Nicole Barthelemy

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

Abstract. Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (nxa0=xa08) or radiographic techniques (nxa0=xa013). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC.

Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer

In order to evaluate the usefulness of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of therapeutic effects, a study was performed before and after therapy in 126 patients with non-small cell lung cancer (NSCLC) codified stage I to stage IIIB. Treatment with an early curative result was given in 58 patients, whereas in 68 cases it was limited to palliation. During the treatment follow-up period (8-40 months), each patient was evaluated every 3 months by clinical examination and < or =6 months by imaging techniques (PET and computed tomography (CT)). A diagnosis of persistent or recurrent tumour was established by means of pathological analysis in 31 patients and by clinical evolution and subsequent imaging progression in 29 other patients. PET showed increased FDG uptake in all cases (n = 60) of persistent or recurrent tumour, whereas CT was nonspecific in 17 cases. Conversely, there were five false positive cases via PET imaging and three via CT. In detecting residual or recurrent NSCLC, PET had a sensitivity of 100% and specificity of 92%, whereas CT had a sensitivity and specificity of 71% and 95% respectively. In conclusion, 18-fluorodeoxyglucose positron emission tomography correctly identified response to therapy in 96% (121 of 126) of patients. Positron emission tomography appears to be more accurate (p = 0.05) than conventional imaging in distinguishing persistent or recurrent tumour from fibrotic scar in patients undergoing treatment for non-small cell lung cancer.

Epidermoid carcinoma of the anal canal treatment results and prognostic variables in a series of 242 cases

UNLABELLEDnFrom 1972 to 1985, 260 cases of anal canal epidermoid carcinoma were irradiated. Eighteen cases treated for palliation were excluded from the study; 242 (93%) were treated with curative intent. The sex ratio was 1/5.5; mean age was 66 years.nnnHISTOLOGYn60.3% were well differentiated epidermoid carcinoma; 31.0% moderately differentiated and 8.7%, cloacogenic cases. Staging: T1: 11.5%; T2: 16.1%; T3a: 17%; T3b: 33.5%; and T4: 21.9%. Abnormal inguinal nodes were present in 15.3% of cases. Crude overall survival (Kaplan-Meier) for the 242 cases is 86.4% at 1 year, 63.9% at 3 years, 51.2% at 5 years, and 30.8% at 10 years. Radiation therapy was the sole treatment for 193 cases. No chemotherapy was given. Patients were irradiated by external beam. They received a first course of X rays (mostly 18 MV, some 6 MV) 40 to 45 Gy (box technique) over 4 to 5 weeks in the pelvis. Age and size of tumor were considered when deciding on the target volume. After a rest period of 4 to 6 weeks, a second course of 15 to 20 Gy in 2 weeks was given through a perineal field by electron-beam of suitable energy. The mean total dose was 60.56 Gy and median was 62.5 Gy; the mean overall treatment duration was 85.3 days (median 82 days) and the mean Time Dose Factor including decay factor was 98.96. In this group, 5-year determinate survival was: T1-T2, 84.5%; T3a, 74.8%; T3b, 64.9%; T4, 58.9%. In 147/193 patients (76.2%) local control was achieved. The overall anal conservation rate was 62.6%. In 106 cases (55%), the anus had maintained normal function. The 5-year survival rate by N was 73.3% in the absence of inguinal nodes (169 cases) and 36.1% if such nodes were present. There was no significant difference in survival rate according to histological type. In the second group, receiving radiation therapy plus surgery, 33/49 cases (T3b-T4) were irradiated before surgery (median dose 40.5 Gy). Post operative radiation therapy was administered in 16 cases (T3b-T4) (median dose 49.6 Gy). The 5-year determinate survival is 53.2% for T3b and 79% for T4. According to the log-rank test, there was no significant difference between survival with radiation therapy alone and radiation therapy plus surgery. Multivariate analysis of the whole group indicated that T stage is the only predictive variable.(ABSTRACT TRUNCATED AT 400 WORDS)

