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A letter to the editor is presented on the use of temozolomide chemotherapy drug instead of cyclophosphamide for diffuse large B-cell lymphoma (DLBCL) treatment.

Background: The Ewing Sarcoma Family of Tumors (ESFT) constitutes a group of rare malignancies, wherein approximately one-third of cases exhibit metastatic spread, particularly impacting prognosis when bone and/or bone marrow (BM) are involved. Primary extra-pulmonary metastatic ESFT often necessitates intensified therapeutic approaches. Accurate staging plays a pivotal role in clinical decision-making, with fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) currently serving as a non-invasive modality for assessing ESFT's BM extent., Methods: In the French phase II COMBINAIR3 (NCT03011528) study, a comprehensive approach for patients with extra-pulmonary ESFT metastasis was evaluated. We prospectively compared the efficacy of PET/CT to BM aspiration and biopsy (BMAB) analysis in patients undergoing initial staging., Results: Among the 42 patients analyzed (median age 14 y, 2:1 male/female ratio), 45% presented with pelvic primary tumors and 83% had bone/BM involvement at diagnosis. Our findings showed PET/CT had 100% specificity and 83.3% sensitivity in detecting initial BM involvement. Overall, PET/CT correctly classified 92.8% of patients, reaching 100% accuracy in patients identified with bone involvement, thus surpassing the standard BMAB., Discussion: These results suggest that the conventional use of BMAB in the initial staging of high-risk ESFT patients can be omitted, promoting PET/CT as a non-invasive alternative, thus improving staging accuracy and treatment decisions in ESFT management., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Performance assessment of positron emission tomography (PET) scanners is crucial to guide clinical practice with efficiency. We have already introduced and experimentally evaluated a simulation method allowing the creation of a controlled ground truth for system performance assessment. In the current study, the goal was to validate the method using patient data and demonstrate its relevance to assess PET performances accuracy in clinical conditions., Methods: Twenty-four patients were recruited and sorted into two groups according to their body mass index (BMI). They were administered with a single dose of 2 MBq/kg 18 F-FDG and scanned using clinical protocols consecutively on two PET systems: the Discovery-IQ (DIQ) and the Discovery-MI (DMI). For each BMI group, sixty synthetic lesions were dispatched in three subgroups and inserted at relevant anatomical locations. Insertion of synthetic lesions (ISL) was performed at the same location into the two consecutive exams. Two nuclear medicine physicians evaluated individually and blindly the images by qualitatively and semi-quantitatively reporting each detected lesion and agreed on a consensus. We assessed the inter-system detection rates of synthetic lesions and compared it to an initial estimate of at least 1.7 more targets detected on the DMI and the detection rates of natural lesions. We determined the inter-reader variability, evaluated according to the inter-observer agreement (IOA). Adequate inter-reader variability was found for IOA above 80%. Differences in standardized uptake value (SUV) metrics were also studied., Results: In the BMI ≤ 25 group, the relative true positive rate (RTPR) for synthetic and natural lesions was 1.79 and 1.83, respectively. In the BMI > 25 group, the RTPR for synthetic and natural lesions was 2.03 and 2.27, respectively. For each BMI group, the detection rate using ISL was consistent to our estimate and with the detection rate measured on natural lesions. IOA above 80% was verified for any scenario. SUV metrics showed a good agreement between synthetic and natural lesions., Conclusions: ISL proved relevant to evaluate performance differences between PET scanners. Using these synthetically modified clinical images, we can produce a controlled ground truth in a realistic anatomical model and exploit the potential of PET scanner for clinical purposes., (© 2024. The Author(s).)

Salivary gland cancers are rare tumors comprising a large group of heterogeneous tumors with variable prognosis. Their therapeutic management at a metastatic stage is challenging due to the lack of therapeutic lines and the toxicity of treatments. [ 177 Lu]Lu-PSMA-617 (prostate-specific membrane antigen) is a vectored radioligand therapy (RLT) initially developed to treat castration-resistant metastatic prostate cancer with encouraging results in terms of efficacy and toxicity. Many malignant cells could be treated with [ 177 Lu]Lu-PSMA-617 as long as they express PSMA as a consequence of androgenic pathway activation. RLT may be used when anti-androgen hormonal treatment has failed, particularly in prostate cancer. [ 177 Lu]Lu-PSMA-617 has been proposed in certain salivary gland cancers, though the expression of PSMA is demonstrated by a significant uptake using [ 68 Ga]Ga-PSMA-11 PET scan. This theranostic approach could be a new therapeutic option, warranting prospective investigation in a larger cohort. We review the literature on this subject and offer a clinical illustration of compassionate use in France as a perspective for administering [ 177 Lu]Lu-PSMA-617 in salivary gland cancer., Competing Interests: The authors declare no conflict of interest.

