FAPI PET/CT in the Diagnosis of Abdominal and Pelvic Tumors

Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) is currently a standard imaging examination used in clinical practice, and plays an essential role in preoperative systemic evaluation and tumor staging in patients with tumors. However, 18F-FDG PET/CT has certain limitations in imaging of some tumors, like gastric mucus adenocarcinoma, highly differentiated hepatocellular carcinoma, renal cell carcinoma, and peritoneal metastasis. Therefore, to search for new tumor diagnosis methods has always been an important topic in radiographic imaging research. Fibroblast activation protein (FAP) is highly expressed in many epithelial carcinomas, and various isotope-labelled fibroblast activation protein inhibitors (FAPI) show lower uptake in the brain and abdominal tissues than in tumor, thus achieving high image contrast and good tumor delineation. In addition to primary tumors, FAPI PET/CT is better than FDG PET/CT for detecting lymph nodes and metastases. Additionally, the highly selective tumor uptake of FAPI may open up new application areas for the non-invasive characterization, staging of tumors, as well as monitoring tumor treatment efficacy. This review focuses on the recent research progress of FAPI PET/CT in the application to abdominal and pelvic tumors, with the aim of providing new insights for diagnostic strategies for tumor patients, especially those with metastases.

Cervical leiomyoma: a rare case with unusual presentation

Leiomyomas or fibroids are the most common benign pelvic tumors in females that grow mono-clonally from the smooth muscle cells of the uterus. Most common tumors of the uterus are fibroids but cervical fibroid is rare during pregnancy with different management difficulties but cervical leiomyomas are less than 5% of all leiomyomas. A middle-aged female patient came to the obstetric opd with complaints of amenorrea for 2 months, per vaginal spotting and abdominal pain for 5 days. Her obstetric score is gravida 2 para 1 living 1. She has no h/o of urinary retention, urgency, constipation or mass per vagina. There is no history of bleeding during coitus. This case is of great importance not only because of its atypical presentation, but because we are dealing with rare pathology that can have consequences as serious as a total uterine inversion or a complete uterovaginal prolapse. Decision of myomectomy SOS hysterectomy may be considered intra operatively based on 1. Age, 2. Parity, 3. Severity of symptoms and 4. Experience of surgeon

Fast Adaptive Temperature-Based Re-Optimization Strategies for On-Line Hot Spot Suppression during Locoregional Hyperthermia

Background: Experience-based adjustments in phase-amplitude settings are applied to suppress treatment limiting hot spots that occur during locoregional hyperthermia for pelvic tumors. Treatment planning could help to further optimize treatments. The aim of this research was to develop temperature-based re-optimization strategies and compare the predicted effectiveness with clinically applied protocol/experience-based steering. Methods: This study evaluated 22 hot spot suppressions in 16 cervical cancer patients (mean age 67 ± 13 year). As a first step, all potential hot spot locations were represented by a spherical region, with a user-specified diameter. For fast and robust calculations, the hot spot temperature was represented by a user-specified percentage of the voxels with the largest heating potential (HPP). Re-optimization maximized tumor T90, with constraints to suppress the hot spot and avoid any significant increase in other regions. Potential hot spot region diameter and HPP were varied and objective functions with and without penalty terms to prevent and minimize temperature increase at other potential hot spot locations were evaluated. Predicted effectiveness was compared with clinically applied steering results. Results: All strategies showed effective hot spot suppression, without affecting tumor temperatures, similar to clinical steering. To avoid the risk of inducing new hot spots, HPP should not exceed 10%. Adding a penalty term to the objective function to minimize the temperature increase at other potential hot spot locations was most effective. Re-optimization times were typically ~10 s. Conclusion: Fast on-line re-optimization to suppress treatment limiting hot spots seems feasible to match effectiveness of ~30 years clinical experience and will be further evaluated in a clinical setting.

SURGICAL TREATMENT OF PATIENTS WITH EXTRAORGANIC TUMORS OF THE PELVIC LOCALIZATION WITH INVASION OF THE ILIAC VESSELS

The aim of our study was to determine the indications for expanding the scope of operations in patients with pelvic extraorgan local formations. Materials and methods. The results of surgical treatment of 7 patients with nonorgan tumors of the pelvic localization, who underwent resection on the main vessels in connection with their involvement in the tumor process, are presented. Results and discussion. A total of 7 interventions were performed on the iliac arteries — 2 resections with an end-to-end anastomosis and 5 prostheses (one case — the aorta resection with reconstruction with a bifurcation prosthesis). Patients with pelvic extraorgan tumors are a special cohort of patients, due to the presence of several organs in a narrow space, which inevitably causes them to fit snugly to the tumor. Locally advanced tumor process in extraorganic tumors involving the main vessels of the pelvis and adjacent organs is not a reason to refuse surgery, and despite the complications, repeated recurrences and previous operations, are well tolerated by patients. This is especially important due to the lack of a real alternative to surgical treatment of this group of patients. Conclusions. Surgical intervention in the treatment of pelvic inorganic tumors involving the main vessels is the only radical method of treatment. Invasion of the main arterial and venous vessels is not a contraindication to surgery in patients with pelvic tumors. Combined angioplastic interventions allow to achieve a long without recurrent period even after cytoreductive operations.

Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

Uterine leiomyomatosis is one of the most common benign pelvic tumors diagnosed in women aged 25-44 years. Clinically, it is manifested by vaginal bleeding, pelvic pain, infertility, digestive and urinary symptoms. The diagnosis of uterine fibroids requires careful clinical and paraclinical evaluation. Based on these data, the therapeutic decision is conducted in most cases. The treatment of uterine leiomyomatosis involves several procedures, such as: total abdominal hystectomy, total vaginal hystectomy, abdominal myomectomy, vaginal, laparoscopic or hysteroscopic myomectomy. Hysteroscopic myomectomy is currently the preferred procedure for submucosal fibroids. It has multiple advantages: shorter recovery time, reduced pain related to movements, shorter duration procedure and fewer risks. The procedure has few contraindications. The most common complication is recurrence. The treatment of choice for prolapsed pedunculated submucous leiomyoma is vaginal myomectomy. As described, the procedure has multiple advantages and generally has a low recurrence rate.

Angiomyxoma of the pelvis in women. Clinical cases

Aggressive pelvic angiomyxoma belongs to one of the rare types of mesenchymal pelvic tumors found in premenopause patients. Currently, this pathology is mainly treated via surgical intervention. Alternatively, it may also be managed by using radiation or hormone therapy. The final diagnosis is usually established by histological examination of removed tumor, because biopsy analysis during examination may not always provide a high diagnostic value. This tumor type is able to relapse, even after 100 % surgically removed intervention. Immunohistochemistry examination reveals expression of progesterone and estrogen receptors. One of the hormone therapy options with good long-term effect is based on using gonadotropin-releasing hormone drugs. Taking into consideration slow tumor growth and hormonal sensitivity, one of the options for managing disease relapse is patient follow-up, especially in perimenopausal subjects. Single clinical cases have been published related to pelvic angiomyxoma so that it results in introducing individualized management for every certain patient, but unified therapeutic approaches have not been developed yet.

Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy

Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.

Prevention of radiotherapy induced enteropathy by probiotics (PREP): protocol for a double-blind randomized placebo-controlled trial

Background Radiation induced enteropathy is a common complication of radiotherapy for pelvic tumors and adversely affects patient quality of life. Probiotics are thought to restore bowel microflora to optimal levels and reinforce intestinal barrier capacity. Although probiotics are effective in the treatment of radiation induced enteropathy, less is known about their efficacy to prevent radiation induced enteropathy. Methods This double-blind randomized placebo-controlled study will investigate the efficacy of probiotics to prevent radiation-induced enteropathy in patients with gynecologic or urologic cancer who received pelvic radiotherapy. The study is designed to enroll 248 eligible patients, who will be randomized 1:1 to a probiotic or placebo group. Toxicities will be evaluated using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Discussion The primary aim of this study is to provide high level evidence for the ability of probiotics to prevent acute radiation induced enteropathy. The secondary aims are to determine the effects of probiotics on the incidence of chronic radiation induced enteropathy and the safety of probiotics in patients with gynecologic or urologic cancer. Trial registration ClinicalTrials.gov (NCT03978949, Registered on 7 June 2019).

Myoma Expulsion after Uterine Artery Embolization

Introduction. Uterine leiomyomas are the most common benign pelvic tumors in women over 35 years and can be symptomatic or asymptomatic. Among the main treatment strategies, there are hormone therapy, hysterectomy, myomectomy, and uterine artery embolization (UAE), a recent and promising treatment for patients who wish to avoid hysterectomy. Ideal candidates for UAE are women with symptomatic uterine leiomyomas that present no desire for pregnancy, premenopausal and heavy menstrual bleeding, or dysmenorrhea caused by intramural fibroids. Case Presentation. A 36-year-old female diagnosed with leiomyomas and an extensive history of failed previous treatments who, in order to preserve her uterus, underwent UAE and had tumor expulsion 15 days after the procedure. The patient remained eight months in amenorrhea and, currently, presents normal hormone levels and irregular periods. Conclusion. UAE presents itself as a minimally invasive procedure and as an efficient alternative for those patients who wish to preserve their uteri and also improve their symptoms and quality of life.