}/s vs. 1.76 (95 % CI, 1.72-1.80) mm{sup 2}/s; P < 0.05]. There is a significant difference between ADC values of small cell lung cancer and non-small cell lung cancer (P < 0.05), while the differences were not significant among histological subtypes of lung cancer. The methodological quality was relatively high, and the data points from Begg's test indicated that there was probably no obvious publication bias. The ADC value is helpful for distinguishing malignant and benign pulmonary lesions and provides a promising method for differentiation of SCLC from NSCLC. (orig.)

  12. Radiotherapy of choroidal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Hoogenhout, J; Gasteren, J J.M. van; Brink, H M.A.; Verbeek, A M; Beex, L V.A.M.

    1989-05-01

    With binocular indirect ophthalmoscopy, fluorescin angiography and ultrasonography 68 choroidal metastases in 52 eyes of 39 patients were diagnosed. The primary tumors were mainly breast cancer (81%) and lung cancer (10%). After radiation treatment the visual acuity improved in 17 eyes (38%), stabilized in 15 eyes (33%), whereas in 13 eyes (29%) deterioration could not be prevented (seven eyes unknown). Regression of the lesions or its accompanying secondary retinal detachment was seen in 78% of the eyes treated. Acute transient side effects of radiation therapy were keratoconjunctivitis (nine patients) and acute glaucoma in one patient. No cataractous changes of the lens were observed in the post radiation period (one to 42 months). Irradiation of choroidal metastases can contribute to improvement of the quality of life with a treatment scheme of 30 Gy in ten daily fractions.

  13. Stereotactic Radiosurgery in the Management of Patients With Brain Metastases of Non-Small Cell Lung Cancer: Indications, Decision Tools and Future Directions

    Directory of Open Access Journals (Sweden)

    Dianne Hartgerink

    2018-05-01

    Full Text Available Brain metastases (BM frequently occur in non-small cell lung cancer (NSCLC patients. Most patients with BM have a limited life expectancy, measured in months. Selected patients may experience a very long progression-free survival, for example, patients with a targetable driver mutation. Traditionally, whole-brain radiotherapy (WBRT has been the cornerstone of the treatment, but its indication is a matter of debate. A randomized trial has shown that for patients with a poor prognosis, WBRT does not add quality of life (QoL nor survival over the best supportive care. In recent decades, stereotactic radiosurgery (SRS has become an attractive non-invasive treatment for patients with BM. Only the BM is irradiated to an ablative dose, sparing healthy brain tissue. Intracranial recurrence rates decrease when WBRT is administered following SRS or resection but does not improve overall survival and comes at the expense of neurocognitive function and QoL. The downside of SRS compared with WBRT is a risk of radionecrosis (RN and a higher risk of developing new BM during follow-up. Currently, SRS is an established treatment for patients with a maximum of four BM. Several promising strategies are currently being investigated to further improve the indication and outcome of SRS for patients with BM: the effectivity and safety of SRS in patients with more than four BM, combining SRS with systemic therapy such as targeted agents or immunotherapy, shared decision-making with SRS as a treatment option, and individualized isotoxic dose prescription to mitigate the risk of RN and further enhance local control probability of SRS. This review discusses the current indications of SRS and future directions of treatment for patients with BM of NSCLC with focus on the value of SRS.

  14. Systematic Review of Brain Metastases in Patients With Non-Small-Cell Lung Cancer in the United States, European Union, and Japan.

    Science.gov (United States)

    Fenske, D Christian; Price, Gregory L; Hess, Lisa M; John, William J; Kim, Edward S

    2017-11-01

    Brain metastases (BRM) occur frequently in non-small-cell lung cancer (NSCLC) and present a substantial unmet medical need. Previous literature on global BRM prevalence, treatment patterns, costs, and outcomes typically has described a subset of these factors. The primary objective of this systematic literature review was to summarize BRM-related epidemiology, treatment patterns, costs, and survival of patients with NSCLC in the United States, European Union, and Japan. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Literature searches were conducted in PubMed, Ovid MedLine, and Embase to identify studies published between 2003 and 2014. Peer-reviewed, English language, and human observational studies of patients with NSCLC and BRM were identified. Demographic characteristics, treatment patterns, histology subtype, costs, and survival data were extracted into Microsoft Excel and descriptively analyzed using SAS version 9.2 (SAS Institute, Inc). Of 8257 studies, 243 were eligible. Data from 46,422 patients with NSCLC and 27,907 patients with BRM were summarized. Radiation therapy was used by 70.7% (n = 19,736) of the total BRM population, followed by systemic therapy (8.9%, n = 2497), and surgery (6.1%, n = 1690). Reported median survival was 9.78 months ranging from 2.5 to 38 months. Radiation therapy had the best outcome at 10.0 months with 41.6% (n = 101) of the studies reporting the use of stereotactic radiosurgery. Highly variable median survival and treatment patterns were reported between countries. Costs and histology subtype data were not reported for most countries, highlighting the need for additional research to describe the economic burden of BRM and improve the diagnosis, prognosis, and prescription of effective therapies. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Combining Whole-Brain Radiotherapy with Gefitinib/Erlotinib for Brain Metastases from Non-Small-Cell Lung Cancer: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Mao-hua Zheng

    2016-01-01

    Full Text Available Background. To comprehensively assess the efficacy and safety of whole-brain radiotherapy (WBRT combined with gefitinib/erlotinib for treatment of brain metastases (BM from non-small-cell lung cancer (NSCLC. Methods. Databases including PubMed, EMBASE.com, Web of Science, and Cochrane Library were searched from inception to April 12, 2015. Studies on randomized controlled trials (RCTs and case-control trials comparing WBRT combined with gefitinib/erlotinib versus WBRT alone for BM from NSCLC were included. Literature selection, data extraction, and quality assessment were performed independently by two trained reviewers. RevMan 5.3 software was used to analyze data. Results. A total of 7 trials involving 622 patients were included. Compared with WBRT alone or WBRT plus chemotherapy, WBRT plus gefitinib/erlotinib could significantly improve response rate (OR = 2.16, 95% CI: 1.35–3.47; P=0.001, remission rate of central nervous system (OR = 6.06, 95% CI: 2.57–14.29; P<0.0001, disease control rate (OR = 3.34, 95% CI: 1.84–6.07; P<0.0001, overall survival (HR = 0.72, 95% CI: 0.58–0.89; P=0.002, and 1-year survival rate (OR = 2.43, 95% CI: 1.51–3.91; P=0.0002. In adverse events (III-IV, statistically significant differences were not found, except for rash (OR = 7.96, 95% CI: 2.02–31.34; P=0.003 and myelosuppression (OR = 0.19, 95% CI: 0.07–0.51; P=0.0010. Conclusions. WBRT plus gefitinib/erlotinib was superior to WBRT alone and well tolerated in patients with BM from NSCLC.

  16. Development and validation of a prediction model for measurement variability of lung nodule volumetry in patients with pulmonary metastases.

    Science.gov (United States)

    Hwang, Eui Jin; Goo, Jin Mo; Kim, Jihye; Park, Sang Joon; Ahn, Soyeon; Park, Chang Min; Shin, Yeong-Gil

    2017-08-01

    To develop a prediction model for the variability range of lung nodule volumetry and validate the model in detecting nodule growth. For model development, 50 patients with metastatic nodules were prospectively included. Two consecutive CT scans were performed to assess volumetry for 1,586 nodules. Nodule volume, surface voxel proportion (SVP), attachment proportion (AP) and absolute percentage error (APE) were calculated for each nodule and quantile regression analyses were performed to model the 95% percentile of APE. For validation, 41 patients who underwent metastasectomy were included. After volumetry of resected nodules, sensitivity and specificity for diagnosis of metastatic nodules were compared between two different thresholds of nodule growth determination: uniform 25% volume change threshold and individualized threshold calculated from the model (estimated 95% percentile APE). SVP and AP were included in the final model: Estimated 95% percentile APE = 37.82 · SVP + 48.60 · AP-10.87. In the validation session, the individualized threshold showed significantly higher sensitivity for diagnosis of metastatic nodules than the uniform 25% threshold (75.0% vs. 66.0%, P = 0.004) CONCLUSION: Estimated 95% percentile APE as an individualized threshold of nodule growth showed greater sensitivity in diagnosing metastatic nodules than a global 25% threshold. • The 95 % percentile APE of a particular nodule can be predicted. • Estimated 95 % percentile APE can be utilized as an individualized threshold. • More sensitive diagnosis of metastasis can be made with an individualized threshold. • Tailored nodule management can be provided during nodule growth follow-up.

  17. Non-small-cell lung cancer: detection of mediastinal lymph node metastases by endoscopic ultrasound and CT

    International Nuclear Information System (INIS)

    Potepan, P.; Meroni, E.; Spagnoli, I.; Milella, M.; Danesini, G.M.; Laffranchi, A.; Civelli, E.; Alloisio, M.; Mariani, L.; Spinelli, P.; Guzzon, A.

    1996-01-01

    In this prospective study endoscopic ultrasound (EUS) and computed tomography (CT) were evaluated to compare diagnostic accuracy of the two methods. They were performed for nodal staging in selected patients admitted to our institution for non-small-cell lung cancer (NSCLC). From February 1992 to July 1993, 45 patients were recruited for the study when N3 and N2 nodal involvement were excluded on standard chest X-ray. All the patients completed EUS and CT exams for staging before treatment. The results of sensitivity, specificity and accuracy were obtained in 30 patients who underwent surgical treatment with macroscopically radical resection of T and N, which allowed a complete surgical and histological comparison of CT and EUS findings. On a per-patient basis CT results were: Sensitivity 63.6%, specificity 78.9% and accuracy of 73.3%; on a nodal station basis sensitivity, specificity and accuracy were 70.0%, 85,1% and 81.6%, respectively. The EUS evaluation showed, on a per-patient basis, values of sensitivity 45.5%, specificity 57.9% and overall diagnostic accuracy of 53.3%. On a nodal station basis the results were 50.0%, 86.6% and 78.2%, respectively. The results obtained in the 30 patients when both techniques were taken in association regarding senstivity (90.9%), specificity (73.7%) and accuracy (80.0%) on a per-patient basis suggest that the association of EUS and CT offers the best approach for preoperative staging of NSCLC. (orig.)

  18. Diffusion-weighted (DW) MRI in lung cancers. ADC test-retest repeatability

    Energy Technology Data Exchange (ETDEWEB)

    Weller, Alex; Papoutsaki, Marianthi Vasiliki; Blackledge, Matthew; DeSouza, Nandita M. [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, CRUK Cancer Imaging Centre, Surrey (United Kingdom); Waterton, John C. [University of Manchester, Manchester (United Kingdom); Chiti, Arturo [Humanitas University, Milan (Italy); Stroobants, Sigrid [Universiteit Antwerpen, Antwerpen (Belgium); Kuijer, Joost [Vrije Universiteit Medisch Centrum, Amsterdam (Netherlands); Morgan, Veronica [Royal Marsden NHS Foundation Trust, Department of Medicine, London (United Kingdom)

    2017-11-15

    To determine the test-retest repeatability of Apparent Diffusion Coefficient (ADC) measurements across institutions and MRI vendors, plus investigate the effect of post-processing methodology on measurement precision. Thirty malignant lung lesions >2 cm in size (23 patients) were scanned on two occasions, using echo-planar-Diffusion-Weighted (DW)-MRI to derive whole-tumour ADC (b = 100, 500 and 800 s/mm{sup -2}). Scanning was performed at 4 institutions (3 MRI vendors). Whole-tumour volumes-of-interest were copied from first visit onto second visit images and from one post-processing platform to an open-source platform, to assess ADC repeatability and cross-platform reproducibility. Whole-tumour ADC values ranged from 0.66-1.94x10{sup -3} mm{sup 2}s{sup -1} (mean = 1.14). Within-patient coefficient-of-variation (wCV) was 7.1% (95% CI 5.7-9.6%), limits-of-agreement (LoA) -18.0 to 21.9%. Lesions >3 cm had improved repeatability: wCV 3.9% (95% CI 2.9-5.9%); and LoA -10.2 to 11.4%. Variability for lesions <3 cm was 2.46 times higher. ADC reproducibility across different post-processing platforms was excellent: Pearson's R{sup 2} = 0.99; CoV 2.8% (95% CI 2.3-3.4%); and LoA -7.4 to 8.0%. A free-breathing DW-MRI protocol for imaging malignant lung tumours achieved satisfactory within-patient repeatability and was robust to changes in post-processing software, justifying its use in multi-centre trials. For response evaluation in individual patients, a change in ADC >21.9% will reflect treatment-related change. (orig.)

  19. Opacity annotation of diffuse lung diseases using deep convolutional neural network with multi-channel information

    Science.gov (United States)

    Mabu, Shingo; Kido, Shoji; Hashimoto, Noriaki; Hirano, Yasushi; Kuremoto, Takashi

    2018-02-01

    This research proposes a multi-channel deep convolutional neural network (DCNN) for computer-aided diagnosis (CAD) that classifies normal and abnormal opacities of diffuse lung diseases in Computed Tomography (CT) images. Because CT images are gray scale, DCNN usually uses one channel for inputting image data. On the other hand, this research uses multi-channel DCNN where each channel corresponds to the original raw image or the images transformed by some preprocessing techniques. In fact, the information obtained only from raw images is limited and some conventional research suggested that preprocessing of images contributes to improving the classification accuracy. Thus, the combination of the original and preprocessed images is expected to show higher accuracy. The proposed method realizes region of interest (ROI)-based opacity annotation. We used lung CT images taken in Yamaguchi University Hospital, Japan, and they are divided into 32 × 32 ROI images. The ROIs contain six kinds of opacities: consolidation, ground-glass opacity (GGO), emphysema, honeycombing, nodular, and normal. The aim of the proposed method is to classify each ROI into one of the six opacities (classes). The DCNN structure is based on VGG network that secured the first and second places in ImageNet ILSVRC-2014. From the experimental results, the classification accuracy of the proposed method was better than the conventional method with single channel, and there was a significant difference between them.

  20. Real-time in vivo tissue characterization with diffuse reflectance spectroscopy during transthoracic lung biopsy: a clinical feasibility study

    NARCIS (Netherlands)

    Spliethoff, Jarich; Prevoo, Warner; Meier, Mark A.J.; de Jong, Jeroen; Evers, Daniel; Evers, Daniel J.; Sterenborg, Hendricus J.C.M.; Lucassen, Gerald; Lucassen, Gerald W.; Hendriks, Benno H.W.; Ruers, Theo J.M.

    2016-01-01

    Purpose: This study presents the first in vivo real-time tissue characterization during image-guided percutaneous lung biopsies using diffuse reflectance spectroscopy (DRS) sensing at the tip of a biopsy needle with integrated optical fibers. Experimental Design: Tissues from 21 consented patients

  1. Cardiac metastases

    NARCIS (Netherlands)

    A. Al-Mamgani (Abrahim); L. Baartman (Lizette); M. Baaijens (Margreet); I. de Pree (Ilse); L. Incrocci (Luca); P.C. Levendag (Peter)

    2008-01-01

    textabstractWe report a case of esophageal cancer with symptomatic metastases to the heart; the patient was treated with short-course radiotherapy with good symptomatic relief. We reviewed the current literature regarding the epidemiology, clinical presentation, diagnostic tools, treatment

  2. Imaging of renal metastases

    International Nuclear Information System (INIS)

    Bruneton, J.N.; Normand, F.; Balu-Maestro, C.; Rogopoulos, A.; Drouillard, J.; Laurent, F.

    1988-01-01

    Metastases are the most frequent malignant tumors of the kidney, but these lesions are of late onset in neoplastic disease. The 19 cases reported here were all investigated with various imaging techniques (CT 12 cases, ultrasonography 12 cases, urography 8 cases, angiography 2 cases, MRI 1 case). The most common primary malignancies were lung cancer, melanoma and cancer of the controlateral kidney. In this series, 8 of the lesions were solitary, and 9 were unilateral. Tumor vascularity was evaluated in 15 cases: 14 of these lesions were hypovascular. The differential diagnosis includes small cysts, lymphoma, bilateral renal cancer, multiple small abscesses and multiple small infarcts [fr

  3. Treating Melanoma Metastases with a Novel Photodynamic Approach

    Science.gov (United States)

    2017-09-01

    AWARD NUMBER: W81XWH-15-1-0270 TITLE: Treating Melanoma Metastases with a Novel Photodynamic Approach PRINCIPAL INVESTIGATOR: Jin Xie...Metastases with a Novel Photodynamic Approach 5a. CONTRACT NUMBER Treating Melanoma Metastases with a Novel Photodynamic Approach 5b. GRANT NUMBER...ligand and after systemic injection, home to tumors in the lung. X-ray of relatively low doses can then be applied externally to the lung area to

  4. Motexafin Gadolinium Combined With Prompt Whole Brain Radiotherapy Prolongs Time to Neurologic Progression in Non-Small-Cell Lung Cancer Patients With Brain Metastases: Results of a Phase III Trial

    International Nuclear Information System (INIS)

    Mehta, Minesh P.; Shapiro, William R.; Phan, See C.; Gervais, Radj; Carrie, Christian; Chabot, Pierre; Patchell, Roy A.; Glantz, Michael J.; Recht, Lawrence; Langer, Corey; Sur, Ranjan K.; Roa, Wilson H.; Mahe, Marc A.; Fortin, Andre; Nieder, Carsten; Meyers, Christina A.; Smith, Jennifer A.; Miller, Richard A.; Renschler, Markus F.

    2009-01-01

    Purpose: To determine the efficacy of motexafin gadolinium (MGd) in combination with whole brain radiotherapy (WBRT) for the treatment of brain metastases from non-small-cell lung cancer. Methods and Materials: In an international, randomized, Phase III study, patients with brain metastases from non-small-cell lung cancer were randomized to WBRT with or without MGd. The primary endpoint was the interval to neurologic progression, determined by a centralized Events Review Committee who was unaware of the treatment the patients had received. Results: Of 554 patients, 275 were randomized to WBRT and 279 to WBRT+MGd. Treatment with MGd was well tolerated, and 92% of the intended doses were administered. The most common MGd-related Grade 3+ adverse events included liver function abnormalities (5.5%), asthenia (4.0%), and hypertension (4%). MGd improved the interval to neurologic progression compared with WBRT alone (15 vs. 10 months; p = 0.12, hazard ratio [HR] = 0.78) and the interval to neurocognitive progression (p = 0.057, HR = 0.78). The WBRT patients required more salvage brain surgery or radiosurgery than did the WBRT+MGd patients (54 vs. 25 salvage procedures, p < 0.001). A statistically significant interaction between the geographic region and MGd treatment effect (which was in the prespecified analysis plan) and between treatment delay and MGd treatment effect was found. In North American patients, where treatment was more prompt, a statistically significant prolongation of the interval to neurologic progression, from 8.8 months for WBRT to 24.2 months for WBRT+MGd (p = 0.004, HR = 0.53), and the interval to neurocognitive progression (p = 0.06, HR = 0.73) were observed. Conclusion: In the intent-to-treat analysis, MGd exhibited a favorable trend in neurologic outcomes. MGd significantly prolonged the interval to neurologic progression in non-small-cell lung cancer patients with brain metastases receiving prompt WBRT. The toxicity was acceptable

  5. Diffusing capacity for lung carbon monoxide (dlco) in chemical lung injuries due to the use of mustard gas in the poisoned soldiers of Iran-Iraq war 2006

    International Nuclear Information System (INIS)

    Rouhi, H.; Ganji, F.

    2010-01-01

    To assess the Mustard gas exposure effects on pulmonary system, particularly on diffusing capacity for lung carbon monoxide (DLCO) and simple spirometry. Sixty-five sulfur mustard- poisoned soldiers from Mostazafan and Janbazan organization were referred to our center in 2005. Complete history, physical examination, chest X ray, Echocardiography, Arterial blood gas, high - resolution computerized tomography, diffusion capacity for lung carbon monoxide and spirometry of these were performed and compared this result with normal value. The mean value of indices in studied injured subjects was: Spirometry: forced expiratory volume in one second (FEV1) = 70.4, Forced vital capacity (FVC) = 66.5, EFE 25-75=81.1, FEV1/FVC=101.9, Flow 25% = 28.7, Flow 50%= 72.9, Flow 75%= 100.1, Sample volume: Functional residual capacity of lungs (FRC) = 131.5, residual volume (RV) = 157.3, RV/TLC= 169.1, Total lung capacity (TLC) = 91.3, KCO= 131.6, TLCO= 116.3. No significant correlation was observed between TLCO values with HRCT, echocardiography, ABG and spirometry values (P>0.05). We recommend TLCO and RV/TLV tests to assess severity of Injuries as there is no a suitable criterion to measure the real consequences of mustard gas on affected combatants. and Biological markers are also needed to determine cause effect relations. (author)

  6. Hemorrhagic brain metastases

    International Nuclear Information System (INIS)

    Takahashi, Motoichiro; Takekawa, S.D.; Suzuki, Kenzo

    1986-01-01

    Tumor hemorrhage on computed tomography (CT) was found in 14 patients with brain metastases (7 % of two hundred patients with brain metastases), from April 1979 to July 1983. Primary foci of these lesions were the lung (6 patients), breast (2), kidney (2), uterus (2), colon (1) and adrenal gland (1). ''Stroke'' syndrome was the initial presenting symptom in 3 patients; neurological focal sign or symptoms of increased intracranial pressure in the remaining patients. CT demonstrated peritumoral hemorrhage in all patients with solid mass, intratumoral hemorrhage in a few patients and also cerebral or ventricular hemorrhage, which was fatal complication, in 2 patients (colon and breast cancers). A cystic mass with fluid-blood level was noted in a patient with breast cancer. Several predisposing factors including chemotherapy, thrombocytopenia, radiotherapy or combination of these were recognized in 8 patients. Of these, chemotherapy was the most causative factor of tumor hemorrhage. Brain irradiation for hemorrhagic brain metastases was effective for prolongation of mean survival time of these patients as follows; 10 months in irradiated group, whereas 1.5 months in non-irradiated group. (author)

  7. 99mTc-MDP bone scanning of patients with diffuse metastatic carcinoma of the axial skeleton

    International Nuclear Information System (INIS)

    Morita, Seiichiro; Ishibashi, Masatoshi; Takahashi, Kazuyuki; Funatsu, Kazuhiro; Yoshii, Toshiaki; Shirabe, Ichiju; Nomura, Yasushi; Ohtake, Hisashi

    1990-01-01

    Fifteen bone scintigrams in patients with diffuse bone metastases were reviewed because of the diffuse radionuclide accumulation in the axial skeleton. Diagnoses were gastric cancer in 6 patients, prostatic cancer in 5, breast cancer in 3, and renal pelvic tumor in one. In 5 patients with gastric cancer, one with prostatic cancer, and one with renal pelvic tumor, initial bone scintigraphy showed diffuse accumulation. In one gastric cancer patient and two breast cancer patients, the multiple bone metastases had altered the diffuse bone metastasis. All patients had no lung or liver metastasis morphologically at the course of diagnosed diffuse bone metastasis. Overall, the diffuse bone metastases were classified into two groups: diffuse symmetrical accumulation in proportion to bone marrow demonstrated in the gastric cancer, and diffuse accumulation centering the axial skeleton with asymmetrical accumulation in the rib and extremities demonstrated in cancer of the prostate. The finding of X ray films were consistent to common bone metastases in proportion to the primary tumor. Diffuse bone metastases did not show the characteristic finding. During the period from the diagnosed time to the death of patients, the patients with gastric cancer died extremely earlier in comparison to the patients with breast cancer and with prostatic cancer. (author)

  8. Diffusion

    International Nuclear Information System (INIS)

    Kubaschewski, O.

    1983-01-01

    The diffusion rate values of titanium, its compounds and alloys are summarized and tabulated. The individual chemical diffusion coefficients and self-diffusion coefficients of certain isotopes are given. Experimental methods are listed which were used for the determination of diffusion coefficients. Some values have been taken over from other studies. Also given are graphs showing the temperature dependences of diffusion and changes in the diffusion coefficient with concentration changes

  9. Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases: Single-Center Prospective Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ludwig, Johannes M. [Yale University, Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (United States); Ambinder, Emily McIntosh [John Hopkins University School of Medicine, Department of Diagnostic Radiology (United States); Ghodadra, Anish [University of Pittsburgh School of Medicine, Interventional Radiology, Department of Radiology (United States); Xing, Minzhi [Yale University, Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (United States); Prajapati, Hasmukh J. [The University of Tennessee Health Science Center, Division of Interventional Radiology, Department of Radiology (United States); Kim, Hyun S., E-mail: kevin.kim@yale.edu [Yale University, Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (United States)

    2016-07-15

    ObjectiveTo investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival.MethodsA single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients’ baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher’s exact tests for categorical and Mann–Whitney U test for continuous variables. Survival was calculated using the Kaplan–Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed.ResultsThere was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73–55.23), with 4.77 months (95 %CI 2.87–26.73) for high and 42.77 months (95 %CI 18.47–59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival.ConclusionsLSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.

  10. FDG-PET/CT and diffusion-weighted imaging for resected lung cancer: correlation of maximum standardized uptake value and apparent diffusion coefficient value with prognostic factors.

