The authors present a list of recommendations on the utilization of 18 F-FDG PET/CT in oncology for the diagnosis, staging and detection of cancer, as well as in the follow-up of the disease progression and possible recurrence. The recommendations were based on the analysis of controlled studies and a systematic review of the literature including both retrospective and prospective studies regarding the clinical usefulness and the impact of 18 F-FDG PET/CT on the management of cancer patients. 18 F-FDG PET/CT should be utilized as a supplement to other conventional imaging methods such as computed tomography and magnetic resonance imaging. Positive results suggesting changes in the clinical management should be confirmed by histopathological studies. 18 F-FDG PET should be utilized in the diagnosis and appropriate clinical management of cancer involving the respiratory system, head and neck, digestive system, breast, genital organs, thyroid, central nervous system, besides melanomas, lymphomas and occult primary tumors. Keywords: FDG-PET; Oncology; Diagnosis; Clinical indications.Apresentamos uma lista de recomendações sobre a utilização de 18 F-FDG PET em oncologia, no diagnóstico, estadiamento e detecção de recorrência ou progressão do câncer. Foi realizada pesquisa para identificar estudos controlados e revisões sistemáticas de literatura composta por estudos retrospectivos e prospectivos. As consequências e o impacto da 18 F-FDG PET no manejo de pacientes oncológicos também foram avaliados. A 18 F-FDG PET deve ser utilizada como ferramenta adicional aos métodos de imagem convencionais como tomografia computadorizada e ressonância magnética. Resultados positivos que sugiram alteração no manejo clínico devem ser confirmados por exame histopatológico. A 18 F-FDG PET deve ser utilizada no manejo clínico apropriado para o diagnóstico de cânceres do sistema respiratório, cabeça e pescoço, sistema digestivo, mama, melanoma, órgão genitais, tireoide, sistema nervoso central, linfoma e tumor primário oculto. Unitermos: PET-FDG; Oncologia; Diagnóstico; Indicações clínicas.
AbstractResumo * Study developed by the Sociedade Brasileira de Cancerologia
All completed the first cycle of CT and 18/21 (85%) patients received 2 cycles of NACT, two with dose reduction 2/21 (9.5%). Grade 3 or higher toxicity was seen in 5/21 (23.8%); commonest was vomiting 2/21 (9.5%). Seven of 21 (33.3%) patients have completed surgery till date. Median duration from NACT end to RT start was 5.8 (1.5-22) weeks, major deviation (> 6 weeks) was seen in 3/7 (43%). Major toxicity was not seen during RT, one patient died 1 week after RT completion. 2 patients progressed on RT during 4th week. Median duration of RT was 5.8 weeks (5-6 weeks) with 1 deviation (>4 days break). Seven patients have undergone Sx, median duration of 6.2 weeks (5-7 weeks) from end of CRT to Sx. Pathological complete response (pCR) was seen in 2/7 (28% patients); 4/7 patients (57%) had ypN0. Postoperative complications were seen in 1/7 (14%) patient. Adjuvant chemotherapy, 3 cycles, was completed by 3 patients. The first 11 patients had poor compliance with 4/11(36%) lost to follow up due to finances/poor motivation and 3/11 (27%) patients had progressive disease while only 4/11 (36%) patients proceeded to Sx. The accrual rate was 1 patient /month. The latter 10 patents had quicker accrual -4 patients / month and better compliance (none lost to follow up). 3 had progression during NACT/RT, 1 patient died following RT-sudden collapse, cause unclear, 3/10 underwent surgery, 2 awaiting surgery and one could not be taken up for RT due to technical issues. Conclusion: Accrual and compliance of patients to this protocol improved over time; a learning curve was seen. Toxicity was acceptable with a pCR in2 out of 7. The protocol is doable and safe, but poor financial support, motivation and disease progression (chemo-selection) in a relatively unselected group of patients inform real-world scenarios.P À 312 The survival of patients with pancreatic cancer in Jeju Island may be related to blood type
Neste relato, aproveitamos um caso pouco usual de adenocarcinoma em mucosa sinonasal para ilustrar o processo de decisão diagnóstica em imuno-histoquímica. Trata-se de paciente do sexo masculino, de 86 anos, apresentando massa intranasal. No estudo imuno-histoquímico, notou-se expressão de antígeno prostático específico (PSA) e do CDX-2, indicando possibilidades diagnósticas divergentes, de metástase de adenocarcinoma prostático ou de adenocarcinoma sinonasal do tipo intestinal (ITAC). A partir desse dilema diagnóstico, buscou-se estabelecer como esses marcadores poderiam ser confrontados em uma decisão diagnóstica, definindo-se as qualidades que um bom marcador imuno-histoquímico deve ter, e como os marcadores utilizados no painel se comparam em relação a essas qualidades e às hipóteses diagnósticas levantadas. Nesse exercício, são desvendados aspectos importantes do processo diagnóstico em patologia.
abstract resumo
In this report, we explore an unusual case of adenocarcinoma detected in the sinonasal mucous membrane in order to illustrate the diagnostic decision process in the immunohistochemical diagnosis. The patient is a 86-year-old man with an intranasal mass. In the immunohistochemical study, it was found expression for
e19198 Background: Oral cancer treatment has becoming progressively more frequent and its costs are rising. To implement strategies that monitor adverse effects, adherence and manage financial resources is of utmost importance. Our goal is to develop an intervention based on pharmaceutical monitoring that promotes the correct use of medication through the early identification of adverse events, as well as to describe an economic analysis of this intervention. Methods: Quasi-experimental study, which included consecutive patients from a private oncologic clinic in Belo Horizonte, Southeast Brazil, who were taking oral medications for the treatment of cancer. Patients had regular consultations with pharmacists, at the beginning of each treatment cycle. The consultation consisted of the assessment of adherence (if they took at least 80% of the pills on a specific period of time) and adverse effects. The number of pills dispensed in the new cycle was adjusted by the number of pills remaining in the previous cycle. Prices were calculated using Brasindice and the dollar price of Feb/2020. Follow-up period was from Oct/2018 to Nov/2019. Results: Throughout the study, 1224 patients were included: 86% female, mean age 63 years, 37% had at least 7 years education. Breast cancer accounted for 77% and prostate cancer for 6% of the patients, and 23% of all patients were treating stage IV cancer. The most used treatments were tamoxifen (44%) anastrazole (34%) and capecitabine (3%). In total, 10.640 pharmacists consultations were performed, which corresponds, on average, 887 consultations per month and 8.7 per patient. On average, 88.6% were adherent to the medication. In 50% of those consultations, patients reported adverse effects (hot flashes 42%, musculoskeletal syndrome 22%, fatigue 14%, cramps 7%). In that scenario, pharmaceutical care has resulted in total savings of 4067 pills or $ 136,854.89 (Table). Conclusions: Pharmaceutical care was responsible for high rates of adherence, despite the high frequency of adverse effects, and also promoted cost savings. [Table: see text]
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