We present the FDG and Ga DOTATATE PET/CT findings of a 68-year-old woman with pulmonary metastases 28 years after her initial diagnosis of central nervous system hemangiopericytoma. The largest of the pulmonary lesions showed prominent Ga DOTATATE uptake with comparatively minimal FDG avidity. Hemangiopericytoma is a rare mesenchymal tumor that arises from malignant pericytes, cells that form the walls of capillaries and postcapillary venules. This case demonstrates the potential of radiolabeled somatostatin analogs as a therapeutic option in the setting of widespread metastatic disease.

Voltage-gated potassium channel limbic encephalitis characteristically presents with neuropsychiatric symptoms and temporal lobe seizures. Positron-emission tomography-computed tomography can be a useful adjunct to the clinical and biochemical work-up.

A high malondialdehyde-oxidized low-density lipoprotein (MDA-oxLDL) level is associated with atherosclerotic cardiovascular diseases and major adverse cardiovascular events. A higher cardio-ankle vascular index (CAVI) is independently associated with an increased risk of cardiovascular events, cardiovascular mortality, myocardial infarction, and stroke in patients with cardiovascular risk. Thus, this study aimed to evaluate the relationship between serum MDA-oxLDL levels and CAVI in patients with triple-vessel coronary artery disease who underwent coronary artery bypass graft (CABG) surgery. Fasting blood samples and baseline characteristics were obtained from 88 patients who had undergone CABG. A commercialized enzyme-linked immunosorbent assay was used to measure MDA-oxLDL levels. An automatic pulse wave analyzer was used to measure CAVI values, and each side of CAVI values of ≥9 was designated as arterial stiffness. In total, 47 participants were assigned to the arterial stiffness group. More patients had diabetes mellitus, were older, and had higher serum MDA-oxLDL levels in the arterial stiffness group than in the control group. A multivariate logistic regression analysis disclosed that MDA-oxLDL and diabetes mellitus were independent predictors of arterial stiffness. Moreover, according to the Spearman’s correlation analysis, the serum MDA-oxLDL level was positively associated with both left and right CAVI. Serum MDA-oxLDL levels were positively associated with arterial stiffness in patients who had undergone CABG.

radiation therapy in the context of isolated or limited lymph node metastases. We analyzed the dosimetric and clinical results of oligometastatic patients treated with SBRT for isolated lymph node metastases in abdomen and/or pelvis. Materials/Methods: In the analysis we included patients with a maximum of 5 lymph node sites of disease with diameter less than 5 cm, located in the abdomen or pelvis. Radiation therapy was administered with Volumetric Modulated Arc Therapy Rapid-Arc (VMAT-RA) and flattening filter-free (FFF) beams; prescribed dose was 45 Gy in 6 fractions of 7.5 Gy each. We analyzed dosimetric data and correlated them with acute toxicity (CTCAE 3.0), local and distant control of disease, progression free survival, and overall survival. Results: From January 2006 to May 2015, we treated 97 patients with lymph node metastases, of which 26 were lost at follow-up. We analyzed than 71 patients with a total of 79 treated lesions, with a mean follow-up of 1.44 years (range 0.14 e 6.21 years). At revaluation, complete response was achieved in 39 (49.3%) lesions and partial response in 28 (35.4%) lesions. Stable disease was demonstrated in 10 (12.6%) cases while only 2 (2.5%) lesions showed progression of disease. The overall clinical benefit rate was 97.5% (77/79 lesions). Acute toxicity was mild: 10 (14%) patients reported G1 toxicity (notably nausea and fatigue); 2 (2.8%) patients reported G2 toxicity (nausea and diarrhea). No Grade 3 and 4 toxicities were reported. In-field progression of disease during follow-up was demonstrated in 18 sites (22.7%) with a median time of 10.7 months. Out-field lymph node progression was demonstrated in 22 (27.8%) cases while distant metastases occurred in 25 (31.6%) cases. Local control rate and overall survival rate at 1 year were 83% and 93%, respectively. Conclusion: In consideration of our dosimetric and clinical results, SBRT with VMAT-RA and FFF beams can be considered a safe and effective approach in oligometastatic patients with abdomino-pelvic isolated lymph node metastases. Although this can be considered an initial experience, these results may be potentially significant for preserving quality of life of patients and delaying further systemic treatments.

Purpose/Objective(s): Current NCCN guidelines for treatment of head and neck cancer recommend initiating radiation therapy within 6 weeks from surgery. We sought to determine the ideal package time (days from surgery to completion of radiation), and how pathologic risk factors impact ideal package time. Materials/Methods: Patients with squamous cell carcinoma of the oropharynx, oral cavity, hypopharynx, and larynx cancer were identified from the National Cancer Data Base between 2004 and 2012. Patients were excluded if they had distant metastases, received less than 45 Gy, or had a package time outside of 9-20 weeks. High risk factors were defined as an oral cavity tumor, T3-4 or N2-3 disease, positive surgical margins, extracapsular extension, and lymphovascular invasion. Overall survival was estimated with the Kaplan-Meier method, and hazard ratios (HR) with Cox regression models. Adjustments were made for socioeconomic variables, comorbidity, risk factors, type of facility for surgery and radiation therapy, distance travelled to facility, length of hospital stay after surgery, unplanned hospital readmission, chemotherapy, radiation dose, and use of IMRT. Results: 38,266 patients were identified, consisting of 30% oral cavity tumors, 27% larynx, 28% tonsil, 12% non-tonsil oropharynx, and 3% hypopharynx. The most commonly employed radiation doses were 60-66 Gy (37%), 66-72 Gy (28%), and 72-76 Gy (23%). 2-year survival was greatest with a 10-week package time (P < 0.0001), and compared to 10 weeks, hazard ratios were significantly worse for package times !12 weeks. 2-year survival was 87% for 9-11 week package times, 83% for 12-14 weeks, 77% for 15-17 weeks, 75% for 18-20 weeks (P < 0.0001). Compared to 9-11 week package time, multivariate analysis showed a HR of 1.03 (P Z 0.22) for 12-14 weeks, HR of 1.14 (P < 0.0001) for 15-17 weeks, and HR of 1.18 (P < 0.0001) for 18-20 weeks. For patients with !3 risk factors, a 9-11 week package time was associated with improved survival compared to 12-14 weeks (HR 1.69, P Z 0.01), 15-17 weeks (HR 2.11 P Z 0.0004), and 18-20 weeks (HR 2.11, P Z 0.0009). For patients with no risk factors, shorter package times were not associated with survival gains; for 1 risk factor, survival loss was associated with 18-20 week package times (P Z 0.01); for 2 risk factors, survival loss was associated with 15-17 and 18-20 week package times (P Z 0.02 and 0.04, respectively). A sensitivity analysis of patients treated to !60 Gy demonstrated similar findings, as did a model restricted to patients receiving IMRT. Conclusion: For patients with non-metastatic squamous cell carcinoma of the head and neck, improved survival after definitive treatment with surgery and adjuvant radiation is associated with a shorter interval from date of surgery to completion of radiation. We found the most effective package time depends on risk factors, and the ideal package time is 11 weeks for patients with !3 risk factors.