Comparison of Standardized Uptake Values in Normal Structures Between PET/CT and PET/MRI in an Oncology Patient Population

Purpose

The purpose of this study was to compare and correlate standardized uptake values (SUV) derived from magnetic resonance attenuation correction (MRAC) with those derived from computed tomography attenuation correction (CTAC) in an oncology patient population.

Procedures

The HIPAA-compliant study was approved by the Internal Review Board and all subjects gave written informed consent prior to inclusion in the study. Forty patients (mean age 61?±?15.1; 20 male) referred for clinically indicated 2-deoxy-2-[¹⁸F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans also underwent a PET/magnetic resonance imaging (MRI) examination. MRAC was performed using an automatic three-segment model. Regions of interest were drawn over eight normal structures in order to obtain SUVmax and SUVmean values. Spearman rank correlation coefficients (r) were calculated and two-tailed paired t tests were performed to compare the SUVmax and SUVmean values obtained from CTAC with those from MRAC.

Results

The mean time after FDG injection was 66?±?7 min for PET/CT and 117?±?15 min for PET/MRI examination. MRAC SUV values were significantly lower than the CTAC SUV values in mediastinal blood pool (p?<?0.001 for both SUVmax and SUVmean) and liver (p?=?0.01 for SUVmean). The MRAC SUV values were significantly higher in bone marrow (p?<?0.001 for both SUVmax and SUVmean), psoas major muscle (p?<?0.001 for SUVmax), and left ventricular myocardium (p?<?0.001 for SUVmax and p?=?0.01 for SUVmean). For the other normal structures, no significant difference was observed. When comparing SUV values generated from CTAC versus MRAC, high correlations between CTAC and MRAC were observed in myocardium (r?=?0.96/0.97 for SUVmax/mean), liver (r?=?0.68 for SUVmax), bone marrow (r?=?0.80/0.83 for SUVmax/mean), lung tissue (r?=?0.70 for SUVmax), and mediastinal blood pool (r?=?0.0.68/.069 for SUVmax/mean). Moderate correlations were found in lung tissue (r?=?0.67 for SUV mean), liver (r?=?0.66 for SUVmean), fat (r?=?0.48/0.53 for SUVmax/mean), psoas major muscle (r?=?0.54/0.58 for SUVmax/mean), and iliacus muscle (r?=?0.41 for SUVmax). Low correlation was found in iliacus muscle (r?=?0.32 for SUVmean).

Conclusions

Using the automatic three-segment model, our study showed high correlation for measurement of SUV values obtained from MRAC compared to those from CTAC, as the reference standard. Differences observed between MRAC and CTAC derived SUV values may be attributed to the time-delay between the PET/CT and PET/MRI scans or biologic clearance of radiotracer. Further studies are required to assess SUV measurements when performing different MR attenuation correction techniques.     

Quantification of Iron-Labeled Cells with Positive Contrast in Mouse Brains

Purpose

To quantify small amounts of iron-labeled cells in mouse brains with magnetic resonance imaging (MRI).

Procedures

Iron-labeled cells (from 500 to 7,500) were stereotaxically transplanted into the brain of living mice that were subsequently imaged with MRI at 4.7 T. We compared four quantitative methods: (1) T2 relaxometry, (2) T2* relaxometry, (3) the volume of the cloverleaf hypointense artifact generated on T2*-weighted images, and (4) the volume of the cloverleaf hyperintense artifact generated on positive contrast images.

Results

The methods based on relaxometry, whether T2 or T2*, did not correlate with the number of injected cells. By contrast, those based on measurement of cloverleaf artifact volume, whether using negative or positive enhancement, showed a significant linear relationship for the given range of cells (R [0.92?C0.95], p?<?0.05).

Conclusions

T2* artifact volume imaging (negative or positive) appears promising for the quantification of magnetically labeled cells following focal injection in the brain.     

Differentiation of Reactive and Tumor Metastatic Lymph Nodes with Diffusion-weighted and SPIO-Enhanced MRI

Objectives

Determination of lymphatic metastasis is of great importance for both treatment planning and patient prognosis. We aim to distinguish tumor metastatic lymph nodes (TLNs) and reactive lymph nodes (RLNs) with diffusion-weighted and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI).

