Salvatore Ialuna

Introduction: Nasopharyngeal carcinoma (NPC) is a distinct malignancy of the head and neck with high prevalence in endemic regions and a strong association with Epstein–Barr virus (EBV). In locally advanced stages, neoadjuvant chemotherapy (NAC) followed by chemoradiotherapy improves outcomes, but response rates vary. Identifying early predictors of NAC response is essential for guiding personalized treatment strategies. This study aims to assess whether baseline [¹⁸F]FDG PET/CT parameters can predict NAC response in NPC patients. Methods: In this retrospective study, 27 patients with histologically confirmed, locally advanced (stage III) NPC underwent baseline [¹⁸F]FDG PET/CT prior to NAC between 2015 and 2023. Quantitative PET parameters including SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were extracted from the primary tumor. NAC response was assessed using RECIST 1.1 criteria and classified as responders (CR + PR) or non-responders (SD + PD). Group comparisons were performed using Student’s t-test. ROC analysis was used to identify optimal cut-off values. A p-value < 0.05 was considered significant. Results: The cohort included 20 males and 7 females (mean age: 60.8 ± 15.2 years). The predominant histotype was undifferentiated non-keratinizing carcinoma (92.6%). A total of 19 patients (70.4%) responded to NAC. Responders had significantly lower baseline SUVmax (10.9 ± 4.8 vs. 15.8 ± 4.1, p = 0.021), MTV (16.2 ± 12.4 vs. 27.8 ± 19.5 cm³, p = 0.045), and TLG (128.6 ± 98.2 vs. 218.7 ± 152.4, p = 0.038). SUVmean was also lower in responders (6.1 ± 2.1 vs. 9.3 ± 2.8), although not statistically reported. ROC analysis identified SUVmax > 12.5 and MTV > 20.0 cm³ as thresholds associated with poor NAC response. Conclusions: Baseline metabolic parameters from [¹⁸F]FDG PET/CT, particularly SUVmax and MTV, may assist stratification of NAC response in nasopharyngeal carcinoma. These biomarkers may facilitate pre-treatment stratification and guide more personalized therapeutic approaches. However, the limited sample size may affect the generalizability of these findings, and larger prospective studies are needed to confirm the results.

Introduction: Fluorodeoxyglucose (FDG) PET/CT is typically the reference imaging method for assessing and tracking lymphomas. However, fibroblast activation protein inhibitor (FAPI) PET is being explored as a potentially useful option, especially when Fluorodeoxyglucose (FDG) scans do not show clear results.Methods: For this systematic review, two researchers searched PubMed/MEDLINE and Cochrane CENTRAL for studies on FAPI PET/CT in lymphoma patients.Results: The literature search initially retrieved 249 articles. After removing duplicates and screening titles and abstracts, and full text, there was a final selection of 15 articles (3 original studies and 12 case reports), encompassing a total of 270 patients. The three original studies were judged to have a low risk of bias according to the QUADAS-2 criteria. The systematic review reveals that FAPI PET/CT exhibits lower diagnostic sensitivity than [¹⁸F]FDG PET/CT in lymphomas characterized by low FAP expression. Nevertheless, FAPI PET/CT retains potential as a complementary imaging modality.Discussion: [¹⁸F]FDG PET/CT remains the gold standard in lymphoma imaging, but FAPI PET/CT can potentially provide supplementary information regarding the molecular characteristics of lymphomas. FAPI PET/CT may have prognostic and therapeutic implications. In particular, it could help identify lymphoma subgroups with distinct stromal environments, potentially serving as a prognostic biomarker. Further large-scale prospective studies are warranted to validate its role in lymphoma management.

Aim: To meta-analyze the utility of transarterial radioembolization (TARE) in patients with liver metastatic breast cancer (BC), based on the objective response rate (ORR) and disease control rate (DCR). Methods: A literature search was performed retrieving studies with (1) at least 10 patients with liver metastatic BC treated with TARE and (2) adequate information to derive ORR and DCR. The ORR is the ratio between patients with liver lesions showing complete response (CR) or partial response (PR) over the total number of patients treated with TARE; the DCR is the ratio between patients with CR, PR, or stable disease (SD) over the total number of patients treated with TARE. Results: Eighteen studies (650 patients) were eligible; the ORR of TARE resulted 50.71% (95% C.I.: 40.04–61.36) and the DCR resulted 88.37% (95% C.I.: 81.89–93.57). Taking into account resin spheres (395 patients), the ORR was 60.35% (95% C.I.: 46.55–73.36) and the DCR was 92.73% (95% C.I.: 87.17–96.80%). Considering glass spheres (144 patients), the ORR was 32.38% (95% C.I.: 18.43–48.16) and the DCR was 82.69% (95% C.I.: 59.29–97.26). Conclusions: This meta-analysis favors the use of TARE in patients with liver metastatic BC either with resin or glass spheres.

