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Background & Aims: Sorafenib and transarterial 90 Y-radioembolization(TARE) are possible treatments for Barcelona Clinic Liver Cancer (BCLC)intermediate-advanced stage hepatocellular carcinoma (HCC). No studydirectly comparing sorafenib and TARE is currently available. This single-centre retrospective study compares the outcomes achieved with sorafeniband TARE in HCC patients potentially amenable to either therapy. Meth-ods: Seventy-four sorafenib (71 ± 10 years, male 87%, BCLC B/C 53%/47%)and 63 TARE HCC patients (66 ± 9 years, male 79%, BCLC B/C 41%/59%)were included based on the following criteria: Child–Pugh class A/B, perfor-mance status ≤1, HCC unfit for other effective therapies, no metastases andno previous systemic chemotherapy. Results: Median overall survivals of thetwo groups were comparable, being 14.4 months (95% CI: 4.3–24.5) in so-rafenib and 13.2 months (95% CI: 6.1–20.2) in TARE patients, with 1-, 2-and 3-year survival rates of 52.1%, 29.3% and 14.7% vs 51.8%, 27.8% and21.6% respectively. Two TARE patients underwent liver transplantation aftersuccessful down-staging. To minimize the impact of confounding factors onsurvival analysis, propensity model matched 32 patients of each group formedian age, tumour gross pathology and the independent prognostic factors(portal vein thrombosis, performance status, Model for End Liver Disease).Even after matching, the median survival did not differ between sorafenib(13.1 months; 95% CI: 1.2–25.9) and TARE patients (11.2 months; 95% CI:6.7–15.7), with comparable 1-, 2- and 3-year survival rates. Conclusions: Incirrhotic patients with intermediate-advanced or not-otherwise-treatableHCC, sorafenib and TARE provide similar survivals. Down-staging allowingliver transplantation only occurred after TARE.Hepatocellular carcinoma (HCC) is the third most com-mon cause of cancer-related death worldwide, and theleading cause of mortality of cirrhotic patients (1, 2).Several curative or palliative treatments are currentlyavailable, according to the cancer burden and liver func-tion. For this choice, American and European guidelinessuggest the use of the Barcelona Clinic Liver Cancer(BCLC) classification which links tumour stage to treat-ment in an evidence-based fashion (3, 4). Only 30–40%of HCCs are diagnosed at an early stage, and advancedstage HCCs (BCLC stage C) account for a large propor-tion of the remaining cases (5). Moreover, despite treat-ment, most early HCCs eventually progress to theadvanced stage. The recommended treatment for thesetumours is sorafenib, because two phase III clinical trialsproved that this treatment prolongs the survival ofChild–Pugh A patients with advanced HCC (6, 7).However, the tolerability of sorafenib is suboptimal, andin a post-marketing multicentre study, it was down-dosed in more than half of the patients and interruptedin 45% of cases, because of severe adverse effects (AEs)or liver function deterioration (8).As more than two-thirds of patients with advancedHCC die from intrahepatic tumour progression or liverfailure, rather than from metastatic disease (9–12), aneffective and well-tolerated locoregional treatment could

The aim of this work was the evaluation of the usefulness of 124I PET/CT sequential scans to predict absorbed doses to metastatic thyroid cancer in patients undergoing 131I therapy. METHODS: From July 2011 until April 2012 8 patients affected by metastatic thyroid cancer were enrolled. Each patient underwent 4 PET/CT scans at 4, 24, 48, 72 h after the administration of about 74 MBq of 124I. Blood samples and whole body exposure measurements were obtained to calculate blood and red marrow doses. Activity concentrations and lesion volumes obtained from PET/CT images were used to evaluate tumour doses with MIRD formalism and spheres model. The average administered 131I therapeutic activity was 6475 MBq (range: 3700-9250 MBq). RESULTS: 124I PET/CT images showed, with a very good resolution, all 131I avid lesions detected by post therapy whole body scans. The average dose rates for blood, red marrow and lesions were respectively: 6.58E-02 ± 1.64E-02 mGy/MBq, 5.73E-02 ± 1.57E-02 mGy/MBq, 2.22E+01 ± 1.62E+01 mGy/MBq. Three out of eight patients did not show any uptake of 124I in all PET/CT scans, despite high level of TSH and CT detectable lesions. Post-therapy 131I whole body scan confirmed the absence of focal iodine uptake. CONCLUSION: Negative 124I PET/CT images probably could be used as predictive of real absence of iodine avidity, avoiding all toxicity from useless 131I therapy. A higher number of patients is necessary to validate these preliminary results and a project is ongoing to compare MIRD results to voxel dosimetry based on Monte Carlo simulation.

Alterations of the cardiac autonomic nervous system play an important role in the pathway of many heart diseases. Nuclear imaging tools have been demonstrated to be useful for global and regional assessment of myocardial innervation. We used (11)C-meta-hydroxy-ephedrine ((11)C-mHED), a catecholamine analogue, as a radiotracer usable with a PET/CT scanner to study the cardiac sympathetic system. After a fast and automatic synthesis of mHED and its labeling with (11)C, we acquired cardiac images by using a PET/ CT scanner. In this paper we present our preliminary results showing the radiotracer bio-distribution in humans 10 minutes post injection. The present study assesses the feasibility of PET/CT with the radiolabeled catecholamine analogue ((11)C-mHED) in order to determine sympathetic innervation in the human heart.

To evaluate the value of 18F-fluorodeoxy-glucose (FDG) positron emission tomography with computed tomography (PET/CT) in myeloma in patients presenting with a solitary plasmacytoma of bone (SPB).Fourteen consecutive patients studied since 2006, all having a diagnosis of SPB before PET/CT imaging took part in this study. In 3 patients PET/CT was performed for staging while in the remaining 11 it was used to monitor therapy. PET/CT was performed using a dedicated tomograph 60-90 minutes after intravenous injection of 53 MBq/kg of 18F-FDG and the results were compared to other diagnostic procedures [radiographs and magnetic resonance imaging (MRI)], biopsy, and other available follow-up data.In 8/14 patients, PET/CT scans showed previously unsuspected sites of increased FDG accumulation. In 6/8 patients, FDG uptake was considered pathologic, depicting myeloma involvement in bone, while in the remaining cases, findings were considered incidental and not related to myeloma. PET findings attributed to myeloma were confirmed (i.e. true positives) in 6/6 cases (100%) and in all patients with findings reported as non-pathologic, myeloma was excluded (100% true negatives).Our preliminary data in a small number of cases suggests that there are a group of patients with SPB (local disease) in whom FDG PET/CT may detect other unsuspected sites of bone involvement, upstaging the extent of the disease. In these cases, SPB may be a local manifestation of multiple myeloma where other sites of involvement have eluded detection by other less sensitive imaging modalities (i.e. skeletal surveys) or anatomically restricted imaging (i.e., less than total body MR or CT). Finding other sites of involvement have significant implications for appropriate treatment of myeloma.