Materials and Methods

Ipsilateral popliteal lymph node metastasis or lymphadenitis model was established by hock injection of either luciferase-expressing 4T1 murine breast cancer cells or complete Freund's adjuvant in male BALB/c mice. At different time points after inoculation, bioluminescence imaging and T₂-weighted, diffusion-weighted, and SPIO-enhanced MRI were performed. Imaging findings were confirmed by histopathological staining.

Results

Size enlargement was observed in both TLNs and RLNs. At day 28, TLNs showed strong bioluminescence signal and bigger size than RLNs (p?<?0.01). At early stages up to day 21, both TLNs and RLNs appeared homogeneous on diffusion-weighted imaging. At day 28, TLNs showed heterogeneous apparent diffusion coefficient (ADC) map with significantly higher average ADC value of 0.41?±?0.03?×?10^?3mm²/s than that of RLNs (0.34?±?0.02?×?10^?3mm²/s; p?<?0.05). On SPIO-enhanced MRI, both TLNs and RLNs showed distinct T₂ signal reduction at day 21 after inoculation. At day 28, TLNs demonstrated partial uptake of the iron oxide particles, which was confirmed by Prussian blue staining.

Conclusions

Both diffusion-weighted and SPIO-enhanced MRI can distinguish tumor metastatic lymph nodes from reactive lymph nodes. However, neither method is able to detect tumor metastasis to the draining lymph nodes at early stages.     

Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction (TOPCARE-AMI): final 5-year results suggest long-term safety and efficacy

Background

Limited data is available for investigating the long-term safety and effects of intracoronary progenitor cell therapy in patients with acute myocardial infarction (AMI).

Objective

To assess the clinical course, NT-proBNP and MRI data as objective markers of cardiac function of the TOPCARE-AMI patients at 5-year follow-up.

Design

The TOPCARE-AMI trial was the first randomized study investigating the effects of intracoronary infusion of circulating (CPC) or bone marrow-derived progenitor cells (BMC) in 59 patients with successfully reperfused AMI.

Results

Five-year follow-up data were completed in 55 patients, 3 patients were lost to follow-up. None of the patients showed any signs of intramyocardial calcification or tumors at 5?years. One patient died during the initial hospitalization, no patient was rehospitalized for heart failure and 16 patients underwent target vessel revascularization (TVR). Only two TVRs occurred later than 1?year after cell administration making it very unlikely that the infused cells accelerate atherosclerotic disease progression. Serum levels of NT-proBNP remained significantly reduced at the 5-year follow-up indicating the absence of heart failure. MRI subgroup analysis in 31 patients documented a persistent improvement of LV ejection fraction (from 46?±?10% at baseline to 57?±?10% at 5?years, p?<?0.001)). Simultaneously, there was a reduction (p?<?0.001) in functional infarct size measured as late enhancement volume normalized to LV mass. However, whereas LV end-systolic volume remained stable, LV end-diastolic volume increased significantly.

Conclusions

The 5-year follow-up of the TOPCARE-AMI trial provides reassurance with respect to the long-term safety of intracoronary cell therapy and suggests favorable effects on LV function.     

Predictors of anxiety and depression in people with colorectal cancer

Background

People living with colorectal cancer are at risk of anxiety and depression. We investigated what factors were most highly associated with these.

Methods

Four hundred and ninety-six people with colorectal cancer completed the Hospital Anxiety and Depression Scale (HADS). Data on functioning, symptoms, illness perceptions and social difficulties were collected by questionnaire. Case-note-identified disease, treatment and co-morbidity data were recorded. Multiple logistic regression identified factors independently predictive of anxiety and depression caseness.

Results

Self-reported history of anxiety/depression predicted anxiety but not depression caseness. Depression caseness predicted anxiety caseness (p?=?0.043), as did poorer self-reported cognitive functioning (p?=?0.001), dyspnoea (p?=?0.015) or diarrhoea (p?=?0.021), reporting a high negative life and emotional impact (p?<?0.001) and having difficulties with finance (p?=?0.007). Having neo-adjuvant radiotherapy increased the odds of depression caseness (p?=?0.007), as did poorer physical (p?=?0.007), cognitive (p?<?0.001) and social (p?<?0.001) functioning, having constipation (p?=?0.011), reporting a high negative life and emotional impact (p?<?0.001), having difficulties with personal care (p?=?0.022) and communicating with others (p?=?0.014).

