Sydney Houry

Impact of Fluorodihydroxyphenylalanine-(18F) Positron Emission Tomography on Management of Adult Patients with Documented or Occult Digestive Endocrine Tumors

CONTEXT AND OBJECTIVES Fluorodihydroxyphenylalanine-(18F) (FDOPA) positron emission tomography (PET) is a recent imaging modality used to localize endocrine tumors. This study was conducted to evaluate the impact of FDOPA-PET on the management of patients referred for carcinoid or noncarcinoid digestive tumors and the clinical relevance of the treatment decisions based on this examination. METHODS AND PATIENTS Between March 2002 and December 2006, 101 FDOPA-PET examinations were performed in 78 adult patients for follow-up of histologically documented carcinoid tumor of the ileum (23 patients) or noncarcinoid digestive tumor (26 patients) or to screen for occult digestive endocrine tumors (29 patients). More than one FDOPA-PET examination was performed in 12 patients. The impact of FDOPA PET was evaluated on a per-patient basis by means of a questionnaire completed by the referring physician, and the relevance of the treatment decision was assessed on the basis of follow-up data. RESULTS The survey response rate was 91% (71 of 78). The overall impact rate of FDOPA-PET on patient management was 25% (18 of 71). The greatest impact was observed for carcinoid tumors (50%: 11 of 22) and was clinically relevant in every case, followed by occult endocrine tumors (16%: four of 25), and was clinically relevant in three of the four cases, and noncarcinoid tumors (13%: 3 of 22), clinically relevant in only one case. CONCLUSION FDOPA-PET appears to be a major tool for the management of carcinoid tumors with excellent diagnostic performances and induced relevant changes in patient management. FDOPA-PET was less sensitive and less useful for the management of noncarcinoid tumors.

Sphincter-saving resection, or not, for cancer of the midrectum

BACKGROUND The purpose of this study was to compare the time to pelvic recurrence and survival after sphincter-saving resection (SSR) or abdominoperineal resection (APR). METHODS Out of the 119 patients with a cancer of the midrectum, 43 had undergone a SSR and 76 an APR for cure. To eliminate bias of a nonrandomized retrospective comparison, an adjustment for baseline prognostic covariates was used. RESULTS Pelvic recurrence rates and survival distribution according to the type of resection did not differ significantly, with P values of 0.31 and 0.95, respectively, by the log-rank test. The Cox regression model incorporated nine binary covariates and the treatment group. Given these nine covariates, treatment did not influence either pelvic recurrence (adjusted P value = 0.62, relative risk = 0.78) or overall survival (adjusted P value = 0.89, relative risk = 1.05). CONCLUSION These results suggest that, in patients with cancer of the midrectum treated by SSR or APR, recurrence and survival rates are similar.

Prothèse métallique expansive dans le traitement palliatif des occlusions colorectales malignes : risque de perforation

Resume Objectif. – Les protheses metalliques expansives sont une alternative a la chirurgie dans le traitement palliatif des occlusions coliques malignes. Le but de ce travail etait de preciser les causes qui pourraient favoriser les complications de ces protheses, notamment les perforations coliques. Malades et methodes. – De novembre 2000 a novembre 2001, 6 malades en occlusion colique maligne, pour lesquels la chirurgie a ete recusee en raison de l’extension tumorale et/ou de l’etat general, ont eu un traitement (n = 5) ou une tentative (n = 1) de traitement palliatif endoscopique par des protheses metalliques expansives. Resultats. – Une seule malade n’a pas eu de complication. Elle est decedee de son cancer 5 mois plus tard. Les 5 autres malades (83 %) ont eu des perforations coliques apres la pose (4 cas) ou la tentative de pose (1 cas) de la prothese. Les perforations sont survenues dans les premieres 24 h suivant l’endoscopie dans 2 cas, 3 et 5 semaines apres dans 2 autres cas, et 10 mois apres dans le cinquieme cas. Deux malades ont eu une colostomie de decharge. Les 3 autres malades ont eu un simple drainage externe de leur perforation et sont decedes peu de temps apres. Conclusion. – Les protheses metalliques expansives sont une alternative seduisante a la chirurgie. Neanmoins, le taux de perforations coliques precoces et tardives doit faire reconsiderer leurs indications comme traitement palliatif definitif.

Hernies inguinales : délais d’apparition des récidives

Resume Le but de cette etude etait d’estimer, chez des malades operes pour une recidive de hernie inguinale, les delais entre la premiere intervention et la date d’apparition de la recidive. Sur 1 474 patients operes pour une hernie, 94 (6,4 %) l’ont ete pour une recidive et font l’objet de ce travail. Les recidives sont apparues dans les deux premieres annees qui ont suivi la premiere intervention chez 40 patients (42 % ; IC 95 40-44 %). Elles ont ete reconnues apres les cinq premieres annees chez 32 malades (34 % ; IC 95 24-44 %), et plus de vingt ans apres la premiere intervention chez 18 patients (19 % ; IC 95 11-27 %). Quinze ans apres la premiere intervention, le taux cumule de recidive etait de 75 %. En conclusion, nos observations suggerent qu’environ deux tiers des recidives apparaissent plus de cinq ans et un quart plus de quinze ans apres la premiere intervention. La plupart des etudes, a cause d’un recul d’observation insuffisant, sous-estiment le taux reel de recidives des hernies inguinales operees.

14. FDG CDET (2D Dual-Head Coincidence Gamma Camera) in the Primary Staging of Oesophageal Cancer. Histopathological Correlation.

Purpose: The aim of this study was to evaluate the role of FDG-CDET for the detection of primary oesophageal tumour, lymph node involvement and distant extension before surgery.Methods and patients: In patients fasting for 6h or more, 150-250 MBq of 18F-FDG were injected i.v. and 2D imaging (whole-body scan and at least a tomoscintigram) was started 45 min. later, using a PICKER gamma camera. We studied 14 patients (pts). All of them were operated on (mean time between FDG and surgery: 5.4 +/- 3.8 days) and staging results were correlated with post surgical histology.Results: The primary lesion took up FDG in all cases but one (FN in a 5 mm lesion). The primary NM staging of these 14 pts was negative with FDG-CDET in 7 cases (4 TN and 3 FN corresponding to an invasion of satellite lymph nodes in 2 cases and to a metastatic infracentimetric subdiaphragmatic lymph node in one case) and positive in 7 cases (7 TP corresponding to 10 foci), revealing in 4 cases a sub-diaphragmatic lymph node extension unknown prior to FDG-CDET. One pt referred for characterisation of an oesophageal lesion (failure of multiple biopsies) had an intense focus of FDG uptake in this area (TP confirmed by surgery). The overall sensitivity was 13/14 = 93% on a per patient basis and 21/25 = 84% on a per lesion basis. Specificity on a per lesion basis was 5/5 = 100%.Conclusion: These first results, obtained in an indication of FDG not frequently evaluated even with dedicated PET systems, seem very promising, the oesophageal neoplastic lesions appearing to take up FDG with a high intensity.