F. Solitro

Early Response to Chemotherapy in Patients With Non–Small-Cell Lung Cancer Assessed by [18F]-Fluoro-Deoxy-D-Glucose Positron Emission Tomography and Computed Tomography

BACKGROUND This study aimed to demonstrate that patients who exhibit a tumor metabolic response to first-line chemotherapy seen on FDG-PET and computed tomography (CT) would survive longer than those who did not show such a response, comparing this evaluation with the morphologic response seen on CT. PATIENTS AND METHODS Images were acquired in 22 consecutive patients with advanced non-small-cell lung cancer (NSCLC) randomized to receive carboplatin/paclitaxel/sorafenib or placebo. FDG-PET was performed within 4 weeks before (PET1) and 2 weeks after starting treatment (PET2). Similarly, CT (CT1) was performed at baseline and then every 2 cycles (6 weeks) during treatment (CT2). Responders and nonresponders were identified with FDG-PET, and metabolic response was then compared with morphologic changes detected by spiral CT. RESULTS Twenty-one of 22 patients completed this study. In terms of progression-free survival (PFS) (45 vs. 22.2 weeks) and overall survival (OS) (77 vs. 47.7 weeks), we observed a trend that was not statistically significant for patients whose response after 2 weeks of treatment was seen on FDG-PET (P = .22 for PFS; P = .15 for OS). CONCLUSION Patients with advanced NSCLC who had a positive outcome, as evidenced by prolonged survival, were those who showed a tumor metabolic response seen on FDG-PET.

Long-term outcome of radiofrequency thermal ablation (RFA) of liver metastases from colorectal cancer (CRC): size as the leading prognostic factor for survival

PurposeThe aim of this study was to review some prognostic factors for survival after radiofrequency ablation (RFA) of metastases from colorectal cancer (CRC).Materials and methodsFrom 1996 to 2009, 262 patients with metastases from CRC were treated with RFA. Fourteen were lost to follow-up. The following predictors were analysed in the remaining 248: synchronous/metachronous metastases, single/multiple metastases, diameter of largest metastasis and absence/presence of extrahepatic metastases. Survival was measured from the date of metastasis diagnosis and from the date of RFA.ResultsSurvival at 1, 2, 3 and 5 years was 93%, 78%, 62% and 35% from metastasis diagnosis, and 84%, 59%, 43% and 23% from the date of RFA. Median survival was 41 months in patients with largest metastasis ≤3 cm and 21.7 months for those with metastases >3 cm (p=0.0001); survival increased to 45.2 months in patients with largest metastasis ≤2.5 cm and fell to 18.5 months in those with metastasis >3.5 cm. Median survival of patients with extrahepatic metastases was significantly lower than that of patients without extrahepatic disease (23.3 vs. 32.6 months, p=0.018).ConclusionsIn light of our long-term results obtained with commonly used equipment, small lesion size (diameter of largest lesion ≤3 or 2.5 cm) proved to be the most favourable prognostic factor for survival in patients with CRC metastases to the liver treated with RFA. This conclusion is probably related to the possibility of obtaining radical ablation and points to the usefulness of devices allowing ablation of larger volumes. In the presence of extrahepatic metastases, RFA has less impact on survival, even though it is potentially useful in patients at a higher risk of death due to hepatic rather than extrahepatic metastases.RiassuntoObiettivoScopo del nostro lavoro è stato rivalutare alcuni predittori di sopravvivenza nella termoablazione con radiofrequenze (RFA) delle metastasi da carcinoma colorettale (CRC).Materiali e metodiTra il 1996 e il 2009 abbiamo trattato con RFA 262 pazienti con metastasi da CRC. Quattordici sono stati persi al follow-up; in 248 sono stati analizzati i seguenti predittori: metastasi sincrone/metacrone, metastasi unica/multiple, diametro della metastasi principale, assenza/presenza di metastasi extraepatiche. Le sopravvivenze sono state calcolate dalla data di diagnosi di metastasi e da quella della RFA.RisultatiLa sopravvivenza a 1, 2, 3, 5 anni è stata 93%, 78%, 62%, 35% dalla diagnosi di metastasi, e 84%, 59%, 43%, 23% dalla RFA. Nei pazienti con metastasi principale ≤3 cm la sopravvivenza mediana è stata 41 mesi vs. 21,7 di quelli con >3 cm (p=0,0001), ma in quelli ≤2,5 cm è salita a 45,2 mesi e in quelli >3,5 cm è scesa a 18,5. La sopravvivenza mediana dei pazienti con metastasi extraepatiche è stata significativamente inferiore a quelli senza (23,3 vs. 32,6 mesi, p=0,018).ConclusioniAlla luce dei nostri risultati a lungo termine, ottenuti con le apparecchiature comunemente utilizzate negli ultimi anni, le piccole dimensioni (diametro della lesione principale ≤3 o 2,5 cm) si confermano il fattore prognostico più favorevole per la sopravvivenza dei pazienti con metastasi epatiche da CRC sottoposti a RFA. Questa conclusione è molto probabilmente riconducibile alla possibilità di un’ablazione radicale e induce a prospettare l’utilità di apparecchiature in grado di aumentare il volume di ablazione. La RFA in presenza di metastasi extraepatiche è meno efficace in termini di sopravvivenza, ma potenzialmente utile nei pazienti a minor rischio di decesso per le metastasi extra-epatiche rispetto a quelle epatiche.