Background: This meta-analysis compared the diagnostic performance of [¹⁸F] fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography/computed tomography (PET/CT) or PET versus Magnetic resonance imaging (MRI) in detecting recurrence or residual tumors at the primary site in patients with nasopharyngeal carcinoma (NPC). Methods: A comprehensive literature search was conducted in the PubMed/MEDLINE and CENTRAL databases to find studies with at least 20 patients with NPC undergoing both [¹⁸F]FDG PET/CT (or [¹⁸F]FDG PET) and MRI for detecting recurrence or assessing residual disease at the primary site. The pooled sensitivity and specificity of PET/CT and MRI were calculated with 95% confidence intervals (CIs) and compared. Results: Five studies, including 1908 patients (six patient groups), were included. PET imaging had higher sensitivity [93.3% (95% CI: 91.3–94.9%); I² = 52.6%] compared to MRI [80.1% (95% CI: 77.2–82.8%); I² = 68.3%], but the specificity of the two modalities was similar: 93.8% (95% CI: 92.2–95.2%; I² = 0%) for PET/CT and 91.8% (95% CI: 90.1–93.4%; I² = 94.3%) for MRI. The areas under the curve (AUCs) for PET/CT and MRI were 0.978 and 0.924, respectively, without significant difference (p = 0.23). Conclusions: This meta-analysis suggests that [¹⁸F]FDG PET imaging and MRI do not significantly differ in diagnostic performance. Nevertheless, [¹⁸F]FDG PET imaging shows higher sensitivity than MRI.

CAR-T-cell therapy, also referred to as chimeric antigen receptor T-cell therapy, is a novel method in the field of immunotherapy for the treatment of non-Hodgkin’s lymphoma (NHL). In patients receiving CAR-T-cell therapy, fluorodeoxyglucose Positron Emission Tomography/Computer Tomography ([¹⁸F]FDG PET/CT) plays a critical role in tracking treatment response and evaluating the immunotherapy’s overall efficacy. The aim of this study is to provide a systematic review of the literature on the studies aiming to assess and predict toxicity by means of [¹⁸F]FDG PET/CT in patients with NHL receiving CAR-T-cell therapy. PubMed/MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were interrogated by two investigators to seek studies involving the use of [¹⁸F]FDG PET/CT in patients with lymphoma undergoing CAR-T-cell therapy. The comprehensive computer literature search allowed 11 studies to be included. The risk of bias for the studies included in the systematic review was scored as low by using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool (QUADAS-2). The current literature emphasizes the role of [¹⁸F]FDG PET/CT in assessing and predicting toxicity in patients with NHL receiving CAR-T-cell therapy, highlighting the evolving nature of research in CAR-T-cell therapy. Additional studies are warranted to increase the collected evidence in the literature.

The aim of this study was to present our preliminary experience with transarterial radioembolization (TARE) using Yttrium-90 (⁹⁰Y), compare the cancer-specific survival (CSS) of patients with hepatocellular carcinoma (HCC) and colorectal cancer (CRC) liver metastases undergoing TARE, and investigate the influence of additional treatments on CSS. Our database was interrogated to retrieve patients who had undergone TARE using Yttrium-90 (⁹⁰Y) glass or resin microspheres. Kaplan–Meier curves and the log-rank test were employed to conduct survival analysis for the different groups (p < 0.05). Thirty-nine patients were retrieved (sex: 27 M, 12 F; mean age: 63.59 ± 15.66 years): twenty-three with hepatocellular carcinoma (HCC) and sixteen with CRC liver metastasis. Globally, the patients with HCC demonstrated a significantly longer CSS than those with CRC liver metastasis (22.64 ± 2.7 vs. 7.21 ± 1.65 months; p = 0.014). Among the patients with CRC liver metastasis, those receiving TARE and additional concomitant treatments (n = 10) demonstrated a longer CSS than the CRC patients receiving only TARE (9.97 ± 2.21 vs. 2.59 ± 0.24 months; p = 0.06). In the HCC group, there was a trend of a longer CSS in patients (n = 8) receiving TARE and additional treatments (27.89 ± 3.1 vs. 17.69 ± 3.14 months; p = 0.15). Patients with HCC seem to achieve a longer survival after TARE compared to patients with CRC liver metastases. In patients with CRC liver metastases, the combination of TARE and additional concomitant treatments may improve survival.