    Science.gov (United States)

    Usuda, Katsuo; Funasaki, Aika; Sekimura, Atsushi; Motono, Nozomu; Matoba, Munetaka; Doai, Mariko; Yamada, Sohsuke; Ueda, Yoshimichi; Uramoto, Hidetaka

    2018-04-09

    Diffusion-weighted magnetic resonance imaging (DWI) is useful for detecting malignant tumors and the assessment of lymph nodes, as FDG-PET/CT is. But it is not clear how DWI influences the prognosis of lung cancer patients. The focus of this study is to evaluate the correlations between maximum standardized uptake value (SUVmax) of FDG-PET/CT and apparent diffusion coefficient (ADC) value of DWI with known prognostic factors in resected lung cancer. A total of 227 patients with resected lung cancers were enrolled in this study. FEG-PET/CT and DWI were performed in each patient before surgery. There were 168 patients with adenocarcinoma, 44 patients with squamous cell carcinoma, and 15 patients with other cell types. SUVmax was a factor that was correlated to T factor, N factor, or cell differentiation. ADC of lung cancer was a factor that was not correlated to T factor, or N factor. There was a significantly weak inverse relationship between SUVmax and ADC (Correlation coefficient r = - 0.227). In analysis of survival, there were significant differences between the categories of sex, age, pT factor, pN factor, cell differentiation, cell type, and SUVmax. Univariate analysis revealed that SUVmax, pN factor, age, cell differentiation, cell type, sex, and pT factor were significant factors. Multivariate analysis revealed that SUVmax and pN factor were independent significant prognostic factors. SUVmax was a significant prognostic factor that is correlated to T factor, N factor, or cell differentiation, but ADC was not. SUVmax may be more useful for predicting the prognosis of lung cancer than ADC values.

  11. Skeletal recurrences and metastases of extraskeletal myxoid chondrosarcoma

    International Nuclear Information System (INIS)

    Ehara, Shigeru; Nishida, Jun; Shiraishi, Hideo; Yoshioka, Hiroshi; Okada, Kyoji; Sumiya, Hisashi; Takano, Hideyuki

    2007-01-01

    The objective was to elucidate clinical and imaging features of skeletal involvement, recurrences, and metastases of extraskeletal myxoid chondrosarcoma. Included in this series are 4 patients, aged 44 to 65 years, 3 of whom were men and 1 a woman. The primary lesions were in the thigh (n 3) and the upper arm (n = 1). Three patients with multiple metastases died of the disease, 2 were considered to have local recurrence in the adjacent bone. Skeletal metastases occurred after lung metastases in 2 cases, and before lung metastases in 1 case. Typical imaging findings are well-defined lesions with no sclerotic margin or matrix mineralization. A slow, but persistent growth is noted on the imaging features. Although skeletal metastases of chondrosarcoma of bone and soft tissue are rare, myxoid chondrosarcomas, currently classified tumors of uncertain differentiation, rarely metastasize and/or recur in the bones. The imaging features are typically of a localized lesion with cortical disruption or expansion. (orig.)

  12. Skeletal recurrences and metastases of extraskeletal myxoid chondrosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Ehara, Shigeru [Iwate Medical University School of Medicine, Department of Radiology, Morioka (Japan); Nishida, Jun; Shiraishi, Hideo [Iwate Medical University School of Medicine, Department of Orthopedic Surgery, Iwate (Japan); Yoshioka, Hiroshi [University of Tsukuba School of Medicine, Department of Radiology, Tsukuba (Japan); Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Okada, Kyoji [Akita University School of Medicine, Department of Orthopedic Surgery, Akita (Japan); Sumiya, Hisashi [Kanazawa University School of Medicine, Department of Nuclear Medicine, Kanazawa (Japan); Yawata Medical Center, Komatsu (Japan); Takano, Hideyuki [Chiba Cancer Center, Division of Diagnostic Imaging, Chiba (Japan)

    2007-09-15

    The objective was to elucidate clinical and imaging features of skeletal involvement, recurrences, and metastases of extraskeletal myxoid chondrosarcoma. Included in this series are 4 patients, aged 44 to 65 years, 3 of whom were men and 1 a woman. The primary lesions were in the thigh (n = 3) and the upper arm (n = 1). Three patients with multiple metastases died of the disease, 2 were considered to have local recurrence in the adjacent bone. Skeletal metastases occurred after lung metastases in 2 cases, and before lung metastases in 1 case. Typical imaging findings are well-defined lesions with no sclerotic margin or matrix mineralization. A slow, but persistent growth is noted on the imaging features. Although skeletal metastases of chondrosarcoma of bone and soft tissue are rare, myxoid chondrosarcomas, currently classified tumors of uncertain differentiation, rarely metastasize and/or recur in the bones. The imaging features are typically of a localized lesion with cortical disruption or expansion. (orig.)

  13. Diffuse parenchymal lung disease in a case of chronic arsenic exposure

    Directory of Open Access Journals (Sweden)

    Somnath Bhattacharya

    2016-01-01

    Full Text Available A 42-year-old housewife, the resident of rural part of West Bengal, presented with gradually progressive exertional dyspnea associated with a dry cough for last 3 years clinical features were suggestive of diffuse parenchymal lung disease (DPLD. Her chest X-ray posteroanterior view and high resolution computed tomography scan of the thorax showed bilateral patchy ground glass opacities and reticulonodular pattern. Search for the etiology revealed classical skin findings of chronic arsenic exposure in the form of generalized darkening and thickening of skin and keratotic lesions over the palms and soles and classical raindrop pigmentation over leg which was present for last 7 years subsequently her bronchoalveolar lavage fluid, hair, nail, and drinking water showed significant amount of arsenic contamination. By exclusion of all known causes of DPLD, we concluded that it was a case of DPLD due to chronic arsenic exposure. To the best of our knowledge, only few case report of DPLD in chronic arsenicosis has been reported till date.

  14. Ground-glass opacity in diffuse lung diseases: high-resolution computed tomography-pathology correlation

    International Nuclear Information System (INIS)

    Santos, Maria Lucia de Oliveira; Vianna, Alberto Domingues; Marchiori, Edson; Souza Junior, Arthur Soares; Moraes, Heleno Pinto de

    2003-01-01

    Ground-glass opacity is a finding frequently seen in high-resolution computed tomography examinations of the chest and is characterized by hazy increased attenuation of lung, however without blurring of bronchial and vascular margins. Due to its un specificity, association with other radiological, clinical and pathological findings must be considered for an accurate diagnostic interpretation. In this paper were reviewed 62 computed tomography examinations of patients with diffuse pulmonary diseases of 14 different etiologies in which ground-glass opacity was the only or the most remarkable finding, and correlated this findings with pathology abnormalities seen on specimens obtained from biopsies or necropsies. In pneumocystosis, ground-glass opacities correlated histologically with alveolar occupation by a foaming material containing parasites, in bronchiole alveolar cell carcinoma with thickening of the alveolar septa and occupation of the lumen by mucus and tumoral cells, in paracoccidioidomycosis with thickening of the alveolar septa, areas of fibrosis and alveolar bronchopneumonia exudate, in sarcoidosis with fibrosis or clustering of granulomas and in idiopathic pulmonary fibrosis with alveolar septa thickening due to fibrosis. Alveolar occupation by blood was found in cases of leptospirosis, idiopathic hemo siderosis, metastatic kidney tumor and invasive aspergillosis whereas oily vacuole were seen in lipoid pneumonia, proteinaceous and lipo proteinaceous material in silico proteinosis and pulmonary alveolar proteinosis, and edematous fluid in cardiac failure. (author)

  15. Cryotherapy in Treating Patients With Lung Cancer That Has Spread to the Other Lung or Parts of the Body

    Science.gov (United States)

    2017-05-25

    Advanced Malignant Mesothelioma; Extensive Stage Small Cell Lung Cancer; Lung Metastases; Recurrent Malignant Mesothelioma; Recurrent Non-small Cell Lung Cancer; Recurrent Small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer

  16. [Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test].

    Science.gov (United States)

    Bokov, P; Delclaux, C

    2016-02-01

    Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  17. Palliative radiotherapy of bone metastases

    International Nuclear Information System (INIS)

    Koswig, S.; Buchali, A.; Boehmer, D.; Schlenger, L.; Budach, V.

    1999-01-01

    Background: The effect of the palliative irradiation of bone metastases was explored in this retrospective analysis. The spectrum of primary tumor sites, the localization of the bone metastases and the fractionation schedules were analyzed with regard to palliation discriminating total, partial and complete pain response. Patients and Methods: One hundred seventy-six patients are included in this retrospective quantitative study from April 1992 to November 1993. Two hundred fifty-eight localizations of painful bone metastases were irradiated. The percentage of bone metastases of the total irradiated localizations in our department of radiotherapy in the Carite-Hospital, the primary tumor sites, the localizations and the different fractionation schedules were explored. The total, partial and complete pain response was analyzed in the most often used fractionation schedules and by primary tumor sites. Results: Eight per cent of all irradiated localizations in the observation period were bone metastases. There were irradiated bone metastases of 21 different tumor sites. Most of the primary tumor sites were breast cancer (49%), lung cancer (6%) and kidney cancer (6%). The most frequent site of metastases was the vertebral column (52%). The most often used fractionation schedules were: 4x5 Gy (32%), 10x3 Gy (18%), 6x5 Gy (9%), 7x3 Gy (7%), 10x2 Gy (5%) and 2x8 Gy. The total response rates in this fractionation schedules were 72%, 79%, 74%, 76%, 75% and 72%, the complete response rates were 35%, 32%, 30%, 35%, 33% and 33%. There were no significant differences between the most often irradiated primary tumor sites, the most frequent localizations and the palliation with regard to total, partial and complete pain response. (orig.) [de

  18. Lung clearance of 99mTc-DTPA aerosols in chronic obstructive pulmonary disease and interstitial pneumopathy diffuse

    International Nuclear Information System (INIS)

    Maliska, Carmelindo; Mello, Rossana Corbo de; Fonseca, Lea M.B.; Maliska, Celsa M.; Wolosker, Sara; Albernaz, Marta S.; Marinho, J.C.A.; Lima, Jose E.T.; Jansen, Jose M.

    1996-01-01

    An increasement in pulmonary epithelial permeability occurs when the alveolar-capillary units are disrupted. This permeability increasement can be measured by the 99m Tc-DTPA aerosol washout from lungs. Twenty three patients (10 healthy normal controls, 6 with COPD, 5 with diffuse infiltrative lung disease (DILD) and 2 asyntomatic patients that underwent radioiodine therapy dose) in order to verify the lung clearance rate of 99m Tc-DTPA in our population. The mean and standard deviation of pulmonary clearance rate in the normal group was 0,722±0,098%min -1 . The COPD patients rate resembled to the normal group rate. Four in five DILD patients had increased pulmonary clearance rate. The 2 patients that underwent radioiodine therapeutic showed normal clearance values of 99m Tc-DTPA from lungs. Our preliminary observations suggest that 99 'm Tc-DTPA clearance can be used as valuable tool in assessing early stages of pulmonary disorders in systemic diseases that may affect the lung. We also suggest that COPD does not seem to raise the pulmonary epithelial permeability. (author)

  19. Immunological circumvention of multiple organ metastases of multidrug resistant human small cell lung cancer cells by mouse-human chimeric anti-ganglioside GM2 antibody KM966.

    Science.gov (United States)

    Hanibuchi, M; Yano, S; Nishioka, Y; Yanagawa, H; Miki, T; Sone, S

    2000-01-01

    serum against SBC-3/DOX cells to a similar extent compared with parental SBC-3 cells. Pretreatment of human effector cells with various cytokines induced further enhancement of the KM966-dependent ADCC against SBC-3/DOX cells. Intravenous injection of SBC-3 or SBC-3/DOX cells into natural killer (NK) cell-depleted severe combined immunodeficient (SCID) mice developed metastases in multiple organs (liver, kidneys and lymph nodes). Interestingly, SBC-3/DOX cells produced metastases more rapidly than SBC-3 cells, suggesting more aggressive phenotype of SBC-3/DOX cells than their parental cells in vivo. Systemic treatment with KM966, given on days 2 and 7, drastically inhibited the formation of multiple-organ metastases produced by both SBC-3 and SBC-3/DOX cells, indicating that KM966 can eradicate metastasis by SCLC cells irrespective of MDR phenotype. These findings suggest that the mouse-human chimeric KM966 targets the GM2 antigen, and might be useful for the immunological circumvention of multiple-organ metastases of refractory SCLC.

  20. Primary bronchial carcinoma or pulmonary metastases

    International Nuclear Information System (INIS)

    Hasse, J.

    1987-01-01

    Operative treatment offers the best chance for long term survival in lung cancer of early stage. In the same way surgery may be the most efficient treatment of lung metastases from tumors of extrapulmonary site. The preoperative investigations have to prove that in case of lung cancer this is restricted to one hemithorax and in lung metastases that these are restricted to the lungs exclusively. They also have to prove that the lung function allows adequate resection. This is mainly lobectomy and pneumonectomy, sometimes sleeve resection and rarely segmentectomy for primary lung cancers. Resection of metastases preferably is by wedge excision or enucleation. In bilateral lesions median sternotomy is the favoured approach to both lungs in a single session. Long term results in primary lung cancer depend on the tumor stage. As a rule of thumb by each step of tumor stage the 5-year-survival rate is cut to half. In regard to histology small cell undifferentiated carcinomas are considered surgical indications only in the very early stage and need to be treated by adjuvant chemotherapy. The operative mortality is correlated to the extent of resection and by average is higher for primary carcinoma of the lung because of the usually higher age level and additional pulmonary damage. Patients operated for pulmonary metastases, however, are in lower age range and due to less functional risks, the operative mortality in most series is between 0 and 3%. Early detection of lung cancer, i.e., immediate and expert exploration of suspicious X-ray findings or respiratory symptoms particularly in smokers and with asbestos exposed individuals will contribute to an increasing efficacy of surgical treatment. (orig.) [de

  1. Diffusion of gases into the lung: How physics can help to understand ...

    Indian Academy of Sciences (India)

    responding subacini work under diffusion limited conditions, while the part of the ... Three-dimensional simulations of the steady-state diffusion of oxy- ... plays an important role, in particular in pulmonary diseases, as it procures a safety.

  2. Risk of Hippocampal Metastases in Small Cell Lung Cancer Patients at Presentation and After Cranial Irradiation: A Safety Profile Study for Hippocampal Sparing During Prophylactic or Therapeutic Cranial Irradiation

    International Nuclear Information System (INIS)

    Kundapur, Vijayananda; Ellchuk, Tasha; Ahmed, Shahid; Gondi, Vinai

    2015-01-01

    Purpose: Neurocognitive impairment (NI) in patients with small cell lung cancer (SCLC) after whole brain radiation treatment (WBRT) is a significant cause of morbidity. Hippocampal avoidance (HA) during WBRT may mitigate or prevent NI in such patients. However, this has not been tested in SCLC patients. The estimated risk of metastases in the HA region (HM) in patients with SCLC at diagnosis or after WBRT is unknown. Our study aimed to determine the risk of HM in patients with SCLC and to assess correlated clinical factors. Methods and Materials: Patients with SCLC who experienced brain metastases (BM) at presentation (de novo) or after WBRT treated at the Saskatoon Cancer Centre between 2005 and 2012 were studied. Relevant neuroimaging was independently reviewed by a neuroradiologist. HM was defined as metastases within 5 mm of the hippocampus. Logistic regression analysis was performed to assess correlation between various clinical variables and HM. Results: Seventy eligible patients were identified. Of 59 patients presenting with de novo BM, 3 patients (5%, 95% confidence interval [CI]: 0%-10.7%) had HM. Collectively there were 359 (range, 1-33) de novo BM with 3 (0.8%, 95% CI: 0%-1.7%) HM deposits. Twenty patients experienced progression of metastatic disease in the brain after WBRT. Of the 20 patients, only 1 patient (5%, 95% CI: 0%-14.5%) experienced HM. On logistic regression, no factors significantly correlated with HM. Conclusion: The overall incidence of HM before or after WBRT in SCLC patients is low, providing preliminary support for the safety of HA during planned clinical trials of HA-WBRT for SCLC

  3. Risk of Hippocampal Metastases in Small Cell Lung Cancer Patients at Presentation and After Cranial Irradiation: A Safety Profile Study for Hippocampal Sparing During Prophylactic or Therapeutic Cranial Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kundapur, Vijayananda, E-mail: Vijayananda.kundapur@saskcancer.ca [Saskatoon Cancer Center, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (Canada); Ellchuk, Tasha [Department of Radiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (Canada); Ahmed, Shahid [Saskatoon Cancer Center, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (Canada); Gondi, Vinai [Cadence Health Brain Tumor Center and Cadence Health Proton Center, Chicago, Illinois (United States)

    2015-03-15

    Purpose: Neurocognitive impairment (NI) in patients with small cell lung cancer (SCLC) after whole brain radiation treatment (WBRT) is a significant cause of morbidity. Hippocampal avoidance (HA) during WBRT may mitigate or prevent NI in such patients. However, this has not been tested in SCLC patients. The estimated risk of metastases in the HA region (HM) in patients with SCLC at diagnosis or after WBRT is unknown. Our study aimed to determine the risk of HM in patients with SCLC and to assess correlated clinical factors. Methods and Materials: Patients with SCLC who experienced brain metastases (BM) at presentation (de novo) or after WBRT treated at the Saskatoon Cancer Centre between 2005 and 2012 were studied. Relevant neuroimaging was independently reviewed by a neuroradiologist. HM was defined as metastases within 5 mm of the hippocampus. Logistic regression analysis was performed to assess correlation between various clinical variables and HM. Results: Seventy eligible patients were identified. Of 59 patients presenting with de novo BM, 3 patients (5%, 95% confidence interval [CI]: 0%-10.7%) had HM. Collectively there were 359 (range, 1-33) de novo BM with 3 (0.8%, 95% CI: 0%-1.7%) HM deposits. Twenty patients experienced progression of metastatic disease in the brain after WBRT. Of the 20 patients, only 1 patient (5%, 95% CI: 0%-14.5%) experienced HM. On logistic regression, no factors significantly correlated with HM. Conclusion: The overall incidence of HM before or after WBRT in SCLC patients is low, providing preliminary support for the safety of HA during planned clinical trials of HA-WBRT for SCLC.

  4. [Lymph node and distant metastases of thyroid gland cancer. Metastases in the thyroid glands].

    Science.gov (United States)

    Schmid, K W

    2015-11-01

    The different biological features of the various major entities of thyroid cancer, e.g. papillary, follicular, poorly differentiated, anaplastic and medullary, depend to a large extent on their different metastatic spread. Papillary thyroid cancer (PTC) has a propensity for cervical lymphatic spread that occurs in 20-50 % of patients whereas distant metastasis occurs in thyroid cancer (FTC) has a marked propensity for vascular but not lymphatic invasion and 10-20 % of FTC develop distant metastases. At the time of diagnosis approximately one third of medullary thyroid cancer (MTC) cases show lymph node metastases, in 10-15 % distant metastases and 25 % develop metastases during the course of the disease. Poorly differentiated (PDTC) and anaplastic thyroid cancer (ATC) spread via both lymphatic and vascular invasion. Thus distant metastases are relatively uncommon in DTC and when they occur, long-term stable disease is the typical clinical course. The major sites of distant metastases are the lungs and bone. Metastases to the brain, breasts, liver, kidneys, muscle and skin are relatively rare or even rare. The thyroid gland itself can be a site of metastases from a variety of other tumors. In autopsy series of patients with disseminated cancer disease, metastases to the thyroid gland were found in up to 10 % of cases. Metastases from other primary tumors to the thyroid gland have been reported in 1.4-3 % of patients who have surgery for suspected cancer of the thyroid gland. The most common primary cancers that metastasize to the thyroid gland are renal cell (48.1 %), colorectal (10.4 %), lung (8.3 %) and breast cancer (7.8 %) and surprisingly often sarcomas (4.0 %).

  5. Evaluation of ALK gene rearrangement in central nervous system metastases of non-small-cell lung cancer using two-step RT-PCR technique.

    Science.gov (United States)

    Nicoś, M; Krawczyk, P; Wojas-Krawczyk, K; Bożyk, A; Jarosz, B; Sawicki, M; Trojanowski, T; Milanowski, J

    2017-12-01

    RT-PCR technique has showed a promising value as pre-screening method for detection of mRNA containing abnormal ALK sequences, but its sensitivity and specificity is still discussable. Previously, we determined the incidence of ALK rearrangement in CNS metastases of NSCLC using IHC and FISH methods. We evaluated ALK gene rearrangement using two-step RT-PCR method with EML4-ALK Fusion Gene Detection Kit (Entrogen, USA). The studied group included 145 patients (45 females, 100 males) with CNS metastases of NSCLC and was heterogeneous in terms of histology and smoking status. 21% of CNS metastases of NSCLC (30/145) showed presence of mRNA containing abnormal ALK sequences. FISH and IHC tests confirmed the presence of ALK gene rearrangement and expression of ALK abnormal protein in seven patients with positive result of RT-PCR analysis (4.8% of all patients, 20% of RT-PCR positive patients). RT-PCR method compared to FISH analysis achieved 100% of sensitivity and only 82.7% of specificity. IHC method compared to FISH method indicated 100% of sensitivity and 97.8% of specificity. In comparison to IHC, RT-PCR showed identical sensitivity with high number of false positive results. Utility of RT-PCR technique in screening of ALK abnormalities and in qualification patients for molecularly targeted therapies needs further validation.

  6. Intracerebral metastasis showing restricted diffusion: Correlation with histopathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Duygulu, G. [Radiology Department, Ege University Medicine School, Izmir (Turkey); Ovali, G. Yilmaz [Radiology Department, Celal Bayar University Medicine School, Manisa (Turkey)], E-mail: gulgun.yilmaz@bayar.edu.tr; Calli, C.; Kitis, O.; Yuenten, N. [Radiology Department, Ege University Medicine School, Izmir (Turkey); Akalin, T. [Pathology Department, Ege University Medicine School, Izmir (Turkey); Islekel, S. [Neurosurgery Department, Ege University Medicine School, Izmir (Turkey)

    2010-04-15

    Objective: We aimed to detect the frequency of restricted diffusion in intracerebral metastases and to find whether there is correlation between the primary tumor pathology and diffusion-weighted MR imaging (DWI) findings of these metastases. Material and methods: 87 patients with intracerebral metastases were examined with routine MR imaging and DWI. 11 hemorrhagic metastatic lesions were excluded. The routine MR imaging included three plans before and after contrast enhancement. The DWI was performed with spin-echo EPI sequence with three b values (0, 500 and 1000), and ADC maps were calculated. 76 patients with metastases were grouped according to primary tumor histology and the ratios of restricted diffusion were calculated according to these groups. ADCmin values were measured within the solid components of the tumors and the ratio of metastases with restricted diffusion to that which do not show restricted diffusion were calculated. Fisher's exact and Mann-Whitney U tests were used for the statistical analysis. Results: Restricted diffusion was observed in a total of 15 metastatic lesions (19, 7%). Primary malignancy was lung carcinoma in 10 of these cases (66, 6%) (5 small cell carcinoma, 5 non-small cell carcinoma), and breast carcinoma in three cases (20%). Colon carcinoma and testicular teratocarcinoma were the other two primary tumors in which restricted diffusion in metastasis was detected. There was no statistical significant difference between the primary pathology groups which showed restricted diffusion (p > 0.05). ADCmin values of solid components of the metastasis with restricted diffusion and other metastasis without restricted diffusion also showed no significant statistical difference (0.72 {+-} 0.16 x 10{sup -3} mm{sup 2}/s and 0.78 {+-} 21 x 10{sup -3} mm{sup 2}/s respectively) (p = 0.325). Conclusion: Detection of restricted diffusion on DWI in intracerebral metastasis is not rare, particularly if the primary tumor is lung or breast

  7. [The clinical characteristics of pulmonary benign metastasizing leiomyoma].

    Science.gov (United States)

    Wang, H P; Shi, J H; Zhang, L

    2017-07-01

    Objective: Pulmonary benign metastasizing leiomyoma (PBML) is a rare entity that leiomyoma of uterus metastasized to the lung. The clinical characteristics of this rare disease were analyzed in this article. Methods: The detailed clinical records of 7 patients diagnosed as PBML at Peking Union Medical College Hospital between January 2001 and June 2015 were reviewed. Results: All patients were women with median age of 44 years (range 28-62). Symptoms included dyspnea (2/7), chest pain (1/7), cyanosis (1/7), cough (1/7) and bloody sputum (1/7), while 4/7 cases were asymptomatic. Six patients had the past-history of leiomyoma of uterus 20 months to 14 years ago among whom 5 patients received hysterectomy. Chest CT showed bilateral, random-distributed multiple round solid nodules, or diffuse-distributed miliary nodules, or single solid nodule, even some small cavities. Extra-pulmonary metastasis was found in left superclavicular lymph node (1 case) and right heart (1 case). Histological tissues were obtained by video-assisted thoracic surgery lung biopsy (4/7), mass resection on tricuspid valve (1/7), transbronchil lung biopsy (1/7), and CT-guided percutaneous lung biopsy (1/7). Pathology showed an interlacing pattern by spindle cells having elongated nuclei without cellular atypia. Ki-67 index was less than 1%. Molecules such as smooth muscle antibody, estrogen receptor (ER) and progestrone receptor (PR) were positive in immunohistochemistry staining. Neither letrozole nor zoladex was effective. Two patients responded to bilateral adnexectomy, presenting as shrunk nodules. No relapsed disease was seen in one patient with single nodule after resection. There was only one patient with disease-related mortality, whose chest CT showed milliary nodules. Conclusion: Although CT findings of PBML are similar to malignancies, the clinical outcome is good. Despite the positive expression of ER and PR, the effectiveness of hormone related treatment is limited. And periodical

  8. The effect of aging and cardiorespiratory fitness on the lung diffusing capacity response to exercise in healthy humans.

