- 作者列表："Graf C","Huellner M","Tschopp O","Bode-Lesniewska B","Schmid C
INTRODUCTION:Brown tumors (BT) are non-neoplastic bone lesions infrequently occurring in patients with long-standing severe hyperparathyroidism (HPT). BT may be identified and characterized using 18-F-sodium fluoride-positron-emission-tomography/computed tomography (18F-NaF-PET/CT). We present a retrospective series of eight primary hyperparathyroidism (pHPT) patients with BT imaged with 18F-NaF-PET/CT. MATERIALS AND METHODS:Imaging assessment included location, diameter, maximum standardized uptake value (SUVmax), metabolically active lesion volume (PETvol) of BT, total metabolically active bone volume (TMBvol) per patient and several computed tomography (CT) features of BT. Where appropriate, we analyzed the association between characteristic features of BT in 18F-NaF-PET/CT, histopathology, clinical symptomatology and laboratory parameters. RESULTS:In our cohort of 8 patients (median age, 49 years, range, 26-73), 72 BT were found. The mean PETvol of BT was 89.48 cm3 ± 122.81 cm3 and the mean SUVmax was 17.5 ± 7.8. The total PETvol of BT per patient correlated positively with serum calcium (r = 0.810, p = 0.015), and negatively with glomerular filtration rate (GFR) (r = - 0.762, p = 0.028). TMBvol correlated significantly with serum PTH (r = 0.810, p = 0.015), alkaline phosphatase (r = 0.762, p = 0.028), and duration of postoperative hospitalization (r = 0.826, p = 0.011, 24.3 days ± 19.8 days). CONCLUSION:18F-NaF-PET/CT is a valuable non-invasive whole-body imaging technique for the assessment of patients with pHPT and BT. TMBvol is associated with PTH and alkaline phosphatase, and the requirement for intense postoperative calcium substitution, which determines the duration of hospitalization.
简介: 棕色肿瘤 (BT) 是一种非肿瘤性骨病变，在长期严重甲状旁腺功能亢进 (HPT) 患者中不常见。BT可使用 18-F-氟化钠-正电子发射断层扫描/计算机断层扫描 (18F-NaF-PET/CT) 进行鉴定和表征。我们对 8 例原发性甲状旁腺功能亢进症 (pHPT) 患者进行了 18F-NaF-PET/CT成像的BT回顾性系列研究。 材料和方法: 影像学评估包括位置、直径、最大标准化摄取值 (SUVmax) 、BT的代谢活跃病变体积 (PETvol) 、总代谢活跃骨体积 (TMBvol) 每个患者和BT的几个计算机断层扫描 (CT) 特征。在适当的情况下，我们分析了 18F-NaF-PET/CT中BT的特征、组织病理学、临床症状学和实验室参数之间的关联。 结果: 在我们的 8 例患者队列 (中位年龄，49 岁，范围，26-73) 中，发现 72 BT。BT的平均PETvol为 89.48立方厘米 ± 122.81立方厘米，平均SUVmax为 17.5 ± 7.8。每个患者BT的总PETvol与血清钙呈正相关 (r = 0.810，p = 0.015)，与肾小球滤过率 (GFR) 呈负相关 (R = - 0.762，p = 0.028)。TMBvol与血清PTH (r = 0.810，p = 0.015) 、碱性磷酸酶 (r = 0.762，p = 0.028) 显著相关，和术后住院时间 (r = 0.826，p = 0.011，24.3 天 ± 19.8 天)。 结论: 18F-NaF-PET/CT是评估pHPT和BT患者的一种有价值的无创全身成像技术。TMBvol与PTH和碱性磷酸酶以及术后强烈钙替代的需求相关，这决定了住院时间。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.