Bronchogenic cysts in the adult: diagnostic criteria derived from the correct use of standard radiography and computed tomography

Purpose . This study was undertaken to identify the radiographic and computed tomography patterns allowing a diagnosis of bronchogenic cystMaterials and methods . We retrospectively reviewed chest radiographs and CT scans of 21 adults (ten men and 11 women, age range 18–74 years) with a histologically confirmed diagnosis of bronchogenic cystResults . Sixteen cysts were located in the mediastinum and five in the lungs. On chest radiography, mediastinal cysts appeared as sharply marginated rounded areas of increased opacity; intrapulmonary cysts also exhibited an air-fluid interface. CT confirmed these morphological features in all cases. In addition, analysis of attenuation values allowed the subdivision of mediastinal cysts into three groups: fluid density (four cases), air density (two cases) and soft-tissue density (ten cases)Conclusions . All bronchogenic cysts were visualised on chest radiography, but the findings were nonspecific and required further characterisation by CT. The CT findings proved to be diagnostic when cystic attenuation values were evident. When soft-tissue attenuation values were demonstrated, a confident diagnosis was not possible, and other solid lesions had to be considered. In such cases, magnetic resonance imaging may be helpful to ascertain the cystic nature of the lesionsRiassuntoObiettivo . Identificare i segni radiografici e TC che permettano di porre diagnosi di cisti broncogeneMateriali e metodi . Sono stati esaminati retrospettivamente i radiogrammi e le TC del torace di 21 pazienti adulti (11 donne e 10 uomini), di età compresa tra 18 e 74 anni, con diagnosi di cisti broncogena confermata istologicamenteRisultati . Le cisti broncogene erano localizzate a livello del mediastino in 16 casi e nel polmone in 5. Nelle radiografie standard del torace le cisti mediastiniche apparivano come opacità tondeggianti a margini netti, mentre quelle intraparenchimali differivano soltanto per la presenza del livello idro-aereo. La TC ha confermato tutti gli aspetti morfologici rilevati nei radiogrammi standard. Basandosi sui valori di attenuazione, le cisti mediastiniche sono state classificate nei seguenti gruppi: lesioni a densità liquida (4 casi), a densità aerea (2 casi) ed a densità dei tessuti molli (10 casi)Conclusioni . Le radiografie del torace dimostrano la presenza della lesione in tutti i pazienti, ma gli aspetti radiografici risultano aspecifici e devono essere ulteriormente valutati mediante esame TC. I reperti tomodensitometrici sono caratteristici quando le lesioni hanno densità liquida. Quando invece hanno attenuazione pari a quella dei tessuti molli, devono essere prese in considerazione nella diagnosi differenziale altre lesioni solide; in questi casi la RM può essere utile per determinarne la natura cistica

Fibrous tumour of the pleura (SFTP): a proteiform disease. Clinical, histological and atypical radiological patterns selected among our cases.

First described by Klemperer and Rabin in 1931, solitary fibrous tumour of the pleura (SFTP) is a mesenchymal tumour that tends to involve the pleura, although it has also been described in other thoracic areas (mediastinum, pericardium and pulmonary parenchyma) and in extrathoracic sites (meninges, epiglottis, salivary glands, thyroid, kidneys and breast). SFTP usually presents as a peripheral mass abutting the pleural surface, to which it is attached by a broad base or, more frequently, by a pedicle that allows it to be mobile within the pleural cavity. A precise preoperative diagnosis can be arrived at with a cutting-needle biopsy, although most cases are diagnosed with postoperative histology and immunohistochemical analysis of the dissected sample. SFTP, owing to its large size or unusual locations (paraspinal, paramediastinal, intrafissural and intraparenchymal), can pose interpretation problems or, indeed, point towards a diagnosis of diseases of a totally different nature. We present some unusual radiographic and computed tomography (CT) images of large SFTP or SFTP located in atypical thoracic locations in patients who underwent surgical resection.RiassuntoIl tumore fibroso solitario della pleura (TFSP), descritto per la prima volta da Klemperer e Rabin nel 1931, é una neoplasia mesenchimale che solitamente coinvolge la pleura, ma che viene descritta anche in altre sedi sia toraciche, quali il mediastino, il pericardio ed il parenchima polmonare, sia extratoraciche, quali le meningi, l’epiglottide, le ghiandole salivari, la tiroide, i reni e la mammella. Di solito si presenta come massa periferica a contatto con la superficie pleurica alla quale è unito da una larga base d’impianto o più spesso da un peduncolo che lo puè rendere mobile all’interno del cavo pleurico. La diagnosi preoperatoria di certezza puè essere ottenuta mediante biopsia con ago tranciante, ma nella maggior parte dei casi è post-chirurgica, frutto dell’esame istologico e dell’analisi immuno-istochimica sul pezzo operatorio. Il tumore fibroso solitario della pleura tuttavia, spesso a causa delle notevoli dimensioni o dello sviluppo in sedi inconsuete (paraspinali, paramediastiniche, intrascissurali ed intraparenchimali) può creare numerose difficoltà di interpretazione o addirittura orientare la diagnosi verso patologie di tutt’altra natura. In questo lavoro presentiamo gli aspetti radiologici inusuali di TFSP di grosse dimensioni o localizzati in sedi toraciche atipiche in pazienti sottoposti ad intervento chirurgico di exeresi.

