Detection Of Recurrent Disease Research Articles

Imaging of neuroendocrine tumors of the pancreas.

Pancreatic neuroendocrine tumors (PNETs) are rare and represent a heterogeneous disease. PNET can be functioning or non-functioning with different clinical presentations and different prognosis based on WHO and pTNM classifications. The role of imaging includes the localization of small functioning tumor, differentiation of these tumors from adenocarcinoma, identification of signs of malignancy and evaluation of extent. PNETs have a broad spectrum of appearance. On CT and MRI, most of functioning PNETs are well defined small tumors with intense and homogeneous enhancement on arterial and portal phases. However, some PNETs with a more fibrous content may have a more delayed enhancement that is best depicted on the delayed phase. Other PNETs can present as purely cystic, complex cystic and solid tumors and calcified tumors. Non-functioning PNETs are larger with less intense and more heterogeneous enhancement. Functional imaging is useful for disease staging, to detect disease recurrence or the primary but also to select patient candidate for peptide receptor radiometabolic treatment. Somatostatin receptor scintigraphy (SRS) (Octreoscan®) is still the most available technique. Gallium 68-SST analogue PET have been demonstrated to be more sensitive than SRS-SPEC and it will be the future of functional imaging for NET. Finally, 18FDG PET/CT is indicated for more aggressive PNET as defined either by negative SRS and huge tumor burden or ki67 above 10% or poorly differentiated PNEC tumors.

Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer.

BackgroundSuspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading.Materials and methodsForty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations.Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard.For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated.ResultsFDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy.ConclusionsFDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0096-y) contains supplementary material, which is available to authorized users.

Development and Validation of Urine-based Peptide Biomarker Panels for Detecting Bladder Cancer in a Multi-center Study.

Urothelial bladder cancer presents high recurrence rates, mandating continuous monitoring via invasive cystoscopy. The development of noninvasive tests for disease diagnosis and surveillance remains an unmet clinical need. In this study, validation of two urine-based biomarker panels for detecting primary and recurrent urothelial bladder cancer was conducted. Two studies (total n = 1,357) were performed for detecting primary (n = 721) and relapsed urothelial bladder cancer (n = 636). Cystoscopy was applied for detecting urothelial bladder cancer, while patients negative for recurrence had follow-up for at least one year to exclude presence of an undetected tumor at the time of sampling. Capillary electrophoresis coupled to mass spectrometry (CE-MS) was employed for the identification of urinary peptide biomarkers. The candidate urine-based peptide biomarker panels were derived from nested cross-sectional studies in primary (n = 451) and recurrent (n = 425) urothelial bladder cancer. Two biomarker panels were developed on the basis of 116 and 106 peptide biomarkers using support vector machine algorithms. Validation of the urine-based biomarker panels in independent validation sets, resulted in AUC values of 0.87 and 0.75 for detecting primary (n = 270) and recurrent urothelial bladder cancer (n = 211), respectively. At the optimal threshold, the classifier for detecting primary urothelial bladder cancer exhibited 91% sensitivity and 68% specificity, while the classifier for recurrence demonstrated 87% sensitivity and 51% specificity. Particularly for patients undergoing surveillance, improved performance was achieved when combining the urine-based panel with cytology (AUC = 0.87). The developed urine-based peptide biomarker panel for detecting primary urothelial bladder cancer exhibits good performance. Combination of the urine-based panel and cytology resulted in improved performance for detecting disease recurrence. Clin Cancer Res; 22(16); 4077-86. ©2016 AACR.

Imaging Evaluation of Malignant Chest Wall Neoplasms.