    Science.gov (United States)

    Coffman, Kirsten E; Carlson, Alex R; Miller, Andrew D; Johnson, Bruce D; Taylor, Bryan J

    2017-06-01

    Aging is associated with deterioration in the structure and function of the pulmonary circulation. We characterized the lung diffusing capacity for carbon monoxide (DL CO ), alveolar-capillary membrane conductance (Dm CO ), and pulmonary-capillary blood volume (Vc) response to discontinuous incremental exercise at 25, 50, 75, and 90% of peak work (W peak ) in four groups: 1 ) Young [27 ± 3 yr, maximal oxygen consumption (V̇o 2max ): 110 ± 18% age predicted]; 2) Young Highly Fit (27 ± 3 yr, V̇o 2max : 147 ± 8% age predicted); 3 ) Old (69 ± 5 yr, V̇o 2max : 116 ± 13% age predicted); and 4 ) Old Highly Fit (65 ± 5 yr, V̇o 2max : 162 ± 18% age predicted). At rest and at 90% W peak , DL CO , Dm CO , and Vc were decreased with age. At 90% W peak , DL CO , Dm CO , and Vc were greater in Old Highly Fit vs. Old adults. The slope of the DL CO -cardiac output (Q̇) relationship from rest to end exercise at 90% W peak was not different between Young, Young Highly Fit, Old, and Old Highly Fit (1.35 vs. 1.44 vs. 1.10 vs. 1.35 ml CO ·mmHg -1 ·liter blood -1 , P = 0.388), with no evidence of a plateau in this relationship during exercise; this was also true for Dm CO -Q̇ and Vc-Q̇. V̇o 2max was positively correlated with 1 ) DL CO , Dm CO , and Vc at rest; and 2 ) the rest to end exercise change in DL CO , Dm CO , and Vc. In conclusion, these data suggest that despite the age-associated deterioration in the structure and function of the pulmonary circulation, expansion of the pulmonary capillary network does not become limited during exercise in healthy individuals regardless of age or cardiorespiratory fitness level. NEW & NOTEWORTHY Healthy aging is a crucial area of research. This article details how differences in age and cardiorespiratory fitness level affect lung diffusing capacity, particularly during high-intensity exercise. We conclude that highly fit older adults do not experience a limit in lung diffusing capacity during

  9. Volume-controlled histographic analysis of pulmonary parenchyma in normal and diffuse parenchymal lung disease: a pilot study

    International Nuclear Information System (INIS)

    Park, Hyo Yong; Lee, Jongmin; Kim, Jong Seob; Won, Chyl Ho; Kang, Duk Sik; Kim, Myoung Nam

    2000-01-01

    located in an area of higher density. Using a home-made histographic analysis system which included a lung volume controller, patients with diffuse parenchymal lung disease could be distinguished from normal contros. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases. (author)

  10. Volume-controlled histographic analysis of pulmonary parenchyma in normal and diffuse parenchymal lung disease: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyo Yong; Lee, Jongmin; Kim, Jong Seob; Won, Chyl Ho; Kang, Duk Sik [School of Medicine, Kyungpook National University, Taegu (Korea, Republic of); Kim, Myoung Nam [The University of Iowa (United States)

    2000-06-01

    located in an area of higher density. Using a home-made histographic analysis system which included a lung volume controller, patients with diffuse parenchymal lung disease could be distinguished from normal contros. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases. (author)

  11. Postural variation of pulmonary diffusing capacity as a marker of lung microangiopathy in Indian patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Avinash Kumar

    2016-01-01

    Full Text Available Introduction: Diabetes mellitus (DM is characterized by the presence of chronic hyperglycemia and formation of advanced glycation end products (AGEs. Interaction between AGE and its receptor leads to endothelial damage and microangiopathy. This study was undertaken to investigate the possibility of using a postural variation of diffusing capacity as an early marker of lung microangiopathy and its correlation with the level of adhesion molecules, HbA1c, duration of diabetes, and insulin resistance in type 2 DM (T2DM patients with and without microangiopathy. Materials and Methods: Forty patients having T2DM without any microangiopathy (n = 20 as well as with microangiopathy (n = 20, and 22 age and sex matched healthy controls were enrolled in this cross-sectional study. Measurement of lung volumes and capacities were done. DLco was measured in sitting and supine position. Levels of vascular cell adhesion molecule-1 (VCAM-1, E-selectin, fasting glucose, and insulin were estimated in plasma of the patients and compared with controls. Results: Restrictive type of ventilatory change was observed in DM patients. Diffusing capacity (% predicted in the supine position (P < 0.0001, postural change in DLco (P < 0.0001, and coefficient of diffusion were significantly less in DM patients as compared to controls. Plasma levels of VCAM-1 were significantly higher in DM patients without microangiopathy and negatively correlated (r = −0.4054, P = 0.0094 with Δ DLco in all diabetic subjects. All patients had significantly higher insulin resistance. Conclusion: Lack of postural increase in diffusing capacity in type 2 diabetic patients along with increased VCAM-1 levels could reflect the presence of an early microangiopathy of the small pulmonary vessels.

  12. Morphological features of choroidal metastases: An OCT analysis

    Directory of Open Access Journals (Sweden)

    Ludovico Iannetti

    2013-01-01

    Full Text Available The morphological characteristics and retinal changes of chroidal metastases using Spectral Domain OCT are described in a case with primary lung adenocarcinoma and secondary choroidal involvement.

  13. Effects of icotinib with and without radiation therapy on patients with EGFR mutant non-small cell lung cancer and brain metastases

    OpenAIRE

    Yun Fan; Yanjun Xu; Lei Gong; luo Fang; Hongyang Lu; Jing Qin; Na Han; Fajun Xie; Guoqin Qiu; Zhiyu Huang

    2017-01-01

    EGFR-TKIs and radiation therapy (RT) are the principal treatment for patients with brain metastases (BM) and EGFR mutant NSCLC. However, the optimal use of brain RT for patients with asymptomatic BM remains undefined. A total of 152 patients were identified. 58 patients were excluded. Of the remaining 97 patients, 56 patients received upfront RT followed by icotinib, including WBRT or SRS. 41 patients received icotinib therapy alone. The mOS from diagnosis of BM was 27.0 months for the whole ...

  14. Bone metastases from gastric cancer. Clinical evaluation on bone scintigram

    Energy Technology Data Exchange (ETDEWEB)

    Seto, Mikito; Tonami, Norihisa; Koizumi, Kiyoshi; Sui, Osamu; Hisada, Kinichi [Kanazawa Univ. (Japan). School of Medicine

    1983-07-01

    We have studied bone scintigrams in 60 patients with gastric cancer. Of these 60 patients, bone metastases were found in 15 patients (25 %). There were no evidence of bone metastases in polypoid lesions, cancers of the antrum, carcinomas in situ, advanced cancers without invasion to serosa, cancer with N/sub 0/ or N/sub 1/ regional lymph node metastases, highly differentiated adenocarcinomas and papillary adenocarcinomas. On the contrary, high rates of bone metastases were seen in cancers of the corpus, advanced cancers with invasion to neighbouring structures and tubular adenocarcinomas. Of these 15 patients with bone metastasis, 3 patients showed very similar clinical features and the findings of ''diffuse bone metastases on bone scintigrams.'' Cancer of the antrum showed high rates of liver metastases, while cancers of the corpus showed high rates of bone metastases. Sixty percent of the patients with bone metastases did not have liver metastases and there seemed to be no significant relationship between liver metastases and bone metastases. From these results we suppose that non-portal tract through the vertebral venous plexus instead of portal tract may be the other route of bone metastases from gastric cancer.

  15. Postural variation of pulmonary diffusing capacity as a marker of lung microangiopathy in Indian patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Kumar, Avinash; Bade, Geetanjali; Trivedi, Anjali; Jyotsna, Viveka P; Talwar, Anjana

    2016-01-01

    Diabetes mellitus (DM) is characterized by the presence of chronic hyperglycemia and formation of advanced glycation end products (AGEs). Interaction between AGE and its receptor leads to endothelial damage and microangiopathy. This study was undertaken to investigate the possibility of using a postural variation of diffusing capacity as an early marker of lung microangiopathy and its correlation with the level of adhesion molecules, HbA1c, duration of diabetes, and insulin resistance in type 2 DM (T2DM) patients with and without microangiopathy. Forty patients having T2DM without any microangiopathy (n = 20) as well as with microangiopathy (n = 20), and 22 age and sex matched healthy controls were enrolled in this cross-sectional study. Measurement of lung volumes and capacities were done. DLco was measured in sitting and supine position. Levels of vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fasting glucose, and insulin were estimated in plasma of the patients and compared with controls. Restrictive type of ventilatory change was observed in DM patients. Diffusing capacity (% predicted) in the supine position (P capacity in type 2 diabetic patients along with increased VCAM-1 levels could reflect the presence of an early microangiopathy of the small pulmonary vessels.

  16. Diffuse Abdominal Splenosis Mimicking Peritoneal Metastases in a 35-Year-Old Man with a Resectable Carcinoma of the Ampulla of Vater

    Directory of Open Access Journals (Sweden)

    Steffen Filskov Sorensen

    2013-09-01

    Full Text Available A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed.

  17. Imaging diagnostics of breast metastases from extramammary tumors; Bildgebende Diagnostik bei Brustmetastasen extramammaerer Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Wienbeck, S.; Lotz, J. [Georg-August-Universitaet Goettingen, Institut fuer Diagnostische und Interventionelle Radiologie, Goettingen (Germany); Nemat, S. [Universitaet Homburg/Saar, Institut fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Surov, A. [Universitaet Leipzig, Institut fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany)

    2017-06-15

    Breast metastases of solid extramammary tumors are very rare in comparison to primary malignancies of the breast and account for only 0.33-6.3% of all malignant neoplasms of the breast. The most common primary tumors are malignant melanoma, distant sarcomas, lung cancer, ovarian cancer, renal cell cancer and thyroid cancer in decreasing order of frequency. This review article summarizes the clinical features and the different imaging findings of breast metastases from different extramammary solid tumors. Breast metastases are often incidental findings in computed tomography (CT) or positron emission tomography CT (PET-CT) imaging. Mammography shows two different imaging patterns, namely focal lesions and diffuse architectural distortion with skin thickening. Breast metastases presenting as focal masses usually occur as solitary and more rarely as multiple round lesions with a smooth edge boundary. Associated calcifications are rare findings. Diffuse architectural distortion with skin thickening is more common in breast metastases from most gastric tumors, ovarian cancer and rhabdomyosarcoma. Using ultrasound most lesions are hypoechoic, oval or round with smooth boundaries and posterior acoustic enhancement. The magnetic resonance imaging (MRI) criteria of breast metastases show an inconstant signal behavior that cannot be safely classified as benign or malignant. In summary, in patients with known malignancies the presence of breast metastases should be considered even with imposing clinically and radiologically benign findings. (orig.) [German] Brustmetastasen solider extramammaerer Tumoren sind im Vergleich zu primaeren Malignomen der Brust mit einer Praevalenz von 0,33-6,3 % aller boesartigen Neubildungen in der Brust sehr selten. Die haeufigsten Primaertumoren sind dabei das maligne Melanom, ferner Sarkome, Bronchial-, Ovarial-, Nierenzell- und Schilddruesenkarzinome mit einer absteigenden Haeufigkeit ihres Auftretens. In dieser Uebersichtsarbeit werden die

  18. Palliative radiotherapy for symptomatic osseous metastases

    International Nuclear Information System (INIS)

    Shigematsu, Naoyuki; Ito, Hisao; Toya, Kazuhito; Ko, Weijey; Kutsuki, Shouji; Tsukamoto, Nobuhiro; Kubo, Atsushi; Dokiya, Takushi; Yorozu, Atsunori.

    1995-01-01

    Bone matastases are one of the most common and serious conditions requiring radiotherapy, but there is still a considerable lack of agreement on optimal radiation schedule. We analyzed patients with symptomatic osseous matastases from lung (72 patients) and breast (63 patients) carcinoma treated by palliative radiotherapy between 1983 and 1992. In this series, the incidences of symptomatic bone metastases appearing within 2 years after the first diagnosis of the primary lesion were 96% and 36% for lung and breast carcinomas, respectively. Thirty percent of bone metastases from breast carcinoma were diagnosed more than 5 years after the first diagnosis. Thus careful follow-up must be carried out for a prolonged period. Pain relief was achieved at almost the same rate for bone metastases from lung and breast carcinomas (81% and 85%, respectively), an the rapid onset of pain relief (15 Gy or less) was obtained in about half the patients for both diseases. The rapid onset of pain relief and the lack of association between the onset of pain relief and primary tumor argued against the conventional theory that tumor shrinkage is a component of the initial response. In contrast to the fact that almost all lung carcinoma patients had very poor prognoses, one third of the breast carcinoma patients were alive more than 2 years after palliative radiotherapy. Thust, the late effects of radiation, such as radiation myelopathy, must be always considered especially in breast carcinoma patients even when it is 'just' palliative radiotherapy for bone metastases. (author)

  19. Diffuse reflectance spectroscopy: a new guidance tool for improvement of biopsy procedures in lung malignancies

    NARCIS (Netherlands)

    Evers, Daniel; Evers, D.J.; Nachabe, R.; Klomp, H.M.; van Sandick, J.W.; Wouters, M.W.; Lucassen, G.W.; Lucassen, Gerald; Hendriks, B.H.; Wesseling, J.; Ruers, Theo J.M.

    2012-01-01

    Background: A significant number of percutaneous intrathoracic biopsy procedures result in indeterminate cytologic or histologic diagnosis in clinical practice. Diffuse reflectance spectroscopy (DRS) is an optical technique that can distinguish different tissue types on a microscopic level. DRS may

  20. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial.

    Science.gov (United States)

    Mulvenna, Paula; Nankivell, Matthew; Barton, Rachael; Faivre-Finn, Corinne; Wilson, Paula; McColl, Elaine; Moore, Barbara; Brisbane, Iona; Ardron, David; Holt, Tanya; Morgan, Sally; Lee, Caroline; Waite, Kathryn; Bayman, Neil; Pugh, Cheryl; Sydes, Benjamin; Stephens, Richard; Parmar, Mahesh K; Langley, Ruth E

    2016-10-22

    Whole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from non-small cell lung cancer (NSCLC), although there have been no randomised clinical trials showing that WBRT improves either quality of life or overall survival. Even after treatment with WBRT, the prognosis of this patient group is poor. We aimed to establish whether WBRT could be omitted without a significant effect on survival or quality of life. The Quality of Life after Treatment for Brain Metastases (QUARTZ) study is a non-inferiority, phase 3 randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for surgical resection or stereotactic radiotherapy were randomly assigned (1:1) to optimal supportive care (OSC) including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone (including dexamethasone). The dose of dexamethasone was determined by the patients' symptoms and titrated downwards if symptoms improved. Allocation to treatment group was done by a phone call from the hospital to the Medical Research Council Clinical Trials Unit at University College London using a minimisation programme with a random element and stratification by centre, Karnofsky Performance Status (KPS), gender, status of brain metastases, and the status of primary lung cancer. The primary outcome measure was quality-adjusted life-years (QALYs). QALYs were generated from overall survival and patients' weekly completion of the EQ-5D questionnaire. Treatment with OSC alone was considered non-inferior if it was no more than 7 QALY days worse than treatment with WBRT plus OSC, which required 534 patients (80% power, 5% [one-sided] significance level). Analysis was done by intention to treat for all randomly assigned patients. The trial is registered with ISRCTN, number ISRCTN3826061. Between March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian centres, and were randomly assigned to

  1. Two quantitative methods for assessment of [Tc-99m]-MAA in the lung in the treatment of liver metastases: a case study

    International Nuclear Information System (INIS)

    Willowson, Kathy P.; Bailey, Dale L.; Baldock, Clive

    2009-01-01

    Full text: Objective: The use of Y-90 microspheres to treat metastatic liver cancer is becoming widely utilized. Despite the fact that the microspheres are delivered directly to the liver, some activity may bypass the liver capillaries and be shunted to the lungs. To evaluate the percentage of pulmonary breakthrough, a pre-therapy test is performed using Tc- 9 9 m labeled spheres. The aim of this project was to compare two quantitative methods for assessing lung uptake, and consider the possibility of organ specific quantification. Method: A previously validated method for achieving CT-based quantitative SPECTI was compared to a simple planar approach. A 44 year old man suffering from metastatic liver sarcoma was referred to the clinic for pre-therapy evaluation. After injection of Tc- 9 9 m labeled microspheres and routine imaging, a SPECT/CT was acquired and specific organ uptake values calculated. A further calibrated injection of [Tc- 9 9 m ]-MAA was then given as a simplified alternative to quantify lung uptake by comparing pre and post counts. Results: The quantitative SPECT/CT method correctly accounted for all injected activity and found 80% of the dose was retained in the liver and 4% in the lungs. The planar method found -4% of the dose in the lungs. Conclusion: The quantitative technique we have developed allows for accurate calculation of organ specific uptake, which has important implications for treatment. The additional MAA injection offers a simplified but accurate method to quantify lung uptake. I. K Willow son, D.L Bailey and C Baldock (2008) Quantitative SPECT reconstructions using CT-derived corrections Phys Med Bioi 53:3099-3112.

  2. Experimental investigation and numerical simulation of 3He gas diffusion in simple geometries: implications for analytical models of 3He MR lung morphometry.

    Science.gov (United States)

    Parra-Robles, J; Ajraoui, S; Deppe, M H; Parnell, S R; Wild, J M

    2010-06-01

    Models of lung acinar geometry have been proposed to analytically describe the diffusion of (3)He in the lung (as measured with pulsed gradient spin echo (PGSE) methods) as a possible means of characterizing lung microstructure from measurement of the (3)He ADC. In this work, major limitations in these analytical models are highlighted in simple diffusion weighted experiments with (3)He in cylindrical models of known geometry. The findings are substantiated with numerical simulations based on the same geometry using finite difference representation of the Bloch-Torrey equation. The validity of the existing "cylinder model" is discussed in terms of the physical diffusion regimes experienced and the basic reliance of the cylinder model and other ADC-based approaches on a Gaussian diffusion behaviour is highlighted. The results presented here demonstrate that physical assumptions of the cylinder model are not valid for large diffusion gradient strengths (above approximately 15 mT/m), which are commonly used for (3)He ADC measurements in human lungs. (c) 2010 Elsevier Inc. All rights reserved.

  3. Impact of whole brain radiation therapy on CSF penetration ability of Icotinib in EGFR-mutated non-small cell lung cancer patients with brain metastases: Results of phase I dose-escalation study.

    Science.gov (United States)

    Zhou, Lin; He, Jiazhuo; Xiong, Weijie; Liu, Yongmei; Xiang, Jing; Yu, Qin; Liang, Maozhi; Zhou, Xiaojuan; Ding, Zhenyu; Huang, Meijuan; Ren, Li; Zhu, Jiang; Li, Lu; Hou, Mei; Ding, Lieming; Tan, Fenlai; Lu, You

    2016-06-01

    Whole-brain radiation therapy (WBRT) and epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are both treatment options for EGFR-mutated non-small cell lung cancer (NSCLC) patients with brain metastases. However, the dose-escalation toxicity and efficacy of combination therapy, and the effect of WBRT on cerebrospinal fluid (CSF) penetration of EGFR-TKIs are still unclear. EGFR-mutated NSCLC patients with brain metastases were enrolled in this study, and the cohorts were constructed with a 3+3 design. The patients received icotinib with escalating doses (125-625mg, tid), and the concurrent WBRT (37.5Gy/15f/3weeks) started a week later. The CSF penetration rates of icotinib were tested before, immediately after, and 4 weeks after WBRT, respectively. Potential toxicities and benefits from dose-escalation treatment were analyzed. Fifteen patients were included in this study, 3 at each dose level from 125mg-375mg and 6 at 500mg with 3 occurred dose-limiting toxicities. The maximal tolerated dose of icotinib was 375mg tid in this combination therapy. There was a significant correlation between icotinib concentration in the CSF and plasma (R(2)=0.599, Picotinib, from 1.2% to 9.7%, reached a maximum at 375mg (median, 6.1%). There was no significant difference for CSF penetration rates among the three test points (median, 4.1% vs. 2.8% vs. 2.8%, P=0.16). The intracranial objective response rate and median intracranial progression free survival are 80% and 18.9 months. WBRT plus concurrent icotinib is well tolerated in EGFR-mutated NSCLC patients with brain metastases, up to an icotinib dose of 375mg tid. The icotinib CSF concentration seemed to have a potential ceiling effect with the dose escalation, and WBRT seemed to have no significant impact on CSF penetration of icotinib till 4 weeks after the treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Tumor Seeding Following Lung Radiofrequency Ablation: A Case Report

    International Nuclear Information System (INIS)

    Yamakado, Koichiro; Akeboshi, Masao; Nakatsuka, Atsuhiro; Takaki, Haruyuki; Takao, Motoshi; Kobayashi, Hiroyasu; Taguchi, Osamu; Takeda, Kan

    2005-01-01

    Lung radiofrequency (RF) ablation was performed for the treatment of a primary lung cancer measuring 2.5 cm in maximum diameter in a 78-year-old man. A contrast-enhanced computed tomography (CT) study performed 3 months after RF ablation showed incomplete ablation of the lung tumor and the appearance of a chest wall tumor 4.0 cm in maximum diameter that was considered to be the result of needle-tract seeding. RF ablation was performed for the treatment of both the lung and the chest wall tumors. Although tumor enhancement was eradicated in both of the treated tumors, follow-up CT studies revealed diffuse intra-pulmonary metastases in both lungs 2 months after the second RF session. He is currently receiving systemic chemotherapy

  5. Diffuse Thyroid Metastasis From Lung Cancer Mimicking Thyroiditis on 99mTc-Pertechnetate Scintigraphy.

    Science.gov (United States)

    Gao, Rui; Gao, Shan; Feng, Jinteng; Wang, Yuanbo; Zhang, Guangjian

    2017-09-01

    Possible thyroiditis was suspected in a 56-year-old man who initially presented sore throat because laboratory examinations revealed decreased serum thyroid hormone and the Tc-pertechnetate scintigraphy showed no tracer uptake by the thyroid gland. However, subsequent examination demonstrated that the absence of pertechnetate activity in the thyroid was due to complete replacement of thyroid gland by the metastasis from lung adenocarcinoma, which was unknown at the initial presentation.

  6. A meta-analysis of 18FDG-PET–CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer

    International Nuclear Information System (INIS)

    Qu Xinhua; Huang Xiaolu; Yan Weili; Wu Lianming; Dai Kerong

    2012-01-01

    Background and purpose: Lung cancer is the most common cause of cancer related death among both men and women worldwide. The skeleton is the most common site of cancer metastasis. Early detection is crucial for prognosis. To evaluate and compare the capability for bone metastasis assessment of [ 18 F] fluoro-2-D-glucose positron emission tomography with computed tomography ( 18 FDG-PET–CT), [ 18 F] fluoro-2-D-glucose positron emission tomography ( 18 FDG-PET), magnetic resonance imaging (MRI) and bone scintigraphy (BS) in lung cancer patients, a meta-analysis is preformed. Methods: We searched MEDLINE, OVID, EMBASE and the Cochrane Library for studies evaluating diagnosis validity of 18 FDG-PET–CT, 18 FDG-PET, MRI and BS between January 1990 and August 2010. Meta-analysis methods were used to pool sensitivity, specificity, diagnostic odd ratios (DORs) and to construct a summary receiver-operating characteristic curve (SROC). Results: A total of 17 articles (9 18 FDG-PET–CT studies, 9 18 FDG-PET studies, 6 MRI studies and 16 BS studies) that included 2940 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for the detection of bone metastasis in lung cancer using 18 FDG-PET–CT, 18 FDG-PET, MRI and BS were 0.92 (95% CI, 0.88–0.95), 0.87 (95% CI, 0.81–0.92), 0.77 (95% CI, 0.65–0.87) and 0.86 (95% CI, 0.82–0.89), respectively. The pooled specificity for the detection of bone metastasis from lung cancer using 18 FDG-PET–CT, 18 FDG-PET, MRI and BS were 0.98 (95% CI, 0.97–0.98), 0.94 (95% CI, 0.92–0.96), 0.92 (95% CI, 0.88–0.95), 0.88 (95% CI, 0.86–0.89), respectively. The pooled DORs estimates for 18 FDG-PET–CT 449.17 were significantly higher than for 18 FDG-PET (118.25, P 18 FDG-PET–CT and 18 FDG-PET were better imaging methods for diagnosing bone metastasis from lung cancer than MRI and BS. 18 FDG-PET–CT has higher diagnostic value (sensitivity, specificity and DORs

  7. Local Control of Lung Derived Tumors by Diffusing Alpha-Emitting Atoms Released From Intratumoral Wires Loaded With Radium-224

    International Nuclear Information System (INIS)

    Cooks, Tomer; Schmidt, Michael; Bittan, Hadas; Lazarov, Elinor; Arazi, Lior; Kelson, Itzhak; Keisari, Yona

    2009-01-01

    Purpose: Diffusing alpha-emitters radiation therapy (DART) is a new form of brachytherapy enabling the treatment of solid tumors with alpha radiation. The present study examines the antitumoral effects resulting from the release of alpha emitting radioisotopes into solid lung carcinoma (LL2, A427, and NCI-H520). Methods and Materials: An in vitro setup tested the dose-dependent killing of tumor cells exposed to alpha particles. In in vivo studies, radioactive wires (0.3 mm diameter, 5 mm long) with 224 Ra activities in the range of 21-38 kBq were inserted into LL/2 tumors in C57BL/6 mice and into human-derived A427 or NCI-H520 tumors in athymic mice. The efficacy of the short-lived daughters of 224 Ra to produce tumor growth retardation and prolong life was assessed, and the spread of radioisotopes inside tumors was measured using autoradiography. Results: The insertion of a single DART wire into the center of 6- to 7-mm tumors had a pronounced retardation effect on tumor growth, leading to a significant inhibition of 49% (LL2) and 93% (A427) in tumor development and prolongations of 48% (LL2) in life expectancy. In the human model, more than 80% of the treated tumors disappeared or shrunk. Autoradiographic analysis of the treated sectioned tissue revealed the intratumoral distribution of the radioisotopes, and histological analysis showed corresponding areas of necrosis. In vitro experiments demonstrated a dose-dependent killing of tumors cells exposed to alpha particles. Conclusions: Short-lived diffusing alpha-emitters produced tumor growth retardation and increased survival in mice bearing lung tumor implants. These results justify further investigations with improved dose distributions.

