BACKGROUND: Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. METHODS: After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. RESULTS: After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth. CONCLUSION: Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.

• MeSH
• dítě MeSH
• fluorodeoxyglukosa F18 terapeutické užití   MeSH
• Hodgkinova nemoc * diagnostické zobrazování   farmakoterapie   komplikace   MeSH
• hyperplazie thymu * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   farmakoterapie   MeSH
• lymfom * farmakoterapie   MeSH
• nádory brzlíku * diagnostické zobrazování   farmakoterapie   komplikace   MeSH
• počítačová rentgenová tomografie MeSH
• pozitronová emisní tomografie metody   MeSH
• radiofarmaka MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• NINLARO (ixazomib),
• MeSH
• inhibitory proteasomu terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   farmakoterapie   MeSH
• mnohočetný myelom * farmakoterapie   krev   patologie   MeSH
• paraproteinemie farmakoterapie   krev   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: To evaluate the differential impact of postoperative radiotherapy (RT) on recurrence patterns in patients treated with radical prostatectomy (RP) using [68Ga]Ga-PSMAHBED-CC conjugate 11 positron emission tomography (PSMA 11-PET). METHODS: We assessed 162 consecutive patients who experienced biochemical recurrence (BCR) after RP for nonmetastatic prostate cancer (PC). All had at least one positive lesion on imaging. No patient was on androgen deprivation therapy (ADT). Patients were categorized into those who had received adjuvant/salvage RT ± ADT and those who did not (RP only). Lesion- and patient-based analyses were performed. The impact of the radiation field was assessed. RESULTS: Overall, 57 BCR patients underwent RP only, 105 received postoperative RT. Median PSA was 1.01 ng/ml (IQR 0.58-2). In the lesion-based analysis, compared to the RP only patients, those who had received postoperative RT, had less lymph node (LN) recurrences distal to the common iliac bifurcation (35.2 vs. 57.9%, p = 0.05), but were more likely to harbor positive LNs proximal to the iliac bifurcation and in the presacral (34.2 vs. 12.3%, p = 0.002) areas as well as bone metastases (25.7 vs. 8.8%, p = 0.01). In the patient-based analysis, the patients with postoperative RT after RP had less recurrence in the pelvis only (pelvic LNs and/or prostate bed) (52.4 vs. 79%, p = 0.002), but were more likely to harbor extrapelvic recurrence (41.9 vs. 15.8%, p = 0.001). Patients who received RT to the prostate bed only had more recurrence to the pelvic LN only (54.2% vs. 23.4%, p = 0.002), but less extrapelvic recurrence (31.3 vs. 53.2%, p = 0.03) and less bone recurrence (16.7 vs. 36.2%, p = 0.031) compared to those patients, who received RT to the prostate bed and pelvic nodes. CONCLUSIONS: Postoperative radiation treatment alters the recurrence pattern in BCR patients after RP. Further prospective studies are needed to establish a decision tree for optimal imaging/management according to previous treatments.

• MeSH
• izotopy gallia metabolismus   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   diagnostické zobrazování   epidemiologie   metabolismus   MeSH
• nádory prostaty patologie   radioterapie   chirurgie   MeSH
• následné studie MeSH
• PET/CT metody   MeSH
• prognóza MeSH
• prostatektomie metody   MeSH
• radiofarmaka metabolismus   MeSH
• radioizotopy galia metabolismus   MeSH
• radioterapie metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Rakousko MeSH

Léčba lokální recidivy po resekci karcinomu endometria je komplikovaná. MRI asistovanou, intenzitou modulovanou radiační terapií (IMRT) je možné aplikovat vysoké dávky záření do nádorů za současné ochrany okolní, normální tkáně. Referujeme případ 64leté ženy s lokální recidivou a malými plicními metastázami po resekci časného karcinomu endometria. Vzhledem k tomu, že pacientka odmítla chemoterapii, byla ke zmírnění dysurie a hematurie provedena vysokodávkovaná IMRT (66 Gy ve 33 frakcích s maximem 82 Gy). Po terapii byl průběh bez komplikací a obtíže ustoupily po jednom měsíci léčby. Dle MRI bylo prokázáno, že lokálně recidivující nádor úplně zmizel 6 měsíců po IMRT a nepodařilo se ho prokázat ani rok po léčbě. Závěrem lze říci, že se jedná o první zprávu o MRI asistované IMRT pro lokálně recidivující karcinom endometria po chirurgické resekci. Vysoko dávkovaná, MRI asistovaná IMRT vedla k úlevě od příznaků, ke zvládnutí lokální recidivy, přičemž toxicita související s léčbou byla minimální.