Neoplasms of the chest wall are uncommon lesions that represent approximately 5% of all thoracic malignancies. These tumors comprise a heterogeneous group of neoplasms that may arise from osseous structures or soft tissues, and they may be malignant or benign. More than 50% of chest wall neoplasms are malignancies and include tumors that may arise as primary malignancies or secondarily involve the chest wall by way of direct invasion or metastasis from intrathoracic or extrathoracic neoplasms. Although 20% of chest wall tumors may be detected at chest radiography, chest wall malignancies are best evaluated with cross-sectional imaging, principally multidetector computed tomography (CT) and magnetic resonance (MR) imaging, each of which has distinct strengths and limitations. Multidetector CT is optimal for depicting bone, muscle, and vascular structures, whereas MR imaging renders superior soft-tissue contrast and spatial resolution and is better for delineating the full extent of disease. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is not routinely performed to evaluate chest wall malignancies. The primary functions of PET/CT in this setting include staging of disease, evaluation of treatment response, and detection of recurrent disease. Ultrasonography has a limited role in the evaluation and characterization of superficial chest wall lesions; however, it can be used to guide biopsy and has been shown to depict chest wall invasion by lung cancer more accurately than CT. It is important that radiologists be able to identify the key multidetector CT and MR imaging features that can be used to differentiate malignant from benign chest lesions, suggest specific histologic tumor types, and ultimately guide patient treatment. (©)RSNA, 2016.

Diagnosis, therapeutic response assessment, and detection of disease recurrence in cardiac sarcoidosis: Integral role of cardiac PET

Sarcoidosis is a systemic disease and recognition of cardiac involvement remains challenging. We report a case and illustrate the integral role of cardiac PET perfusion-metabolic imaging in evaluating various stages of cardiac sarcoidosis. A 61-year-old African-American male presented with a 6-month history of progressive exertional dyspnea, cough, palpitations, and atypical chest pain. Physical exam was consistent with acute heart failure and his baseline EKG showed sinus rhythm with frequent premature ventricular contractions. Chest x-ray showed bilateral hilar adenopathy and telemetry monitoring was significant for multiple runs of nonsustained ventricular tachycardia. Echocardiography showed ejection fraction of 30% with global biventricular hypokinesis. Patient underwent coronary angiogram revealing minimal coronary atherosclerosis. A gadolinium-enhanced cardiac MRI was obtained (Figure 1), and a diagnosis of pulmonary and cardiac sarcoidosis was made following which a dual chamber defibrillator was implanted. Prednisone 20 mg daily and methotrexate 12.5 mg weekly was planned. However, given that treatment response and disease progression assessment could not be achieved with serial cardiac MRI (ICD placed), a baseline rest Rubidium 82/F-18 flourodeoxyglucose (Rb-82/18-FDG) cardiac PET was obtained prior to treatment to be used to then assess treatment response with serial scans as indicated showing pattern consistent with active cardiac sarcoidosis (Figure 2). Treatment was initiated and methotrexate titrated up to 15 mg weekly. He was seen in the clinic five months after medical therapy was initiated. Subjectively reported minimal to no symptoms. A repeat cardiac PET was done (Figure 3) using same protocol to assess response to therapy showed marked improvement. His dose of prednisone was decreased to 10 mg daily and then discontinued. Few months later, amiodarone and methotrexate were discontinued due to early development of interstitial lung disease. Seven months after discontinuation of medical therapy, he developed recurrent heart failure symptoms. Echocardiogram EF was 30%-35%. Repeat cardiac PET was done (Figure 4) showing recurrence of active cardiac sarcoidosis. He was reinitiated on prednisone at 50 mg but refused to take it due to weight gain and did not return for follow-up appointments. This case highlights the role of cardiac PET not only in situations where MRI cannot be used but also following treatment response and disease reactivation which is challenging to assess with cardiac MRI. The emerging importance of cardiac PET in cardiac sarcoidosis is now acknowledged in the recent consensus documents and nuclear societies recommendations 1,2 as an indicator of cardiac sarcoidosis in contrast to prior older imaging criteria for CS which included on SPECT or MRI abnormalities. 3 Whole body imaging to evaluate sarcoid activity in other extra cardiac organs apart from the heart and quantitation of standardized uptake values (SUVmax) to enhance diagnosis of disease activity and response to therapy were not available in our study but are key methods to better evaluate and assess sarcoidosis as shown in recent studies. 4

Utility of KRAS mutation detection using circulating cell-free DNA from patients with colorectal cancer.