  8. Effects of icotinib with and without radiation therapy on patients with EGFR mutant non-small cell lung cancer and brain metastases.

    Science.gov (United States)

    Fan, Yun; Xu, Yanjun; Gong, Lei; Fang, Luo; Lu, Hongyang; Qin, Jing; Han, Na; Xie, Fajun; Qiu, Guoqin; Huang, Zhiyu

    2017-03-23

    EGFR-TKIs and radiation therapy (RT) are the principal treatment for patients with brain metastases (BM) and EGFR mutant NSCLC. However, the optimal use of brain RT for patients with asymptomatic BM remains undefined. A total of 152 patients were identified. 58 patients were excluded. Of the remaining 97 patients, 56 patients received upfront RT followed by icotinib, including WBRT or SRS. 41 patients received icotinib therapy alone. The mOS from diagnosis of BM was 27.0 months for the whole cohort (95% CI, 23.9-30.1 months). There was no difference in OS between the RT followed by icotinib group and the icotinib alone group (31.9 vs. 27.9 months, P = 0.237), and similar results were found in the SRS subgroup (35.5 vs. 27.9 months, P = 0.12). Patients with the EGFR Del19 mutation had a longer OS than patients with the exon 21 L858R mutation (32.7 vs. 27.4, P = 0.037). Intracranial progression-free survival (PFS) was improved in the patients who received RT followed by icotinib compared to those receiving icotinib alone (22.4 vs. 13.9 months, P = 0.043). Patients with EGFR-mutant adenocarcinoma and BM treated with icotinib exhibited prolonged survival. A longer duration of intracranial control was observed with brain RT.

  9. Diagnostic imaging of skeletal metastases

    International Nuclear Information System (INIS)

    Scutellari, P. N.; Addonisio, G.; Righi, R.; Giganti, M.

    2000-01-01

    Purpose of this article is to present an algorithm for detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic cancer patients. February to March 1999 it was randomly selected and retrospectively reviewed the clinical charts of 100 cancer patients (70 women and 30 men; mean age: 63 years, range: 55-87). All the patients had been staged according to TNM criteria and had undergone conventional radiography and bone scan; when findings were equivocal, CT and MRI had been performed too. The primary lesions responsible for bone metastases were sited in the: breast (51 cases), colon (30 cases: 17 men and 13 women), lung (7 cases: 6 men and 1 woman), stomach (4 cases: 2 men and 2 women), skin (4 cases: 3 men and 1 woman), kidney (2 men), pleura (1 woman), and finally liver (1 man). The most frequent radiographic pattern was the lytic type (52%), followed by osteosclerotic, mixed, lytic vs mixed and osteosclerotic vs lytic patterns. The patients were divided into two groups: group A patients were asymptomatic and group B patients had local symptoms and/or pain. Skeletal metastases are the most common malignant bone tumors: the spine and the pelvis are the most frequent sites of metastasis, because of the presence of high amounts of red (hematopoietic active) bone marrow. Pain is the main symptom, even though many bone metastases are asymptomatic. Pathological fractures are the most severe consequences. With the algorithm for detection and diagnosis of skeletal metastases two different diagnostic courses are available for asymptomatic and symptomatic patients. Bone scintigraphy remains the technique of choice in asymptomatic patients in whom skeletal metastases are suspected. However this technique, though very sensitive, is poorly specific, and thus a negative bone scan finding is double-checked with another physical examination: if the findings remain negative, the diagnostic workup is over. On the contrary, in

  10. Lung nodules after whole lung radiation

    International Nuclear Information System (INIS)

    Cohen, M.D.; Mirkin, D.L.; Provisor, A.; Hornback, N.B.; Smith, J.A.; Slabaugh, R.D.

    1983-01-01

    It is essential to recognize radiation pneumonitis after whole lung irradiation, or nodular changes in response to chemotherapy, so that such conditions are not mistaken for tumor metastases, causing grave error in patient management and the possibility of further lung damage

  11. A phase II study of icotinib and whole-brain radiotherapy in Chinese patients with brain metastases from non-small cell lung cancer.

    Science.gov (United States)

    Fan, Yun; Huang, Zhiyu; Fang, Luo; Miao, Lulu; Gong, Lei; Yu, Haifeng; Yang, Haiyan; Lei, Tao; Mao, Weimin

    2015-09-01

    Icotinib is a new first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. A phase II study was conducted to evaluate the efficacy and safety of icotinib in combination with whole-brain radiotherapy (WBRT) in Chinese NSCLC patients with brain metastases (BMs); the cerebrospinal fluid (CSF)/plasma concentrations of icotinib were also investigated. Eligible patients had BMs from NSCLC, regardless of the EGFR status. Icotinib was administered at 125 mg orally 3 times/day until tumor progression or unacceptable toxicity, concurrently with WBRT (3.0 Gy per day, 5 days per week, to 30 Gy). CSF and plasma samples were collected simultaneously from 10 patients. Icotinib concentrations in the CSF and plasma were measured by high-performance liquid chromatography coupled with tandem mass spectrometry. Twenty patients were enrolled. The median follow-up time was 20.0 months. The overall response rate was 80.0%. The median progression-free survival time was 7.0 months (95% CI 1.2-13.2 months), and the median survival time (MST) was 14.6 months (95% CI 12.5-16.7 months). Of the 18 patients with known EGFR status, the MST was 22.0 months for those with an EGFR mutation and was 7.5 months for those with wild-type EGFR (P = 0.0001). The CSF concentration and penetration rate of icotinib were 11.6 ± 9.1 ng/mL and 1.4 ± 1.1%, respectively. No patient experienced ≥grade 4 toxicity. Icotinib was well tolerated in combination with WBRT and showed efficacy in patients with BMs from NSCLC. This clinical benefit was related to the presence of activating EGFR mutations.

  12. Icotinib versus whole-brain irradiation in patients with EGFR-mutant non-small-cell lung cancer and multiple brain metastases (BRAIN): a multicentre, phase 3, open-label, parallel, randomised controlled trial.

    Science.gov (United States)

    Yang, Jin-Ji; Zhou, Caicun; Huang, Yisheng; Feng, Jifeng; Lu, Sun; Song, Yong; Huang, Cheng; Wu, Gang; Zhang, Li; Cheng, Ying; Hu, Chengping; Chen, Gongyan; Zhang, Li; Liu, Xiaoqing; Yan, Hong Hong; Tan, Fen Lai; Zhong, Wenzhao; Wu, Yi-Long

    2017-09-01

    For patients with non-small-cell lung cancer (NSCLC) and multiple brain metastases, whole-brain irradiation (WBI) is a standard-of-care treatment, but its effects on neurocognition are complex and concerning. We compared the efficacy of an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), icotinib, versus WBI with or without chemotherapy in a phase 3 trial of patients with EGFR-mutant NSCLC and multiple brain metastases. We did a multicentre, open-label, parallel randomised controlled trial (BRAIN) at 17 hospitals in China. Eligible participants were patients with NSCLC with EGFR mutations, who were naive to treatment with EGFR-TKIs or radiotherapy, and had at least three metastatic brain lesions. We randomly assigned participants (1:1) to either icotinib 125 mg orally (three times per day) or WBI (30 Gy in ten fractions of 3 Gy) plus concurrent or sequential chemotherapy for 4-6 cycles, until unacceptable adverse events or intracranial disease progression occurred. The randomisation was done by the Chinese Thoracic Oncology Group with a web-based allocation system applying the Pocock and Simon minimisation method; groups were stratified by EGFR gene mutation status, treatment line (first line or second line), brain metastases only versus both intracranial and extracranial metastases, and presence or absence of symptoms of intracranial hypertension. Clinicians and patients were not masked to treatment assignment, but individuals involved in the data analysis did not participate in the treatments and were thus masked to allocation. Patients receiving icotinib who had intracranial progression only were switched to WBI plus either icotinib or chemotherapy until further progression; those receiving icotinib who had extracranial progression only were switched to icotinib plus chemotherapy. Patients receiving WBI who progressed were switched to icotinib until further progression. Icotinib could be continued beyond progression if a clinical benefit

  13. Quantitative consensus of supervised learners for diffuse lung parenchymal HRCT patterns

    Science.gov (United States)

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A.; Bartholmai, Brian J.; Robb, Richard A.

    2013-03-01

    Automated lung parenchymal classification usually relies on supervised learning of expert chosen regions representative of the visually differentiable HRCT patterns specific to different pathologies (eg. emphysema, ground glass, honey combing, reticular and normal). Considering the elusiveness of a single most discriminating similarity measure, a plurality of weak learners can be combined to improve the machine learnability. Though a number of quantitative combination strategies exist, their efficacy is data and domain dependent. In this paper, we investigate multiple (N=12) quantitative consensus approaches to combine the clusters obtained with multiple (n=33) probability density-based similarity measures. Our study shows that hypergraph based meta-clustering and probabilistic clustering provides optimal expert-metric agreement.

  14. The role of perfusion lung scanning and diffusion capacity for early diagnosis of micro circulatory disturbances in chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Petrova, D.; Shoshlov, P.; Hadjikostova, H.

    2002-01-01

    The development of chronic obstructive pulmonary disease (COPD) and the frequent inflammatory exacerbations with development of respiratory failure lead to changes in the micro circulatory and an increased risk of lung thrombotic and thromboembolic complication. The aim of the study was to establish the possibility of the perfusion lung scanning and diffusion capacity for early diagnosis of pulmonary micro circulatory disturbances in COPD with mild and moderate respiratory failure. 59 COPD patients were investigated. The data presented significant segmental disorders. Only in 5 (8.47%) of them the perfusion lung scintigrams were normal. In 23 of the patients, single-breath diffusing capacity (DICO) and its two components: membranous component (Dm) and capillary blood component (Vc) were determined. DICO was lower especially Vc the mean sign of micro circulatory disorders. A relationship between the degree of hypoxaemia and the changes found in the perfusion scintigraphy was found. Changes in the pulmonary lung scanning and in the diffusion capacity in COPD with mild respiratory failure seem to be an early diagnostic test. The early anticoagulant and desaggregant prevention may decrease the risk of thrombotic complications in the development of the disease. (authors)

  15. Morphological appearance, content of extracellular matrix and vascular density of lung metastases predicts permissiveness to infiltration by adoptively transferred natural killer and T cells

    DEFF Research Database (Denmark)

    Yang, Q.; Goding, S.; Hagenaars, M.

    2006-01-01

    . Analyses of tumors for extracellular matrix (ECM) components and PECAM-1(+) vasculature, revealed that the I-R lesions are hypovascularized and contain very little laminin, collagen and fibronectin. In contrast, the I-P loose tumors are well-vascularized and they contain high amounts of ECM components....... Interestingly, the distribution pattern of ECM components in the I-P loose tumors is almost identical to that of the normal lung tissue, indicating that these tumors develop around the alveolar walls which provide the loose tumors with both a supporting tissue and a rich blood supply. In conclusion, tumor...... infiltration by activated NK and T cells correlates with the presence of ECM components and PECAM-1(+) vasculature in the malignant tissue. Thus, analysis of the distribution of ECM and vasculature in tumor biopsies may help select patients most likely to benefit from cellular adoptive immunotherapy....

  16. False-positive radioactive iodine uptake mimicking miliary lung metastases in a patient affected by papillary thyroid cancer and IgA deficiency

    Energy Technology Data Exchange (ETDEWEB)

    Demidowich, Andrew Paul; Reynolds, James C. [National Institutes of Health, Bethesda (United States); Kundu, Amartya [Dept. of MedicineUniversity of Massachusetts Medical School, Worcester (United States); Celi, Francesco S. [Div. of Endocrinology and MetabolismVirginia Commonwealth UniversityRichmond (United States)

    2016-09-15

    A 42-year-old female with immunoglobulin A deficiency and recurrent sinopulmonary infections underwent thyroidectomy for papillary thyroid cancer (PTC). Follow-up {sup 123}I scintigraphy demonstrated diffuse pulmonary uptake, suggesting metastatic disease. However, subsequent pathologic, biochemical and radiographic testing proved that she was in fact disease free, and the initial {sup 123}I pulmonary uptake was identified as a false positive. Inflammatory conditions may rarely cause iodine uptake in non-thyroidal tissues due to local retention, organification, and/or immunologic utilization. To avoid exposing patients to unnecessary treatments, it is critical for clinicians to recognize that comorbid pulmonary conditions may mimic metastatic PTC on radioiodine scintigraphy.

  17. Radiation therapy of brain metastases

    International Nuclear Information System (INIS)

    Obata, Yasunori; Morita, Kozo; Watanabe, Michiko; Niwa, Kokichi

    1982-01-01

    From January 1974 to December 1980, 104 patients with brain metastases were treated by irradiation to the whole brain. The results of treatment and the relation between CT images and effectiveness of irradiation were analized. The lung was the most common site of the primary tumor (67/104, 64.4%). The breast was a distant second in frequency (13/104, 12.5%) and fewer cases had other primary tumors (24/104, 23.1%). There were 63 males and 41 females. Their mean age was 56.0 years old. The interval between onset of symptoms from primary disease and of those from the brain metastases were 26.5 months for the breast cancer, 7.6 months for undifferentiated carcinoma of the lung and 13.2 months for all patients. Significant neurologic improvement was obtained in 85.7% of the patients (86 cases) irradiated as previous plans. The survival for the entire group of patients (86 cases) was 60.5% at 3 months, 31.4% at 6 months, 11.6% at 12 months an 3.5% at 18 months. Multiplicity of the metastatic brain tumror did not affect the prognosis but the control of the primary lesion affected the prognosis. The CT images of 41 cases before treatment revealed the enhanced mass was mainly homogeneous for the case with the breast cancer and mainly ring like for the case with squamous cell carcinoma of the lung. But the characters of the enhanced mass did not affect the prognosis. On the other hand, the analysis of the CT images of 37 cases before and after the treatment revealed the relation between the tumor regression and the improvement in neurologic symptoms. (J.P.N.)

  18. Diagnostic performance of 18F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma.

    Science.gov (United States)

    Ishiguchi, Hiroaki; Ito, Shinji; Kato, Katsuhiko; Sakurai, Yusuke; Kawai, Hisashi; Fujita, Naotoshi; Abe, Shinji; Narita, Atsushi; Nishio, Nobuhiro; Muramatsu, Hideki; Takahashi, Yoshiyuki; Naganawa, Shinji

    2018-04-17

    Recent many studies have shown that whole body "diffusion-weighted imaging with background body signal suppression" (DWIBS) seems a beneficial tool having higher tumor detection sensitivity without ionizing radiation exposure for pediatric tumors. In this study, we evaluated the diagnostic performance of whole body DWIBS and 18 F-FDG PET/CT for detecting lymph node and bone metastases in pediatric patients with neuroblastoma. Subjects in this retrospective study comprised 13 consecutive pediatric patients with neuroblastoma (7 males, 6 females; mean age, 2.9 ± 2.0 years old) who underwent both 18 F-FDG PET/CT and whole-body DWIBS. All patients were diagnosed as neuroblastoma on the basis of pathological findings. Eight regions of lymph nodes and 17 segments of skeletons in all patients were evaluated. The images of 123 I-MIBG scintigraphy/SPECT-CT, bone scintigraphy/SPECT, and CT were used to confirm the presence of lymph node and bone metastases. Two radiologists trained in nuclear medicine evaluated independently the uptake of lesions in 18 F-FDG PET/CT and the signal-intensity of lesions in whole-body DWIBS visually. Interobserver difference was overcome through discussion to reach a consensus. The sensitivities, specificities, and overall accuracies of 18 F-FDG PET/CT and whole-body DWIBS were compared using McNemer's test. Positive predictive values (PPVs) and negative predictive values (NPVs) of both modalities were compared using Fisher's exact test. The total numbers of lymph node regions and bone segments which were confirmed to have metastasis in the total 13 patients were 19 and 75, respectively. The sensitivity, specificity, overall accuracy, PPV, and NPV of 18 F-FDG PET/CT for detecting lymph node metastasis from pediatric neuroblastoma were 100, 98.7, 98.9, 95.0, and 100%, respectively, and those for detecting bone metastasis were 90.7, 73.1, 80.3, 70.1, and 91.9%, respectively. In contrast, the sensitivity, specificity, overall accuracy, PPV

  19. Comparison of Shallow and Deep Learning Methods on Classifying the Regional Pattern of Diffuse Lung Disease.

    Science.gov (United States)

    Kim, Guk Bae; Jung, Kyu-Hwan; Lee, Yeha; Kim, Hyun-Jun; Kim, Namkug; Jun, Sanghoon; Seo, Joon Beom; Lynch, David A

    2017-10-17

    This study aimed to compare shallow and deep learning of classifying the patterns of interstitial lung diseases (ILDs). Using high-resolution computed tomography images, two experienced radiologists marked 1200 regions of interest (ROIs), in which 600 ROIs were each acquired using a GE or Siemens scanner and each group of 600 ROIs consisted of 100 ROIs for subregions that included normal and five regional pulmonary disease patterns (ground-glass opacity, consolidation, reticular opacity, emphysema, and honeycombing). We employed the convolution neural network (CNN) with six learnable layers that consisted of four convolution layers and two fully connected layers. The classification results were compared with the results classified by a shallow learning of a support vector machine (SVM). The CNN classifier showed significantly better performance for accuracy compared with that of the SVM classifier by 6-9%. As the convolution layer increases, the classification accuracy of the CNN showed better performance from 81.27 to 95.12%. Especially in the cases showing pathological ambiguity such as between normal and emphysema cases or between honeycombing and reticular opacity cases, the increment of the convolution layer greatly drops the misclassification rate between each case. Conclusively, the CNN classifier showed significantly greater accuracy than the SVM classifier, and the results implied structural characteristics that are inherent to the specific ILD patterns.

  20. Multiple Cutaneous Metastases as Initial Presentation in Advanced Colon Cancer

    Directory of Open Access Journals (Sweden)

    Sudheer Nambiar

    2018-01-01

    Full Text Available Skin metastases from advanced colorectal cancer are relatively rare and occur most often when the cancer is advanced, following the spread to other organs. Cutaneous metastases occur in about 3% of advanced colorectal cancers. We present an extremely rare case of a 68-year-old woman with advanced ascending colon adenocarcinoma that presented with multiple rapidly progressing painless cutaneous metastatic lesions with no other distant metastases. Of all the tumors, breast cancer most commonly spreads as cutaneous metastasis is followed by lung, colorectal, renal, ovarian, and bladder cancers. Cutaneous metastases can present in a variety of clinical manifestations, such as a rapidly growing painless dermal or subcutaneous nodule with intact overlying epidermis or as ulcers. In cases where the cutaneous deposit is isolated, as in visceral metastasis, there is a role for radical management such as wide local excision and reconstruction. In our patient, since she had multiple cutaneous metastases she began treatment with palliative systemic combination chemotherapy.

  1. SU-F-J-224: Impact of 4D PET/CT On PERCIST Classification of Lung and Liver Metastases in NSLC and Colorectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Meier, J; Lopez, B; Mawlawi, O [UT MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: To quantify the impact of 4D PET/CT on PERCIST metrics in lung and liver tumors in NSCLC and colorectal cancer patients. Methods: 32 patients presenting lung or liver tumors of 1–3 cm size affected by respiratory motion were scanned on a GE Discovery 690 PET/CT. The bed position with lesion(s) affected by motion was acquired in a 12 minute PET LIST mode and unlisted into 8 bins with respiratory gating. Three different CT maps were used for attenuation correction: a clinical helical CT (CT-clin), an average CT (CT-ave), and an 8-phase 4D CINE CT (CT-cine). All reconstructions were 3D OSEM, 2 iterations, 24 subsets, 6.4 Gaussian filtration, 192×192 matrix, non-TOF, and non-PSF. Reconstructions using CT-clin and CT-ave used only 3 out of the 12 minutes of the data (clinical protocol); all 12 minutes were used for the CT-cine reconstruction. The percent change of SUVbw-peak and SUVbw-max was calculated between PET-CTclin and PET-CTave. The same percent change was also calculated between PET-CTclin and PET-CTcine in each of the 8 bins and in the average of all bins. A 30% difference from PET-CTclin classified lesions as progressive metabolic disease (PMD) using maximum bin value and the average of eight bin values. Results: 30 lesions in 25 patients were evaluated. Using the bin with maximum SUVbw-peak and SUVbw-max difference, 4 and 13 lesions were classified as PMD, respectively. Using the average bin values for SUVbw-peak and SUVbw-max, 3 and 6 lesions were classified as PMD, respectively. Using PET-CTave values for SUVbw-peak and SUVbw-max, 4 and 3 lesions were classified as PMD, respectively. Conclusion: These results suggest that response evaluation in 4D PET/CT is dependent on SUV measurement (SUVpeak vs. SUVmax), number of bins (single or average), and the CT map used for attenuation correction.

  2. SU-F-J-224: Impact of 4D PET/CT On PERCIST Classification of Lung and Liver Metastases in NSLC and Colorectal Cancer

    International Nuclear Information System (INIS)

    Meier, J; Lopez, B; Mawlawi, O

    2016-01-01

    Purpose: To quantify the impact of 4D PET/CT on PERCIST metrics in lung and liver tumors in NSCLC and colorectal cancer patients. Methods: 32 patients presenting lung or liver tumors of 1–3 cm size affected by respiratory motion were scanned on a GE Discovery 690 PET/CT. The bed position with lesion(s) affected by motion was acquired in a 12 minute PET LIST mode and unlisted into 8 bins with respiratory gating. Three different CT maps were used for attenuation correction: a clinical helical CT (CT_clin), an average CT (CT_ave), and an 8-phase 4D CINE CT (CT_cine). All reconstructions were 3D OSEM, 2 iterations, 24 subsets, 6.4 Gaussian filtration, 192×192 matrix, non-TOF, and non-PSF. Reconstructions using CT_clin and CT_ave used only 3 out of the 12 minutes of the data (clinical protocol); all 12 minutes were used for the CT_cine reconstruction. The percent change of SUVbw_peak and SUVbw_max was calculated between PET_CTclin and PET_CTave. The same percent change was also calculated between PET_CTclin and PET_CTcine in each of the 8 bins and in the average of all bins. A 30% difference from PET_CTclin classified lesions as progressive metabolic disease (PMD) using maximum bin value and the average of eight bin values. Results: 30 lesions in 25 patients were evaluated. Using the bin with maximum SUVbw_peak and SUVbw_max difference, 4 and 13 lesions were classified as PMD, respectively. Using the average bin values for SUVbw_peak and SUVbw_max, 3 and 6 lesions were classified as PMD, respectively. Using PET_CTave values for SUVbw_peak and SUVbw_max, 4 and 3 lesions were classified as PMD, respectively. Conclusion: These results suggest that response evaluation in 4D PET/CT is dependent on SUV measurement (SUVpeak vs. SUVmax), number of bins (single or average), and the CT map used for attenuation correction.

  3. A Neuro-oncologist's Perspective on Management of Brain Metastases in Patients with EGFR Mutant Non-small Cell Lung Cancer.

