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M Picchio

Publications and source records attributed to M Picchio.

At least 19 recordsLinked to original sources
PubMed2006

Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer.

PURPOSE: The aims of this study were to compare CT with PET/CT results in patients with suspected ovarian cancer recurrence and to assess the impact of the PET/CT findings on their clinical management. METHODS: Thirty-two consecutive patients with suspected ovarian cancer recurrence were retrospectively included in the study. Abdominal contrast-enhanced CT and PET/CT with [(18)F]FDG, in addition to conventional follow-up, were performed in all 32 patients. After the comparison between CT and PET/CT results, based on clinical reports, changes in the clinical management of patients (intermodality changes) due to PET/CT information were analysed. RESULTS: Twenty of the 32 patients were positive at CT (62.5%) versus 29 (90.6%) at PET/CT. Intermodality changes in management, i.e. use of a different treatment modality, after PET/CT examination were indicated in 14/32 (44%) patients. In particular, before PET/CT study, the planned management was as follows: wait-and-see in 7/32 (22%), further instrumental examinations in 4/32 (12%), chemotherapy in 10/32 (31%), diagnostic surgical treatment in 6/32 (19%) and surgical treatment in the remaining 5/32 (16%). After PET/CT study, wait-and-see was indicated in 1/32 (3%), further instrumental examinations in 7/32 (22%), chemotherapy in 16/32 (50%), diagnostic surgical treatment in 2/32 (6%) and surgical treatment in the remaining 6/32 (19%). CONCLUSION: Integrated PET/CT could detect tumour relapse in a higher percentage of patients than could CT. A change in the clinical management was observed in 44% of cases when PET/CT information was added to conventional follow-up findings.

Adult↗
PubMed2006

PET/CT and radiotherapy.

This article reviews the state of the art of PET/CT applications in radiotherapy, specifically its use in disease staging, patient selection, treatment planning and treatment evaluation. Diseases for which radiotherapy with radical intent is indicated will be considered, as well as those in which PET/CT may actually change the course of disease. The methodological and technological aspects of PET/CT in radiotherapy are discussed, focusing on the problem of target volume definition with CT and PET functional imaging and the problem of tumor motion with respect to imaging and dose delivery.

Humans↗
PubMed2005

Feasibility of [18F]FDG-PET and coregistered CT on clinical target volume definition of advanced non-small cell lung cancer.

AIM: To prospectively evaluate the impact of coregistered positron emission tomography (PET) and computed tomography (CT) in 3D conformal radiotherapy (3D-CRT) planning in patients with non-small lung cancer (NSCLC). METHODS: Twenty-one patients (median age: 57 years; range: 42-80 years) referred to 3D-CRT for NSCLC were recruited. Positron emission tomography with 18F-fluorodeoxyglucose ([18F]FDG-PET) and conventional CT images were coregistered (PET/CT images) using a commercial software package based on surface matching technique. Neoplastic areas were contoured on [18F]FDG-PET images with the aid of the correspondent CT image by a nuclear medicine physician. CT images and their relative PET contours were then transferred to treatment planning system. A radiation oncologist firstly contoured clinical target volumes (CTV) on CT scan alone (CTV-CT), and then on coregistered PET/CT images (CTV-PET/CT). CTV-CT and CTV-PET/CT were compared for each patient; a difference higher than 25% was considered of clinical relevance. RESULTS: Three patients were shifted to palliative radiotherapy for metastatic disease or very large tumor size, showed by [18F]FDG-PET. Of the remaining 18 patients a CTV change, after inclusion of PET/CT data, was observed in 10/18 cases (55%): larger in 7/18 (range 33-279%) and smaller in 3/18 patients (range 26-34%), mainly due to inclusion or exclusion of lymph-nodal disease and to better definition of tumor extent. CTV changes smaller than 25% occurred in the remaining 8/18 patients. CONCLUSIONS: [18F]FDG-PET and CT images co-registration in radiotherapy treatment planning led to a change in CTV definition in the majority of our patients, which may significantly modify management and radiation treatment modality in these patients.