Conclusion

Levels of anxiety caseness were similar to those of non-clinical samples, but depression caseness was higher, particularly in those who had received neo-adjuvant radiotherapy. Most factors associated with possible or probable depression may be modified with appropriate intervention.     

Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients

Background

Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES).

Methods

Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF?<?30%, LVEF 30?C45%, and LVEF?>?45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests.

Results

A total of 975 subjects was included (LVEF?<?30%: 46, LVEF 30?C45%: 208, LVEF?>?45%: 721). Patients with LVEF?<?30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7?days (p?=?0.012 for all-cause death and p?=?0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30?days and at long-term (p?<?0.001 for death, and p?<?0.001 for MACE). After a median of 18?months, risk of death totaled 39 versus 13 versus 8% (p?<?0.001) and risk of MACE 44 versus 24 versus 22% (p?=?0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point.

Conclusions

Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.     

Caregivers’ morbidity in palliative care unit: predicting by gender, age, burden and self-esteem

Purpose

This study assesses psychological distress suffered by caregivers of patients with a disease at an advanced and terminal state admitted at a palliative care unit. Specifically, these areas were examined in how distress was perceived: the contribution of caregiving burden, caregivers’ self-esteem, caregivers’ age and gender.

Methods

The sample constituted of 159 caregivers. Measurements included the Hospital Anxiety and Depression Scale (HADS) to assess distress, the shortened version of the Zarit Burden Inventory and Rosenberg self-esteem scale.

Results

Approximately 77% of the caregivers reported probable significant distress (HADS ≥12), with a similar proportion with anxiety (76.1%) and depression (77.4%) within the caregivers’ symptomatology. Multiple regression analysis revealed that the caregivers’ self-esteem (p?<?0.01) and caregivers’ burden (p?<?0.01) were stronger predictors of caregivers’ distress than the socio-demographic characteristics, age or gender (p?<?0.05).

Conclusions

A high prevalence of morbidity was noticed in caregivers of patients admitted at the palliative care unit. The early provision of psychological support to caregivers by healthcare staff may indeed help to decrease comorbidity symptoms.     

Palliative and oncologic co-management: symptom management for outpatients with cancer

Purpose

Although outpatient palliative care clinics are increasingly common, evidence for their efficacy remains limited.

Methods

We conducted an observational study at the palliative care clinic of an academic cancer center to assess the association between palliative care co-management and symptoms and quality of life. Two hundred sixty-six adult outpatients were seen for a minimum of two palliative care visits within 120 days. A subset of 142 patients was seen for a third visit within 240 days. Patients completed a questionnaire containing validated symptom, quality of life, and spiritual wellbeing questions at each visit.

Results

The first follow-up visit was on average 41 days after the initial visit; the second follow-up visit was on average 81 days after the initial visit. Between the initial and first follow-up visits, there was significant improvement in pain (p?<?0.001), fatigue (p?<?0.001), depression (p?<?0.001), anxiety (p?<?0.001), quality of life (p?=?0.002), and spiritual wellbeing (p?<?0.001), but not nausea (p?=?0.14). For the subset of patients seen for a second follow-up visit, the improvements in pain, fatigue, depression, anxiety, quality of life, and spiritual wellbeing persisted (p?≤?0.005 for trend of each symptom). Patients had similar improvement regardless of their gender, age, ethnicity, disease stage, disease progression, and concurrent oncologic treatments.

Conclusions

Palliative care was associated with significant improvement in nearly all the symptoms evaluated. A sustained change in symptoms was observed in the subset of patients seen for a second follow-up visit. Members of all subgroups improved.     

Evaluation of intrapsychic processes, anxiety, and depression in postmenopausal women affected by breast cancer: a case–control study

Background

The study of intrapsychic modalities can help to understand the association between depression and breast cancer patients and what kind of intervention can be planned. There is evidence that breast cancer is associated with the development of depression. The study of intrapsychic modalities may explain this association. Therefore, we aimed at investigating the intrapsychic and interpersonal processes of the structure of personality, anxiety, and depression of postmenopause breast cancer women.