    Science.gov (United States)

    McGranahan, Tresa; Nagpal, Seema

    2017-04-01

    Management of non-small cell lung cancer (NSCLC) with brain metastasis (BrM) has been revolutionized by identification of molecular subsets that have targetable oncogenes. Historically, survival for NSCLC with symptomatic BrM was weeks to months. Now, many patients are surviving years with limited data to guide treatment decisions. Tumors with activating mutations in epidermal growth factor receptor (EGFRact+) have a higher incidence of BrM, but a longer overall survival. The high response rate of both systemic and BrM EGFRact+ NSCLC to tyrosine kinase inhibitors (TKIs) has led to the rapid incorporation of new therapies but is outpacing evidence-based decisions for BrM in NSCLC. While whole brain radiation therapy (WBRT) was the foundation of management of BrM, extended survival raises concerns for the subacute and late effects radiotherapy. We favor the use of TKIs and delaying the use of WBRT when able. At inevitable disease progression, we consider alternative dosing schedules to increase CNS penetration (such as pulse dosing of erlotinib) or advance to next generation TKI if available. We utilize local control options of surgery or stereotactic radiosurgery (SRS) for symptomatic accessible lesions based on size and edema. At progression despite available TKIs, we use pemetrexed-based platinum doublet chemotherapy or immunotherapy if the tumor has high expression of PDL-1. We reserve the use of WBRT for patients with more than 10 BrM and progression despite TKI and conventional chemotherapy, if performance status is appropriate.

  4. Cytogenetic findings in metastases from colorectal cancer

    DEFF Research Database (Denmark)

    Bardi, G; Parada, L A; Bomme, L

    1997-01-01

    Eighteen tumor samples from 11 patients with metastatic colorectal cancer were cytogenetically analyzed after short-term culturing. Of the 13 metastases examined, 11 were from lymph nodes, 1 from the peritoneum and 1 from the lung. In 5 of the 11 patients, matched samples from the primary tumor...... colorectal carcinomas, and del(10)(q22) and add(16)(p13), which so far have not been associated with primary tumors and which may play a particular pathogenetic role in the metastatic process....

  5. Unique genetic profiles from cerebrospinal fluid cell-free DNA in leptomeningeal metastases of EGFR-mutant non-small-cell lung cancer: a new medium of liquid biopsy.

    Science.gov (United States)

    Li, Y S; Jiang, B Y; Yang, J J; Zhang, X C; Zhang, Z; Ye, J Y; Zhong, W Z; Tu, H Y; Chen, H J; Wang, Z; Xu, C R; Wang, B C; Du, H J; Chuai, S; Han-Zhang, H; Su, J; Zhou, Q; Yang, X N; Guo, W B; Yan, H H; Liu, Y H; Yan, L X; Huang, B; Zheng, M M; Wu, Y L

    2018-04-01

    Leptomeningeal metastases (LM) are more frequent in non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Due to limited access to leptomeningeal lesions, the purpose of this study was to explore the potential role of cerebrospinal fluid (CSF) as a source of liquid biopsy in patients with LM. Primary tumor, CSF, and plasma in NSCLC with LM were tested by next-generation sequencing. In total, 45 patients with suspected LM underwent lumbar puncture, and those with EGFR mutations diagnosed with LM were enrolled. A total of 28 patients were enrolled in this cohort; CSF and plasma were available in 26 patients, respectively. Driver genes were detected in 100% (26/26), 84.6% (22/26), and 73.1% (19/26) of samples comprising CSF cell-free DNA (cfDNA), CSF precipitates, and plasma, respectively; 92.3% (24/26) of patients had much higher allele fractions in CSF cfDNA than the other two media. Unique genetic profiles were captured in CSF cfDNA compared with those in plasma and primary tissue. Multiple copy number variations (CNVs) were mainly identified in CSF cfDNA, and MET copy number gain identified in 47.8% (11/23) of patients was the most frequent one, while other CNVs included ERBB2, KRAS, ALK, and MYC. Moreover, loss of heterozygosity (LOH) of TP53 was identified in 73.1% (19/26) CSF cfDNA, which was much higher than that in plasma (2/26, 7.7%; P liquid biopsy medium for LM in EGFR-mutant NSCLC.

  6. Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis

    Science.gov (United States)

    Kuroda, Hiroaki; Sakao, Yukinori; Mun, Mingyon; Uehara, Hirofumi; Nakao, Masayuki; Matsuura, Yousuke; Mizuno, Tetsuya; Sakakura, Noriaki; Motoi, Noriko; Ishikawa, Yuichi; Yatabe, Yasushi; Nakagawa, Ken; Okumura, Sakae

    2015-01-01

    Background Left upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC) located in the left upper division. Methods We retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy) with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako’s method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station. Results We enrolled 417 patients (237 men, 180 women). Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC. Conclusions Interlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC. PMID:26247881

  7. Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis.

    Directory of Open Access Journals (Sweden)

    Hiroaki Kuroda

    Full Text Available Left upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC located in the left upper division.We retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako's method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station.We enrolled 417 patients (237 men, 180 women. Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC.Interlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC.

  8. Paullinia cupana Mart var. sorbilis, guaraná, reduces cell proliferation and increases apoptosis of B16/F10 melanoma lung metastases in mice

    Directory of Open Access Journals (Sweden)

    H. Fukumasu

    2008-04-01

    Full Text Available We showed that guaraná (Paullinia cupana Mart var. sorbilis had a chemopreventive effect on mouse hepatocarcinogenesis and reduced diethylnitrosamine-induced DNA damage. In the present experiment, we evaluated the effects of guaraná in an experimental metastasis model. Cultured B16/F10 melanoma cells (5 x 10(5 cells/animal were injected into the tail vein of mice on the 7th day of guaraná treatment (2.0 mg P. cupana/g body weight, per gavage and the animals were treated with guaraná daily up to 14 days until euthanasia (total treatment time: 21 days. Lung sections were obtained for morphometric analysis, apoptotic bodies were counted to calculate the apoptotic index and proliferating cell nuclear antigen-positive cells were counted to determine the proliferation index. Guaraná-treated (GUA animals presented a 68.6% reduction in tumor burden area compared to control (CO animals which were not treated with guaraná (CO: 0.84 ± 0.26, N = 6; GUA: 0.27 ± 0.24, N = 6; P = 0.0043, a 57.9% reduction in tumor proliferation index (CO: 23.75 ± 20.54, N = 6; GUA: 9.99 ± 3.93, N = 6; P = 0.026 and a 4.85-fold increase in apoptotic index (CO: 66.95 ± 22.95, N = 6; GUA: 324.37 ± 266.74 AB/mm², N = 6; P = 0.0152. In this mouse model, guaraná treatment decreased proliferation and increased apoptosis of tumor cells, consequently reducing the tumor burden area. We are currently investigating the molecular pathways of the effects of guaraná in cultured melanoma cells, regarding principally the cell cycle inhibitors and cyclins.

  9. Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

    Directory of Open Access Journals (Sweden)

    Watanabe Masahiro

    2012-09-01

    Full Text Available Abstract Introduction Pulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter. Case presentation The baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition. Conclusions Therapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

  10. Outcomes of Adolescent and Adult Patients with Lung Metastatic Osteosarcoma and Comparison of Synchronous and Metachronous Lung Metastatic Groups.

    Directory of Open Access Journals (Sweden)

    Ayse Gok Durnali

    Full Text Available Osteosarcomas with lung metastases are rather heterogenous group. We aimed to evaluate the clinicopathological characteristics and outcomes of osteosarcoma patients with lung metastases and to compare the synchronous and metachronous lung metastatic groups. A total of 93 adolescent and adult patients with lung metastatic osteosarcoma, from March 1995 to July 2011, in a single center, were included. Sixty-five patients (69.9% were male. The median age was 19 years (range, 14-74. Thirty-nine patients (41.9% had synchronous lung metastases (Group A and 54 patients (58.1% had metachronous lung metastases (Group B. The 5-year and 10-year post-lung metastases overall survival (PLM-OS was 17% and 15%, respectively. In multivariate analysis for PLM-OS, time to lung metastases (p = 0.010, number of metastatic pulmonary nodules (p = 0.020, presence of pulmonary metastasectomy (p = 0.007 and presence of chemotherapy for lung metastases (p< 0.001 were found to be independent prognostic factors. The median PLM-OS of Group A and Group B was 16 months and 9 months, respectively. In Group B, the median PLM-OS of the patients who developed lung metastases within 12 months was 6 months, whereas that of the patients who developed lung metastases later was 16 months. Time to lung metastases, number and laterality of metastatic pulmonary nodules, chemotherapy for lung metastatic disease and pulmonary metastasectomy were independent prognostic factors for patients with lung metastatic osteosarcoma. The best PLM-OS was in the subgroup of patients treated both surgery and chemotherapy. The prognosis of the patients who developed lung metastases within 12 months after diagnosis was worst.

  11. Distant Metastases of Nasopharyngeal Carcinoma after Definite Irradiation

    International Nuclear Information System (INIS)

    Chung, Eun Ji; Lee, Hyung Sik; Moon, Sun Rock; Kim, Gwi Eon; Loh, John Juhn-Kyu

    1991-01-01

    One hundred and thirty five patients with carcinoma of the nasopharynx were treated by radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University between August 1977 and July 1987. Of the 30 patients omitted: 8 had distant metastases at initial diagnosis or during radiotherapy; 18 patients refused or did not received a full course of radiation therapy, and four had not been confirmed histologically. The remaining 105 patients were analyzed to determine the incidence and patter of distant metastases. Diagnosis of distant metastases was made based on clinical signs and radiography, even though histologic confirmation was not made. Twenty-six patients developed distant metastases after definite irradiation of nasopharynx and neck, an incidence rate of 24.8%. The common sites of distant metastases were, in descending order, bone, lung, liver, and brain. There was a strong correlation between Ho's N stage and distant metastases rate. But sex, age, histologic subtype (squamous cell and undifferentiated cell), AJC T and N stage, treatment modalities (radiotherapy alone and radiotherapy combined with chemotherapy) were not significant. Of those patients who developed distant metastases, 80.8% were discovered within 2 years of their radical radiotherapy. The prognosis for nasopharyngeal carcinoma patients developing distant metastases was poor: median survival was nine months and 80% of those patients died within two years of the initial diagnosis of distant metastasis

  12. Lung

    International Nuclear Information System (INIS)

    DeNardo, G.L.; Blankenship, W.J.; Burdine, J.A. Jr.; DeNardo, S.J.

    1975-01-01

    At present no simple statement can be made relative to the role of radionuclidic lung studies in the pediatric population. It is safe to assume that they will be used with increasing frequency for research and clinical applications because of their sensitivity and ready applicability to the pediatric patient. Methods comparable to those used in adults can be used in children older than 4 years. In younger children, however, a single injection of 133 Xe in solution provides an index of both regional perfusion and ventilation which is easier to accomplish. This method is particularly valuable in infants and neonates because it is rapid, requires no patient cooperation, results in a very low radiation dose, and can be repeated in serial studies. Radionuclidic studies of ventilation and perfusion can be performed in almost all children if the pediatrician and the nuclear medicine specialist have motivation and ingenuity. S []ontaneous pulmonary vascular occlusive disease which occurs in infants and pulmonary emboli in children are easily detected using radionuclides. The pathophysiologic defects of pulmonary agenesis, bronchopulmonary sequestration, and foreign body aspiration may be demonstrated by these techniques. These techniques also appear to be useful in following patients with bronchial asthma, cystic fibrosis, congenital emphysema, and postinfection pulmonary abnormalities. (auth)

  13. Immune responses to metastases

    International Nuclear Information System (INIS)

    Herberman, R.B.; Wiltrout, R.H.; Gorelik, E.

    1987-01-01

    The authors present the changes in the immune system in tumor-bearing hosts that may influence the development of progression of metastases. Included are mononuclear cell infiltration of metastases; alterations in natural resistance mediated by natural killer cells and macrophages; development of specific immunity mediated by T-lymphocytes or antibodies; modulation of tumor-associated antigen expression; and the down-regulation of the immune response to the tumor by several suppressor mechanisms; the augmentation of the immune response and its potential for therapeutic application; includes the prophylaxis of metastases formation by NK cells; the therapy of metastases by augmentation NK-, macrophage-, or T-lymphocyte-mediated responses by biological response modifiers; and the transfer of anticancer activity by cytoxic T-lymphocytes or immunoconjugates of monoclonal antibodies with specificity for tumors

  14. Lung diffusing capacity for nitric oxide and carbon monoxide in relation to morphological changes as assessed by computed tomography in patients with cystic fibrosis

    Directory of Open Access Journals (Sweden)

    Nowak Dennis

    2009-06-01

    Full Text Available Abstract Background Due to large-scale destruction, changes in membrane diffusion (Dm may occur in cystic fibrosis (CF, in correspondence to alterations observed by computed tomography (CT. Dm can be easily quantified via the diffusing capacity for nitric oxide (DLNO, as opposed to the conventional diffusing capacity for carbon monoxide (DLCO. We thus studied the relationship between DLNO as well as DLCO and a CF-specific CT score in patients with stable CF. Methods Simultaneous single-breath determinations of DLNO and DLCO were performed in 21 CF patients (mean ± SD age 35 ± 9 y, FEV1 66 ± 28%pred. Patients also underwent spirometry and bodyplethysmography. CT scans were evaluated via the Brody score and rank correlations (rS with z-scores of functional measures were computed. Results CT scores correlated best with DLNO (rS = -0.83; p S = -0.63; p CO (rS = -0.79; p NO were significantly lower than for DLCO (p 1, IVC or bodyplethysmographic (e.g., SRaw, RV/TLC indices were weaker than for DLNO or DLCO but most of them were also significant (p Conclusion In this cross sectional study in patients with CF, DLNO and DLCO reflected CT-morphological alterations of the lung better than other measures. Thus the combined diffusing capacity for NO and CO may play a future role for the non-invasive, functional assessment of structural alterations of the lung in CF.

  15. Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes

    International Nuclear Information System (INIS)

    Zakaria, Rasheed; Das, Kumar; Radon, Mark; Bhojak, Maneesh; Rudland, Philip R; Sluming, Vanessa; Jenkinson, Michael D

    2014-01-01

    Diffusion-weighted MRI (DWI) has been used in neurosurgical practice mainly to distinguish cerebral metastases from abscess and glioma. There is evidence from other solid organ cancers and metastases that DWI may be used as a biomarker of prognosis and treatment response. We therefore investigated DWI characteristics of cerebral metastases and their peritumoral region recorded pre-operatively and related these to patient outcomes. Retrospective analysis of 76 cases operated upon at a single institution with DWI performed pre-operatively at 1.5T. Maps of apparent diffusion coefficient (ADC) were generated using standard protocols. Readings were taken from the tumor, peritumoral region and across the brain-tumor interface. Patient outcomes were overall survival and time to local recurrence. A minimum ADC greater than 919.4 × 10 -6 mm 2 /s within a metastasis predicted longer overall survival regardless of adjuvant therapies. This was not simply due to differences between the types of primary cancer because the effect was observed even in a subgroup of 36 patients with the same primary, non-small cell lung cancer. The change in diffusion across the tumor border and into peritumoral brain was measured by the “ADC transition coefficient” or ATC and this was more strongly predictive than ADC readings alone. Metastases with a sharp change in diffusion across their border (ATC >0.279) showed shorter overall survival compared to those with a more diffuse edge. The ATC was the only imaging measurement which independently predicted overall survival in multivariate analysis (hazard ratio 0.54, 95% CI 0.3 – 0.97, p = 0.04). DWI demonstrates changes in the tumor, across the tumor edge and in the peritumoral region which may not be visible on conventional MRI and this may be useful in predicting patient outcomes for operated cerebral metastases

  16. Liver metastases of breast carcinoma detected on /sup 99m/Tc-methylene diphosphonate bone scan

    International Nuclear Information System (INIS)

    Baumert, J.E.; Lantieri, R.L.; Horning, S.; McDougall, I.R.

    1980-01-01

    The accumulation of bone-seeking radiopharmaceuticals has been reported in liver metastases from colon carcinoma and oat cell carcinoma of the lung. Two patients with breast carcinoma in whom hepatic metastases were visualized on /sup 99m/Tc-methylene diphosphonate bone images are described. This has not been previously reported

  17. Gamma Knife Treatment of Brainstem Metastases

    Science.gov (United States)

    Peterson, Halloran E.; Larson, Erik W.; Fairbanks, Robert K.; MacKay, Alexander R.; Lamoreaux, Wayne T.; Call, Jason A.; Carlson, Jonathan D.; Ling, Benjamin C.; Demakas, John J.; Cooke, Barton S.; Peressini, Ben; Lee, Christopher M.

    2014-01-01

    The management of brainstem metastases is challenging. Surgical treatment is usually not an option, and chemotherapy is of limited utility. Stereotactic radiosurgery has emerged as a promising palliative treatment modality in these cases. The goal of this study is to assess our single institution experience treating brainstem metastases with Gamma Knife radiosurgery (GKRS). This retrospective chart review studied 41 patients with brainstem metastases treated with GKRS. The most common primary tumors were lung, breast, renal cell carcinoma, and melanoma. Median age at initial treatment was 59 years. Nineteen (46%) of the patients received whole brain radiation therapy (WBRT) prior to or concurrent with GKRS treatment. Thirty (73%) of the patients had a single brainstem metastasis. The average GKRS dose was 17 Gy. Post-GKRS overall survival at six months was 42%, at 12 months was 22%, and at 24 months was 13%. Local tumor control was achieved in 91% of patients, and there was one patient who had a fatal brain hemorrhage after treatment. Karnofsky performance score (KPS) >80 and the absence of prior WBRT were predictors for improved survival on multivariate analysis (HR 0.60 (p = 0.02), and HR 0.28 (p = 0.02), respectively). GKRS was an effective treatment for brainstem metastases, with excellent local tumor control. PMID:24886816

  18. The effect of non-small cell lung cancer histology on survival as measured by the graded prognostic assessment in patients with brain metastases treated by hypofractionated stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Ma, Liang-Hua; Li, Guang; Zhang, Hong-Wei; Wang, Zhi-Yu; Dang, Jun; Zhang, Shuo; Yao, Lei

    2016-01-01

    The purpose of this study was to investigate the impact of histology on survival stratified by the Graded Prognostic Assessment (GPA) for non-small cell lung cancer (NSCLC) in a group of selected patients treated recently. A total of 171 NSCLC patients with brain metastases treated by hypofractionated stereotactic radiotherapy with or without whole-brain radiotherapy between 2001 and 2011 were included. The GPA score was calculated for each patient. Tumor histologies were categorized into adenocarcinoma (ADCA) and non-ADCA. Median survival time (MST, in months) was calculated using the Kaplan-Meier method. The log-rank test was used to determine statistical differences. MSTs by histology were: ADCA 15 (n = 92) and non-ADCA 10 (n = 79) (p < 0.001). For all patients, the MSTs by GPA score were: GPA 3.5-4, 24; GPA 2.5-3, 15; GPA 1.5-2, 9 and GPA 0-1, 6 (p < 0.001). The histology of ADCA showed a statistically significant higher MST than non-ADCA for patients with GPA 2.5-4. For GPA 2.5-3, MSTs were: ADCA 18, non-ADCA 10 (p = 0.007); for GPA 3.5-4, MSTs were: ADCA 30, non-ADCA 17 (p = 0.046). For GPA 0-2, MSTs did not differ significantly by histology. For GPA 0-1, MSTs were: ADCA 8, non-ADCA 4 (p = 0.146); GPA 1.5-2, MSTs were: ADCA 10, non-ADCA 8 (p = 0.291). We further found that non-ADCA in upper GPA class (3.5–4) had similar survival with ADCA in lower GPA class (2.5–3) (MSTs were 17 and 18, respectively, p = 0.775). This phenomenon also happened between patients of non-ADCA in upper GPA class (2.5–3) and those of ADCA in lower GPA class (1.5–2) (MSTs were both 10, p = 0.724). We confirmed that the histology of NSCLC had effect on the GPA in these selected patients treated recently. ADCA showed a statistically significant higher MST than non-ADCA with GPA 2.5-4. The non-ADCA in upper GPA classes (3.5-4 and 2.5-3) had similar survival to ADCA in lower GPA classes (2.5-3 and 1.5-2, respectively). The histology as a new factor should be added to the original

  19. Surgical treatment of brain metastases - a review. Part 2. Results of treatment

    International Nuclear Information System (INIS)

    Wronski, M.; Czernicki, Z.

    1994-01-01

    Results of treatment of most frequent brain metastases from nonsmall cell lung cancer, breast cancer, malignant melanoma and kidney tumors are discussed. Also efficacy of surgical treatment, chemotherapy, radiotherapy and radiosurgery is analyzed

  20. Palliative radiotherapy for liver metastases

    International Nuclear Information System (INIS)

    Eble, M.J.; Gademann, G.; Wannenmacher, M.

    1993-01-01

    The role of palliative irradiation was analysed in 55 patients with liver metastases from colorectal, breast and lung cancer, treated with irradiation doses more than 10 Gy. In 47 patients irradiation alone was done. In 29 patients the disease involved not only the liver, but was disseminated. A mean dose of 23.8 Gy was delivered, with daily fractions of 1.5, 1.8 or 2 Gy. Complete and near complete pain relief was obtained in six and nine patients. Normalized and near normalized values of bilirubin serum levels were obtained in five and seven patients. Relief of pain as well as normalisation of cholestasis were significantly correlated with the irradiation doses applied. Median survival was 36.5 days for patients with lung cancer, 70.5 and 73 days for patients with breast and colorectal cancer. Irradiation doses given and the status of disease were significantly correlated to prognosis. In the majority of our patients with clinical symptoms, i.e. pain or cholestase, irradiation alone was sufficient for palliation of these symptoms. Prognosis is limited because of the disseminated state of disease in 62% of the patients. In a group of patients, suffering from colorectal cancer with good prognostic criteria, the simultaneous application of radiotherapy and systemic chemotherapy was able to increase significantly the survival with minor toxicity. The use of a three-dimensional treatment planning could optimize the radiotherapy, due to the dose-volume histogram analysis. (orig./MG) [de

  1. Use of intravoxel incoherent motion diffusion-weighted MR imaging for assessment of treatment response to invasive fungal infection in the lung

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Chenggong; Xiong, Wei; Wu, Yuankui; Li, Caixia; Xu, Yikai [Southern Medical University, Department of Medical Imaging Center, Nanfang Hospital, Guangzhou (China); Xu, Jun; Wei, Qi; Feng, Ru; Liu, Qifa [Southern Medical University, Department of Hematology, Nanfang Hospital, Guangzhou (China); Chan, Queenie [Philips Healthcare, New Territories, Hon Kong (China)

    2017-01-15

    The purpose of this study was to determine whether intravoxel incoherent motion (IVIM) -derived parameters and apparent diffusion coefficient (ADC) could act as imaging biomarkers for predicting antifungal treatment response. Forty-six consecutive patients (mean age, 33.9 ± 13.0 y) with newly diagnosed invasive fungal infection (IFI) in the lung according to EORTC/MSG criteria were prospectively enrolled. All patients underwent diffusion-weighted magnetic resonance (MR) imaging at 3.0 T using 11 b values (0-1000 sec/mm{sup 2}). ADC, pseudodiffusion coefficient D*, perfusion fraction f, and the diffusion coefficient D were compared between patients with favourable (n=32) and unfavourable response (n=14). f values were significantly lower in the unfavourable response group (12.6%±4.4%) than in the favourable response group (30.2%±8.6%) (Z=4.989, P<0.001). However, the ADC, D, and D* were not significantly different between the two groups (P>0.05). Receiver operating characteristic curve analyses showed f to be a significant predictor for differentiation, with a sensitivity of 93.8% and a specificity of 92.9%. IVIM-MRI is potentially useful in the prediction of antifungal treatment response to patients with IFI in the lung. Our results indicate that a low perfusion fraction f may be a noninvasive imaging biomarker for unfavourable response. (orig.)

  2. Phase II study on stereotactic body radiotherapy of colorectal metastases

    DEFF Research Database (Denmark)

    Høyer, Morten; Roed, Henrik; Traberg Hansen, Anders

    2006-01-01

    Surgical resection provides long term survival in approximately 30% of patients with colorectal carcinoma (CRC) liver metastases. However, only a limited number of patients with CRC-metastases are amendable for surgery. We have tested the effect of stereotactic body radiotherapy (SBRT) in the tre......Surgical resection provides long term survival in approximately 30% of patients with colorectal carcinoma (CRC) liver metastases. However, only a limited number of patients with CRC-metastases are amendable for surgery. We have tested the effect of stereotactic body radiotherapy (SBRT......) in the treatment of inoperable patients with CRC-metastases. Sixty-four patients with a total number of 141 CRC-metastases in the liver (n = 44), lung (n = 12), lymph nodes (n = 3), suprarenal gland (n = 1) or two organs (n = 4) were treated with SBRT with a central dose of 15 Gy x 3 within 5-8 days. Median follow...... due to hepatic failure, one patient was operated for a colonic perforation and two patients were conservatively treated for duodenal ulcerations. Beside these, only moderate toxicities such as nausea, diarrhoea and skin reactions were observed. SBRT in patients with inoperable CRC-metastases resulted...

  3. Extra-Neural Metastases of Malignant Gliomas: Myth or Reality?

    Energy Technology Data Exchange (ETDEWEB)

    Beauchesne, Patrick [Neuro-Oncology, CHU de NANCY, Hôpital Central, CO n°34, 54035 Nancy Cedex (France)

    2011-01-27

    Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years— despite debulking surgery, radiotherapy and cytotoxic chemotherapy—with a median survival of 9–12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases.