In this study, we evaluated the clinical utility of detecting KRAS mutations in circulating cell‐free (ccf)DNA of metastatic colorectal cancer patients. We prospectively recruited 94 metastatic colorectal cancer patients. Circulating cell‐free DNA was extracted from plasma samples and analyzed for the presence of seven KRAS point mutations. Using the Invader Plus assay with peptide nucleic acid clamping method and digital PCR,KRAS mutations were detected in the ccfDNA in 35 of 39 patients previously determined to have primary tumors containing KRAS mutations using the Luminex method, and in 5 of 55 patients with tumors containing wild‐type KRAS. Curative resection was undertaken in 7 of 34 patients with primary and ccfDNA KRAS mutations, resulting in the disappearance of the mutation from the cell‐free DNA in five of seven patients. Three of these patients had tumor recurrence and KRAS mutations in their ccfDNA reappeared. Epidermal growth factor receptor blockade was administered to 24 of the KRAS tumor wild‐type patients. Of the 24 patients with wild‐type KRAS in their primary tumors, three patients had KRAS mutations in their ccfDNA and did not respond to treatment with epidermal growth factor receptor (EGFR) blockade. We also detected a new KRAS mutation in five patients during chemotherapy with EGFR blockade, before disease progression was detectable with imaging. The detection of KRAS mutations in ccfDNA is an attractive approach for predicting both treatment response and acquired resistance to EGFR blockade, and for detecting disease recurrence.

Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: Role in the early diagnosis of recurrence

ObjectiveThe aim of this study was to assess the potential benefit of routine squamous cell carcinoma antigen (SCC-Ag) assessment during follow-up of patients after treatment for early cervical cancer with regard to early diagnosis of cancer recurrence before clinical signs and symptoms occur. MethodsAll clinical, pathological, and serological data of patients referred to the Department of Gynecologic Oncology between July 1999 and June 2014, were retrospectively collected and analyzed. The SCC-Ag levels of 197 patients with diagnosis of stage I or II cervical squamous carcinoma, were performed. ResultsIn the univariate analysis, serum SCC-Ag was not significantly associated with grading (p=0.85), LVSI (p=0.95) and FIGO stage (p=0.83) but it was significantly associated with recurrence of disease (p<0.001). The Cox multivariate analyses showed that serum SCC-Ag level was an independent and statistically significant prognostic factor for OS and PFS. The median time interval between SCC-Ag test and diagnosis of recurrence were 0.3 and 1.8months for positive and negative SCC-Ag groups respectively (p=0.01). Considering patients with recurrence, no significant difference in terms of DFS and OS was found between women with high or low SCC-Ag levels. ConclusionsSerum SCC-Ag reflects the response to treatment, and rising antigen levels often precede the clinical detection of recurrent disease, and may lead to early diagnosis. However such an advantage does not seem to improve the cure rate of patients with elevated SCC-Ag levels, most likely due to the lack of curative salvage treatments.

The Current Status of PSMA PET-CT for Evaluating Biochemical PSA Relapse in Prostate Cancer

In the curative treatment of prostate cancer (PC), up to 40 % of PC cases may suffer disease recurrence depending on their prognostic factors. In these men, monitoring with prostate-specific antigen (PSA) testing may herald this event but it does not provide information on the site or extent of PC recurrence. It remains important to have an imaging modality that can detect disease recurrence at the earliest stage when disease may still be local or regional and radical ablative therapies could provide recurrence salvage or to reliably exclude patients from unnecessary therapy when there is evidence of distant micrometastatic disease. Functional imaging can provide improved detection over conventional imaging with CT, MRI and bone scanning. Choline PET has been reported to have higher PC detection sensitivity than FDG-PET but this falls with lower PSA values. PSMA PET has been reported to provide greater sensitivity and specificity particularly with lower PSA, i.e. <0.5–1 and may yield greater utility to quantify the relapse status of PC men. This article will review the status of PSMA PET-CT for PSA recurrences following PC treatment.