Adult↗
PubMed2004

Diagnosis of local recurrence after radical prostatectomy.

In the long-term there is biochemical evidence of recurrent prostate carcinoma in approximately 40% of patients after radical prostatectomy (RP). Detecting the site of recurrence (local vs distant) is critical for defining the optimum treatment. Pathological and clinical variables, e.g. Gleason score, involvement of seminal vesicles or lymph nodes, margin status at surgery, and especially the timing and pattern of prostate-specific antigen (PSA) recurrence, may help to predict the site of relapse. Transrectal ultrasonography (TRUS) of the prostatic fossa in association with TRUS-guided needle biopsy is considered more sensitive than a digital rectal examination for detecting local recurrence, especially if PSA levels are low. Although it cannot detect minimal tumour mass at very low PSA levels (< 1 ng/mL) TRUS biopsy is presently the most sensitive method for detecting local recurrence. Nevertheless, the conclusive role of biopsy of the vesico-urethral anastomosis remains unclear. However, 111In-capromab pendetide scintigraphy and [11C]-choline tomography (which are better than conventional imaging for detecting metastatic tumour), have low detection rates for local disease and are considered complementary to TRUS in this setting. Patients with a high PSA after RP may be managed with external beam salvage radiotherapy. An initial PSA of < 1 ng/mL, Gleason score < 8 and radiation dose of 66-70 Gy seem to be key factors in determining success. Although a positive TRUS anastomotic biopsy may predict a better outcome after radiation therapy, the need to take a biopsy in the event of PSA failure remains under investigation. The value of salvage radiation to the prostatic bed for PSA-only progression after RP remains in question.

Biopsy↗
PubMed2004

PET/CT in diagnostic oncology.

In the last years positron emission tomography (PET) with 18F-fluorodeoxyglucose ([18F]FDG) has become an established technique for the staging and follow-up of a wide variety of neoplasms. As PET imaging is based on the physiological mediated distribution of the administered tracer, rather than on anatomic and structural characteristics of tissue, the addition of CT imaging to PET improves the interpretation of PET images. Recently, integrated PET/CT scanners have been developed that can produce directly functional PET and anatomical CT data 1 session, without moving the patient and with minimal delay between the reconstruction and fusion of the 2 image data sets. In addition, CT images are also being used for attenuation correction in the reconstruction process of the PET emission data. A brief review of the most relevant technical characteristics of 3 PET/CT systems, which represent the state of the art of this technology, are described. Furthermore an overview of PET/CT acquisition protocols and clinical applications of PET/CT in oncology are described. Overall, advantages of PET/CT over PET that may influence the clinical routine, have been identified as a) the shorter image acquisition time with benefit on patients throughput and on patient compliance, b) the better accuracy in anatomically localizing focal areas of abnormal tracer uptake and defining tumor extent and c) the possibility to stage a disease in 1 single step.

Fluorodeoxyglucose F18↗
PubMed2003

Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis.

OBJECTIVE: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is now a procedure of proven clinical value in the staging of primary lung cancer. This study evaluated the role of PET in the preoperative assessment of resectable lung metastases. METHODS: Eighty-six patients with previously treated malignancy and proven or suspected lung metastases, deemed resectable at computed tomography scan, were investigated with 89 preoperative PET procedures. Primary tumor sites were: gastrointestinal in 32 cases, sarcoma in 13, urologic in 14, breast in 8, head and neck in 7, gynecologic in 5, thymus in 5, other in 5. Seventy lung resections were performed in 68 patients of whom only 54 proved to be lung metastasis, 7 were primary lung tumors, and 9 were benign lesions. RESULTS: In 19 cases (21%) lung surgery was excluded on the basis of PET scan results due to extrapulmonary metastases (11 cases), primary site recurrence (2), mediastinal adenopathy (2), or benign disease (4). All mediastinal node metastases (7 cases) were detected by PET with a sensitivity, accuracy, and negative predictive value for mediastinal staging of 100%, 96%, and 100%, respectively, versus 71%, 92%, and 95% of the computed tomography scan. In the group of patients who underwent lung resection, PET sensitivity for detection of lung metastasis was 87%. CONCLUSIONS: PET scan proved to be a valuable staging procedure in patients with clinically resectable lung metastasis and changed the therapeutic management in a high proportion of cases.