Methods

All participants (n?=?63) underwent the following tests: SASB questionnaire (Structural Analysis of Interpersonal Behavior), describing intrapsychic and interpersonal processes, validated on the basis of DSMIV, and the CDQ and ASQ questionnaires describing depression and anxiety. We compared two groups: breast cancer (n?=?63) and a healthy control group of women without cancer (n?=?83).

Results

Patients with breast cancer presented medium to high levels of anxiety and depression and intrapsychic level showed that they had less autonomy in their choices with low acceptance of their own feelings and tendency to be depressed compared to the control group (Cl 1 autonomy F?=?10.21, p?<?0.05, Cl 2 autonomy and love F?=?13.01, p?<?0.001, Cl 3 love F?=?10.50, p?<?0.01, Cl 5 control F?=?6.44, p?<?0.05, Cl 6 control and hate F?=?4.49, p?<?0.05, ASQ F?=?6.07, p?<?0.05, and CDQ F?=?6.24, p?<?0.05).

Conclusions

Intrapsychic characteristics such as tendency to depression, inability to being in contact with their own feelings, may be linked to difficulties in facing treatment and their condition of illness. Knowledge of these modalities could allow to plan a psychotherapeutic and multidisciplinary intervention aimed at facing the different phases of medical treatment.     

Clinical correlates of endothelial function in chronic heart failure

Objective

There is a close link between heart failure and endothelial dysfunction. Brachial flow-mediated dilation (FMD) is a validated non-invasive measure of endothelial function. The aim of this study was to investigate the clinical correlates of FMD in patients with chronic heart failure (CHF).

Design, setting, patients

We evaluated 60 CHF outpatients (age 62?±?14?years; 49 males, NYHA class 2.2?±?0.7, left ventricular ejection fraction, LVEF, 33?±?8%) taking conventional medical therapy (ACE-inhibitors and/or ARBs 93%, beta-blockers 95%) and in stable clinical conditions.

Main outcome measures

The maximum recovery value of FMD was calculated as the ratio of the change in diameter (maximum-baseline) over the baseline value.

Results

As compared with patients with a higher FMD, those with FMD below the median value (4.3%) were more frequently affected by ischemic cardiopathy (50 vs. 23%; p?=?0.032) and diabetes mellitus (20 vs. 3%; p?=?0.044), had a higher NYHA class (2.5?±?0.5 vs. 1.9?±?0.7; p?<?0.001) and NT-proBNP (2,690?±?3,690 vs. 822?±?1,060; p?=?0.001), lower glomerular filtration rate estimated by Cockcroft-Gault (GFRCG: 63?±?28 vs. 78?±?25; p?=?0.001) and LVEF (29?±?8 vs. 37?±?9; p?=?0.001), as well as more frequently showing a restrictive pattern (40 vs. 7%; p?=?0.002). In a multivariate regression model (R ²?=?0.48; p?<?0.001), FMD remained associated only with the NYHA class (p?=?0.039) and diabetes mellitus (p?=?0.024).

Conclusions

This study demonstrates that a better functional status and absence of diabetes mellitus are associated to higher FMD regardless of the etiology of the cardiac disease.     

Half-dose gadobenate dimeglumine versus standard-dose gadodiamide in dynamic magnetic resonance imaging of non-cirrhotic livers: a retrospective intra-individual crossover comparison

Purpose

The purpose of this study was to compare enhancement characteristics of half-dose gadobenate dimeglumine (0.05 mmol kg^?1) with standard-dose gadodiamide (0.10 mmol kg^?1), in the assessment of hepatic vessels and lesions, using retrospective intra-individual crossover comparison methodology.

Methods

Ethics committee approval was obtained. From 2004 to 2012, 21 patients underwent MRI examination with both standard-dose gadodiamide and half-dose gadobenate dimeglumine, using the same liver MRI protocol at 1.5 T. Eighteen patients whose scans showed no artifacts were selected. Quality of liver lesion [12 hemangiomas, 7 focal nodular hyperplasias (FNHs)] and liver vessel enhancement, and the global diagnostic quality of studies were ranked on a scale of 1–4 by two independent radiologists. Contrast-to-noise ratio (CNR) and % enhancement of liver vessels and lesions were calculated based on region of interest, signal intensity, and noise standard deviation measurements performed at 0, 20 s, 1, 3, and 5 min post-contrast injection. Qualitative and quantitative results were compared using the paired Wilcoxon signed rank and Student’s t-tests, respectively.