Treatment of local recurrence after resection of endometrial cancer is complicated. MRI-guided intensity modulated radiation therapy (IMRT) can deliver high doses of radiation to tumors while sparing the surrounding normal tissues. Here, we report a case of 64-year-old woman with local recurrence and small lung metastases after resection of early endometrial cancer. Since the patient refused chemotherapy, high-dose MRI-guided IMRT (66 Gy in 33 fractions with a maximum of 82 Gy) was performed to alleviate dysuria and hematuria. Her post-treatment course was uneventful and her symptoms resolved after 1 month of treatment. MRI demonstrated that the locally recurrent tumor disappeared completely 6 months after IMRT, and the condition persisted 1 year later. In conclusions, this is the first report of MRI-guided IMRT for locally recurrent endometrial cancer after resection. High-dose MRI-guided IMRT leads to relief of symptoms by controlling local recurrence, and the treatment-related toxicity was minimal.

• MeSH
• adenokarcinom MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   radioterapie   MeSH
• magnetická rezonanční tomografie MeSH
• nádory endometria * chirurgie   radioterapie   MeSH
• nádory plic diagnostické zobrazování   sekundární   MeSH
• radioterapie s modulovanou intenzitou * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND AND OBJECTIVES: Transoral laser surgery is the optimal surgical treatment modality for the early stages of glottic cancer. To allow for further treatment to be as effective and as minimal as possible, persistent or recurrent tumors should be detected very soon. The main aim is to minimize the risk of necessity of performing a total laryngectomy. Flexible videoendoscopy with narrow band imaging (NBI) was recommended by the European Laryngological Society as a diagnostic method for the follow-up of patients treated for laryngeal cancer. Nevertheless, the efficacy of this technique has not been extensively studied in patients after transoral laser cordectomies for vocal fold cancer. The aim of this study was to evaluate the efficacy of in-office transnasal NBI flexible videoendoscopy in the follow-up of patients after transoral laser cordectomy for glottic cancer. We also focused on describing the specific characteristics of recurrent tumor appearance. MATERIALS AND METHODS: The presented study was conceived as a prospective study. Ninety-four consecutive patients who underwent transoral laser cordectomy for severe dysplasia, Tis, T1, and T2 glottic cancer in the period from June 2010 to August 2015 were enrolled in the study. All patients were postoperatively regularly followed using transnasal videoendoscopic examinations with NBI. Whenever a suspect lesion was identified during in-office examination, its nature was proven histologically. RESULTS: We discovered 23 suspect findings in 21 patients by means of flexible videoendoscopy with NBI. Fifteen (65.2%) of them were histologically confirmed as recurrent tumors, whereas in 8 (34.8%) of them, the recurrent tumor was not proven. In two patients, the recurrent tumor was evident on computed tomography or magnetic resonance imaging, but NBI endoscopy did not reveal relapsing disease. The rest (71 patients) were considered true negative. Of the 15 recurrent tumors detected by NBI-coupled videoendoscopy, 8 (53.3%) were identified as submucosal masses with nonsignificant or no vascular changes, 4 (26.7%) were noted as the progression of leukoplakia without visible vascular changes, only 2 (13.3%) showed typical vascular changes, and, in 1 (6.7%) case, evident, significantly exophytic tumor with pathological vascularization was discovered. The sensitivity, specificity, and positive and negative predictive values of the in-office transnasal videolaryngoscopy with NBI were calculated to be 88%, 92%, 71%, and 97%, respectively. CONCLUSIONS: The results of the study demonstrate that transnasal endoscopy with NBI in an outpatient setting is an excellent method for the follow-up of patients after transoral laser cordectomy for glottic cancer. The method achieves high sensitivity, specificity, and negative predictive value and a slightly low positive predictive value. Nevertheless, we must bear in mind that recurrent tumors after previous endoscopic resection may have a completely different appearance than new tumors originating from previously untreated tissues. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

• MeSH
• dospělí MeSH
• endoskopické operace přirozenými otvory * MeSH
• glottis MeSH
• laryngektomie * MeSH
• laserová terapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   MeSH
• nádory hrtanu diagnostické zobrazování   chirurgie   MeSH
• následné studie MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• úzkopásmové zobrazení * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Klíčová slova
• NINLARO (ixazomib),
• MeSH
• inhibitory proteasomu terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   farmakoterapie   MeSH
• mnohočetný myelom * farmakoterapie   krev   patologie   MeSH
• paraproteinemie farmakoterapie   krev   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

