scholarly journals P03.05 Could suspected Glioblastomas be Treated without Hystological Diagnosis?

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii25-iii26
Author(s):  
K Cortés Mateus ◽  
I Valduvieco Ruíz ◽  
E Verger Fransoy ◽  
E Pineda Losada ◽  
L Oleaga Zufiria ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Imaging Techniques ◽  
Best Supportive Care ◽  
Histological Diagnosis ◽  
Tumor Board ◽  
Radiological Criteria ◽  
Medical Indication ◽  
Radiological Data ◽  
Treatment Type ◽  
Karnofsky Index

Abstract BACKGROUND Probable unresectable Glioblastomas (GB) diagnosed by imaging techniques withouth anatomo-pathological (ap) confirmation could be treated under standard treatment. We reported the outcomes from this strategy in our center after tumor board evaluation. MATERIAL AND METHODS From January/10 to September/16, 303 patients (pt) with GB were assessed by tumor board, during the same period 66 patients were consecutive analyzed with suspected GB by radiological criteria without histological diagnosis. We focus in the last group and analyzed the demographic/radiological data, non-biopsy causes, treatment type (concomitant Radio-Chemotherapy (RT/Ch), exclusive RT or Ch or Best supportive care (BSC)), Karnofsky index (KI) and degree of comorbidity (Charlson index (CI)). RESULTS Sixty six patients, 17.88% of the total GB cases (with/without ap). Average age: 77 years (33–91). Biopsy: non-diagnostic in 4pt. No biopsy: 62pt; due to non medical indication (71%), localization (22.7%), voluntary (4.5%). Treatment Type: Active: 43.93%, without biopsy due to non-medical indication (44.8%) and localization (41.37%). BSC: 53.03%, without biopsy due to non-medical indication 82.85%, localization 8.5%, voluntary 5.7%. Overall survival: 11.65 months in patients with active treatment and 4.8 months in BSC, greater benefit in <70 years and KI≥ 70 with statistical signification. CONCLUSION The diagnosis of GB by radiological criteria with the new imaging techniques has a good diagnostic-therapeutic correlation. In cases where surgical intervention is not possible, standard treatment offers good results. Age and KPS are variables that allow predicting a better evolution course. Although it was not possible to obtain a histological diagnosis, in this type of cases liquid biopsy could contribute to diagnosis this type of lesions inaccessible to biopsy.

scholarly journals Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

2016 ◽  
Vol 4 (1) ◽  
pp. 28
Author(s):  
Rajeev Dwivedi ◽  
Ruban Raj Joshi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Treatment ◽  
Functional Results ◽  
Supracondylar Fracture ◽  
Supracondylar Fractures ◽  
Radiological Criteria ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Mean Time

Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.   Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.   Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.   Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

scholarly journals Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group – ESOI Joint Paper

2022 ◽  
Vol 11 ◽  
Author(s):  
Laure Fournier ◽  
Lioe-Fee de Geus-Oei ◽  
Daniele Regge ◽  
Daniela-Elena Oprea-Lager ◽  
Melvin D’Anastasi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Imaging Techniques ◽  
Tumour Size ◽  
Tumour Response ◽  
Solid Tumours ◽  
Correct Interpretation ◽  
Joint Paper ◽  
Measurement Variability ◽  
Treatment Type ◽  
Reader Experience

Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.

Phase II trial of old age acute myeloid leukemia treatment by arsenic trioxide and low-dose subcutaneous cytosin arabinoside

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7075-7075
Author(s):  
A. Ghavamzadeh ◽  
S. Hashemi ◽  
K. Alimoghaddam ◽  
Z. Nasri Moghaddam ◽  
M. Shadpour ◽  
...  
Keyword(s):  
Arsenic Trioxide ◽  
Old Age ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Standard Treatment ◽  
Best Supportive Care ◽  
High Risk Group ◽  
Leukemia Treatment ◽  
Wbc Count ◽  
Very High

7075 Background: AML is a disease of old age, but unfortunately due to several factors standard treatment can not be delivered to these patients. Here we tried to achieve to bet possible response to these patients. Methods: Eleven old age patients selected for this trial. Patients couldn't tolerate standard treatment of AML due to old age or comorbid disorders. Treatment consist of best supportive care plus administration of low dose ARA-C (20mg/day as SQ) for 10 days each months and arsenic trioxide 10 mg/day as 2 hour iv infusion each month. Patients followed by CBC and BMA/B when peripheral blood normalized or every other month. Results: This cohort consist of 8 men and 3 women. Median age was 75 y/o (55–80). Median WBC count Hb level and platelet count at presentation were 42,860μl, 8.3g/dl and 30,500/μl, respectively. Complete remission observed in 6 and partial remission in one patient (RR = 63.6%), but remission was short live, after 6 months one patient was in CR and one in PR. After 12 months, only one patient was in PR. Median survival was 6 months and 6 patients survive more than 6 months. Two patients are alive after 12 months. Conclusions: Although prognosis of old age AML remain poor, but with this type of treatment RR is acceptable. In this very high-risk group of very old AML, combination of ATO and ARA-C possibly could improve survival. No significant financial relationships to disclose.

