Search

Objective: To investigate the feasibility of fluorescence molecular imaging (FMI), using cetuximab‐800CW, as an intraoperative tool to determine surgical margins in penile squamous cell carcinoma (PSCC). Patients and methods: A total of 11 patients with PSCC received 75 mg cetuximab followed by 15 mg cetuximab‐800CW 2 days before surgery. FMI of the whole excision specimen and tissue slices was performed. Fluorescence visualisation was correlated to histopathology. Based on tumour and healthy tissue regions of interest, mean fluorescence intensity was calculated for each individual patient. Results: Significant differences between tumour and healthy mean fluorescence intensity were found with tumour‐to‐background ratios of a median (IQR) of 1.51 (0.99) and a mean (SD) of 1.51 (0.32) in the excision specimen and tissue slices, respectively. One patient showed a high relative fluorescence intensity with a signal‐to‐background ratio of 1.79, corresponding to a tumour‐positive margin on fresh frozen sectioning. Conclusion: In this Phase I study we showed that cetuximab‐800CW seems suitable to discriminate PSCC from background tissue. The tracer was well tolerated, and no false positive spots were seen. [ABSTRACT FROM AUTHOR]

Background: Radium‐223 and taxane chemotherapy each improve survival of patients with metastatic castration‐resistant prostate cancer (mCRPC). Whether the radium‐223–taxane sequence could extend survival without cumulative toxicity was explored. Methods: The global, prospective, observational REASSURE study (NCT02141438) assessed real‐world safety and effectiveness of radium‐223 in patients with mCRPC. Using data from the prespecified second interim analysis (data cutoff, March 20, 2019), hematologic events and overall survival (OS) were evaluated in patients who were chemotherapy‐naive at radium‐223 initiation and subsequently received taxane chemotherapy starting ≤90 days ("immediate") or >90 days ("delayed") after the last radium‐223 dose. Results: Following radium‐223 therapy, 182 patients received docetaxel (172 [95%]) and/or cabazitaxel (44 [24%]); 34 patients (19%) received both. Seventy‐three patients (40%) received immediate chemotherapy and 109 patients (60%) received delayed chemotherapy. Median time from last radium‐223 dose to first taxane cycle was 3.6 months (range, 0.3–28.4). Median duration of first taxane was 3.7 months (range, 0–22.0). Fourteen patients (10 in the immediate and four in the delayed subgroup) had grade 3/4 hematologic events during taxane chemotherapy, including neutropenia in two patients in the delayed subgroup and thrombocytopenia in one patient in each subgroup. Median OS was 24.3 months from radium‐223 initiation and 11.8 months from start of taxane therapy. Conclusions: In real‐world clinical practice settings, a heterogeneous population of patients who received sequential radium‐223–taxane therapy had a low incidence of hematologic events, with a median survival of 1 year from taxane initiation. Thus, taxane chemotherapy is a feasible option for those who progress after radium‐223. Clinical Trial Registration: ClinicalTrials.gov identifier NCT02141438. Plain Language Summary: Radium‐223 and chemotherapy are treatment options for metastatic prostate cancer, which increase survival but may affect production of blood cells as a side effect.We wanted to know what would happen if patients received chemotherapy after radium‐223.Among the 182 men treated with radium‐223 who went on to receive chemotherapy, only two men had severe side effects affecting white blood cell production (neutropenia) during chemotherapy.On average, the 182 men lived for 2 years after starting radium‐223 and 1 year after starting chemotherapy.In conclusion, patients may benefit from chemotherapy after radium‐223 treatment without increasing the risk of side effects. [ABSTRACT FROM AUTHOR]

Background/objectives: Accurate and uniform interpretation and reporting of metastatic prostate cancer (PCa) lesions on prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) are indispensable. 18F-PSMA-1007 is increasingly used because of its favorable imaging characteristics. However, increased non-specific skeletal uptake may be an important pitfall of this radioligand. Therefore, we aimed to assess the interobserver variation in reporting skeletal 18F-PSMA-1007 uptake on PET/CT. Design/methods: In total, 33 18F-PSMA-1007 PET/CT scans of 21 patients with primary PCa and 12 patients with biochemical recurrence were included, and a total of 85 skeletal lesions were evaluated by three independent observers. The primary endpoint was the interobserver variability of the likelihood of malignancy of the skeletal lesions on both patient and lesion level (kappa analysis). Results: Observers qualified most lesions as not malignant (81–91%) and the overall mean interobserver agreement was moderate on both patient (κ: 0.54) and lesion level (κ: 0.55). In 52 lesions without corresponding CT substrate, the rating resulted in not malignant in 95–100%. Availability of additional imaging (60% of lesions) did not improve interobserver agreement (κ: 0.39 on lesion level) and resulted in unchanged rating for all observers in 78%. Conclusion: This interobserver analysis of skeletal 18F-PSMA-1007 uptake resulted in moderate agreement, in line with rates reported in literature. Importantly, the presence of non-specific skeletal uptake without CT substrate, as a potential shortcoming of 18F-PSMA-1007, did not impair interobserver agreement. [ABSTRACT FROM AUTHOR]

Background: Incidental imaging findings (incidentalomas) are common, but there is currently no effective means to investigate their clinical relevance. Purpose: To introduce a new concept to postprocess a medical imaging examination in a way that incidentalomas are concealed while its diagnostic potential is maintained to answer the referring physician's clinical questions. Material and Methods: A deep learning algorithm was developed to automatically eliminate liver, gallbladder, pancreas, spleen, adrenal glands, lungs, and bone from unenhanced computed tomography (CT). This deep learning algorithm was applied to a separately held set of unenhanced CT scans of 27 patients who underwent CT to evaluate for urolithiasis, and who had a total of 32 incidentalomas in one of the aforementioned organs. Results: Median visual scores for organ elimination on modified CT were 100% for the liver, gallbladder, spleen, and right adrenal gland, 90%–99% for the pancreas, lungs, and bones, and 80%–89% for the left adrenal gland. In 26 out of 27 cases (96.3%), the renal calyces and pelves, ureters, and urinary bladder were completely visible on modified CT. In one case, a short (<1 cm) trajectory of the left ureter was not clearly visible due to adjacent atherosclerosis that was mistaken for bone by the algorithm. Of 32 incidentalomas, 28 (87.5%) were completely concealed on modified CT. Conclusion: This preliminary technical report demonstrated the feasibility of a new approach to postprocess and evaluate medical imaging examinations that can be used by future prospective research studies with long-term follow-up to investigate the clinical relevance of incidentalomas. [ABSTRACT FROM AUTHOR]