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Abstract: Rak požiralnika sodi med rake prebavil z najslabšo prognozo. V zadnjih letih pa se preživetje bolnikov z rakom požiralnika podaljšuje z vpeljavo novih oblik zdravljenja. Klinične študije so pokazale pomemben doprinos k izboljšanju preživetja ter časa do napredovanja bolezni z uporabo kombinirane kemoterapije z imunoterapijo pri bolnikih z razširjenim rakom požiralnika. Pri bolnikih po resekciji raka požiralnika pa na klinični pomembnosti pridobiva dopolnilno zdravljenje z nivolumabom. Kvalitetna obravnava bolnikov z rakom požiralnika je multidisciplinarna ter vključuje tako prehransko, kirurško, radio-terapevtsko, sistemsko ter paliativno obravnavo. Pričujoči prispevek nam poda primer bolnika z loko-regionalno boleznijo raka požiralnika, ki je post-operativno prejel dopolnilno terapijo z nivolumabom. Drugi primer pa opisuje bolnika z razširjeno boleznijo raka ezofagogastričnega stika, ki je prejel kombinirano kemoterapijo z imunoterapijo z nivolumabom.
Keywords: rak požiralnika, sistemsko zdravljenje, rak prebavil
Published in DiRROS: 12.01.2023; Views: 53; Downloads: 17
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Keywords: limfomi, imunoterapija, limfoproliferativne bolezni
Published in DiRROS: 17.11.2022; Views: 132; Downloads: 45
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Abstract: Purpose: To develop quantitative molecular imaging biomarkers of immune-related adverse event (irAE) development in malignant melanoma (MM) patients receiving immune-checkpoint inhibitors (ICI) imaged with 18F-FDG PET/CT. Methods: 18F-FDG PET/CT images of 58 MM patients treated with anti-PD-1 or anti-CTLA-4 ICI were retrospectively analyzed for indication of irAE. Three target organs, most commonly affected by irAE, were considered: bowel, lung, and thyroid. Patient charts were reviewed to identify which patients experienced irAE, irAE grade, and time to irAE diagnosis. Target organs were segmented using a convolutional neural network (CNN), and novel quantitative imaging biomarkers - SUV percentiles (SUVX%) of 18F-FDG uptake within the target organs - were correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. Patients who did not experience irAE were used to establish normal ranges for target organ 18F-FDG uptake. Results: A total of 31% (18/58) patients experienced irAE in the three target organs: bowel (n=6), lung (n=5), and thyroid (n=9). Optimal percentiles for identifying irAE were bowel (SUV95%, AUROC=0.79), lung (SUV95%, AUROC=0.98), and thyroid (SUV75%, AUROC=0.88). Optimal cut-offs for irAE detection were bowel (SUV95%>2.7 g/mL), lung (SUV95%>1.7 g/mL), and thyroid (SUV75%>2.1 g/mL). Normal ranges (95% confidence interval) for the SUV percentiles in patients without irAE were bowel [1.74, 2.86 g/mL], lung [0.73, 1.46 g/mL], and thyroid [0.86, 1.99 g/mL]. Conclusions: Increased 18F-FDG uptake within irAE-affected organs provides predictive information about the development of irAE in MM patients receiving ICI and represents a potential quantitative imaging biomarker for irAE. Some irAE can be detected on 18F-FDG PET/CT well before clinical symptoms appear.
Keywords: melanoma, malignant melanoma, immune-checkpoint inhibitors, molecular imaging biomarkers
Published in DiRROS: 07.09.2022; Views: 139; Downloads: 56
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Keywords: kemoterapija, rak debelega črevesa in danke, gastrointestinalni tumorji
Published in DiRROS: 14.07.2022; Views: 369; Downloads: 94
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Keywords: melanom, rak kože, sistemsko zdravljenje
Published in DiRROS: 11.04.2022; Views: 238; Downloads: 89
Full text (429,44 KB)