  4. Extra-Neural Metastases of Malignant Gliomas: Myth or Reality?

    International Nuclear Information System (INIS)

    Beauchesne, Patrick

    2011-01-01

    Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years— despite debulking surgery, radiotherapy and cytotoxic chemotherapy—with a median survival of 9–12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases

  5. Anesthetic drugs accelerate the progression of postoperative metastases of mouse tumors.

    OpenAIRE

    Shapiro, J; Jersky, J; Katzav, S; Feldman, M; Segal, S

    1981-01-01

    Experiments were made to investigate the effect of four anesthetic drugs that are commonly used in surgical practice on the postoperative growth of mouse tumors in syngeneic recipients. These experiments revealed that some of the anesthetics when applied for surgical excision of the local tumor, strongly accelerated postoperative progression of spontaneous lung metastases produced by the 3LL Lewis lung carcinoma and by the B16 melanoma. Some of the drugs caused the appearance of metastases in...

  6. Breakdown of lung framework and an increase in pores of Kohn as initial events of emphysema and a cause of reduction in diffusing capacity.

    Science.gov (United States)

    Yoshikawa, Akira; Sato, Shuntaro; Tanaka, Tomonori; Hashisako, Mikiko; Kashima, Yukio; Tsuchiya, Tomoshi; Yamasaki, Naoya; Nagayasu, Takeshi; Yamamoto, Hiroshi; Fukuoka, Junya

    2016-01-01

    Pulmonary emphysema is the pathological prototype of chronic obstructive pulmonary disease and is also associated with other lung diseases. We considered that observation with different approaches may provide new insights for the pathogenesis of emphysema. We reviewed tissue blocks of the lungs of 25 cases with/without emphysema and applied a three-dimensional observation method to the blocks. Based on the three-dimensional characteristics of the alveolar structure, we considered one face of the alveolar polyhedron as a structural unit of alveoli and called it a framework unit (FU). We categorized FUs based on their morphological characteristics and counted their number to evaluate the destructive changes in alveoli. We also evaluated the number and the area of pores of Kohn in FUs. We performed linear regression analysis to estimate the effect of these data on pulmonary function tests. In multivariable regression analysis, a decrease in the number of FUs without an alveolar wall led to a significant decrease in the diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO per unit alveolar volume, and an increase in the area of pores of Kohn had a significant effect on an increase in residual capacity. A breakdown in the lung framework and an increase in pores of Kohn are associated with a decrease in DLCO and DLCO per unit alveolar volume with/without emphysema.

  7. CT and MR imaging in the evaluation of leptomeningeal metastases

    International Nuclear Information System (INIS)

    Xiao Jiahe; Wang Dayou; Deng Kaihong

    1999-01-01

    Objective: To study the manifestations of leptomeningeal metastases on CT and MR imaging, and evaluate the diagnostic significance of both modalities for this disease. Methods: Clinical and neuroradiological data of 21 cases with leptomeningeal metastases were retrospectively reviewed. In this series, 16 patients were studied by CT and 7 patients by MRI, 2 patients by both CT and MRI. Results: Abnormal enhancement of pia and subarachnoid space, appearing as diffuse pattern in 10 cases, nodular pattern in 8 cases and mixed pattern with diffuse plus nodules in 3 cases, were visualized by CE-CT and Gd-MRI. Diffuse enhancement followed the convolutions of gyri and surface of brainstem, and extended into cerebral cisterns and sulci. the foci appeared as enhanced nodules 0.2-3.0 cm in diameter and 1 or more in number. Nodules with infiltration of cerebral parenchymal were found in 4 patients. In 86% of all cases, diffuse or nodular foci occurred in basilar systems and adjacent cerebellar and cerebral sulci. There were 4 cases associated with ependymal nodular enhancement and 10 cases with widened irregular tentorial enhancement. Intracerebral metastases in 9 cases and hydrocephalus in 13 cases were found in this series. Conclusions: CE-CT and Gd-MRI are had significant clinical diagnostic value for leptomeningeal metastases, Gd-MRI is superior to CE-CT. Because of the limitation in the evaluation of leptomeningeal invasion by neoplasms on CT and MRI, definitive diagnosis of leptomeningeal metastases depends on combination of clinical and imaging data

  8. Use of radiopharmaceuticals for treating bone metastases

    International Nuclear Information System (INIS)

    Alberti Ramírez, Alejandro; Morín Zorrilla, José; Cruz Arencibia, Jorge

    2016-01-01

    Cancer prevalence is estimated at around 2% of the population and on average between 64-80% of patients with solid tumors develop bone metastases, being breast tumors, lung and prostate those who do more frequency. In this paper an estimate of the prevalence of bone pain from metastases, with reference to the data reported in the literature is presented. the different treatment techniques are summarized for pain management with special emphasis on Radionuclidic therapy, analyzing the different factors to consider for the selection of suitable radiopharmaceutical. cost data and cost-benefit of some radiopharmaceuticals for the purpose to take into account during their selection are provided. It is concluded that although the treatment of metastatic bone disease requires multidisciplinary therapies, Radionuclidic therapy is not sufficiently used, particularly by inadequate perception of risks and costs of radiopharmaceuticals, despite the undeniable support of its efficacy and tolerability. (author)

  9. The impact of iterative reconstruction in low-dose computed tomography on the evaluation of diffuse interstitial lung disease

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyun Ju; Chung, Myung Jin; Shin, Kyung Eun; Hwang, Hye Sun; Lee, Kyung Soo [Dept. of Radiology nd Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-11-15

    To evaluate the impact of iterative reconstruction (IR) on the assessment of diffuse interstitial lung disease (DILD) using CT. An American College of Radiology (ACR) phantom (module 4 to assess spatial resolution) was scanned with 10-100 effective mAs at 120 kVp. The images were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), with blending ratios of 0%, 30%, 70% and 100%, and model-based iterative reconstruction (MBIR), and their spatial resolution was objectively assessed by the line pair structure method. The patient study was based on retrospective interpretation of prospectively acquired data, and it was approved by the institutional review board. Chest CT scans of 23 patients (mean age 64 years) were performed at 120 kVp using 1) standard dose protocol applying 142-275 mA with dose modulation (high-resolution computed tomography [HRCT]) and 2) low-dose protocol applying 20 mA (low dose CT, LDCT). HRCT images were reconstructed with FBP, and LDCT images were reconstructed using FBP, ASIR, and MBIR. Matching images were randomized and independently reviewed by chest radiologists. Subjective assessment of disease presence and radiological diagnosis was made on a 10-point scale. In addition, semi-quantitative results were compared for the extent of abnormalities estimated to the nearest 5% of parenchymal involvement. In the phantom study, ASIR was comparable to FBP in terms of spatial resolution. However, for MBIR, the spatial resolution was greatly decreased under 10 mA. In the patient study, the detection of the presence of disease was not significantly different. The values for area under the curve for detection of DILD by HRCT, FBP, ASIR, and MBIR were as follows: 0.978, 0.979, 0.972, and 0.963. LDCT images reconstructed with FBP, ASIR, and MBIR tended to underestimate reticular or honeycombing opacities (-2.8%, -4.1%, and -5.3%, respectively) and overestimate ground glass opacities (+4.6%, +8.9%, and

  10. Modelling non-homogeneous stochastic reaction-diffusion systems: the case study of gemcitabine-treated non-small cell lung cancer growth.

    Science.gov (United States)

    Lecca, Paola; Morpurgo, Daniele

    2012-01-01

    Reaction-diffusion based models have been widely used in the literature for modeling the growth of solid tumors. Many of the current models treat both diffusion/consumption of nutrients and cell proliferation. The majority of these models use classical transport/mass conservation equations for describing the distribution of molecular species in tumor spheroids, and the Fick's law for describing the flux of uncharged molecules (i.e oxygen, glucose). Commonly, the equations for the cell movement and proliferation are first order differential equations describing the rate of change of the velocity of the cells with respect to the spatial coordinates as a function of the nutrient's gradient. Several modifications of these equations have been developed in the last decade to explicitly indicate that the tumor includes cells, interstitial fluids and extracellular matrix: these variants provided a model of tumor as a multiphase material with these as the different phases. Most of the current reaction-diffusion tumor models are deterministic and do not model the diffusion as a local state-dependent process in a non-homogeneous medium at the micro- and meso-scale of the intra- and inter-cellular processes, respectively. Furthermore, a stochastic reaction-diffusion model in which diffusive transport of the molecular species of nutrients and chemotherapy drugs as well as the interactions of the tumor cells with these species is a novel approach. The application of this approach to he scase of non-small cell lung cancer treated with gemcitabine is also novel. We present a stochastic reaction-diffusion model of non-small cell lung cancer growth in the specification formalism of the tool Redi, we recently developed for simulating reaction-diffusion systems. We also describe how a spatial gradient of nutrients and oncological drugs affects the tumor progression. Our model is based on a generalization of the Fick's first diffusion law that allows to model diffusive transport in non

  11. Management of Brain Metastases.

    Science.gov (United States)

    Jeyapalan, Suriya A.; Batchelor, Tracy

    2004-07-01

    Advances in neurosurgery and the development of stereotactic radiosurgery have expanded treatment options available for patients with brain metastases. However, despite several randomized clinical trials and multiple uncontrolled studies, there is not a uniform consensus on the best treatment strategy for all patients with brain metastases. The heterogeneity of this patient population in terms of functional status, types of underlying cancers, status of systemic disease control, and number and location of brain metastases make such consensus difficult. Nevertheless, in certain situations, there is Class I evidence that supports one approach or another. The primary objectives in the management of this patient population include improved duration and quality of survival. Very few patients achieve long-term survival after the diagnosis of a brain metastasis.

  12. High-Frequency Jet Ventilation for Complete Target Immobilization and Reduction of Planning Target Volume in Stereotactic High Single-Dose Irradiation of Stage I Non-Small Cell Lung Cancer and Lung Metastases

    International Nuclear Information System (INIS)

    Fritz, Peter; Kraus, Hans-Joerg; Muehlnickel, Werner; Sassmann, Volker; Hering, Werner; Strauch, Konstantin

    2010-01-01

    Purpose: To demonstrate the feasibility of complete target immobilization by means of high-frequency jet ventilation (HFJV); and to show that the saving of planning target volume (PTV) on the stereotactic body radiation therapy (SBRT) under HFJV, compared with SBRT with respiratory motion, can be predicted with reliable accuracy by computed tomography (CT) scans at peak inspiration phase. Methods and Materials: A comparison regarding different methods for defining the PTV was carried out in 22 patients with tumors that clearly moved with respiration. A movement span of the gross tumor volume (GTV) was defined by fusing respiration-correlated CT scans. The PTV enclosed the GTV positions with a safety margin throughout the breathing cycle. To create a PTV from CT scans acquired under HFJV, the same margins were drawn around the immobilized target. In addition, peak inspiration phase CT images (PIP-CTs) were used to approximate a target immobilized by HFJV. Results: The resulting HFJV-PTVs were between 11.6% and 45.4% smaller than the baseline values calculated as respiration-correlated CT-PTVs (median volume reduction, 25.4%). Tentative planning by means of PIP-CT PTVs predicted that in 19 of 22 patients, use of HFJV would lead to a reduction in volume of ≥20%. Using this threshold yielded a positive predictive value of 0.89, as well as a sensitivity of 0.94 and a specificity of 0.5. Conclusions: In all patients, SBRT under HFJV provided a reliable immobilization of the GTVs and achieved a reduction in PTVs, regardless of patient compliance. Tentative planning facilitated the selection of patients who could better undergo radiation in respiratory standstill, both with greater accuracy and lung protection.

  13. Inguinal metastases from testicular cancer

    DEFF Research Database (Denmark)

    Daugaard, Gedske; Karas, Vladimir; Sommer, Peter

    2006-01-01

    To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease.......To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease....

  14. Malignant pilomatricoma in a dog with local and distant metastases ...

    African Journals Online (AJOL)

    The dog had a malignant pilomatricoma removed from the left lateral thigh 6 months earlier. Histopathology review of the cutaneous and scapular mass identified the same tumour type, confirming metastatic disease; additional metastases to the inguinal lymph node, liver and lungs were identified. Chemotherapy resulted in ...

  15. A study of computational dosimetry and boron biodistribution for ex – situ lung BNCT at RA-3 Reactor

    International Nuclear Information System (INIS)

    Garabalino, M.A.; Trivillin, V. A.; Monti Hughes, A.; Pozzi, E.C.C.; Thorp, S.; Curotto, P; Miller, M.; Santa Cruz, G.A.; Saint Martin, G.; Schwint, A.E.; González, S.J.; Farías, R.O; Portu, A.; Ferraris, S.; Santa María, J.; Lange, F.; Bortolussi, S.; Altieri, S.

    2013-01-01

    Within the context of the preclinical ex-situ BNCT Project for the treatment of diffuse lung metastases, we performed boron biodistribution studies in a sheep model and computational dosimetry studies in human lung to evaluate the potential therapeutic efficacy of the proposed technique. Herein we report preliminary data that supports the use of the sheep model as an adequate human surrogate in terms of boron kinetics and uptake in clinically relevant tissues. Furthermore, the estimation of the potential therapeutic efficacy of the proposed treatment in humans, based on boron uptake values in the large animal model, yields promising tumor control probability values even in the most conservative scenario considered. (author)

  16. Uncommon mucosal metastases to the stomach

    Directory of Open Access Journals (Sweden)

    Kanthan R

    2009-08-01

    Full Text Available Abstract Background Metastases to the stomach from an extra-gastric neoplasm are an unusual event, identified in less than 2% of cancer patients at autopsy. The stomach may be involved by hematogenous spread from a distant primary (most commonly breast, melanoma or lung, or by contiguous spread from an adjacent malignancy, such as the pancreas, esophagus and gallbladder. These latter sites may also involve the stomach via lymphatic or haematogenous spread. We present three cases of secondary gastric malignancy. Methods/Results The first is a 19-year-old male who received a diagnosis of testicular choriocarcinoma in September 2004. Metastatic malignancy was demonstrated in the stomach after partial gastrectomy was performed to control gastric hemorrhage. The second is a 75-year-old male, generally well, who was diagnosed with adenocarcinoma of the lung in September 2005. Poorly differentiated adenocarcinoma of the lung was demonstrated in a subsequent biopsy of "gastric polyps". The third is an 85-year-old man with no known history of malignancy who presented for evaluation of iron deficiency anemia by endoscopy in February 2006. Biopsies of the colonic and gastric mucosa demonstrated moderately differentiated invasive colonic adenocarcinoma with metastatic deposits in the stomach. Conclusion While the accurate recognition of these lesions at endoscopy is fraught with difficulty, pathological awareness of such uncommon metastases in the gastric mucosa is essential for accurate diagnosis and optimal patient management.

  17. Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale

    International Nuclear Information System (INIS)

    Menassa, L.; Haddad, S.; Aoun, N.; Slaba, S.; Atallah, N.

    1997-01-01

    We report the case of a patient in whom brain MR imaging was requested for initial symptoms of intracranial hypertension. The presence of multiple intracranial hemorrhagic lesions suggested brain metastases. Body screening showed periosteal osteosarcoma of the left fibula with no lung metastases, but with a patent foramen ovale which probably allowed neoplastic cells to reach the brain without being filtered through the lungs. The conclusion of this study was that a left-right cardiac communication is to be considered in cases of isolated brain metastases from osteosarcoma. (orig.). With 3 figs

  18. Synchronous colorectal liver metastases

    NARCIS (Netherlands)

    A.E.M. van der Pool (Anne)

    2011-01-01

    textabstractColorectal cancer is one of the most common malignancies worldwide and ranks second in cancer-related deaths in many parts of the Western world. Once in the lymph or blood vessels, colorectal cancer can quickly spread and the liver is known to be a favourable site for metastases. The

  19. Usefulness of {sup 99m}Tc-depreotide scintigraphy for the diagnosis of bone metastases in non-small cell lung cancer stage 3-4; Apport de la scintigraphie au {sup 99m}Tc-depreotide pour le diagnostic de lesions osseuses secondaires dans le cancer bronchopulmonaire non a petites cellules stade 3-4

    Energy Technology Data Exchange (ETDEWEB)

    Costo, S.; Dunet, V.; Agostini, D.; Bouvard, G. [CHU Cote de Nacre, Service de Medecine Nucleaire et Isotopes, 14 - Caen (France); Halley, A. [Centre Havrais d' Imagerie Nucleaire, 76 - Montivilliers (France); Bergot, E.; Porret, E.; Zalcman, G. [CHU Cote de Nacre, Service de Pneumologie, 14 - Caen (France)

    2009-02-15

    Objective In non-small cell lung cancer (NSCLC), metastatic bone involvement is usually assessed using conventional {sup 99m}Tc-HMDP bone scintigraphy, which has a high sensitivity but a poor specificity. The purpose of this study was to assess the usefulness of the {sup 99m}Tc-D scintigraphy for the detection of malignant bone metastases in patients with NSCLC stage III or IV and to compare these results with {sup 99m}Tc-HMDP bone scan findings. Methods Nineteen patients (13 M and 6 F, mean age 59 years) with proven NSCLC, suspected to have stage III or IV were enrolled prospectively. All patients underwent whole body {sup 99m}Tc-HMDP and {sup 99m}Tc-D scintigraphy to detect bone metastases within a mean interval of 14 days. Each focal uptake of {sup 99m}Tc-D or {sup 99m}Tc-HMDP was considered benign or malignant, leading to positive or negative diagnosis for bone involvement. The final diagnosis of bone metastases was established by a lung specialist, on the basis of additional imaging modalities and of 12 months follow-up. Results Twelve bone lesions were identified by {sup 99m}Tc-D scintigraphy, 10 were classified as bone metastases and two were classified as inflammatory bone lesions. Four patients were metastatic. Fifty eight bone lesions were detected by {sup 99m}Tc-HMDP scintigraphy, 26 of whom were considered malignant, eight patients were thus considered metastatic. Thereby, the two nuclear medicine modalities were concordant for 13 patients, that is 68% of cases and were discordant for six patients, representing 32% of cases. Diagnostic sensitivity, specificity and accuracy of depreotide scintigraphy and {sup 99m}Tc-HMDP bone scintigraphy were 75% for both, 93.3 and 73.3%, and 89.5 and 73.3% respectively. Conclusion Our data suggest that depreotide scintigraphy with the same sensitivity, a better accuracy and specificity than those of {sup 99m}Tc-HMDP bone scan can detect metastatic bone lesions in patients with NSCLC suspected to have stage III or IV

  20. Magnetic resonance imaging of intramuscular metastases

    International Nuclear Information System (INIS)

    Surov, Alexey; Spielmann, Rolf-Peter; Behrmann, Curd; Fiedler, Eckhard; Voigt, Wieland; Wienke, Andreas; Holzhausen, Hans-Juergen

    2011-01-01

    The aim of the present study was to analyse magnetic resonance findings of intramuscular metastases (IM) in a relatively large series. From January 2000 to January 2010, 28 patients (207 metastases) were retrospectively identified in the radiological database of the Martin-Luther-University. Several different scanning protocols were used depending on the localisation of IM. In 12 patients diffusion-weighted (DW) images were obtained with a multi-shot SE-EPI sequence. Apparent diffusion coefficient (ADC) maps were also calculated. Furthermore, fusion images were manually generated between the DW and half-Fourier acquisition single-shot turbo spin echo (HASTE) images. On T2-weighted images, 97% of the recognised IM were hyperintense in comparison to unaffected musculature, and 3% were mixed iso- to hyperintense. On T1-weighted images most IM (91%) were homogeneously isointense in comparison to muscle tissue, whereas 4% were hypointense, and 5% lightly hyperintense. ADC maps were calculated for 91 metastases ranging from 0.99 to 4.00 mm 2 s -1 (mean value 1.99 ± 0.66). ADC values of low ( 3.0) in 6%. Of the IM that were investigated with contrast medium, 88.5% showed marked enhancement. It was homogeneous in 88% and heterogenous in 6%. Rim enhancement with central low attenuation was seen in 6%. There was no difference in enhancement characteristics with respect to ADC values or fusion patterns. Peritumoral enhancement was identified in 2.4%. Magnetic resonance features of muscle metastases are relatively typical and consist of round or oval intramuscular masses with well-defined margins, marked enhancement, low or moderate ADC values, and moderate to high signal intensity on fusion images. (orig.)

  1. High-resolution computed tomography to differentiate chronic diffuse interstitial lung diseases with predominant ground-glass pattern using logical analysis of data

    International Nuclear Information System (INIS)

    Martin, Sophie Grivaud; Brauner, Michel W.; Rety, Frederique; Kronek, Louis-Philippe; Brauner, Nadia; Valeyre, Dominique; Nunes, Hilario; Brillet, Pierre-Yves

    2010-01-01

    We evaluated the performance of high-resolution computed tomography (HRCT) to differentiate chronic diffuse interstitial lung diseases (CDILD) with predominant ground-glass pattern by using logical analysis of data (LAD). A total of 162 patients were classified into seven categories: sarcoidosis (n = 38), connective tissue disease (n = 32), hypersensitivity pneumonitis (n = 18), drug-induced lung disease (n = 15), alveolar proteinosis (n = 12), idiopathic non-specific interstitial pneumonia (n = 10) and miscellaneous (n = 37). First, 40 CT attributes were investigated by the LAD to build up patterns characterising a category. From the association of patterns, LAD determined models specific to each CDILD. Second, data were recomputed by adding eight clinical attributes to the analysis. The 20 x 5 cross-folding method was used for validation. Models could be individualised for sarcoidosis, hypersensitivity pneumonitis, connective tissue disease and alveolar proteinosis. An additional model was individualised for drug-induced lung disease by adding clinical data. No model was demonstrated for idiopathic non-specific interstitial pneumonia and the miscellaneous category. The results showed that HRCT had a good sensitivity (≥64%) and specificity (≥78%) and a high negative predictive value (≥93%) for diseases with a model. Higher sensitivity (≥78%) and specificity (≥89%) were achieved by adding clinical data. The diagnostic performance of HRCT is high and can be increased by adding clinical data. (orig.)

  2. Evaluation of connectivity map-discovered celastrol as a radiosensitizing agent in a murine lung carcinoma model: Feasibility study of diffusion-weighted magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Hong Young Jun

    Full Text Available This study was designed to identify potential radiosensitizing (RS agents for combined radio- and chemotherapy in a murine model of human lung carcinoma, and to evaluate the in vivo effect of the RS agents using diffusion-weighted magnetic resonance imaging (DW-MRI. Radioresistance-associated genes in A549 and H460 cells were isolated on the basis of their gene expression profiles. Celastrol was selected as a candidate RS by using connectivity mapping, and its efficacy in lung cancer radiotherapy was tested. Mice inoculated with A549 carcinoma cells were treated with single ionizing radiation (SIR, single celastrol (SC, or celastrol-combined ionizing radiation (CCIR. Changes in radiosensitization over time were assessed using DW-MRI before and at 3, 6, and 12 days after therapy initiation. The tumors were stained with hematoxylin and eosin at 6 and 12 days after therapy. The percentage change in the apparent diffusion coefficient (ADC value in the CCIR group was significantly higher than that in the SC and SIR group on the 12th day (Mann-Whitney U-test, p = 0.05; Kruskal-Wallis test, p < 0.05. A significant correlation (Spearman's rho correlation coefficient of 0.713, p = 0.001 was observed between the mean percentage tumor necrotic area and the mean ADC values after therapy initiation. These results suggest that the novel radiosensitizing agent celastrol has therapeutic effects when combined with ionizing radiation (IR, thereby maximizing the therapeutic effect of radiation in non-small cell lung carcinoma. In addition, DW-MRI is a useful noninvasive tool to monitor the effects of RS agents by assessing cellularity changes and sequential therapeutic responses.

  3. Effects of therapeutic irradiation delivered in early childhood upon subsequent lung function

    International Nuclear Information System (INIS)

    Wohl, M.E.B.; Griscom, N.T.; Graggis, D.G.; Jaffe, N.

    1975-01-01

    To determine the long-term effects of therapeutic pulmonary irradiation and treatment with actinomycin D during a period of lung growth, 12 patients treated for Wilms' tumor metastatic to the lung and 8 patients treated for Wilms' tumor with no evidence of pulmonary metastases were studied 7 to 14 years after their initial tumor therapy. All patients had received irradiation to the tumor bed and treatment with actinomycin D. Group 1 had received a single course of bilateral pulmonary irradiation; group 2 had received additional pulmonary irradiation and/or thoracic surgery; group 3 had received no therapeutic irradiation directed primarily to the chest. Total lung capacity (TLC) averaged 71 percent of predicted value in group 1, 58 percent in group 2, and 94 percent in group 3. Diffusing capacity in groups 1 and 2 was reduced to the same extent as lung volume. Quasi-static pressure-volume relationships, studied in three of six patients in group 1, were within the normal range when lung volume was expressed as percentage of observed TLC. Airway resistance, evaluated by spirometry, maximum expiratory flow-volume curves, and resistance of the total respiratory system, was normal or reduced. The data support the hypothesis that therapeutic irradiation during a period of lung growth primarily affects the lung parenchyma and produces a decrease in subsequent size of both the lung and chest wall. No effect of actinomycin D alone upon the lung could be demonstrated

  4. F-18 FDG PET/CT in Bilateral Diffuse Pulmonary Lymphangitic Carcinomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Senthil, Raja; Parghane, Rahul; Kashyap, Raghava; Bhattacharya, Anish; Mittal, Bhagwant Rai [Postgraduate Institute of Medical Education and Resaarch, Chandigarh (India)

    2012-06-15

    A 51-year-old female patient, who had undergone left-sided modified radical mastectomy for left breast carcinoma 4 years ago, presented with dyspnea of 4 months duration F-18 FDG PET/CT of this patient showed diffusely in-creased FDG uptake in the bilateral lung fields along the thickened bronchovascular bundles. SUVmax of lymphangitic lung was 5.2. The standardized uptake ratio (SUR) of mediastinal blood pool to lymphangitic lung was 0.44. High resolution computed tomography (HRCT) of the same patient showed thickening of interlobular septa and bronchovaseular bundles, with preservation of normal parenchymal architecture. Multiple intrapulmonary nodules and bilateral hilar lymphadenopathy with pulmonary lymphangitic carcinomatosis (PLC). The lungs are the second most common sites for metastases after lymph nodes. These metastases are usually nodular on radiologic images. PLC with interstitial involvement constitutes only 7% of pulmonary metastastases. The most common primary sites, in order of frequency, are adenocarcinoma of the lung, breast, stomach, colon, and prostrate. HRCT has been the modality of choice in the radiologic diagnosis of PLC. Only a few studies have de-scribed the F-18 FDG PET/CT findings in pulmonary lymphangitic carcinomatosis. These studies have shown diffusely increased FDG uptake corresponding to the typical changes in the CT as the most common finding. One study has reported that F-18 FDG PET/CT is 100% specific and 86% sensitive in diagnosing PLC by subjective analysis. The mean SUV in the region of pulmonary lymphangitic lung was 1.26{+-}0.45 and that of blood pool to normal lung was 3.78{+-}1.37.