The pulmonary nodule: clinical and radiological characteristics affecting a diagnosis of malignancy

The role of computed tomography (CT) in the diagnosis of the solitary pulmonary nodule (SPN) is constantly expanding. CT helps to detect a growing number of increasingly small lesions, but, as with chest radiography, the primary goal in the evaluation of small pulmonary nodules is to exclude malignancy. Despite the availability of numerous, variously invasive, diagnostic tests, diagnostic accuracy tends to decline as the size of the nodule decreases. The role of the radiologist is therefore to help the clinician determine the most appropriate management strategy by using all available modalities [CT, magnetic resonance (MR) imaging, positron emission tomography (PET)] and evaluating the patient’s clinical history and the imaging features leading to a diagnosis of benignity or malignancy. Imaging features include nodule size, margins, calcifications and fatty component, internal features (cavitations, pseudocavitations, air bronchogram, halo sign), as well as advanced techniques for characterisation (growth rate, contrast enhancement) and management (computer-aided diagnosis, Bayesian analysis, neural networks). The aim of this paper is to summarise the approach to pulmonary nodules from the point of view of the radiologist, oncologist and thoracic surgeon.RiassuntoIl ruolo della TC nella diagnostica dei noduli polmonari è in continua espansione: con tale metodica, infatti, si individua un numero crescente di lesioni e di dimensioni sempre minori, ma come avveniva con le radiografie, il primo obiettivo nel valutare questi piccoli noduli è escluderne la natura maligna. Sono disponibili numerosi test diagnostici, più o meno invasivi, ma la loro accuratezza diagnostica diminuisce con la riduzione delle dimensioni del nodulo. Il ruolo del radiologo consiste quindi nell’aiutare il clinico a scegliere la strategia diagnostica più appropriata, adottando tutte le metodiche a sua disposizione (TC, RM, PET) e valutando la storia clinica e quegli aspetti radiologici che lo indirizzino verso una diagnosi di benignità o di malignità: dimensioni, margini, presenza di calcificazioni o di una componente adiposa, caratteristiche proprie del nodulo (cavitazioni, pseudocavitazioni, broncogramma aereo, segno dell’alone), integrati a tecniche avanzate di caratterizzazione (tasso di crescita, contrast enhancement) e di gestione (diagnosi computer-assistita, analisi bayesiana, reti neurali). Obiettivo di questo lavoro è fare il punto della situazione sull’approccio al nodulo polmonare dal punto di vista del radiologo e dell’oncologo da un lato e del chirurgo toracico dall’altro.

Solitary fibrous tumor of the lung: Three rare cases of intraparenchymal nodules

Solitary fibrous tumor (SFT) of the pleura usually presents as a peripheral mass, in contact with the surface of the pleura. However, on occasion, it can occur separately from the pleura, in the lung parenchyma. We describe the radiological and imaging features of three SFTs of the lung, diagnosed in our department, with relevant clinical data. The diagnosis of SFT of the lung, although rare, should be considered in a slow-growing solitary lung parenchymal nodule.

The role of radiology in the evaluation of the immunotherapy efficacy

In the last years, a great interest has arisen on immunotherapy for the treatment of advanced non-small cell lung cancer (NSCLC). Check-point inhibitor drugs are now considered clinical practice standard in different settings and their use is expected to increase significantly in the near future. As treatment options for lung cancer advance and vary, the different patterns of radiological response increase in number and heterogeneity. To correctly evaluate the radiological findings after and during these treatments is of paramount importance, both in the clinical and sperimental setting. In consideration of their peculiar mechanism, immunotherapies can determine unusual response patterns on imaging, that cannot be correctly evaluated with the traditional response criteria such as World Health Organization (WHO) and Response Evaluation Criteria in Solid Tumours (RECIST). Therefore, during these years, several response criteria [immune-related response criteria (irRC), irRECIST and iRECIST] were proposed and applied in clinical trials on immunotherapies. The aim of this review is to describe the radiological findings after immunotherapy, to critically discuss the different response criteria and the imaging of immune-related adverse events.