The Role of Imaging in Advanced Endometrial Carcinoma

2009 ◽  
Vol 05 (01) ◽  
pp. 68
Author(s):  
Helen Addley ◽  
Evis Sala ◽  
◽  
Keyword(s):  
Endometrial Carcinoma ◽  
Treatment Planning ◽  
Endometrial Thickness ◽  
Imaging Techniques ◽  
Treatment Selection ◽  
Histological Diagnosis ◽  
Initial Assessment ◽  
Oncological Treatment

Imaging in endometrial carcinoma has many roles. It is used in the initial assessment of symptomatic patients for demonstration of abnormal endometrial thickness. Once the histological diagnosis of endometrial carcinoma is confirmed, imaging can accurately stage the tumour, facilitating surgical and oncological treatment planning. This article will review the different imaging techniques available and their roles in staging, treatment selection and follow-up of patients with endometrial carcinoma.

scholarly journals Small Bowel Mesenteric Pseudocysts: Report of a Case and Review of the Literature

2020 ◽  
pp. 1-3
Author(s):  
Gaetano Di Vita ◽  
Beatrice D'Orazio ◽  
Bonventre Sebastiano ◽  
Martorana Guido ◽  
Cudia Bianca ◽  
...  
Keyword(s):  
Ct Scan ◽  
Standard Treatment ◽  
Clinical Symptoms ◽  
Imaging Techniques ◽  
Surgical Excision ◽  
Mesenteric Cyst ◽  
Review Of The Literature ◽  
Complete Surgical Excision ◽  
Specific Symptoms

Background: Mesenteric pseudocyst (MP) are rare clinical entity presenting a thick fibrotic wall with internal septae without epithelial lining cells. Case Report: We described one case of MP of a 50-year-old woman with persistent, non-specific, and non-responding to medical therapy abdominal pain. Laboratory tests, clinical examination and the abdominal US were un-conclusive while the CT scan of the abdomen showed a cystic lesion of the jejunal mesentery. We performed a laparoscopic surgical excision of the lesion with the resolution of clinical symptoms. The lesion resulted in inflammatory mesenteric cyst at the histological examination. At 5 years CT scan follow up we did not record any recurrences. Conclusion: MP present themselves without specific symptoms, diagnostic imaging techniques such as US or CT scan may define its features, location or size but fail in determining their benign or malign nature. In fact, even if, the majority of these lesions are benign, a rate of malign transformation of around 3% has been reported, which is why the complete surgical excision is the gold standard treatment.

scholarly journals Clinical Effectiveness of Oncological Treatment in Metastatic Colorectal Cancer Is Independent of Comorbidities and Age

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2091
Author(s):  
Dora Niedersüß-Beke ◽  
Manuel Orlinger ◽  
David Falch ◽  
Cordula Heiler ◽  
Gudrun Piringer ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Systemic Treatment ◽  
Clinical Effectiveness ◽  
Best Supportive Care ◽  
Specific Therapy ◽  
Optimal Care ◽  
Oncological Treatment ◽  
Treatment Type ◽  
Oncological Centers ◽  
Resection Of Metastases

We aimed to investigate the effectiveness of oncological treatments in metastatic CRC related to comorbidities and age. This retrospective study included 1105 patients from three oncological centers. aaCCI and CCI was available from 577 patients. An aaCCI > 3 was of the highest predictive value compared to other aaCCI-levels, CCI or age (p < 0.001 for all). Treatment (best supportive care (BSC), systemic treatment only (STO) and resection of metastases (ROM)) significantly prolonged survival in patients with aaCCI > 3 (STO: HR 0.39, CI 0.29–0.51; ROM: HR 0.16, CI 0.10–0.24) and patients older than 70 years (STO: HR 0.56, CI 0.47–0.66; ROM: HR 0.23, 0.18–0.30). Median overall survival was shorter in patients with aaCCI or age > 70 years and interaction for treatment type not significant for aaCCI, but significant for age older or younger than 70 years (STO: p = 0.01; ROM p = 0.02). BSC is more often considered as optimal care for patients with an aaCCI > 3 (37.6% vs. 12.4%; p < 0.001) or age > 70 years (35.7% vs. 11.2%; p < 0.001). Older patients or patients with comorbidities benefit from cancer-specific therapy independently of their age and comorbidities.

