Thyroid cancer is associated with a broad range of different mutations, including RET (rearranged during transfection) fusion genes. The importance of characterizing RET fusion-positive tumors has recently increased due to the possibility of targeted treatment. The aim of this study was to identify RET fusion-positive thyroid tumors, correlate them with clinicopathological features, compare them with other mutated carcinomas, and evaluate long-term follow-up of patients. The cohort consisted of 1564 different thyroid tissue samples (including 1164 thyroid carcinoma samples) from pediatric and adult patients. Samples were analyzed for known driver mutations occurring in thyroid cancer. Negative samples were subjected to extensive RET fusion gene analyses using next-generation sequencing and real-time PCR. RET fusion genes were not detected in any low-risk neoplasm or benign thyroid tissue and were detected only in papillary thyroid carcinomas (PTCs), in 113/993 (11.4%) patients, three times more frequently in pediatric and adolescent patients (29.8%) than in adult patients (8.7%). A total of 20 types of RET fusions were identified. RET fusion-positive carcinomas were associated with aggressive tumor behavior, including high rates of lymph node (75.2%) and distant metastases (18.6%), significantly higher than in NTRK fusion, BRAF V600E and RAS-positive carcinomas. Local and distant metastases were also frequently found in patients with microcarcinomas positive for the RET fusions. 'True recurrences' occurred rarely (2.4%) and only in adult patients. The 2-, 5-, 10-year disease-specific survival rates were 99%, 96%, and 95%, respectively. RET fusion-positive carcinomas were associated with high invasiveness and metastatic activity, but probably due to intensive treatment with low patient mortality.
- MeSH
- dítě MeSH
- dospělí MeSH
- karcinom * MeSH
- lidé MeSH
- mladiství MeSH
- mutace MeSH
- nádory štítné žlázy * genetika patologie MeSH
- papilární karcinom štítné žlázy MeSH
- prognóza MeSH
- protoonkogenní proteiny B-raf genetika MeSH
- protoonkogenní proteiny c-ret genetika MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whereas other causes are relatively rare. There is increasing evidence on using hybrid single-photon emission computed tomography (SPECT) to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT. METHODS: This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources: MEDLINE, Embase, CINAHL, SCOPUS, and 3 other sources. Titles and abstracts were screened and classified into diagnostic studies, facet block studies, and surgical studies. We synthesized the results narratively. RESULTS: The search yielded 2347 records. We identified 10 diagnostic studies comparing SPECT or SPECT/computed tomography (CT) with magnetic resonance imaging, CT, scintigraphy, or clinical examination. Furthermore, we found 8 studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain, and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction, subaxial cervical spine, or the lumbar spine were identified. CONCLUSIONS: According to the available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a good effect, but this has not been confirmed by controlled studies. SPECT/CT might therefore be a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.
- MeSH
- bederní obratle chirurgie MeSH
- bolest krku etiologie komplikace MeSH
- bolesti zad diagnostické zobrazování etiologie MeSH
- degenerace meziobratlové ploténky * komplikace diagnostické zobrazování chirurgie MeSH
- jednofotonová emisní výpočetní tomografie metody MeSH
- lidé MeSH
- nemoci kloubů * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Možnosti léčby neuroendokrinních nádorů se v České republice v posledních letech obohatily o peptidovou receptorovou radionuklidovou terapii. Doposud je její použití omezené na tumory gastroenteropankreatického původu. Nicméně v rámci doporučení mezinárodních odborných společností ji nacházíme jako volbu i v jiných indikacích. V tomto článku je rozebíráno, jakým způsobem jsou vybíráni vhodní kandidáti k léčbě a její postavení v terapeutickém algoritmu ostatních neuroendokrinních nádorů, které ještě potřebuje oficiální potvrzení prospektivními randomizovanými studiemi.
The treatment options for neuroendocrine tumors in the Czech Republic have been enriched in recent years with peptide receptor radionuclide therapy. So far, its use is limited to tumors of gastroenteropancreatic origin. However, as part of the recommendations of international professional societies, we find it as an option in other indications as well. This article discusses how suitable candidates for treatment are selected and its position in the therapeutic algorithm of other neuroendocrine tumors, which still needs official confirmation by prospective randomized studies.
Od března 2021 používáme ve Fakultní nemocnici v Motole k léčbě gastroenteropankreatických neuroendokrinních nádorů peptidovou receptorovou radionuklidovou terapii (peptide receptor radionuclide therapy, PRRT) s použitím 177Lu-oxodotreotidu (177Lu-DOTATATE, přípravek Lutathera), který se váže na somatostatinové receptory těchto nádorů a radiací je ničí. Článek popisuje praktické postupy během indikace k terapii, její průběh, věnuje se možným komplikacím a doporučením ohledně dalšího sledování po léčbě.
Since March 2021, we have been using peptide receptor radionuclide therapy (PRRT) at the University Hospital in Motol to treat gastroenteropancreatic neuroendocrine tumors using 177Lu-oxodotreotide (177Lu-DOTATATE, trade name Lutathera), which binds to the somatostatin receptors of these tumors and destroys them by radiation. This article describes the practical procedures during the indication for therapy, its course, deals with possible complications and recommendations for further follow-up after treatment.
Vzhledem k rostoucí incidenci gastroenteropankreatic- kých neuroendokrinních tumorů (GEP NET) jsou intenzivně hledány nové možnosti terapie. Konvenčními metodami terapie tohoto onemocnění stále zůstávají chirurgická léčba, radioterapie a u méně diferencovaných typů chemoterapie. V posledních dvou letech byla v ČR implementována nová terapeutická modalita nukleární medicíny [177 Lu]oxodotreo- tid, radiofarmakum vykazující vysokou afinitu vůči somato- statinovým receptorům typu 2 (SST2) zvýšeně exprimova- ným maligními buňkami GEP NET. Tato práce shrnuje nejdůležitější aspekty peptidové receptorové radioterapie pomocí [177 Lu]oxodotreotidu a první zkušenosti s tímto radiofarmakem v praxi v ČR, a to ve FN Motol.
The incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) leads to intensive research of new therapeutic modalities. Surgical therapy, radiotherapy and, for less differentiated types, chemotherapy are still the conventional methods of treatment. In the last two years, a new therapeutic modality of nuclear medicine used for palliative treatment has been implemented in the Czech Republic. It is [177 Lu]oxodotreotide, a radiopharmaceutical showing high affinity for somatostatin type 2 receptors (SST2) expressed by malignant GEP-NETs cells. This paper reviews the most important aspects of peptide receptor radiotherapy with [ 177 Lu]oxodotreotide and the first experience with this radiopharmaceutical in practise in the Czech Republic at the Motol University Hospital.