Pretreatment minimal staging for non-small cell lung cancer: an updated consensus report

aDepartment of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London S W3 6NP, UK, bHospital Erasme, Brussels, Belgium ‘Peter MacCallum Cancer Institute, Melbourne. Australia ?entre Hospital, Vnivversity de Liege, Liege, Belgium ‘Mayo, Clinic, Rochester, MN, USA ‘Hopita Tenon, Paris, France gMassachusetts General Hospital, Boston, MA, USA h Washington University Medical Center, St. Louis, MO. USA ‘Serv. de chirurgie thoracique, Paris, France iUniversity of Michigan, Ann Arbor, MI. USA kNational Navy Medical Center. Bethesda, MD, USA ‘Medical Academy, Gdansk. Poland “‘Academy Ziekenhuis Rotterdam, Rotterdam, The Netherlands “Initut Gustave-Roussy, Villejuif; France ‘Polyclinique de Courlancy. Reims, France PA-2 Vrde Vniversiteit Brussell, Jeite, Belgium a University of Limburg, Maastricht. The Netherlands

Post-operative adjuvant therapy for non-small-cell lung cancer

a The Vanderbilt Clinic, Nashville, USA bInstituto de Radiomedicina, Santiago, Chile ‘CHU du Sart Tilman, Liege, Belgique ‘Mayo Clinic, Rochester, USA eRush-Presb. St Luke’s, Chicago, USA ‘Mallinkrodt Institute of Radiology, St. Louis, USA gCro Aviano and G.H. Pordenone, Avlano, Italy hSamsungMedical Center, Seoul, Korea ‘H@ital l@versitaire de Strasbowg, Strasbourg, France 1 Institut J. Bordet, Bruxelles, Belgium

Screening for malnutrition in lung cancer patients undergoing radiotherapy

PurposeThe assessment of nutritional problems is vital to support patients undergoing radiotherapy. Poor nutritional status may occur as a result of preexisting problems, older age, the cancer itself, or treatment side effects. Malnutrition impairs the outcome of the disease and affects patients. This prospective study aimed at developing two simple tools to screen malnutrition before radiotherapy and to assess, prior to treatment, the risk of malnutrition after radiotherapy.MethodsForty-seven lung cancer patients treated with curative intent were evaluated before radiotherapy and after completion of the treatment. To assess patient’s malnutrition, two well-known screening tools (PG-SGA and NRS-2002) were used, complemented by patient-specific characteristics, yielding a 59-item questionnaire. Malnutrition status was defined using Thoresen’s criteria. The two screening tools derived by multivariate analyses were validated by comparing anthropometric, biological, and nutritional variables between patients at risk of malnutrition and those who are not.ResultsMalnutrition detection prior to radiotherapy was based on the equation “MDSu2009=u20095.88 − 0.20u2009×u2009BMIu2009+u20090.05u2009×u2009(percent weight loss over past 6xa0months),” while malnutrition prediction after radiotherapy was given by “MPSu2009=u20093.67u2009+u20090.98u2009×u2009(age ≥70) − 0.12u2009×u2009BMIu2009+u20091.20u2009×u2009edema.” Agreement between observed and estimated outcomes was quite high for the two scores (kappa coefficient 0.80 and 0.85, respectively).ConclusionsThe two assessment tools were found parsimonious and easy to use. Further studies are needed to validate them in larger lung cancer groups and in other cancer populations.

P-173 Interleukin-6 and transforming growth factor-beta1 are increased in bronchoalveolar lavage fluid following thoracic radiotherapy

Purpose: None small cell lung cancer (NSCLC) is the most common cancer in male in our hospital. The initial treatment for localized early disease is usually surgery. Adjuvant radiotherapy may be given if evidence of high risk of local recurrence, such as cut end invasion, larger tumor, regional LN metastasis, etc. The results of the postoperative radiotherapy are reviewed retrospectively. Materials and Methods: From January 1990 through December 2000, a total of 120 patients with NSCLC had received postoperative radiotherapy. External beam with 6 or IO MV photon from linear accelerator to cover all mediastinal area and tumor bed area by conventional technique is used. The planning dose is around 50-60 Gy with booster dose to high risk area. But 19 (15.8%) patients could not complete treatment over 50 Gy. Most patients without received chemotherapy. Results: There were 93 males, 27 females, age range 34-85, median 64 years. Squamous cell 59, adenocarcinoma 42, adenosquamous cell 10, other 9. Follow up to end of 2002, 101 (84%) patients expired, 19 (16%) were alive. The median survival time is 22 months, overall 2-, 5-year survival rate are 43%, 8% respectively. Factors affected survivals were analyzed. Patients with only cut end invasion and higher radiation dose over 60 Gy had slight better survivals. Five patients developed radiation pneumonitis after radiotherapy. Conclusion: Postoperative radiotherapy for NSCLC may benefit to control local disease but may be limited for improving survivals. Further increased radiation dose by new techniques or adjuvant with chemotherapy might be considered in future.