To evaluate the role of magnetic resonance spectroscopy imaging (MRSI) parameters to predict early biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with non-metastatic prostate cancer (PCa). Between November 2010 and March 2012, 60 consecutive patients with clinically non-metastatic biopsy confirmed PCa underwent RP after MRSI assessment in a prospective study. Demographic, clinicopathological, magnetic resonance imaging (MRI) staging, MRSI parameters, and postoperative serum prostate-specific antigen were recorded. The univariate and multivariate Cox regression analyses were used to assess the association between potential prognosticators and early BCR (BCR less than 12 months after RP). In univariate Cox regression, preoperative serum PSA (prostate-specific antigen) (HR - hazard ratio = 1.016, p=0.003), surgical Gleason score > 7 (HR = 5.034, p=0.006) and MRSI risk score (HR = 4.061, p=0.0001); and in multivariate model, preoperative serum PSA (HR = 1.012; p=0.046), surgical GS > 7 (HR = 4.196; p=0.017) and MRSI risk score (HR = 3.256; p=0.013) were associated with early BCR. The greatest AUC (area under the curve) was related to MRSI risk score (AUC = 0.733) and the AUC of the multivariate model was 0.776. MRI/MRSI parameters specially MRSI risk score might be acceptable predictors of early BCR. These parameters can improve the accuracy of predictive nomograms to assess the risk of BCR after RP.

• MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   MeSH
• magnetická rezonanční tomografie metody   MeSH
• nádory prostaty diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• prostatektomie * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

• MeSH
• buněčná diferenciace MeSH
• lidé MeSH
• lokální recidiva nádoru * diagnostické zobrazování   epidemiologie   etiologie   terapie   MeSH
• nádorové komplikace v těhotenství * diagnóza   epidemiologie   patologie   terapie   MeSH
• nádory štítné žlázy * diagnóza   epidemiologie   patologie   terapie   MeSH
• novorozenec MeSH
• papilární karcinom * diagnóza   epidemiologie   patologie   terapie   MeSH
• progrese nemoci MeSH
• rizikové faktory MeSH
• těhotenství * psychologie   MeSH
• tyreoidektomie MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství * psychologie   MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the gallbladder are extremely rare; indeed, the English expert literature reports a mere handful of case reports and case series on this topic. According to the WHO classification of 2010, MINEN are considered to be tumors consisting of two major components, neuroendocrine and non-neuroendocrine, each of which hosts at least 30% of the total cellular population. To date, the etiology and pathogenesis of MINEN have not been precisely determined and the non-specific symptoms generally result in late diagnosis (mainly in the terminal stages of the condition) and contribute to the generally poor prognosis. As far as the management of the disease is concerned, radical surgery plays a crucial role; however, the significance of surgical debulking and biological therapy applying somatostatin analogues has not yet been determined. CASE PRESENTATION: A 56-year-old female was referred to our department for a rapidly progressing tumor in the subhepatic area along with the infiltration of S5 and S6 liver segments. With regard to preoperative findings, the tumor appeared as operable, although, during the surgery, an extensive involvement of the hepatoduodenal ligament by the tumor through the lymph nodes was revealed. Due to acute perioperative bleeding from the necrotic tumor, we decided to perform modified resection. Histologically, the tumor was confirmed as MINEN of gallbladder, where the neuroendocrine component was dominant over the non-neuroendocrine component. Six weeks after the discharge, the patient underwent a follow-up CT revealing large recurrence of the disease. Thereafter, the patient was started on systemic therapy with etoposide and carboplatin in combination with somatostatin analogues. Thirteen months after the surgery, the patient is in good clinical condition, and while a recently performed PET/MRI scan revealed a hepatic lesion and hilar lymphadenopathy in full regression, there was a spread of small peritoneal and pleural metastases. The patient remains in the follow-up care. CONCLUSIONS: The occurrence of mixed neuroendocrine-non-neuroendocrine neoplasms is extremely rare. Radical surgery remains the only potentially effective approach to the cure of this disease. The role of biological therapy and debulking in the management of the disease has not yet been precisely defined. In our experience, both of these methods have the potential to positively influence overall survival rates and the postoperational quality of life of patients.