Results

No qualitative differences were noted in enhancement of liver vessels, hemangiomas, and FNHs. There was no statistically significant difference between the global diagnostic qualities of scans performed with the two contrast agents. Quantitatively, liver vessels and hemangiomas did not demonstrate statistically significant differences in contrast enhancement. At 20 s, FNHs achieved higher CNR (P = 0.02) with gadodiamide.

Conclusion

Half-dose gadobenate dimeglumine results in similar contrast enhancement compared to standard-dose gadodiamide in assessment of liver vessels, hemangiomas, and FNHs, and is a reasonable alternative to standard doses of extracellular agents in dynamic liver MRI.     

The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study

Purpose

Disease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.

Methods

Patients with advanced (stage IIIB/IV) NSCLC (N?=?450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy—Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.

Results

A high proportion of patients experienced lung cancer symptoms: fatigue (100 %), loss of appetite (97 %), shortness of breath (95 %), cough (93 %), pain (92 %), and blood in sputum (63 %). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (β?=??0.204; p?<?0.001), cough (β?=??0.145; p?<?0.01), pain (β?=??0.265; p?<?0.001), and shortness of breath (β?=??0.145; p?<?0.01) were found to be significant predictors of the quality of life.

Conclusions

Symptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.     

Satisfaction with information and its association with illness perception and quality of life in Indonesian breast cancer patients

Purpose

The aims of this study were to assess the level of satisfaction with the information on illness and treatment among breast cancer patients, to explore its association with patients’ illness perceptions and quality of life, and to provide recommendations for improvement of the information provided.

Methods

Seventy breast cancer patients at the Outpatient Surgical Oncology Clinic in Hasan Sadikin Hospital in Indonesia were recruited consecutively in a cross-sectional study design. They completed a demographic form, the Satisfaction with Cancer Information Profile, the Brief Illness Perception Questionnaire, and the World Health Organization Quality of Life.

Results

A considerable number of breast cancer patients (41–86 %) were dissatisfied with the amount and content of the information they received, particularly on the information about access to patient support groups and the impact of their treatment on long-term quality of life. The majority of patients were dissatisfied with the amount of written information provided. Patients who were satisfied with the type and timing of information received had stronger beliefs in personal control (β?=??0.30, p?<?0.05), lesser concerns about their health condition (β?=??0.47, p?<?0.01), and better understanding of their illness (β?=??0.27, p?<?0.05), and were less emotionally affected by their illness (β?=??0.27, p?<?0.05). In addition, the satisfied patients had a more positive perception of their general health (β?=?0.31, p?<?0.05) and better psychological health condition (β?=?0.33, p?<?0.05).

Conclusions

Satisfaction with the information provided is associated with better health outcomes, including more positive illness perceptions. This study appears to highlight the importance of providing adequate and sufficient information that meets the needs of patients.     

Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore

Purpose

This prospective cohort study aims to investigate the direct hospitalization costs incurred during febrile neutropenia (FN) in inpatients with underlying hematological conditions and also to elucidate the factors associated with a high cost of managing febrile neutropenia.

Methods

Patients with underlying hematological conditions and documented FN were recruited between October 2008 and February 2011. FN-related costs included all costs incurred from the first day of FN until the last day of antibiotics prescribed. Relevant clinical factors were analyzed using generalized estimating equation models to elucidate the factors that were associated with higher costs of FN.

Results

A total of 175 patients were recruited with 303 documented episodes of FN. In non-transplant patients, 75.6 % of the FN episodes occurred. The median and mean cost incurred for each FN episode was USD9,060 (interquartile range?=?USD5,047–16,631) and USD15,298 (standard deviation?±?USD17,459), respectively, accounting for approximately 38 % of the median total hospitalization cost and 37 % of the mean total hospitalization cost. The ward charges (44.1 %) constituted the largest component of the cost, followed by the laboratory charges (27.3 %) and medications (18.7 %), of which antimicrobials constituted 9.6 % of the cost of FN. The factors associated with higher costs of FN include cytomegalovirus reactivation (p?<?0.001), longer duration of antibiotics (p?<?0.001), lower absolute neutrophil count nadir (p?<?0.001), allogeneic stem cell transplantation (p?<?0.01), and diagnosis of invasive fungal infection (p?<?0.05).