scholarly journals Inflammatory Breast Cancer in a Very Young Genetically Susceptible Woman: Case Presentation in a Tumour Board Session, Discussion and Decision-Making

2020 ◽  
pp. 59-64
Author(s):  
Sadaf Alipour
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Standard Treatment ◽  
Prophylactic Mastectomy ◽  
Radical Mastectomy ◽  
Immediate Breast Reconstruction ◽  
Tumor Board ◽  
Case Presentation ◽  
Contralateral Mastectomy ◽  
Nipple Sparing

Background: Inflammatory breast cancer is a very aggressive type of breast cancer which invades skin lymphatics. The standard treatment includes neoadjuvant chemotherapy followed by modified radical mastectomy and postsurgical radiation. Preserving the skin or nipple are not considered reasonable due to the involvement of the dermal lymphatics and therefore skin sparing or nipplesparing mastectomy are not usually carried out for this type of breast cancer. Case presentation: In this article, we present a case of inflammatory breast cancer in a very young woman who was positive for BRCA2 genes. Question: The possibility to perform nipple sparing or skin sparing mastectomy and immediate breast reconstruction, and the indication for prophylactic contralateral mastectomy as discussed in the tumor board are presented in this article. Conclusion: Neither of the more conservative techniques of mastectomy was appropriate for this case. Also, the prognosis of the patient mostly depends on the course of the ipsilateral tumor and prophylactic mastectomy would be wise only if the subsequent course of the disease is favourable.

scholarly journals Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013085
Author(s):  
Philipp Karschnia ◽  
Leon Kaulen ◽  
Niklas Thon ◽  
Joachim M. Baehring
Keyword(s):  
Imaging Techniques ◽  
Final Diagnosis ◽  
Best Supportive Care ◽  
Conus Medullaris ◽  
Blood Analysis ◽  
Mri Findings ◽  
Csf Analysis ◽  
Lower Extremity Strength ◽  
History Of ◽  
Patient’S History

A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last two years, and the patient’s history was notable for severe Listeria monocytogenes meningitis four years prior to presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled ‘man-in-the-barrel’ syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.

Malignant otitis externa with optic neuritis

1998 ◽  
Vol 112 (3) ◽  
pp. 274-277 ◽  
Author(s):  
A. P. Bath ◽  
J. R. Rowe ◽  
A. J. Innes
Keyword(s):  
Optic Neuritis ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Otitis Externa ◽  
Oxygen Therapy ◽  
Standard Treatment ◽  
Imaging Techniques ◽  
Malignant Otitis Externa

AbstractMalignant otitis externa is a serious condition that presents difficulties in treatment, and also in monitoring its progress. A case of malignant otitis externa with optic neuritis is presented that remained refractory to standard treatment but was cured by adjuvant hyperbaric oxygen therapy. This is the only reported case that has survived this disease with optic neuritis. The usefulness of imaging techniques in this condition is discussed, as well as the ESR, in evaluating the effectiveness of treatment.

Integration of radiomic, genomic and clinical data to support decision making for lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14607-e14607 ◽  
Author(s):  
Thierry Colin
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Medical Information ◽  
Lung Metastases ◽  
Imaging Techniques ◽  
Early Response ◽  
Tumor Board ◽  
Base Line ◽  
Full Potential ◽  
Therapeutic Decisions

e14607 Background: Medical imaging techniques play a central role in the evaluation of lung cancer and proper images analysis is essential for determining the location and stage of tumors, for diagnosis and prognosis assessment, guiding therapeutic decisions and for monitoring tumor response during and after treatment. It also supports interventional radiology acts (i.e. biopsies, thermo-ablations or embolization). Yet, this source of information, which is critical for the decision-making process, is not being used to its full potential. Besides, NGS technics allow the precise characterization of the genomic profile of a tumor by detecting mutations, evaluating the TMB and providing additional information such as the PD-L1 status. Methods: We have used an AI-based strategy to improve the stratification of cohorts of patients suffering from lung cancer. Using an advanced segmentation technology, we were able to quickly and precisely extract 3D Radiomic characteristics from the images. We then combined extracted heterogeneity and texture indicators with the biology information thanks to a machine learning based methodology. Results: We have applied this strategy to stage 4 NSCLC with EGFR mutation treated with TKI and have shown that stratification of the cohort with respect to the OS can be delivered using the base-line CT-scan and the first two exams used for the evaluation of the early response to the treatment. The same strategy was developed for the monitoring of lung metastases in order to help scheduling thermo-ablation by providing a prediction of the growth of the lesion in oligo-metastatic cases. Conclusions: This study paves the way to a near future when Artificial Intelligence will provide precise evaluation of lung tumors and full integration of all the medical information available for each patient to support the decision making within the tumor board.

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