Failure pattern and salvage treatment after radical treatment of head and neck cancer

Purpose The aim of the study was to test the hypothesis that head and neck cancer (HNC) patients benefit from specialized follow-up (FU), as this strategy ensures timely detection of relapses for successful salvage treatment. This was done by evaluation of the pattern of failure, the temporal distribution of recurrences, and the outcome of salvage treatment in a contemporary cohort of HNC patients.Methods The study evaluated a cohort of 2062 consecutive patients treated with curative intent at Aarhus University Hospital from 1 January 2000 to 31 December 2013. The database of DAHANCA contained recordings of recurrent disease in 567 patients with primary tumors of the larynx, pharynx, oral cavity, nasal cavity, paranasal sinuses and salivary glands. A review of medical records was performed in order to update and supplement the database.Results Failures of the 567 patients were primarily in T-site (65%) followed by N-site (36%) and M-site (22%). The vast majority of the first recurrences occurred within the first years after primary treatment; 62%, 82%, and 91% within the first, second and third year, respectively. Totally, 51% were amenable for salvage treatment, and 44% benefited from salvage in terms of a complete response. Permanent tumor control was observed in 128 patients (23%) after one or two salvage attempts. The highest salvage rate was recorded in patients with primary glottic carcinoma (41%) and the lowest among hypopharyngeal cancers (2%). Asymptomatic recurrence was recorded in 12% of all recurrences and this was found to be a positive prognostic factor for disease-specific survival, as they had significantly better outcome after salvage.Conclusion Our data support the usefulness of specialized FU in terms of early detection of recurrent disease. In particular patients with silent recurrences benefited from early detection, as they had a significantly lower risk ratio of death from primary HNC.

An Update of Biochemical Markers of Hepatocellular Carcinoma

The definition of a tumor marker is broad, which covers a wide spectrum of biomacromolecules synthesized in excess concentration by a wide variety of neoplastic cells. Tumor markers can be normal endogenous products that are produced at a greater rate in cancer cells or the products of newly switched on genes that remained inactive in the normal cells. These markers consist of any products of either tumor itself or the host in reaction to tumor's presence that distinguishes malignant tissues from benign and is measurable in body fluids or tissues. They increase with progressive or recurrent disease, decrease with response to treatment, and normalize with remission. Clinical applications include screening in asymptomatic individuals, confirming a suspected diagnosis, assisting in tumor classification and staging, prognosis, monitoring treatment response, surveillance for residual disease, and early detection of recurrent disease.

Role of Positron Emission Tomography and Computed Tomography Imaging for Detecting Disease Recurrence Following Adjuvant Radiation Therapy in Oropharyngeal Cancer

The role of posttreatment imaging for oropharyngeal cancer (OPC) patients treated with definitive chemoradiation is well defined. However, the role of posttreatment surveillance for patients undergoing adjuvant radiation therapy is unclear. The goal of this study is to provide data on how surveillance modality (clinical surveillance vs computed tomography [CT] vs positron emission tomography [PET]/CT) impacts the detection of disease recurrence. This is a retrospective, institutional review board–approved analysis of 52 cases of OPC recurrence from the year 1997 to 2015 at Mayo Clinic Rochester, MN. These cases failed after being treated with surgery followed by adjuvant radiation therapy with or without chemotherapy. Time to failure was determined following adjuvant radiation treatment. Local, nodal, or distant failure patterns were categorized based on clinical or imaging evaluations. Among the 52 cases with disease recurrence, the mean time to recurrence following adjuvant treatment was 10.7 months (median 8 months). Distant, regional, and local failure comprised 79%, 13%, and 8% of the cohort, respectively. A total of 36 patients (69%) failed within the first year following completion of treatment: 3 local, 5 nodal, and 28 distant. Among the patients that failed, 12 were detected clinically, whereas 24 were detected by imaging modalities. CT detected 8 cases while PET was successful in detecting 16 cases. The mean time to clinical detection was 5 months (3 local [25%], 2 nodal [17%], 7 distant [58%]), while the mean time to detection by imaging was 6.2 months (1 local [4%], 5 nodal [21%], 18 distant [75%]). In the imaging category, the mean time of recurrence detection was 7.5 months by CT scan and 5.5 months by PET. Early local failures are generally detected by physical exam (25% vs 4%). However, imaging exam was superior at detecting nodal and distant failure (17% vs 21% in nodal and 58% vs 75% in distant). PET detected distant failures earlier than CT by an average of approximately 2 months. Imaging modalities remain the optimal tool for detecting early distant and regional recurrence. Surveillance and follow-up in OPC patients undergoing adjuvant therapy warrants early imaging for regional and distant disease detection.