Conclusion

The economic cost of management of FN in hematology inpatients is considerable and in addition to the overall risk of mortality for this condition. Strategies to reduce FN or ameliorate its costs are essential for this group of patients.     

Green tea halts progression of cardiac transthyretin amyloidosis: an observational report

Background

Treatment options in patients with amyloidotic transthyretin (ATTR) cardiomyopathy are limited. Epigallocatechin-3-gallate (EGCG), the most abundant catechin in green tea (GT), inhibits fibril formation from several amyloidogenic proteins in vitro. Thus, it might also halt progression of TTR amyloidosis. This is a single-center observational report on the effects of GT consumption in patients with ATTR cardiomopathy.

Methods

19 patients with ATTR cardiomyopathy were evaluated by standard blood tests, echocardiography, and cardiac MRI (n?=?9) before and after consumption of GT and/or green tea extracts (GTE) for 12?months.

Results

Five patients were not followed up for reasons of death (n?=?2), discontinuation of GT/GTE consumption (n?=?2), and heart transplantation (n?=?1). After 12?months no increase of left ventricular (LV) wall thickness and LV myocardial mass was observed by echocardiography. In the subgroup of patients evaluated by cardiac MRI a mean decrease of LV myocardial mass (?12.5?%) was detected in all patients. This was accompanied by an increase of mean mitral annular systolic velocity of 9?% in all 14 patients. Total cholesterol (191.9?±?8.9 vs. 172.7?±?9.4?mg/dL; p?p?Conclusions Our observation suggests an inhibitory effect of GT and/or GTE on the progression of cardiac amyloidosis. We propose a randomized placebo-controlled investigation to confirm our observation.     

Pancreatic adenocarcinoma: a pilot study of quantitative perfusion and diffusion-weighted breath-hold magnetic resonance imaging

Purpose

To confirm the feasibility of breath-hold DCE-MRI and DWI at 3T to obtain the intra-abdominal quantitative physiologic parameters, K ^trans, k _ep, and ADC, in patients with untreated pancreatic ductal adenocarcinomas.

Methods

Diffusion-weighted single-shot echo-planar imaging (DW-SS-EPI) and dynamic contrast-enhanced (DCE) MRI were used for 16 patients with newly diagnosed biopsy-proven pancreatic ductal adenocarcinomas. K ^trans, k _ep, and apparent diffusion coefficient (ADC) values of pancreatic tumors, non-tumor adjacent pancreatic parenchyma (NAP), liver metastases, and normal liver tissues were quantitated and statistically compared.

Results

Fourteen patients were able to adequately hold their breath for DCE-MRI, and 15 patients for DW-SS-EPI. Four patients had liver metastases within the 6 cm of Z axis coverage centered on the pancreatic primary tumors. K ^trans values (10^?3 min^?1) of primary pancreatic tumors, NAP, liver metastases, and normal liver tissues were 7.3 ± 4.2 (mean ± SD), 25.8 ± 14.9, 8.1 ± 5.9, and 45.1 ± 15.6, respectively, k _ep values (10^?2 min^?1) were 3.0 ± 0.9, 7.4 ± 3.1, 5.2 ± 2.0, and 12.1 ± 2.8, respectively, and ADC values (10^?3 mm²/s) were 1.3 ± 0.2, 1.6 ± 0.3, 1.1 ± 0.1, and 1.3 ± 0.1, respectively. K ^trans, k _ep, and ADC values of primary pancreatic tumors were significantly lower than those of NAP (p < 0.05), while K ^trans and k _ep values of liver metastases were significantly lower than those of normal liver tissues (p < 0.05).

Conclusions

3T breath-hold quantitative physiologic MRI is a feasible technique that can be applied to a majority of patients with pancreatic adenocarcinomas.     

Phase I/II trial of formoterol fumarate combined with megestrol acetate in cachectic patients with advanced malignancy

Purpose

The aim of this study was to test the safety, tolerability and efficacy of a novel combination of an anabolic β₂-agonist and an appetite stimulant in patients with cancer cachexia.