Female↗
PubMed2003

[18F]fluorodeoxyglucose positron emission tomography as a useful indicator of metastatic gestational trophoblastic tumor: preliminary results in three patients.

OBJECTIVE: The goal of this study was to evaluate the usefulness of positron emission tomography with [(18)F]fluorodeoxyglucose ([(18)F]FDG-PET) in detecting metastases in patients with gestational trophoblastic tumor (GTTs). METHODS: A retrospective study was conducted on three patients with GTTs who had been studied with [(18)F]FDG-PET and computed tomography (CT) after an increase in human chorionic beta-gonadotropin (betahCG) serum levels. PET scans were performed with a multiring whole-body positron emission tomograph 45 min after an intravenous bolus injection of [(18)F]FDG ( approximately 5.2 MBq/kg). CT studies were obtained on a spiral scanner prior and after administration of intravenous iodinated contrast material. Within a week of CT and [(18)F]FDG-PET studies, the patients underwent surgical procedures for histological diagnosis. RESULTS: In one patient, a lung lesion positive for neoplastic tissue with [(18)F]FDG-PET and negative with CT was confirmed to be a GTT metastasis at histology. In another patient, [(18)F]FDG-PET was negative, while CT was positive for the presence of lung metastasis; no viable tumor tissue was found at histological analysis. The remaining patient had a positive [(18)F]FDG-PET and CT study for lung metastasis; this was confirmed at histological analysis. In the same patient, both [(18)F]FDG-PET and CT depicted the presence of a liver lesion. Necrotic lesion regression after treatment was clearly documented with [(18)F]FDG-PET only. CONCLUSIONS: Our preliminary results suggest that [(18)F]FDG-PET may be useful for the assessment of metastatic disease in patients with GTTs.

Adult↗
PubMed2003

Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography.

PURPOSE: We compared [11C]choline-positron emission tomography (PET) with [18F]fluorodeoxyglucose-PET for re-staging prostate cancer in a group of 100 patients. MATERIALS AND METHODS: A total of 100 consecutive patients referred for whole body [18F]fluorodeoxyglucose-PET for clinical prostate re-staging after radical treatment for prostate cancer were retrospectively included in the study. Mean prostate specific antigen (PSA) was 6.57 ng./ml. In all cases [11C]choline-PET was also performed. PET studies were done with a multiring device 5 minutes after intravenous injection of approximately 370 MBq. [11C]choline and 60 minutes after injection of approximately 370 MBq. [18F]fluorodeoxyglucose. PET findings were compared with those obtained with different conventional imaging and with PSA assessed at the time of PET and 1 year later. RESULTS: Areas of abnormal focal increases were noted in 47% of patients on [11C]choline-PET and in 27% on [18F]fluorodeoxyglucose-PET. Of the 100 patients 49 had positive conventional imaging findings. All except 14 [11C]choline-PET findings were concordant with conventional imaging, including 6 negative and 8 positive conventional imaging results. All except 1 [11C]choline-PET negative cases also had negative conventional imaging after 1 year. PSA at 1 year remained stable or decreased in 80% and 62% of [11C]choline-PET negative and positive cases, respectively. CONCLUSIONS: [11C]choline-PET seems to be useful for re-staging prostatectomy cases with increasing serum PSA levels. It is superior to [18F]fluorodeoxyglucose-PET and complementary to conventional imaging but with the advantage of staging disease at a single step.

Aged↗
PubMed2003

Advanced ovarian carcinoma: usefulness of [(18)F]FDG-PET in combination with CT for lesion detection after primary treatment.

AIM: To determine the additional value of [(18)F]FDG-PET in combination with computed tomography (CT) over CT used alone, for evaluating ovarian cancer patients after primary treatment. METHODS: Twenty-five women (mean age: 53.6 years) had primary debulking surgery followed by chemotherapy for histologically proven ovarian carcinoma. At initial diagnosis, the tumor types were papillary serous adenocarcinoma (n=20), endometroid carcinoma (n=3), mixed mullerian tumor (n=1), and granulosa cell tumor (n=1). All patients underwent [(18)F]FDG-PET and contrast enhanced CT examinations, within 30 days of the completion of chemotherapic treatment. [(18)F]FDG-PET images were interpreted with the knowledge of CT findings (PET+CT); conversely, CT images were evaluated with no knowledge of the [(18)F]FDG-PET results. Within 7 day of imaging studies, 2(nd)-look laparoscopy (n=7) or laparotomy (n=18) was performed for histological confirmation. In all cases, imaging findings were then correlated with results of histopathologic examination. RESULTS: Of the 23 neoplastic viable lesions, all histologically confirmed, 16 could be detected by CT alone and 19 by PET+CT. An inflammatory lymph-node was misdiagnosed as viable tumor with both PET+CT and CT alone; an area of scar tissue in the presacral region was also misinterpreted as malignant tissue with CT alone. Overall lesion-based sensitivity, specificity and accuracy in assessing focal areas of residual tumor were as follows: 69.56%, 83.33%, 74.28% for CT, and 82.60%, 91.67%, 85.71% for PET+CT. The negative predictive value of PET+CT was markedly higher (73.33%), compared to that of CT alone (58.82%). CONCLUSION: PET used in combination with CT allows to accurately assess tumor response. A major advantage of PET+CT over CT alone is in excluding the presence of residual viable lesions after treatment.

Adult↗
PubMed2003

Evaluation of the clinical performances of a large NaI(Tl) crystal 3D PET scanner.

AIM: This study was aimed at assessing the clinical performances of a NaI(Tl) crystal 3D PET scanner, C-PET (ADAC-UGM), using a multi-ring 2D BGO PET scanner (multi-ring PET), as a reference. METHODS: Thirty-seven oncological patients were studied in sequence with multi-ring PET and C-PET, within 30 days of a CT study. In order to assess the behaviour of C-PET in relation to acquisition count rate, patients were divided into 3 groups according to the count rate at the time of the C-PET scan acquisition. Group A (n=21): 3000-5000 kcounts/sec (recommended count rate range); Group B (n=8): <3000 Kcounts/sec and Group C (n=8): >5000 Kcounts/sec. RESULTS: The number of lesions detected by multi-ring PET and C-PET, classified according to size, was compared. For Group A and Group B there was a good agreement between C-PET and multi-ring PET in terms of lesion detectability (relative sensitivity: 99.9% and 96.0%, respectively), while for Group C the relative sensitivity of C-PET was 61.9%. CONCLUSION: Optimal performances of the C-PET scanner can thus be obtained at a count rate within or below the recommended range. Despite a lower lesion/background contrast resulting from a high scatter and random noise, the sensitivity of C-PET in detecting hypermetabolic lesions is comparable to that of multi-ring PET. These findings are discussed in relation to the physical performance of the two scanners and particularly in relation to the 3D vs 2D acquisition modality.

Adult↗
PubMed2002

Fluoro-deoxi-glucose uptake and angiogenesis are independent biological features in lung metastases.