Purpose: Data about incidence, biological, and clinical characteristics of oligometastatic breast cancer (OMBC) are scarce. However, these data are essential in determining optimal treatment strategy. Gaining knowledge of these elements means observing and describing large, recent, and consecutive series of OMBC in their natural history., Methods: We collected data retrospectively at our institution from 998 consecutive patients diagnosed and treated with synchronous or metachronous metastatic breast cancer (MBC) between January 2014 and December 2018. The only criterion used to define OMBC was the presence of one to five metastases at diagnosis., Results: Of 998 MBC, 15.8% were classified OMBC. Among these, 88% had one to three metastases, and 86.7% had only one organ involved. Bone metastases were present in 52.5% of cases, 20.9% had progression to lymph nodes, 14.6% to the liver, 13.3% to the brain, 8.2% to the lungs, and 3.8% had other metastases. 55.7% had HR+/HER2- OMBC, 25.3% had HER2+OMBC, and 19% had HR-/HER2- OMBC. The HR+/HER2- subtype statistically correlated with bone metastases (p = 0.001), the HER2+subtype with brain lesions (p = 0.001), and the HR-/HER2- subtype with lymph node metastases (p = 0.008). Visceral metastases were not statistically associated with any OMBC subtypes (p = 0.186). OMBC-SBR grade III was proportionally higher than in the ESME series of 22,109 MBC (49.4% vs. 35.1%, p < 0.001)., Conclusion: OMBC is a heterogeneous entity whose incidence is higher than has commonly been published. Not an indolent disease, each subgroup, with its biological and anatomical characteristics, merits specific management., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We report the case of a 62-year-old woman with previous history of stage III Hodgkin lymphoma. Routine follow-up CT scan revealed 2 years after end of treatment the appearance of mediastinal nodes, suspected of lymphoma recurrence. An F-FDG PET/CT was performed showing hypermetabolic mediastinal lymph nodes with diffuse symmetric osteomedullar hypermetabolism of pelvis and scapulae. In the hypothesis of either recurrence or multisystemic inflammatory disorder, bone marrow and lymph node biopsies were performed, revealing the presence of noncaseating epithelioid cell granulomas, leading to the diagnosis of multisystemic sarcoidosis. This case illustrates the sarcoidosis-lymphoma syndrome.

We report the case of a 50-year-old man, with previous history of grade 3 intracranial hemangiopericytoma with initial complete surgical resection, addressed for local recurrence. Surgical revision performed 18 months after initial surgery allowed only partial resection, leaving residual disease along the optic nerve. Complementary radiotherapy with proton was decided. F-FDG PET/CT and F-choline PET/CT were both performed for treatment planning. F-FDG PET showed no uptake of the residual tumor, whereas F-choline depicted highly metabolic residual disease uptake with excellent delineation of local recurrence. F-choline PET/CT appears as a useful PET tracer for hemagiopericytoma imaging.

Malignant conjunctival melanoma is a rare tumor. A 46-year-old woman with a history of locally recurrent left conjunctival melanoma was followed by F-FDG PET/CT. Four years after the local recurrence treated by orbital exenteration, the follow-up PET/CT scan showed an incidental intense FDG uptake mass infiltrating the gallbladder associated with a low uptake of an infracentimetric pulmonary nodule. The patient was completely asymptomatic with no sign of local recurrence. Laparoscopic cholecystectomy was performed, and histopathologic findings were consistent with gallbladder metastasis of melanoma. After almost 2 years of immunotherapy, the patient is still in complete response.

Breast angiosarcoma is a rare and aggressive tumor. The role of F-FDG PET/CT in breast angiosarcoma is poorly known. We report a series of 13 lesions in 11 patients with histologically proven primary or secondary breast angiosarcoma who underwent FDG PET/CT at the initial assessment in our institution. All breast lesions showed FDG avidity. Visually and statistically, we observed a significant difference of SUVmax uptake foci between primary and secondary breast angiosarcoma (Wilcoxon test P < 0.0046) and a significantly poorer prognosis for high SUVmax than those with low SUVmax (P = 0.049) regardless of primary or secondary origins.

A 38-year-old woman was referred for staging of an alveolar rhabdomyosarcoma revealed by a breast metastasis with unknown primary. Whole-body F-FDG PET/CT localized the primary tumor as an asymptomatic soft tissue lesion of the right foot with a significant uptake. PET/CT detected hepatic and pancreatic metastases and also showed a multifocal bone marrow involvement, which was not detected by the contrast-enhanced CT. These results led to a significant change in treatment management as the patient received local radiotherapy of the primitive lesion and polychemotherapy.

Infectious lymph nodes mimicking lymphoma is challenging for accurate staging. Although 18 F-FDG is a nonspecific tracer accumulating not only in tumor cells but also in inflammatory tissues, the metabolic features and uptake kinetics give valuable information: 18 F-FDG PET/CT appears as a useful problem solver tool in ambiguous situation.

A 67-year-old woman was referred for staging of an insulinoma. CT has shown a pancreatic tumor, a portal thrombus, and an ovarian mass presumed not to be related with the insulinoma. These three lesions were highly positive on Ga DOTATOC PET/CT, leading to the hypothesis of a malignant insulinoma with neoplastic vein thrombus and ovarian metastasis, which was subsequently confirmed histologically. Despite severe hypoglycemia preventing fasting, F-FDG PET/CT was informative, showing significant uptake by the thrombus, which corresponded to the most aggressive lesion (Ki67 of 3.5% for the primary pancreatic tumor and 19.6% for the thrombus).

Purpose: Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression., Methods: We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT)., Results: In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region., Conclusions: These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.

The oropharyngeal candidiasis is a common condition in cancer patients treated by irradiation, during and after their treatment. For example, almost 70% of patients treated with chemoradiation for head and neck cancer are colonized, and 40% of symptomatic patients have an oropharyngeal candidiasis. Furthermore, we noticed an increase in non-albicans Candida strains, which are present in almost 50% of samples. Cancer treatments, especially radiation therapy, and comorbidities are risk factors of oropharyngeal candidiasis. Oropharyngeal candidiasis has substantial effects on quality of life, and may limit treatment. Epidemiologic data, physiopathology, clinical diagnosis criteria, consequences and treatment of oropharyngeal candidiasis will be discussed in this article., (Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)