Assessment of postoperative local and distant recurrence in colorectal cancer patients: Comparison between PET/CT and CECT

ObjectiveTo assess the diagnostic performance of 18F-FDG PET/CT scan in the detection of recurrent disease in CRC patients who have suspected local and/or distant recurrent disease compared to contrast enhanced CT scan (CECT). Material and method96 CRC treated patients with suspected recurrence were examined by CECT and 18F-FDG PET/CT. Pathological results, clinical or imaging follow-up, or the responsiveness of the lesion to the treatment with chemotherapy or radiation therapy were reviewed for gold standard. ResultsRecurrent or metastatic disease was found in 74 (77.1%) of 96 patients. Calculated sensitivity, specificity, and accuracy of 18F-FDG PET/CT were 92%, 72.7%, and 88.5%. The specificity of 18F-FDG PET/CT was statistically significantly better than that of CECT as it can reduce the false positive results of CECT in 13 patients, however regarding the sensitivity.18F-FDG PET/CT showed better value but without statistical significance. Conclusion18F-FDG PET/CT is a better method to evaluate postoperative CRC patients with suspected tumor recurrence or distant metastasis than CT with significantly higher specificity.

Abstract P4-10-13: Follow-up care of breast cancer patients who were treated in a German breast cancer centre - Survey of patients and attending physicians and analysis of treatment data

Abstract Introduction: Breast cancer treatment leads to long-lasting impairments which, according to international guidelines, have to be identified and treated in follow-up care. It remains unclear how follow-up care is perceived by patients and if all needs are met in routine care. Methods: All breast cancer patients who underwent surgery in a German breast cancer centre from 2007 to 2013 were asked to fill out a standardized scanner-readable questionnaire. Medical data were retrieved from their charts and statistically analyzed together with the questionnaire responses. Physicians who could possibly care for breast cancer patients after primary therapy were invited to fill out a standardized scanner-readable questionnaire as well. Results: 920 questionnaires were filled out and returned (response rate: 61%) by patients. Median age at the time of the survey was 65 years (32-95). 58% of patients still received some form of therapy, 94% of them hormonal therapy. 94% were still in follow-up care, 5% stopped and 1% never went. Intervals of follow-up visits suggested by international guidelines were assessed as "quite right" in 93%. The following examinations were conducted throughout the whole follow-up period at least once: physical examination (93%), mammography (90%), sonography of breast (81%) and liver (22%), laboratory (56%), tumor marker (23%), bone scan (21%), MRI (20%) and CT (15%). Different items were rated on a 6-point scale ranging from "0" "not true at all" to "5" "completely true". Follow-up care was regarded as very important for the own health (4.7), reassuring and calming (4.5), well-being to be looked after (4.4) and well cared for (4.4). A continuous contact between patient and doctor was appreciated (4.4). Visits were connected only to a part with distress (2.1), the median score on the NCCN distress thermometer was 4 (0-10). 105 questionnaires were answered by healthcare professionals (response rate 12%), most of them general practitioners (51%) or gynecologists (30%). Doctors carried out or referred asymptomatic patients most often to the following examinations: medical history taking (92%), physical examination (87%), blood chemistry (63%) and tumor markers (40%). Mammography was mentioned in 45%, sonographic examinations of breast, liver and axilla in 49%, 45% and 38%, respectively. 55% were (very) satisfied with international guidelines on follow-up care. Intervals and duration of follow-up visits were assessed as "quite right" in 88% and 60%, respectively. Different items were rated on a 6-point scale ranging from "0" "not important at all" to "5" "very important". Detection of disease recurrence and secondary tumors (4.8), reassurance of patients (4.7) and detection of treatment toxicities (4.5) were assessed as most important aims in follow-up care. Conclusions: An overwhelming majority of patients makes use of follow-up care. Most important qualities from the patient's perspective are reassurance, a feeling of security, calming and continuous care by their doctor. Examinations which are not recommended in international guidelines are used by a considerable amount of healthcare providers. Citation Format: Weide R, Feiten S, Friesenhahn V, Heymanns J, Köppler H, Meister R, van Roye C, Thomalla J, Wey D, Dünnebacke J. Follow-up care of breast cancer patients who were treated in a German breast cancer centre - Survey of patients and attending physicians and analysis of treatment data. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-13.

