This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.
At the University Hospital Essen intraocular tumors are treated by four radiotherapy modalities: eye plaque brachytherapy with 106Ru/106Rh and 125I for the uveal melanoma treatment (and some cases of retinoblastoma) external beam therapy at accelerators (X5-MV to X15-MV) for the retinoblastoma treatment and proton therapy for some selected cases of high risk (e.g. juxtapapillary uveal tumors). An average number of 150-200 melanoma patients per year are undergoing radiotherapy. Of these, 5-10% are treated with protons in cooperation with the Centre Antoine Lacassagne in Nice/France, 10-15% with 125Ι plaques and the rest with 106Ru/106Rh plaques.For uveal melanomae, the indication for either an 125 Ιor a 106Ru/106Rh plaque therapy depends on the prominence of the tumor. In the case of 106R Υ/ lo6 Rh applicators, a maximal sclera dose of 1,000-1,200 Gy and a minimal apex dose of 100 Gy is delivered for a maximal tumor prominence of 5-6 mm. The minimal scleral dosage is 700 Gy, sufficient for a safe occlusion of the uveal vessels in the tumor region. A brachytherapy with a 125 I plaque and a dosage of 80 Gy at the apex is a possible therapy concept for a tumor prominence from 5 up to 10 mm
Biochemical recurrence (BCR) after prostate cancer surgery is common, even after additional salvage radiotherapy. BCR might be explained by target miss. Improved diagnostic accuracy provided by PET could potentially circumvent this therapeutic gap. Therefore, we evaluated consecutive 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT, 11 C-choline PET/CT, and standard CT imaging in the same patient with regard to TNM-stage migration and accordingly adapted curative radiotherapy options including ablative treatment of oligometastases (n # 5). The cost efficacy of PET-versus CT-based treatment was also calculated. Methods: The prospective register database (064/2013BO1) was retrospectively searched for patients fulfilling the following 3 inclusion criteria: BCR after radical prostatectomy (pT2-pT4 pN0-pN1 cM0, postoperative radiotherapy allowed); 11 C-choline PET/CT, 68 Ga-PSMA PET/CT, and diagnostic CT performed within 24 h; and available clinical data. Ten treatment routines were defined according to current practice. Furthermore, intention-to-treat and treatment-related costs depending on the shift of TNM stage after imaging were analyzed. Eighty-three patients were eligible (median prostate-specific antigen level, 1.9 ng/mL). Results: Both PET examinations led to concordant results in 72% of patients, whereas the concordance of TNM staging between 68 Ga-PSMA PET and diagnostic CT was only 36%. Incorrect staging would lead to "wrong" treatment and therefore to additional costs. A 68 Ga-PSMA PET study would be cost-effective if additional costs do not exceed €3,844 ($4,312) (vs. CT). The number needed to image was 2 (for CT) and 4 (for 11 C-choline PET) to avoid 1 incorrect treatment. In addition, 68 Ga-PSMA PET staging enabled new curative options in half the patients with previous radiotherapy who otherwise receive palliative androgen deprivation therapy. Conclusion: 68 Ga-PSMA PET/CT is cost-effective in all patients with regard to avoidance of incorrect treatment. It enabled new curative options for patients with previous radiotherapy who are usually treated palliatively. Therefore, 68 Ga-PSMA PET/CT staging should become standard for BCR after surgery with or without radiotherapy.
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