• MeSH
• cholecystektomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   terapie   MeSH
• maligní smíšený nádor diagnóza   patologie   terapie   MeSH
• nádory žlučníku diagnóza   patologie   terapie   MeSH
• neuroendokrinní karcinom diagnóza   patologie   terapie   MeSH
• počítačová rentgenová tomografie MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• výsledek terapie MeSH
• žlučník diagnostické zobrazování   patologie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Advanced stage Hodgkin's lymphoma represents a heterogeneous group of patients with different risk profiles. Data suggests that interim PET assessment during chemotherapy is superior to baseline international prognostic scoring in terms of predicting long-term treatment outcome in patients with Hodgkin's lymphoma. We therefore hypothesised that early interim PET-imaging after two courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) might be suitable for guiding treatment in patients with advanced stage Hodgkin's lymphoma. We aimed to assess whether intensifying standard chemotherapy (BEACOPPescalated) by adding rituximab would improve progression-free survival in patients with positive PET after two courses of chemotherapy. METHODS: In this open-label, international, randomised, phase 3 study, we recruited patients aged 18-60 years with newly diagnosed, advanced stage Hodgkin's lymphoma from 160 hospitals and 77 private practices in Germany, Switzerland, Austria, the Netherlands, and the Czech Republic. Interim PET-imaging was done after two cycles of BEACOPPescalated and centrally assessed by an expert panel. Patients with a positive PET after 2 cycles of BEACOPPescalated chemotherapy (PET-2) were randomly assigned (1:1) to receive six additional courses of either BEACOPPescalated (BEACOPPescalated group) or BEACOPPescalated plus rituximab (R-BEACOPPescalated group). PET-2 was assessed using a 5-point scale with (18)FDG uptake higher than the mediastinal blood pool (corresponding to Deauville scale 3) defined as positive. BEACOPPescalated was given as previously described; rituximab was given intravenously at a dose of 375 mg/m(2) (maximum total dose 700 mg), the first administration starting 24 h before starting the fourth cycle of BEACOPPescalated (day 0 and day 3 in cycle 4, day 1 in cycles 5-8). Randomisation was done centrally and used the minimisation method including a random component, stratified according to centre, age, stage, international prognostic score, and sex. The primary efficacy endpoint was 5 year progression-free survival, analysed in the intention-to-treat population. We are reporting this second planned interim analysis as the final report of the trial. The trial is registered with ClinicalTrials.gov, number NCT00515554. FINDINGS: Between May 14, 2008, and May 31, 2011, we enrolled 1100 patients. 440 patients had a positive PET-2 and were randomly assigned to either the BEACOPPescalated group (n=220) or the R-BEACOPPescalated group (n=220). With a median follow-up of 33 months (IQR 25-42) for progression-free survival, estimated 3 year progression-free survival was 91·4% (95% CI 87·0-95·7) for patients in the BEACOPPescalated group and 93·0% (89·4-96·6) for those in the R-BEACOPPescalated group (difference 1·6%, 95% CI -4·0 to 7·3; log rank p=0·99). Common grade 3-4 adverse events were leucopenia (207 [95%] of 218 patients in the BEACOPPescalated group vs 211 [96%] of 220 patients in the R-BEACOPPescalated group), and severe infections (51 [23%] vs 43 [20%] patients). Based on a futility analysis, the independent data monitoring committee recommended publication of this second planned interim analysis as the final result. Six (3%) of 219 patients in the BEACOPPescalated group and ten (5%) of 220 in the R-BEACOPPescalated group died; fatal treatment-related toxic effects occurred in one (<1%) patient in the BEACOPPescalated group and three (1%) in the R-BEACOPPescalated group, all of them due to infection. INTERPRETATION: The addition of rituximab to BEACOPPescalated did not improve the progression-free survival of PET-2 positive patients with advanced stage Hodgkin's lymphoma. However, progression-free survival for PET-2 positive patients was much better than expected, exceeding even the outcome of PET-2-unselected patients in the previous HD15 trial. Thus, PET-2 cannot identify patients at high-risk for treatment failure in the context of the very effective German Hodgkin Study Group standard treatment for advanced stage Hodgkin's lymphoma. FUNDING: Deutsche Krebshilfe; Swiss State Secretariat for Education, Research and Innovation (SERI); and Roche Pharma.

• MeSH
• bleomycin aplikace a dávkování   MeSH
• cyklofosfamid aplikace a dávkování   MeSH
• dospělí MeSH
• doxorubicin aplikace a dávkování   MeSH
• etoposid aplikace a dávkování   MeSH
• Hodgkinova nemoc diagnostické zobrazování   farmakoterapie   mortalita   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   farmakoterapie   mortalita   patologie   MeSH
• mezinárodní agentury MeSH
• míra přežití MeSH
• následné studie MeSH
• pozitronová emisní tomografie metody   MeSH
• prednison aplikace a dávkování   MeSH
• prognóza MeSH
• prokarbazin aplikace a dávkování   MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• rituximab aplikace a dávkování   MeSH
• staging nádorů MeSH
• vinkristin aplikace a dávkování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH