Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07)

PURPOSE Our main objective was to prospectively determine the prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. PATIENTS AND METHODS Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). RESULTS Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. CONCLUSION Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

New Clinical Indications for (18)F/(11)C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature

CONTEXT Radiolabelled choline positron emission tomography has changed the management of prostate cancer patients. However, new emerging radiopharmaceutical agents, like radiolabelled prostate specific membrane antigen, and new promising hybrid imaging will begin new challenges in the diagnostic field. OBJECTIVE The continuous evolution in nuclear medicine has led to the improvement in the detection of recurrent prostate cancer (PCa), particularly distant metastases. New horizons have been opened for radiolabelled choline positron emission tomography (PET)/computed tomography (CT) as a guide for salvage therapy or for the assessment of systemic therapies. In addition, new tracers and imaging tools have been recently tested, providing important information for the management of PCa patients. Herein we discuss: (1) the available evidence in literature on radiolabelled choline PET and their recent indications, (2) the role of alternative radiopharmaceutical agents, and (3) the advantages of a recent hybrid imaging device (PET/magnetic resonance imaging) in PCa. EVIDENCE ACQUISITION Data from recently published (2010-2015), original articles concerning the role of choline PET/CT, new emerging radiotracers, and a new imaging device are analysed. This review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. EVIDENCE SYNTHESIS In the restaging phase, the detection rate of choline PET varies between 4% and 97%, mainly depending on the site of recurrence and prostate-specific antigen levels. Both 68gallium (68Ga)-prostate specific membrane antigen and 18F-fluciclovine are shown to be more accurate in the detection of recurrent disease as compared with radiolabelled choline PET/CT. Particularly, Ga68-PSMA has a detection rate of 50% and 68%, respectively for prostate-specific antigen levels < 0.5ng/ml and 0.5-2ng/ml. Moreover, 68Ga- PSMA PET/magnetic resonance imaging demonstrated a particularly higher accuracy in detecting PCa than PET/CT. New tracers, such as radiolabelled bombesin or urokinase-type plasminogen activator receptor, are promising, but few data in clinical practice are available today. CONCLUSIONS Some limitations emerge from the published papers, both for radiolabelled choline PET/CT and also for new radiopharmaceutical agents. Efforts are still needed to enhance the impact of published data in the world of oncology, in particular when new radiopharmaceuticals are introduced into the clinical arena. PATIENT SUMMARY In the present review, the authors summarise the last evidences in clinical practice for the assessment of prostate cancer, by using nuclear medicine modalities, like positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging.

The golden ship and other tales : translated from the Swahili

[Gertrude Ward]. With illustrations by Lilian Bell & Alice B. Woodward

Element oxides in basaltic glass fragments from ODP Hole 203-1243B

Sand-sized basaltic glass fragments were recovered in the liner of Core 203-1243B-19R, the deepest recovery from Hole 1243B. Microprobe analysis of 582 glassy cuttings cluster into five compositionally distinct groups, most of which are unlike the lithologic units described on board ship. Drilling operations intended to sweep cuttings from the caving hole and differences between the cuttings and geochemically distinct lithologic units of the upper part of the basement indicate that the cuttings came mainly, if not entirely, from the lower part of the hole. They give information about the part of Hole 1243B that had poor core recovery. Enriched mid-ocean-ridge basalt (MORB) from the upper part of the hole and transitional MORB from two groups of cuttings from sources low in the hole may be a trace of the Galápagos plume on the Pacific plate or may be a normal consequence of eruptions from two distinct magmas on fast-spreading crust.

Probabilistic models for the prediction of a ship performance in dynamic ice

We introduce two probabilistic, data-driven models that predict a ship's speed and the situations where a ship is probable to get stuck in ice based on the joint effect of ice features such as the thickness and concentration of level ice, ice ridges, rafted ice, moreover ice compression is considered. To develop the models to datasets were utilized. First, the data from the Automatic Identification System about the performance of a selected ship was used. Second, a numerical ice model HELMI, developed in the Finnish Meteorological Institute, provided information about the ice field. The relations between the ice conditions and ship movements were established using Bayesian learning algorithms. The case study presented in this paper considers a single and unassisted trip of an ice-strengthened bulk carrier between two Finnish ports in the presence of challenging ice conditions, which varied in time and space. The obtained results show good prediction power of the models. This means, on average 80% for predicting the ship's speed within specified bins, and above 90% for predicting cases where a ship may get stuck in ice. We expect this new approach to facilitate the safe and effective route selection problem for ice-covered waters where the ship performance is reflected in the objective function.