  5. Lung morphometry using hyperpolarized 129 Xe multi-b diffusion MRI with compressed sensing in healthy subjects and patients with COPD.

    Science.gov (United States)

    Zhang, Huiting; Xie, Junshuai; Xiao, Sa; Zhao, Xiuchao; Zhang, Ming; Shi, Lei; Wang, Ke; Wu, Guangyao; Sun, Xianping; Ye, Chaohui; Zhou, Xin

    2018-05-04

    To demonstrate the feasibility of compressed sensing (CS) to accelerate the acquisition of hyperpolarized (HP) 129 Xe multi-b diffusion MRI for quantitative assessments of lung microstructural morphometry. Six healthy subjects and six chronic obstructive pulmonary disease (COPD) subjects underwent HP 129 Xe multi-b diffusion MRI (b = 0, 10, 20, 30, and 40 s/cm 2 ). First, a fully sampled (FS) acquisition of HP 129 Xe multi-b diffusion MRI was conducted in one healthy subject. The acquired FS dataset was retrospectively undersampled in the phase encoding direction, and an optimal twofold undersampled pattern was then obtained by minimizing mean absolute error (MAE) between retrospective CS (rCS) and FS MR images. Next, the FS and CS acquisitions during separate breath holds were performed on five healthy subjects (including the above one). Additionally, the FS and CS synchronous acquisitions during a single breath hold were performed on the sixth healthy subject and one COPD subject. However, only CS acquisitions were conducted in the rest of the five COPD subjects. Finally, all the acquired FS, rCS and CS MR images were used to obtain morphometric parameters, including acinar duct radius (R), acinar lumen radius (r), alveolar sleeve depth (h), mean linear intercept (L m ), and surface-to-volume ratio (SVR). The Wilcoxon signed-rank test and the Bland-Altman plot were employed to assess the fidelity of the CS reconstruction. Moreover, the t-test was used to demonstrate the effectiveness of the multi-b diffusion MRI with CS in clinical applications. The retrospective results demonstrated that there was no statistically significant difference between rCS and FS measurements using the Wilcoxon signed-rank test (P > 0.05). Good agreement between measurements obtained with the CS and FS acquisitions during separate breath holds was demonstrated in Bland-Altman plots of slice differences. Specifically, the mean biases of the R, r, h, L m , and SVR between the CS and

  6. Bone scintiscanning in metastases

    International Nuclear Information System (INIS)

    Cayla, J.; Basset, J.Y.

    1986-01-01

    The three fold interest of bone scintiscanning is discussed in relation to 182 cases of bone metastases of various origins. Firstly, this technic facilitates early diagnosis of invasion of the bone by the detection of metastatic lesions which, in 7.7% of cases are still infraradiologic, or even of reflex algodystrophy of the legs, which can be detected only from a scintiscan, long before X-ray plates can show the lumbar metastasis which is responsible. Secondly, the method is able to pick up more metastasic sites in 54.4% of cases than can be detected by X-ray; this is confirmed by investigation of the S/R ratio (ratio of the number of strongly binding sites to the number of sites showing radiologic damage) which is greater than unity for a considerable period. Thirdly, repeated scintiscanography provides a prognosis, because the survival time appears to be fairly closely correlated with the regression, stability or extension of strongly binding sites, although a ''flare phenomenon'' may give the erroneous impression that the metastatic process has deteriorated. Repeated scintiscanography also provides a good way of evaluating the efficacy of medical treatment, particularly in the case of bone metastases of mammary or prostatic origin. Sometimes, the decision for or against prophylactic or palliative orthopedic surgery may be based to a considerable extent on data provided by scintiscan [fr

  7. Diffusion-weighted MR imaging in comparison to integrated [18F]-FDG PET/CT for N-staging in patients with lung cancer

    International Nuclear Information System (INIS)

    Pauls, Sandra; Schmidt, Stefan A.; Juchems, Markus S.; Klass, Oliver; Luster, Markus; Reske, Sven Norbert; Brambs, Hans-Juergen; Feuerlein, Sebastian

    2012-01-01

    Purpose The purpose of this study was to prospectively determine the diagnostic accuracy of diffusion-weighted imaging (DWI) using MRI in the staging of thoracic lymph nodes in patients with lung cancer, and to compare the performance to that of PET/CT. Patients and Method 20 consecutive patients (pts) with histologically proven lung cancer were included in this study. In all pts FDG-PET/CT was routinely performed to stage lung carcinoma. Additionally, MRI (1.5 T) was performed including native T1w, T1w post contrast medium, T2w, and DWI sequences. Regarding the N stage based on the results of the PET/CT there were 5 patients with N0, 3 patients with N1, 5 patients with N2 and 7 patients with N3. Image analysis was performed by two radiologists (R1 and R2), respectively. The reviewers had to chose between 1 (at least one lymph node within a station is malignant) or 0 (no lymph nodes suspicious for malignancy). First the T1 post contrast sequence was analyzed. In a second step the DWI sequence (b = 800) was analyzed. Both steps were performed in a blinded fashion. Results MR imaging with or without DWI only agreed with the results of the PET/CT regarding the N stage in 80% of the patients—15% were understaged and 5% overstaged. There was excellent interobserver agreement; the N-staging result only differed in 1 patient for DWI, resulting in correlation coefficients of 0.98 for DWI and 1.0 for MRI. Compared to PET-CT MRI overstaged one and understaged 4 patients, while DWI overstaged one and understaged 3 patients. This resulted in correlation coefficients of 0.814 (R1 and R2) for MRI and 0.815 (R1) and 0.804 (R2) for DWI. Regarding the ADC values there were no significant differences between ipsilateral hilar (1.03 mm 2 /s ± 0.13), subcarinal (0.96 mm 2 /s ± 0.24), ipsilateral mediastinal (1.0 mm 2 /s ± 0.18), contralateral mediastinal (0.93 mm 2 /s ± 0.23) and supraclavicular (0.9 mm 2 /s ± 0.23) lymph nodes. Conclusion Diffusion-weighted imaging does not

  8. Boron uptake measurements in metastatic tumours in rat lung

    International Nuclear Information System (INIS)

    Bortolussi, S.; Altieri, S.; Bruschi, P.

    2006-01-01

    Lung carcinoma is the leading cause of cancer mortality worldwide; despite the introduction over the last few years of new therapeutic agents, very little progress has been made in terms of survival, and the overall prognosis for these patients remains poor. For these reasons any efforts to find and validate new effective therapeutic procedures for lung cancer are very timely and essential. To study the possibility to apply BNCT in the cure of diffuse pulmonary tumours, we created a BNCT Lung Project in Pavia, supported by Ministry of Education, University and Research (MIUR), in which Physicists, Medical Doctors and Biologists are involved. The first steps were; 1. development of an animal model for Boron uptake measurements in healthy and tumour lung tissues; 2. evaluation of the possibility to treat patients with epithermal neutron beams (See S. Altieri et al., this Conference); 3. in-vitro study of BNCT efficacy (see A. Zonta et al.). Spatial Boron distribution by neutron radiography in lung metastases from Colon Adenocarcinoma is reported; furthermore we present preliminary results of Boron concentration measures in rat lung tissues. The measures were performed using alpha spectrometry in thin tissue samples. (author)

  9. Intrabilary obstruction by colorectal metastases

    OpenAIRE

    Traeger, Luke; Kiroff, George

    2018-01-01

    Abstract Intrabiliary colorectal metastases are rare. We present a case of an 84-year-old man who developed obstructive jaundice secondary to intrabiliary growth of colorectal metastases. The patient presented with three weeks of jaundice and significant weight loss in the preceding months. The patient’s background included metastatic colorectal carcinoma, with a previous right hemicolectomy and left hepatectomy for liver metastases. A MRCP showed an obstruction of the biliary tract transitio...

  10. Expression of follicle-stimulating hormone receptor by the vascular endothelium in tumor metastases

    International Nuclear Information System (INIS)

    Siraj, Ahsan; Gonin, Julie; Radu, Aurelian; Ghinea, Nicolae; Desestret, Virginie; Antoine, Martine; Fromont, Gaëlle; Huerre, Michel; Sanson, Marc; Camparo, Philippe; Pichon, Christophe; Planeix, François

    2013-01-01

    The Follicle Stimulating Hormone receptor (FSHR) is expressed by the vascular endothelium in a wide range of human tumors. It was not determined however if FSHR is present in metastases which are responsible for the terminal illness. We used immunohistochemistry based on a highly FSHR-specific monoclonal antibody to detect FSHR in cancer metastases from 6 major tumor types (lung, breast, prostate, colon, kidney, and leiomyosarcoma) to 6 frequent locations (bone, liver, lymph node, brain, lung, and pleura) of 209 patients. In 166 patients examined (79%), FSHR was expressed by blood vessels associated with metastatic tissue. FSHR-positive vessels were present in the interior of the tumors and some few millimeters outside, in the normally appearing tissue. In the interior of the metastases, the density of the FSHR-positive vessels was constant up to 7 mm, the maximum depth available in the analyzed sections. No significant differences were noticed between the density of FSHR-positive vessels inside vs. outside tumors for metastases from lung, breast, colon, and kidney cancers. In contrast, for prostate cancer metastases, the density of FSHR-positive vessels was about 3-fold higher at the exterior of the tumor compared to the interior. Among brain metastases, the density of FSHR-positive vessels was highest in lung and kidney cancer, and lowest in prostate and colon cancer. In metastases of breast cancer to the lung pleura, the percentage of blood vessels expressing FSHR was positively correlated with the progesterone receptor level, but not with either HER-2 or estrogen receptors. In normal tissues corresponding to the host organs for the analyzed metastases, obtained from patients not known to have cancer, FSHR staining was absent, with the exception of approx. 1% of the vessels in non tumoral temporal lobe epilepsy samples. FSHR is expressed by the endothelium of blood vessels in the majority of metastatic tumors

  11. Breakdown of lung framework and an increase in pores of Kohn as initial events of emphysema and a cause of reduction in diffusing capacity

    Directory of Open Access Journals (Sweden)

    Yoshikawa A

    2016-09-01

    Full Text Available Akira Yoshikawa,1 Shuntaro Sato,2,3 Tomonori Tanaka,1 Mikiko Hashisako,1,4 Yukio Kashima,5,6 Tomoshi Tsuchiya,7 Naoya Yamasaki,7 Takeshi Nagayasu,7 Hiroshi Yamamoto,2 Junya Fukuoka1,6 1Nagasaki Educational and Diagnostic Center of Pathology (NEDCP, Department of Pathology, 2Clinical Research Center, Nagasaki University Hospital, Nagasaki, 3Division of Biostatistics, Kurume University School of Medicine, Fukuoka, 4Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 5Department of Pathology, Hyogo Prefectural Awaji Medical Center, Sumoto, 6Department of Pathology, 7Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Purpose: Pulmonary emphysema is the pathological prototype of chronic obstructive pulmonary disease and is also associated with other lung diseases. We considered that observation with different approaches may provide new insights for the pathogenesis of emphysema. Patients and methods: We reviewed tissue blocks of the lungs of 25 cases with/without emphysema and applied a three-dimensional observation method to the blocks. Based on the three-dimensional characteristics of the alveolar structure, we considered one face of the alveolar polyhedron as a structural unit of alveoli and called it a framework unit (FU. We categorized FUs based on their morphological characteristics and counted their number to evaluate the destructive changes in alveoli. We also evaluated the number and the area of pores of Kohn in FUs. We performed linear regression analysis to estimate the effect of these data on pulmonary function tests. Results: In multivariable regression analysis, a decrease in the number of FUs without an alveolar wall led to a significant decrease in the diffusing capacity of the lung for carbon monoxide (DLCO and DLCO per unit alveolar volume, and an increase in the area of

  12. Trace metals in fluids lining the respiratory system of patients with idiopathic pulmonary fibrosis and diffuse lung diseases.

    Science.gov (United States)

    Bargagli, Elena; Lavorini, Federico; Pistolesi, Massimo; Rosi, Elisabetta; Prasse, Antje; Rota, Emilia; Voltolini, Luca

    2017-07-01

    Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease with a poor prognosis and an undefined etiopathogenesis. Oxidative stress contributes to alveolar injury and fibrosis development and, because transition metals are essential to the functioning of most proteins involved in redox reactions, a better knowledge of metal concentrations and metabolism in the respiratory system of IPF patients may provide a valuable complementary approach to prevent and manage a disease which is often misdiagnosed or diagnosed in later stages. The present review summarizes and discusses literature data on the elemental composition of bronchoalveolar lavage (BAL), induced sputum and exhaled breath condensate (EBC) from patients affected by IPF and healthy subjects. Available data are scanty and the lack of consistent methods for the collection and analysis of lung and airways lining fluids makes it difficult to compare the results of different studies. However, the elemental composition of BAL samples from IPF patients seems to have a specific profile that can be distinguished from that of patients with other interstitial lung diseases (ILD) or control subjects. Suggestions are given towards standard sampling and analytical procedures of BAL samples, in the aim to assess typical element concentration patterns and their potential role as biomarkers of IPF. Copyright © 2017 Elsevier GmbH. All rights reserved.

  13. An Interesting Case of Retropharyngeal Lymph Nodal Metastases in a Case of Iodine-Refractory Thyroid Cancer.

    Science.gov (United States)

    Harisankar, Chidambaram Natrajan Balasubramanian; Vijayabhaskar, Ramakrishnan

    2018-01-01

    Metastases to cervical lymph node are fairly common in differentiated thyroid cancer. In iodine-refractory disease, the disease may persist in the thyroid bed, cervical lymph nodes, lungs, or the bones commonly. Retropharyngeal lymph nodal involvement in thyroid cancer is unusual and may even be the presenting complaint. We represent a case of iodine-refractory thyroid cancer with retropharyngeal lymph nodal involvement in addition to lung metastases.

  14. Diffusion of hyperpolarized {sup 129}Xe in the lung: a simplified model of {sup 129}Xe septal uptake and experimental results

    Energy Technology Data Exchange (ETDEWEB)

    Patz, Samuel; Muradyan, Iga; Dabaghyan, Mikayel; Washko, George R; Hatabu, Hiroto; Butler, James P [Center for Pulmonary Functional Imaging, Departments of Radiology and Pulmonary Medicine, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA 02115 (United States); Hrovat, Mirko I, E-mail: patz@bwh.harvard.edu [Mirtech, Inc., Brockton, MA 02301 (United States)

    2011-01-15

    We used hyperpolarized {sup 129}Xe NMR to measure pulmonary alveolar surface area per unit gas volume S{sub A}/V{sub gas}, alveolar septal thickness h and capillary transit time {tau}, three critical determinants of the lung's primary role as a gas exchange organ. An analytical solution for a simplified diffusion model is described, together with a modification of the xenon transfer contrast imaging technique utilizing 90{sup 0} radio-frequency pulses applied to the dissolved phase, rather than traditional 180{sup 0} pulses. With this approach, three-dimensional (3D) maps of S{sub A}/V{sub gas} were obtained. We measured global S{sub A}/V{sub gas}, h and {tau} in four normal subjects, two subjects with mild interstitial lung disease (ILD) and two subjects with mild chronic obstructive pulmonary disease (COPD). In normals, S{sub A}/V{sub gas} decreased with increasing lung volume from {approx}320 to 80 cm{sup -1}; both h{approx}13 {mu}m and {tau}{approx}1.5 s were relatively constant. For the two ILD subjects, h was, respectively, 36 and 97% larger than normal, quantifying an increased gas/blood tissue barrier; S{sub A}/V{sub gas} and {tau} were normal. The two COPD subjects had S{sub A}/V{sub gas} values {approx}25% that of normals, quantifying septal surface loss in emphysema; h and {tau} were normal. These are the first noninvasive, non-radiation-based, quantitative measurements of h and {tau} in patients with pulmonary disease.

  15. Change in Diffusing Capacity After Radiation as an Objective Measure for Grading Radiation Pneumonitis in Patients Treated for Non-Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lopez Guerra, Jose Luis [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Department of Radiation Oncology, Hospitales Universitarios Virgen del Rocio, Seville (Spain); Gomez, Daniel, E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Zhuang Yan; Levy, Lawrence B. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Eapen, George [Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Liu Hongmei; Mohan, Radhe; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2012-08-01

    Purpose: Scoring of radiation pneumonitis (RP), a dose-limiting toxicity after thoracic radiochemotherapy, is subjective and thus inconsistent among studies. Here we investigated whether the extent of change in diffusing capacity of the lung for carbon monoxide (DLCO) after radiation therapy (RT) for non-small-cell lung cancer (NSCLC) could be used as an objective means of quantifying RP. Patients and Methods: We analyzed potential correlations between DLCO and RP in 140 patients who received definitive RT ({>=}60 Gy) with or without chemotherapy for primary NSCLC. All underwent DLCO analysis before and after RT. Post-RT DLCO values within 1 week of the RP diagnosis (Grade 0, 1, 2, or 3) were selected and compared with that individual's preradiation values. Percent reductions in DLCO and RP grade were compared by point biserial correlation in the entire patient group and in subgroups stratified according to various clinical factors. Results: Patients experiencing Grade 0, 1, 2, or 3 RP had median percentage changes in DLCO after RT of 10.7%, 13%, 22.1%, or 35.2%. Percent reduction in DLCO correlated with RP Grade {<=}1 vs. {>=}2 (p = 0.0004). This association held for the following subgroups: age {>=}65 years, advanced stage, smokers, use of chemotherapy, volume of normal lung receiving at least 20 Gy {>=}30%, and baseline DLCO or forced expiratory volume in 1 second {>=}60%. Conclusions: By correlating percent change in DLCO from pretreatment values at the time of diagnosis of RP with RP grade, we were able to identify categories of RP based on the change in DLCO. These criteria provide a basis for an objective scoring system for RP based on change in DLCO.

  16. Change in Diffusing Capacity After Radiation as an Objective Measure for Grading Radiation Pneumonitis in Patients Treated for Non-Small-Cell Lung Cancer

    International Nuclear Information System (INIS)

    Lopez Guerra, Jose Luis; Gomez, Daniel; Zhuang Yan; Levy, Lawrence B.; Eapen, George; Liu Hongmei; Mohan, Radhe; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing

    2012-01-01

    Purpose: Scoring of radiation pneumonitis (RP), a dose-limiting toxicity after thoracic radiochemotherapy, is subjective and thus inconsistent among studies. Here we investigated whether the extent of change in diffusing capacity of the lung for carbon monoxide (DLCO) after radiation therapy (RT) for non-small-cell lung cancer (NSCLC) could be used as an objective means of quantifying RP. Patients and Methods: We analyzed potential correlations between DLCO and RP in 140 patients who received definitive RT (≥60 Gy) with or without chemotherapy for primary NSCLC. All underwent DLCO analysis before and after RT. Post-RT DLCO values within 1 week of the RP diagnosis (Grade 0, 1, 2, or 3) were selected and compared with that individual’s preradiation values. Percent reductions in DLCO and RP grade were compared by point biserial correlation in the entire patient group and in subgroups stratified according to various clinical factors. Results: Patients experiencing Grade 0, 1, 2, or 3 RP had median percentage changes in DLCO after RT of 10.7%, 13%, 22.1%, or 35.2%. Percent reduction in DLCO correlated with RP Grade ≤1 vs. ≥2 (p = 0.0004). This association held for the following subgroups: age ≥65 years, advanced stage, smokers, use of chemotherapy, volume of normal lung receiving at least 20 Gy ≥30%, and baseline DLCO or forced expiratory volume in 1 second ≥60%. Conclusions: By correlating percent change in DLCO from pretreatment values at the time of diagnosis of RP with RP grade, we were able to identify categories of RP based on the change in DLCO. These criteria provide a basis for an objective scoring system for RP based on change in DLCO.

  17. Scanning of bone metastases

    International Nuclear Information System (INIS)

    Robillard, J.

    1977-01-01

    The Centers against cancer of Caen, Angers, Montpellier, Strasbourg and 'the Curie Foundation' have confronted their experience in detection of bone metastases by total body scanning. From the investigation by this procedure, of 1,467 patients with cancer, it results: the confrontation between radio and scanning shows a rate of false positive and false negative identical to the literature ones; the countage scanning allows to reduce the number of false positive; scanning allows to direct bone biopsy and to improve efficiency of histological examination [fr

  18. Extraneural metastases in medulloblastoma

    Directory of Open Access Journals (Sweden)

    V M F Muoio

    2011-01-01

    Full Text Available Medulloblastoma is the most common childhood malignant tumor of central nervous system, but it may also occur in adults. It presents high invasive growth with spreading of tumor cells into the leptomeningeal space along the neuroaxis early in the course of the disease. Extraneural metastases are rare but frequently lethal, occurring only in 1 to 5% of patients, and are related, in the most of cases, to the presence of ventriculoperitoneal shunt. Here we characterize the clinical profile of five cases of medulloblastoma with systemic spreading of tumor cells, also comparing them to cases already described in the literature.

  19. Uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases on FDG PET/CT: A case report

    International Nuclear Information System (INIS)

    Wang, Hui Chun; Wang, Yu Bin; Chen, Xiao Hong; Cu, Lan Lan

    2016-01-01

    A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy

  20. Uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases on FDG PET/CT: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Hui Chun; Wang, Yu Bin; Chen, Xiao Hong; Cu, Lan Lan [PET/CT Center, Gansu Provincial Hospital, Lanzhou (China)

    2016-04-15

    A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.

  1. BRAIN METASTASES OF GERM CELL TUMORS. THE RUSSIAN CANCER RESEARCH CENTER'S EXPERIENCE

    Directory of Open Access Journals (Sweden)

    A. A. Tryakin

    2014-07-01

    Full Text Available This paper analyzes the experience in treating 20 patients with nonseminomatous germ cell tumors metastasizing to the brain. It presents brain metastasis-associated factors: multiple lung metastases; IGCCCG poor prognosis; and a baseline human chorionic gonadotropin level of > 50000 mIU/ml. The authors have identified a group to be screened for brain metastasis, which includes patients with intermediate/poor prognosis and multiple lung metastases. Long-term survival was achieved in 45 % of patients with baseline brain damage and in 22 % of those with metastases revealed after first-line chemotherapy. The positive prognostic factors associated with long-term survival were a single brain lesion, no neurological symptoms, and achievement of clinical complete personse in the brain.

  2. Hyperthermia, immunity and metastases

    International Nuclear Information System (INIS)

    Lopatin, V.F.

    1983-01-01

    The analysis of literature data concerning local hyperthermia effects shows that temperatures over 41-42 deg C (in the whole tumor volume), causing tumor growth inhibition and cell injury, can change antigenic nature of a malignant tissue. The tumor injured by thermal effect is able probably the full length of time of injured tissue resorption to maintain at a sufficiently high level antitumoral immunity and lay obstacles to emergence of metastases or even cause regression of those tumoral foci which have not been exposed to direct effect of the injuring agent. The facts of tumoral foci regression take place also upon radiation effect which is associated as well with participation of immune mechanisms. In.experiments with animals an essential increase of immunogenic character of malignant cells exposed to ionizing radiation effect has been observed. It follows that radiation injury of tumoral tissue as well as thermal one is able to stimulate antitumoral immunity and reduce the probability of emergence of metastases. But in case of radiotherapy immunosuppression effect of ionizing radiation (at the expense of inhibition of proliferation and death of immunocompetent cells) can essentially overlap immunostimulating effect related to the changes in antigenic character of tumoral cells

  3. Breast metastases from rectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    LI Jia; FANG Yu; LI Ang; LI Fei

    2011-01-01

    Metastases to the breast from extramammary neoplasms are very rare, constituting 2.7% of all malignant breast tumours. The most common primary tumor metastatic to the breast is primary breast cancer. Rectal cancer metastasizing to the breast is extremely rare. We report a case of aggressive rectal carcinoma with metastasis to the breast.

  4. [Percutaneous radiofrequency ablation of hepatic metastases. Preliminary experience].