Methods

Thirteen patients (M/F 5:8) with advanced malignancy and involuntary weight loss received oral formoterol (80 μg/day) and megestrol acetate (480 mg/day) for up to 8 weeks. Quadriceps size (MRI), quadriceps and hand-grip strength, lower limb extensor power, physical activity and quality of life were measured at baseline and at 8 weeks. Response criteria were specified pre-trial, with a major response defined as an increase in muscle size ≥4 % or function ≥10 %.

Results

Six patients withdrew before 8 weeks, reflecting the frail, comorbid population. In contrast, six out of seven (86 %) patients completing the course achieved a major response for muscle size and/or function. In the six responders, mean quadriceps volume increased significantly (left 0.99 vs. 1.05 L, p?=?0.012; right 1.02 vs. 1.06 L, p?=?0.004). There was a trend towards an increase in quadriceps and handgrip strength (p?>?0.05). The lack of appetite symptom score declined markedly (76.2 vs. 23.8; p?=?0.005), indicating improvement. Adverse reactions were few, the commonest being tremor (eight reports), peripheral oedema (three), tachycardia (two) and dyspepsia (two).

Conclusions

In this frail cohort with advanced cancer cachexia, an 8-week course of megestrol and formoterol in combination was safe and well tolerated. Muscle mass and/or function were improved to a clinically significant extent in most patients completing the course. This combination regimen warrants further investigation in larger, randomized trials.     

The early discontinuation of palliative chemotherapy in older patients with cancer

Purpose

Older patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.

Methods

Ninety-eight patients older than 65 years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson’s co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.

Results

Active treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1 months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OS?=?3.1 vs. 14.7 months in patients with ED compared with patients without ED, p?<?0.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (p?=?0.001, p?=?0.048, p?=?0.001, p?<?0.001, p?<?0.001, p?=?0.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratio?=?5.03; 95 % confidence interval?=?1.50–16.87: odds ratio?=?3.06; confidence interval?=?1.03–9.12, respectively).

Conclusions

ED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.     

Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sectional study in China

Objective

The aim of this study was to investigate the symptom and symptom clusters of patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), and to discuss the relationship between symptoms, symptom clusters, and symptom interference.

Materials and methods

Patients with HCC who received TACE were asked to rate their symptoms using the M. D. Anderson Symptom Inventory and the symptom checklist particularly for HCC. To determine the interrelationships among symptoms and identify the symptom clusters, a principal component analysis with varimax rotation was carried out on the symptom items. Spearman correlation analysis was done to assess the relationship between symptom clusters and symptom interference.

Results

A total of 155 patients finished the whole procedure between November 2010 and May 2011. Before TACE, the five most severe symptoms, ranked in order, were fatigue (3.40?±?2.26), distress (3.35?±?2.60), sadness (3.01?±?2.66), sleep disturbance (2.63?±?2.57), and lack of appetite (2.26?±?2.38). After TACE, fatigue (4.88?±?2.31) was the most serious symptom, followed by sleep disturbance (4.80?±?2.25), distress (4.59?±?2.32), sadness (4.45?±?2.16), lack of appetite (4.25?±?2.51). Two symptom clusters were found before TACE: psychological symptom cluster and sickness symptom cluster. Two new symptom clusters were found after TACE: upper gastrointestinal symptom cluster and liver function impairment symptom cluster, with the two original symptom clusters remained relatively stable. The highest symptom interference items pre- and post-TACE were work and enjoyment of life, followed by mood. The symptoms of distress, sadness, fatigue, sleep disturbance, and lack of appetite were all significantly associated with the total interference (r?=?0.443–0.615, p?<?0.01 or p?<?0.05). Symptom clusters were significantly correlated with the total symptom interference before and after TACE (r?=?0.176–0.638, p?<?0.01 or p?<?0.05).

Conclusion

Psychological symptom cluster and sickness symptom cluster are common for HCC patients before and after TACE. Liver function impairment and upper gastrointestinal symptom clusters are directly related to TACE treatment. Both the symptoms and symptom clusters have significant interference on the daily life of HCC patients undergoing TACE. However, more work is needed to further clarify the symptom clusters associated with TACE and to test the effectiveness of TACE in easing symptoms and improving quality of life of HCC patients.