Abstract P4-09-16: A monoclonal antibody with exceptional specificity across major breast cancer subtypes

Abstract Background: Breast cancer (BC) remains the second leading cause of cancer-related deaths for women in the United States and is recognized to be a heterogeneous disease. Advances in technologies such as whole genome sequencing are leading the way to precision medicine and the leading researchers are envisioning personalized therapies in the not too distant future. However, given the diversity of cancer cell populations, that remains a challenging task at best. The tumor form of MUC1 (designated tMUC1), a transmembrane glycoprotein, is aberrantly glycosylated and overexpressed in ∼95% of BC. We have developed an antibody (TAB004) that specifically recognizes tMUC1 across all major subtypes of BC and importantly does not recognize normal breast epithelia. This is a significant development in light of the challenges faced in treating triple negative BC. Methods: A panel of thirty BC cell lines was obtained from ATCC. The following techniques were used to assess the specificity of TAB 004 to the major subtypes based on ER, PR and Her2 expression: 1) Flow cytometry to quantify membrane bound expression of tMUC1 using Cy7-conjugated TAB004; 2) Western blotting to detect molecular weight patterns of tMUC1 in whole cell lysate; 3) A TAB004 based GMP-grade ELISA kit to measure shed tMUC1 in the supernatant and 4) In vivo imaging of tumors in mice using TAB 004 conjugated to Indocyanine Green (ICG). Specificity and sensitivity was further confirmed using primary human serum and tissue samples from all major BC subtypes obtained from bio-repositories at Duke University Cancer Center, Fox Chase Cancer Center and Carolinas Health Care System. Shed tMUC1 in serum samples were tested using the TAB 004 ELISA kit and tissue sections were analyzed using immunohistochemical (IHC) staining with TAB 004 conjugated to HRP. Results: 1) Flow cytometry data shows that TAB 004 recognized tMUC1 on all major BC subtypes: 25 out of 30 BC cell lines tested had higher expression than a normal epithelial breast cell line; 2) Western blotting also detected tMUC1 on all BC subtypes with distinct molecular weight patterns; 3) ELISA showed high levels of shed tMUC1 by most BC cells and correlated with bound/cytoplasmic levels. 4) In vivo imaging shows clear localization of TAB004-ICG to the tumors expressing tMUC1. Primary human breast cancer patient data shows that shed tMUC1 was detected in the serum obtained from all major BC subtypes and showed statistically significant differentiation from normal/benign. IHC results show strong tMUC1 expression in malignant tissue with excellent differentiation from adjacent normal tissue. Conclusion: TAB004 antibody's extraordinary specificity across major BC subtypes has been confirmed with flow cytometry, western blotting, ELISA and Immunohistochemistry. A number of clinical applications are under development: (a) An ELISA test as a supplement to mammography for the early detection of BC in women with dense breasts; (b) serum monitoring during treatment and to detect disease recurrence; and, (c) targeted antibody-drug/antibody-imaging agent based therapies and imaging modalities particularly for triple negative BC. Citation Format: Das Roy L, Zhou R, Dillon L, Moore LJ, Puri R, Marks JR, Lyerly HK, Mukherjee P. A monoclonal antibody with exceptional specificity across major breast cancer subtypes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-09-16.