Neoangiogenesis and enhanced glucose metabolism in neoplasms are likely to be activated by the same biochemical stimulus; hypoxia. A correlation between these two parameters has been postulated. The objective of this study was to evaluate the relationship between Fluoro-desoxi-glucose uptake at positron emission tomography scan and angiogenesis in lung metastasis. Fluoro-desoxi-glucose activity, expressed as a standard uptake value, and microvessel intratumoural density, were retrospectively calculated in a series of 43 lung metastasis resected in 19 patients. Primary sites were colorectal cancer in 16 metastases, sarcoma in eight, gynaecological in four and other sites in 15. The correlation between the two parameters was tested by logistic regression and multivariate analysis. Positron emission tomography scan was positive in 17 patients (sensitivity 89%). No correlation was observed between standard uptake value and microvessel intratumoural density in this series of lung metastasis. Positron emission tomography negative and positive nodules presented comparable value of microvessel intratumoural density (12.9 vs 11.3). Standard uptake value was significantly correlated with nodules size and was higher in colon cancer metastasis than in sarcoma ones. Microvessel intratumoural density was independent from nodule size but significantly higher in sarcoma than in colon cancer metastasis. The lack of correlation was confirmed by multivariate analysis after adjustment for tumour type and nodules size. The present study demonstrated that positron emission tomography scan is positive in a high proportion of patients regardless of microvessel density. Glucose uptake and angiogenesis appear to be independent biological features in lung metastasis. This observation may have implications for future antiangiogenic therapies.

Adult↗
PubMed1999

Tension-free laparoscopic and open hernia repair: randomized controlled trial of early results.

The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo tension-free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair (OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group: 49.6 (5.4) versus 33. 9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p = 0.69; NS). The mean +/- SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable), was 3.1 +/- 0.2 (1-7) in the LHR subset and 2.7 +/- 0.2 (1-5) in the OHR group (p = 0.14; NS); on the second postoperative day the score was 2.3 +/- 0.2 (1-6) and 1.8 +/- 0.1 (1-4), respectively (p < 0.03). The time +/- SEM (range) of resumption of pain-free normal activities and work was faster in OHR group: 6.1 +/- 0.2 (4-8) weeks versus 6.5 +/- 0.1 (4-8) weeks; p < 0.03. Our results showed that tension-free open hernia repair is superior to LHR in terms of postoperative pain with no important differences in recovery. </HEA

Disease-Free Survival↗
PubMed1997

[Esophago-jejuno-gastroplasty in the treatment of peptic stenosis of the esophagus].

From 1973 to 1994, 21 patients with esophageal peptic stenosis were submitted to esophago-jejuno-gastroplasty with Merendino's technique. In 14 cases peptic stenosis developed after Heller's myotomy for achalasia, associated in 3 cases with fundoplication. In 3 patients the stenosis was secondary to fundoplication. Other 3 subjects presented a primary stenosis. One patient showed Barrett's esophagus with in situ carcinoma. Endoscopic esophageal dilatation was attempted in every patient with no satisfactory results. One patient died for a postoperative cardiopulmonary failure (4.7%). One patient developed a fistula of the esophago-jejunal anastomosis treated with enteral nutrition successfully (4.7%). In another subject splenectomy was performed following a iatrogenic injury (4.7%). Minor complications developed in 5 patients (23.7%). After one year from operation in 1 patient a severe stricture of esophago-jejunal anastomosis appeared; it was treated with anastomotic resection and reconstruction. After 8 years one patient was submitted to a partial resection of interposed jejunal loop, that was redundant. In 18 patients long term follow-up showed good results in 14 patients (78%), discrete in 2 (11%), unsatisfactory in 2 (11%). Our results show that Merendino's esophago-jejunal gastroplasty allows to achieve good results with acceptable rate of mortality and morbidity.

Adolescent↗
PubMed1992

[Leiomyoma associated with esophageal diverticulosis].

The Authors report a case of leiomyoma located in an epi-phrenic diverticulum. The development of the leiomyoma may have weakened the esophageal wall and caused the diverticulum to appear. Surgical treatment consisted of diverticulectomy with myotomy and a Belsey MK IV antireflux procedure.

Diverticulum, Esophageal↗
PubMed1992

[Local recurrence after gastrectomy for cancer. Presentation of 2 clinical cases].

The Authors report two cases with local recurrence after partial gastrectomy for advanced gastric carcinoma. The Authors suggest that chemo and/or radiotherapy associated with surgical treatment can improve the prognosis in some patients with recurrence. Response to chemotherapy and time elapsing before recurrence appears may select this group of patients.

Adenocarcinoma↗