    Science.gov (United States)

    De Baere, T; Elias, D; Ducreux, M; Dromain, C; Kuach, V; Gamal El Din, M; Sobotka, A; Lasser, P; Roche, A

    1999-11-01

    To evaluate the efficiency of percutaneous radiofrequency ablation in the treatment of liver metastases. Eighteen patients with 31 liver metastases, mainly from colorectal cancer, 10 - 35 mm in diameter (m = 23), underwent 26 courses of percutaneous radiofrequency ablation. Fifteen patients had previously undergone hepatectomy, and 3 patients had contra-indications to surgery. Imaging guidance was ultrasound in 21 patients, CT in 4 (tumors not seen with ultrasound), and both in 1. A generator working at 450 KHz with a maximum output power of 150 W was used to treat each lesion for 18 - 20 min. Treatment was monitored with real time ultrasound. Among the 12 patients followed more than 3 months, only one of the 24 treated lesions recurred after a mean follow up of 259 ¿ 109 days. Liver disease was controlled in 8 of the 12 patients after 90 - 509 days (m = 306). Among these 8 patients, 3 were tumor free after 559, 378 and 90 days, respectively; 2 died tumor free of non-tumoral disease (pulmonary embolism, digestive bleeding); 3 developed lung metastases treated with chemotherapy (n = 2) or surgery (n = 1). Three of the 12 patients had widespread hepatic tumor occurrence, and one patient died of these metastases. Six patients experienced mild skin burns, but no major complication was observed. Radiofrequency ablation of hepatic metastases appears safe and promising in this preliminary experience. Further investigation is needed.

  5. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma

    Science.gov (United States)

    Doval, Dinesh Chandra; Bhatia, Komal; Vaid, Ashok Kumar; Pavithran, Keechelat; Sharma, Jai Bhagwan; Hazarika, Digant; Jena, Amarnath

    2006-01-01

    Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC. PMID:16937544

  6. Disentegrating lung tumor

    International Nuclear Information System (INIS)

    Mamedbekov, Eh.N.; Kyazimova, L.G.; Mamed''yarova, F.A.

    1992-01-01

    Clinical and roentgenological appearances of tuberculosis and tumoral lesions of bronchi and lungs are similar. It makes possible of wrong diagnosis of disease. Complications in diagnosis are connected with that fact that increase of frequency of pulmonary carcinoma both in patients with active tuberculosis and in persons with residual posttuberculous changes in respiratory organs is observed. Patients with specific processes in the lungs was presented. Additional X-ray examination was carried out on the base of clinical symptoms and results of X-ray examination. The diagnosis was established: disintegrating blastoma of the right lung with metastases to mediastinum lymph nodes

  7. Discrete multi-physics simulations of diffusive and convective mass transfer in boundary layers containing motile cilia in lungs.

    Science.gov (United States)

    Ariane, Mostapha; Kassinos, Stavros; Velaga, Sitaram; Alexiadis, Alessio

    2018-04-01

    In this paper, the mass transfer coefficient (permeability) of boundary layers containing motile cilia is investigated by means of discrete multi-physics. The idea is to understand the main mechanisms of mass transport occurring in a ciliated-layer; one specific application being inhaled drugs in the respiratory epithelium. The effect of drug diffusivity, cilia beat frequency and cilia flexibility is studied. Our results show the existence of three mass transfer regimes. A low frequency regime, which we called shielding regime, where the presence of the cilia hinders mass transport; an intermediate frequency regime, which we have called diffusive regime, where diffusion is the controlling mechanism; and a high frequency regime, which we have called convective regime, where the degree of bending of the cilia seems to be the most important factor controlling mass transfer in the ciliated-layer. Since the flexibility of the cilia and the frequency of the beat changes with age and health conditions, the knowledge of these three regimes allows prediction of how mass transfer varies with these factors. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Boron uptake measurements in a rat model for Boron Neutron Capture Therapy of lung tumours

    Energy Technology Data Exchange (ETDEWEB)

    Bortolussi, S., E-mail: silva.bortolussi@pv.infn.i [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); National Institute of Nuclear Physics (INFN), Section of Pavia, via Bassi 6, 27100 Pavia (Italy); Bakeine, J.G. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); Ballarini, F. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); National Institute of Nuclear Physics (INFN), Section of Pavia, via Bassi 6, 27100 Pavia (Italy); Bruschi, P. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); Gadan, M.A. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Protti, N.; Stella, S. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); National Institute of Nuclear Physics (INFN), Section of Pavia, via Bassi 6, 27100 Pavia (Italy); Clerici, A.; Ferrari, C.; Cansolino, L.; Zonta, C.; Zonta, A. [Department of Surgery, University of Pavia, via Ferrata 27100 Pavia (Italy); Nano, R. [Department of Animal Biology, University of Pavia, via Ferrata 27100 Pavia (Italy); Altieri, S. [Department of Nuclear and Theoretical Physics, University of Pavia, via Bassi 6, 27100 Pavia (Italy); National Institute of Nuclear Physics (INFN), Section of Pavia, via Bassi 6, 27100 Pavia (Italy)

    2011-02-15

    Lung carcinoma is the leading cause of cancer mortality in the Western countries. Despite the introduction over the last few years of new therapeutic agents, survival from lung cancer has shown no discernible improvement in the last 20 years. For these reasons any efforts to find and validate new effective therapeutic procedures for lung cancer are very timely. The selective boron uptake in the tumour with respect to healthy tissues makes Boron Neutron Capture Therapy a potentially advantageous option in the treatment of tumours that affect whole vital organs, and that are surgically inoperable. To study the possibility of applying BNCT to the treatment of diffuse pulmonary tumours, an animal model for boron uptake measurements in lung metastases was developed. Both healthy and tumour-bearing rats were infused with Boronophenylalanine (BPA) and sacrificed at different time intervals after drug administration. The lungs were extracted, and prepared for boron analysis by neutron autoradiography and {alpha}-spectroscopy. The boron concentrations in tumour and normal lung were plotted as a function of the time elapsed after BPA administration. The concentration in tumour is almost constant within the error bars for all the time intervals of the experiment (1-8 h), while the curve in normal lung decreases after 4 h from BPA infusion. At 4 h, the ratio of boron concentration in tumour to boron concentration in healthy lung is higher than 3, and it stays above this level up to 8 h. Also the images of boron distribution in the samples, obtained by neutron autoradiography, show a selective absorption in the metastases.

  9. Spinal metastases of malignant gliomas

    International Nuclear Information System (INIS)

    Materlik, B.; Steidle-Katic, U.; Feyerabend, T.; Richter, E.; Wauschkuhn, B.

    1998-01-01

    Purpose: Extracranial metastases of malignant gliomas are rare. We report 2 cases with spinal metastases in patients suffering from glioma. Patients and Method: Two patients (33 and 57 years old) developed spinal canal metastases of a glioblastoma multiforme and anaplastic astrocytoma Grade III respectively 25 and 9 months after surgical resection and radiotherapy. Both metastases were confirmed pathohistologically. Results: Intraspinal metastases were irradiated with a total dose of 12.6 Gy and 50 Gy. Treatment withdrawal was necessary in one patient due to reduced clinical condition. Regression of neurological symptoms was observed in the second patient. Conclusions: Spinal spread of malignant glioma should be considered during care and follow-up in glioma patients with spinal symptoms. (orig.) [de

  10. Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusing capacity in cystic fibrosis: a randomized, controlled, crossover trial.

    Science.gov (United States)

    Radtke, Thomas; Böni, Lukas; Bohnacker, Peter; Maggi-Beba, Marion; Fischer, Peter; Kriemler, Susi; Benden, Christian; Dressel, Holger

    2018-06-14

    Regular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF). Combination of cycling exercise and chest physiotherapy using the Flutter® device on sputum properties has not yet been investigated. This prospective, randomized crossover study compared a single bout of continuous cycling exercise at moderate intensity (experiment A, control condition) vs a combination of interval cycling exercise plus Flutter® (experiment B). Sputum properties (viscoelasticity, yield stress, solids content, spinnability, and ease of sputum expectoration), pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were assessed at rest, directly and 45 min post-exercise (recovery) at 2 consecutive visits. Primary outcome was change in sputum viscoelasticity (G', storage modulus; G", loss modulus) over a broad frequency range (0.1-100 rad.s - 1 ). 15 adults with CF (FEV 1 range 24-94% predicted) completed all experiments. No consistent differences between experiments were observed for G' and G" and other sputum properties, except for ease of sputum expectoration during recovery favoring experiment A. DLNO, DLCO, alveolar volume (V A ) and pulmonary capillary blood volume (V cap ) increased during experiment A, while DLCO and V cap increased during experiment B (all P < 0.05). We found no differences in absolute changes in pulmonary diffusing capacity and its components between experiments, except a higher V A immediately post-exercise favoring experiment A (P = 0.032). The additional use of the Flutter® to moderate intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate intensity continuous cycling alone. Elevations in diffusing capacity represent an acute exercise-induced effect not sustained post-exercise. ClinicalTrials.gov; No.: NCT02750722 ; URL: clinical.trials.gov; Registration date: April 25th, 2016.

  11. 18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究%Comparison between 18F-NaF PET and PET-CT to detect bone metastases in patients with lung cancer

    Institute of Scientific and Technical Information of China (English)

    王俊起; 高硕; 李彦生

    2009-01-01

    目的 对比研究18F-氟化钠(18F-NaF)PET和PET-CT对肺癌骨转移诊断的准确性.方法 34例初始诊断为肺癌的患者接受18F-NaF PET-CT检查,对PET和PET-CT图像分别进行解释,发现的病变分为恶性、良性和不确定三种.骨转移的综合评价方法包括MRI(34例)、18F-氟脱氧葡糖糖PET-CT(4例)、组织学活检(2例)和临床随访(6例).结果 按患者水平分析时,34例患者中的11例(32%)发生骨转移,其中,18F-NaF PET-CT准确诊断所有患者的骨转移,无假阳性和假阴性,而18F-NaF PET诊断真阳性8例、3例不能确定,18F-NaF PET确诊的8例骨转移患者中的4例PET没有显示全部转移病变(假阴性和不确定病变);按病变水平分析时,118个病变获得最终诊断,其中转移病变47个、良性病变71个,其中,18F-NaF PET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个,而18F-NaF PET-CT诊断真阳性46个、假阴性1个、真阴性71个.按患者水平分析,将不确定病变归为恶性时,18F-NaF PET-CT的特异性高于18F-NaF PET(100% vs 78%,χ2=10.78,P0.05);按病变水平分析时,得到与患者水平分析相似结果.结论 18F-NaF PET-CT诊断肺癌骨转移的准确性优于18F-NaF PET,PET-CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力.%Objective To evaluate the effect of 18F-sodium fluoride(18F-NaF)PET-CT in the detection of bone metastases in patients with lung cancer.Methods Thirty-four patients with newly diagnosed lung cancer were performed with 18F-NaF PET-CT.18F-NaF PET and 18F-NaF PET-CT were interpreted separately.Lesions were categorized as malignant,benign or inconclusive.A panel of reference methods was used,including MRI(34 patients),18F-fluorodeoxyglucose PET-CT(4 patients),histopathology(2 patients),or clinical follow-up of at least 6 months(6 patients).Results In patient-based analysis,11 of 34 patients had bone metastases.18F-NaF PET-CT correctly diagnosed all 11 patients with

  12. Inhibition of the development of metastases by dietary vitamin C:K3 combination.

    Science.gov (United States)

    Taper, Henryk S; Jamison, James M; Gilloteaux, Jacques; Summers, Jack L; Calderon, Pedro Buc

    2004-07-09

    The tumor growth-inhibiting and chemo-potentiating effects of vitamin C and K(3)combinations have been demonstrated both in vitro and in vivo. The purpose of this study was to investigate the influence of orally administered vitamin C and K(3) on the metastasis of mouse liver tumor (T.L.T.) cells implanted in C3H mice. Adult male C3H mice were given water containing vitamin C and K3 (15 g/0.15 g dissolved in 1000 ml) beginning 2 weeks before tumor transplantation until the end of the experiment. T.L.T. cells (106) were implanted intramuscularly in the right thigh of mice. All mice were sacrificed 42 days after tumor transplantation. Primary tumor, lungs, lymph nodes and other organs or tissues suspected of harboring metastases were macroscopically examined. Samples of primary tumors, their local lymph nodes, lungs and main organs such as liver, kidneys, spleen were taken for histological examination. Forty-two percent of control mice exhibited lung metastases and 27% possessed metastases in local lymph nodes whereas 24% of vitamin-treated mice exhibited lung metastases and 10% possessed local lymph nodes metastases. The total number of lung metastases was 19 in control group and 10 in vitamin C and K(3)-treated mice. Histopathological examination of the metastatic tumors from the vitamin-treated mice revealed the presence of many tumor cells undergoing autoschizic cell death. These results demonstrate that oral vitamin C and K(3) significantly inhibited the metastases of T.L.T. tumors in C3H mice. At least a portion of this inhibition was due to tumor cell death by autoschizis.

  13. Hybrid [{sup 18}F]-FDG PET/MRI including non-Gaussian diffusion-weighted imaging (DWI): Preliminary results in non-small cell lung cancer (NSCLC)

    Energy Technology Data Exchange (ETDEWEB)

    Heusch, Philipp [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Univ Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, D-45147 Essen (Germany); Köhler, Jens [Univ Duisburg-Essen, Medical Faculty, Department of Medical Oncology, D-45147 Essen (Germany); Wittsack, Hans-Joerg [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Heusner, Till A., E-mail: Heusner@med.uni-duesseldorf.de [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Buchbender, Christian [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Poeppel, Thorsten D. [Univ Duisburg-Essen, Medical Faculty, Department of Nuclear Medicine, D-45147 Essen (Germany); Nensa, Felix; Wetter, Axel [Univ Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, D-45147 Essen (Germany); Gauler, Thomas [Univ Duisburg-Essen, Medical Faculty, Department of Medical Oncology, D-45147 Essen (Germany); Hartung, Verena [Univ Duisburg-Essen, Medical Faculty, Department of Nuclear Medicine, D-45147 Essen (Germany); Lanzman, Rotem S. [Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany)

    2013-11-01

    Purpose: To assess the feasibility of non-Gaussian DWI as part of a FDG-PET/MRI protocol in patients with histologically proven non-small cell lung cancer. Material and methods: 15 consecutive patients with histologically proven NSCLC (mean age 61 ± 11 years) were included in this study and underwent whole-body FDG-PET/MRI following whole-body FDG-PET/CT. As part of the whole-body FDG-PET/MRI protocol, an EPI-sequence with 5 b-values (0, 100, 500, 1000 and 2000 s/mm{sup 2}) was acquired for DWI of the thorax during free-breathing. Volume of interest (VOI) measurements were performed to determine the maximum and mean standardized uptake value (SUV{sub max}; SUV{sub mean}). A region of interest (ROI) was manually drawn around the tumor on b = 0 images and then transferred to the corresponding parameter maps to assess ADC{sub mono}, D{sub app} and K{sub app}. To assess the goodness of the mathematical fit R{sup 2} was calculated for monoexponential and non-Gaussian analysis. Spearman's correlation coefficients were calculated to compare SUV values and diffusion coefficients. A Student's t-test was performed to compare the monoexponential and non-Gaussian diffusion fitting (R{sup 2}). Results: T staging was equal between FDG-PET/CT and FDG-PET/MRI in 12 of 15 patients. For NSCLC, mean ADC{sub mono} was 2.11 ± 1.24 × 10{sup −3} mm{sup 2}/s, D{sub app} was 2.46 ± 1.29 × 10{sup −3} mm{sup 2}/s and mean K{sub app} was 0.70 ± 0.21. The non-Gaussian diffusion analysis (R{sup 2} = 0.98) provided a significantly better mathematical fitting to the DWI signal decay than the monoexponetial analysis (R{sup 2} = 0.96) (p < 0.001). SUV{sub max} and SUV{sub mean} of NSCLC was 13.5 ± 7.6 and 7.9 ± 4.3 for FDG-PET/MRI. ADC{sub mono} as well as D{sub app} exhibited a significant inverse correlation with the SUV{sub max} (ADC{sub mono}: R = −0.67; p < 0.01; D{sub app}: R = −0.69; p < 0.01) as well as with SUV{sub mean} assessed by FDG-PET/MRI (ADC{sub mono}: R

  14. Metastases of the digestive tract

    International Nuclear Information System (INIS)

    Caramella, E.; Bruneton, J.N.; Roux, P.; Aubanel, D.; Lecomte, P.

    1983-01-01

    In addition to personal observations of 77 patients with one or more metastatic sites in the gastrointestinal tract, the authors reviewed over 1000 similar cases in the literature. The general radiologic aspects of each location (oesophagus, stomach, intestine, colon/rectum) are discussed. The pathophysiology of this type of metastasis explains the radiologic images obtained during barium transit examinations. The lymphatic type of spread observed in the oesophageal region in connection with carcinoma of the breast is the origin of stenosis of the middle third. The haematogenous type of diffusion encountered during melanomas creates intramural or intraluminal radiologic images. Two means of spread can be observed in the stomach. Haematogenous spread can result in frequently multiple and ulcerated nodular submucosal lesions from melanomas and bronchogenic carcinomas; it can also cause a more or less stenotic invasive image, especially in connection with carcinoma of the breast. Dissemination by means of the mesenteric reflections, and in particular around the gastrocolic ligament, explains the spread of a carcinoma of the transverse colon towards the stomach. The most frequent secondary sites in the gastrointestinal tract occur in the small intestine, the majority of these metastases being caused by pelvic tumours. Whether occurring in the small intestine or the colon, the patophysiology is similar: direct invasion by a non-contiguous primary carcinoma along the fascias and mesenteric attachments (more rarely by lymphatic permeation), dissemination by the peritoneal fluid or haematogenuous spread. In the first two types of dissemination cited, the image encountered is often hard to differentiate from radiation-induced lesions. (orig.)

  15. Ovarian metastases: Computed tomographic appearances

    International Nuclear Information System (INIS)

    Megibow, A.J.; Hulnick, D.H.; Bosniak, M.A.; Balthazar, E.J.

    1985-01-01

    Computed tomographic scans of 34 patients with ovarian metastases were reviewed to assess the radiographic appearances and to correlate these with the primary neoplasms. Primary neoplasms were located in the colon (20 patients), breast (six), stomach (five), small bowel (one), bladder (one), and Wilms tumor of the kidney (one). The radiographic appearance of the metastatic lesions could be described as predominantly cystic (14 lesions), mixed (12 lesions), or solid (seven lesions). The cystic and mixed lesions tended to be larger in overall diameter than the solid. The metastases from gastric carcinoma appeared solid in four of five cases. The metastases from the other neoplasms had variable appearances simulating primary ovarian carcinoma

  16. Non-small cell lung cancer: Whole-lesion histogram analysis of the apparent diffusion coefficient for assessment of tumor grade, lymphovascular invasion and pleural invasion.

    Science.gov (United States)

    Tsuchiya, Naoko; Doai, Mariko; Usuda, Katsuo; Uramoto, Hidetaka; Tonami, Hisao

    2017-01-01

    Investigating the diagnostic accuracy of histogram analyses of apparent diffusion coefficient (ADC) values for determining non-small cell lung cancer (NSCLC) tumor grades, lymphovascular invasion, and pleural invasion. We studied 60 surgically diagnosed NSCLC patients. Diffusion-weighted imaging (DWI) was performed in the axial plane using a navigator-triggered single-shot, echo-planar imaging sequence with prospective acquisition correction. The ADC maps were generated, and we placed a volume-of-interest on the tumor to construct the whole-lesion histogram. Using the histogram, we calculated the mean, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC, skewness, and kurtosis. Histogram parameters were correlated with tumor grade, lymphovascular invasion, and pleural invasion. We performed a receiver operating characteristics (ROC) analysis to assess the diagnostic performance of histogram parameters for distinguishing different pathologic features. The ADC mean, 10th, 25th, 50th, 75th, 90th, and 95th percentiles showed significant differences among the tumor grades. The ADC mean, 25th, 50th, 75th, 90th, and 95th percentiles were significant histogram parameters between high- and low-grade tumors. The ROC analysis between high- and low-grade tumors showed that the 95th percentile ADC achieved the highest area under curve (AUC) at 0.74. Lymphovascular invasion was associated with the ADC mean, 50th, 75th, 90th, and 95th percentiles, skewness, and kurtosis. Kurtosis achieved the highest AUC at 0.809. Pleural invasion was only associated with skewness, with the AUC of 0.648. ADC histogram analyses on the basis of the entire tumor volume are able to stratify NSCLCs' tumor grade, lymphovascular invasion and pleural invasion.

  17. Quantitative cerebral blood flow calculation method using xenon CT. Introduction of a factor reflecting diffusing capacity of the lung for xenon

    International Nuclear Information System (INIS)

    Sase, Shigeru; Honda, Mitsuru; Noguchi, Yoshitaka

    2007-01-01

    In calculating cerebral blood flow (CBF) using the Fick principle, time-course information on arterial tracer concentration is indispensable and exerts considerable influence on the accuracy of CBF. In xenon-enhanced CT (Xe-CT), the time-course change rate for end-tidal xenon concentration (Ke), which can be measured, and that for arterial xenon concentration (Ka) have been assumed to be equal. However, it has been pointed out that there are large differences between Ke and Ka in many cases. We have introduced a single factor (γ) which correlates Ke with Ka in the equation Ka=γ x (1-e -Ke/γ ). This factor, γ, reflects the diffusing capacity of the lung for xenon; larger γ values correspond to larger diffusing capacities and Ka is equal to Ke when γ is infinity. Kety's equation contains two parameters: CBF and xenon solubility coefficient We added a third parameter, γ, to Kety's equation, and developed an efficient method to obtain the γ value for each Xe-CT study. Applying this method to ten normal subjects (35.4±16.3 years, mean±standard deviation (SD)), we obtained γ value of 1.01±0.17 and the average CBF value of 38.8±7.5 mL/100 g/min in basal ganglia. The wash-in period could be shortened to two minutes using this method. Xe-CT with this factor (γ) as a parameter enhances its clinical availability as well as the accuracy of CBF. (author)

  18. Occipital condyle metastasis: an unusual clinical presentation in carcinoma of the lung

    International Nuclear Information System (INIS)

    Pasricha, R.; Mohanty, P.P.; Madan, R.C.; Datta, N.R.

    2005-01-01

    Metastases to the base of the skull and occipital condyle metastases are uncommon as a presenting feature of malignancy. Lung cancers are known for their metastatic potential to various sites, some of which could be the only presenting feature of the underlying malignancy. However, occipital condyle metastases are very rare and to the best of our knowledge, metastases to this site from carcinoma of the lung, as a presenting feature, have never been reported in the literature. The present case report describes the clinical, radiological and the therapeutic interventions that were undertaken in a patient presenting with lung cancer who had solely the features of occipital condyle metastasis

  19. Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Ebinu, Julius O.; Lwu, Shelly; Monsalves, Eric; Arayee, Mandana [Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario (Canada); Chung, Caroline; Laperriere, Normand J. [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario (Canada); Kulkarni, Abhaya V.; Goetz, Pablo [Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario (Canada); Zadeh, Gelareh, E-mail: gelareh.zadeh@uhn.on.ca [Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario (Canada)

    2013-03-01

    Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates.

  20. Gamma Knife Radiosurgery for the Treatment of Cystic Cerebral Metastases

    International Nuclear Information System (INIS)

    Ebinu, Julius O.; Lwu, Shelly; Monsalves, Eric; Arayee, Mandana; Chung, Caroline; Laperriere, Normand J.; Kulkarni, Abhaya V.; Goetz, Pablo; Zadeh, Gelareh

    2013-01-01

    Purpose: To assess the role of Gamma Knife radiosurgery (GKRS) in the treatment of nonsurgical cystic brain metastasis, and to determine predictors of response to GKRS. Methods: We reviewed a prospectively maintained database of brain metastases patients treated at our institution between 2006 and 2010. All lesions with a cystic component were identified, and volumetric analysis was done to measure percentage of cystic volume on day of treatment and consecutive follow-up MRI scans. Clinical, radiologic, and dosimetry parameters were reviewed to establish the overall response of cystic metastases to GKRS as well as identify potential predictive factors of response. Results: A total of 111 lesions in 73 patients were analyzed; 57% of lesions received prior whole-brain radiation therapy (WBRT). Lung carcinoma was the primary cancer in 51% of patients, 10% breast, 10% colorectal, 4% melanoma, and 26% other. Fifty-seven percent of the patients were recursive partitioning analysis class 1, the remainder class 2. Mean target volume was 3.3 mL (range, 0.1-23 mL). Median prescription dose was 21 Gy (range, 15-24 Gy). Local control rates were 91%, 63%, and 37% at 6, 12, and 18 months, respectively. Local control was improved in lung primary and worse in patients with prior WBRT (univariate). Only lung primary predicted local control in multivariate analysis, whereas age and tumor volume did not. Lesions with a large cystic component did not show a poorer response compared with those with a small cystic component. Conclusions: This study supports the use of GKRS in the management of nonsurgical cystic metastases, despite a traditionally perceived poorer response. Our local control rates are comparable to a matched cohort of noncystic brain metastases, and therefore the presence of a large cystic component should not deter the use of GKRS. Predictors of response included tumor subtype. Prior WBRT decreased effectiveness of SRS for local control rates