New Strategies in Prostate Cancer: Prostate-Specific Membrane Antigen (PSMA) Ligands for Diagnosis and Therapy.

Key issues for prostate cancer patients are the detection of recurrent disease and the treatment of metastasized cancer. Early detection is a major challenge for all conventional imaging modalities. Furthermore, therapy of patients with hormone-resistant tumor lesions presents a major clinical challenge. Because the prostate-specific membrane antigen (PSMA) is frequently overexpressed in prostate cancer, several PSMA-targeting molecules are under development to detect and treat metastatic castration-resistant prostate cancer (mCRPC). mCRPC represents a situation where cure is no longer achievable and novel therapeutic approaches for palliation and increase of survival are needed. In this article, we discuss the recent development for noninvasive detection of recurrent disease and therapy of mCRPC with corresponding PSMA-targeted radioligands.

Mammographic Surveillance after Breast Reconstruction-is Imaging Necessary?

Background: There is no consensus in regards to surveillance of women after mastectomy and reconstruction for breast cancer. Mammographic detection rates are low for surveillance after reconstruction and whilst there is insufficient evidence to support annual mammography in these women, there is widespread variation in its use. We aimed to investigate the mode of detection of recurrent disease and comment on the use of surveillance mammography in our population of women undergoing mastectomy and reconstruction. Method: Data were retrieved from the Auckland Breast Cancer Registry (ABCR). All women with recurrence after mastectomy and reconstruction between 2000 and 2013 were identified from the database. Clinical records were reviewed for type of reconstruction, site of recurrence and mode of detection. Results: 1565 women underwent mastectomy and reconstruction. There were 54 women (3.4%) with locoregional recurrence (LRR) and 134 with distant disease (8.5%). Of all women with LRR, 51 women (94%) presented with a palpable mass. The remaining 3 women had their recurrence detected on mammography and had DCIS in their original histology. Only 16 of the 54 women had at least one surveillance mammogram. 12 of 16 women had a normal mammogram less than 9 months prior to diagnosis of recurrent disease. Conclusion: Regular mammographic surveillance after mastectomy and reconstruction was not performed in this group, and therefore we cannot evaluate the value of regular mammographic surveillance after mastectomy and reconstruction. However, in light of the existing body of literature, there is no evidence to support regular mammographic surveillance after mastectomy and reconstruction.

Effect of Chemotherapy on Tumor Marker (Ca 15.3) and Serum in Breast Cancer Patients of Southern Eastern Region of Chhattisgarh; 6 Years Follow up Study

Background: At many centers tumor markers are used to detect disease recurrence and to monitor response to chemotherapy therapy in patients with advanced disease, although the real value of serial observation of marker levels remains disputed. In this study, we evaluated the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Aim: The present study was aimed to ascertain the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Material & Methods: 40 breast cancer patients and 10 cancer patient other than breast cancer (control subject) from regional cancer center were studied. All the cancer patients were aged between 27 to 56 years old with BSA and BMI ranged between 1.30-1.98 and 13.06-39.51 respectively. Tumor marker CA 15.3 level was done by ELISA, haematological test was measured by cell counter and biochemical assay was measured by Autoanalyzer. Tumor size was measured before and after chemotherapy. Patients were followed 6 years. Survival at 6 years is 60%. The data were analyzed using SPSS (20.0). Results: The result revealed that as compared to control patients the CA 15.3 maker was statistically significantly higher among breast cancer patients in before as well as in after chemotherapy cycles as well as it accessed the normal range of CA 15.3 (9-36 U/ml). Further, results of Chi-square test revealed statistically significant changes in serum parameters after chemotherapy. Glucose, urea, creatinine, bilirubin (total), bilirubin (direct), ALT (Alanine amino transferase), AST (Aspartate amino transferase), ALP (Alkaline phosphatase) and globulin were found to be significantly increase whereas, CA (15.3), WBC, Hb (haemoglobin), platelets, serum serum sodium, serum potassium, total protein and albumin were found to be significantly decreased, after chemotherapy. 83.3% tumour reduction in case group reported. The 6-year overall survival was 51% in the case group. Overall survival in operated group was 49.4 % and non-operated group was 52.1%. Conclusion: It is concluded that CA (15.3) is specific and sensitive maker for breast cancer. Further, prominent fluctuations in serum parameters due to chemotherapy specify consequent side-effects among breast cancer patients. Keywords: Chemotherapy, CA (15.3), breast cancer, AST, ALT, ALP, T. Protein

