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Luca Filippi,Alida Ciorra,Barbara Sardella,Orazio Schillaci,Oreste Bagni 대한핵의학회 2014 핵의학 분자영상 Vol.48 No.4
Abstract 90Y radioembolization and peptide-receptor radionuclidetherapy (PRRT) with177Lu-DOTATATE are both effectivetreatments for patients with inoperable neuroendocrinemetastatic tumors (NET). We report the case of a 72-year-oldman with severe functional syndrome due to a metastaticNET. 68Ga-DOTATOC positron-emission tomography (PET)revealed high somatostatin receptor expression in a gross livermetastasis, in one abdominal lymph node and in severals k e l e t a l l esions. The patient underwent l iverradioembolization with 90Y-resin microspheres followed byfour cycles of PRRT with177Lu-DOTATATE. After 3 months,a complete remission of the functional syndrome was observed. 68Ga-DOTATOC PET demonstrated a complete responsefor skeletal and lymph nodal lesions with a residualbulky mass in the liver. Therefore a further 90Yradioembolization was performed as consolidation treatmentfor the hepatic lesion. Six months after these combined treatments,68Ga-DOTATOC PET demonstrated complete metabolicresponse in liver and stable extrahepatic lesions. Nosignificant long-term adverse reactions were registered. Toour knowledge, the sequential use of 90Y radiembolizationbefore and after PRRT in a liver-dominant advanced NET hasnot been reported in the literature and this case suggests thatthese combined treatments can be safe and effective.
Filippi Luca,Angela Spanu,Bagni Oreste,Orazio Schillaci,Barbara Palumbo 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.5
We describe the case of 74-year-old-male, previously treated with fronto-parietal craniotomy due to primary glioblastoma multiforme (GBM), followed by concurrent radiation therapy (RT) and temozolomide (TMZ) chemotherapy. Magnetic resonance imaging (MRI) of the brain, at 1 month after completing RT + TMZ, depicted partial response. Three months later, the patient was submitted to a further brain MRI, that resulted doubtful for therapy induced changes (i.e., pseudoprogression). The patient, who had been previously treated with prostatectomy for prostate cancer (PC), underwent a positron emission tomography/computed tomography (PET/CT) scan with 18F-choline for PC biochemical recurrence. 18F-choline whole body PET/CT resulted negative for PC relapse, while segmental brain PET, co-registered with MRI, demonstrated increased tracer uptake corresponding to tumor boundaries. In order to solve differential diagnosis between pseudoprogression and GBM recurrence, brain PET/CT with 18F-L-dihydroxy-phenil-alanine (18F-DOPA) was subsequently performed: fused axial PET/MRI images showed increased 18F-DOPA incorporation in the peri-tumoral edema, but not in tumor boundaries, consistent with the suspicion of GBM pseudoprogression, as then confirmed by clinical and radiological follow-up.
Perrone Salvatore,Ortu La Barbera Elettra,Ottone Tiziana,Capriata Marcello,Passucci Mauro,Filippi Luca,Bagni Oreste,Voso Maria Teresa,Cimino Giuseppe 대한핵의학회 2020 핵의학 분자영상 Vol.54 No.5
223Ra-dichloride is a bone-seeking targeted alpha (α)-emitting approved for bonemetastases in prostate cancer. Here, we report a case of therapy-related acute promyelocytic leukemia (t-APL) following administration of 223Ra, showing some evidence of a causative relationship. A patient with metastatic prostate cancer received therapy with 223Ra, with 6 injections of the radiopharmaceutical at a standard dose of 55 kBq/kg at 4-week intervals for a cumulative administered activity of 26.3MBq. PET/CT with 18F-methylcholine repeated 1 month after the conclusion of 223Ra was negative. After 8 months, he developed pancytopenia and we made a diagnosis of therapy-related acute promyelocytic leukemia (t-APL). We then studied the genomic locations of the breakpoints in the PML and RARA genes, which were at nucleotide positions 1708-09 of PML intron 3, respectively, outside the previously reported Topo II-associated hotspot region. t-APL was cured with all-trans-retinoic acid (ATRA) and arsenic trioxide. The type of PML/RARA rearrangement we identified, in absence of other myelotoxic treatments, is suggestive of a possible direct causal relationship with exposure to 223Ra and warrants further investigations.