Clinical case of patient with ovarian cancer: possibilities of surgical treatment

Ovarian cancer (OC) occupies the third place in the structure of gynecological malignancies and it’s still known for its high mortality rate. Therefore this disease remains one of the actual problems in modern oncology. The standard of care for patients with OC consists of primary surgery, followed by platinum-based chemotherapy in a case of the disease recurrence. These combined chemotherapy regimens allow to make significant improvement in survival rates in patients with OC. Surgery is another treatment option which can be applied in patients with recurrent OC including disease recurrence after prior chemotherapy. This method enables to make considerable improvement in survival for this certain group of patients. We report a clinical case of young patient suffering from recurrent OC. The disease was initially diagnosed in 2001. After that the patient underwent several types of surgery and multiple courses of polychemotherapy. Detection of disease recurrence in 2013 required to conduct a very complicated surgical treatment. Currently this patient is under active follow-up with no signs of disease progression or disease recurrence. Application of enterocystoplasty technique (bladder augmentation using bowel segments) in reconstruction of the urinary tract in this particular case enabled to preserve the quality of patient’s life as well as to conduct radical surgery. In order to reduce artificial bladder activity, reduce/eliminate urinary incontinence and improve the quality of patient’s life botulinum toxin A was injected into the bladder wall. The effect of this injection was positive. To sum up, teamwork between the members of urology and oncology departments done in time allowed to provide complete urologic help which included examination with the use of modern highly technological equipment and treatment followed by methods of neurological rehabilitation. All these led to significant improvement of the quality of the patient’s life.

Recommendations for Follow-up Care for Gynecologic Cancer Survivors.

Gynecologic cancer survivors are expected to increase in number over the coming years. This is attributable in part to an increased incidence of gynecologic malignancies as the population ages. Earlier detection and improved treatments will lead to improved survival. Women who have completed their cancer treatment and are disease-free enter a phase of follow-up care. This care can be provided by gynecologic oncologists, general gynecologists, or primary care practitioners, depending on local practices and geographic area. The key components of follow-up include complete history and physical examination. There should be judicious use of appropriate testing to detect disease recurrence, assessment, and management of therapy-related symptoms and provision of psychosocial support. Well-woman care and ongoing screening for other malignancies remain an important component of care that should not be overlooked. This review provides recommendations regarding follow-up care for women with gynecologic malignancies. There is very little high-quality evidence available to guide such care.

Radiofármaco [18f]- fdg: un aporte novedoso para el diagnóstico de cáncer en el país

The University of Costa Rica (UCR) will soon have a centre for the early detection of cancer. It will be able to produce positron-emission radiopharmaceuticals. The positron emission tomography (PET) is a nuclear medicine procedure in which the in vivo distribution of a labeled pharmaceutical can be studied. The main PET radiopharmaceutical is 2-deoxy-2-(18F)fluoro-D-glucose (FDG). This radiopharmaceutical is used in oncology in diagnosis, staging, prognostic assessment, therapy monitoring, radiotherapy planning and detection of recurrent disease. The purpose of the review is to deal with vital aspects regarding the production of the radionuclide 18F in the cyclotron, the synthesis and quality control of FDG and PET image acquisition. Furthermore, it summarizes existing information regarding patient preparation and compares the FDG PET/CT oncologic indications covered by public healthcare systems in Ecuador, Uruguay and Spain.