Background: The aim of this study was to investigate whether high body mass index (BMI) increases the risk of recurrence and correlates with higher glucose uptake in recurrent lesions in post-menopausal female patients with breast cancer. Methods: A hospital database was searched to retrieve breast cancer patients who had undergone an [¹⁸F]FDG PET/CT scan before neoadjuvant chemotherapy and curative-intent surgery. BMI was calculated at the baseline [¹⁸F]FDG PET/CT scan. There was a median follow-up of 5 years after the baseline PET/CT scan to identify recurrence in the breast (T_rec); lymph nodes (N_rec); and distant locations (M_rec). Furthermore, SUVmax was measured at the sites of recurrence. A chi-square test was used to investigate any difference in the frequency of any recurrence, T_rec, N_rec, and M_rec, between overweight women (BMI ≥ 25 kg/m²) and women with a BMI < 25 kg/m² (p < 0.05). SUVmax was compared using a t-test (p < 0.05) between the two groups. Results: A total of 142 post-menopausal patients (BMI: 26.84 ± 5.59; 84 overweight and 58 with normal weight) were retrieved from the database. There were 48 recurrences at the follow-up. The chi-square test demonstrated in overweight women an increased frequency of any recurrence (35 vs. 13; p = 0.025) and T_rec (15 vs. 2; p = 0.018) and a higher T_rec SUVmax (4.74 ± 2.90 vs. 1.85 ± 0.63; p = 0.09) compared to women with a BMI < 25 kg/m². Conclusions: BMI seems to correlate with an increased rate of recurrence, especially in the breast, and a higher glucose uptake in post-menopausal patients with recurrent breast cancer.

Nowadays, the utility of positron emission tomography/computed tomography (PET/CT) is well established in nasopharyngeal carcinoma (NPC). The incidence of NPC in the West population, especially in children, is very low. We present the first Italian case of a pediatric patient with NPC followed up with 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT scan in addition to the standard follow-up imaging methods, including CT and magnetic resonance imaging. The 18 F-FDG PET/CT scan was helpful in discriminating between metastatic and benign osseous lesions, thereby helping clinicians to determine the most appropriate therapeutic regimen. These findings support the clinical utility of 18 F-FDG PET/CT in the diagnostic work-up of pediatric patients with NPC.

We present our preliminary experience with transarterial radioembolization (TARE) with Yt-trium-90, and investigate the influence of additional treatments, injected activity, mean dose to the tumor on overall survival (OS). Our database was interrogated to retrieve patients who had undergone TARE with Yttrium-90 (90Y) glass or resin microspheres. The following information were searched: 1) type of pathology; 2) sex; 3) age; 4) administered activity; 5) mean dose to the tumor; 6) additional treatments; 7) OS. The OS of the different groups of patients were compared (p<0.05). A bivariate correlation (p<0.05) was used to investigate the association between injected activity and OS, and between mean dose to the tumor on OS. Thirty-nine patients were retrieved (Sex: 27 M, 12 F; mean age: 61.26 ± 14.95 years): 23 with hepatocellular carcinoma (HCC) and 16 with colorectal cancer (CRC) liver metastasis. Globally, patients with HCC demonstrated a sig-nificantly longer OS than those with CRC liver metastasis (22.66±19.11 vs. 10.41±8.75 months; p=0.022). Among patients with CRC liver metastasis, those receiving TARE and additional treatment demonstrated a longer OS than patients receiving only TARE (23.50±19.76 months vs. 8.54±5.31; p=0.018), there was a direct correlation between injected activity and OS (R=0.55, p=0.034) and between mean activity reaching the tumor and OS (R=0.812; p=0.008). Patients with HCC receiving TARE achieved a longer OS than those with CRC liver metastasis. Additional treatments, increasing injected activity and higher mean dose to the tumor seem beneficial for outcome, especially in patients with CRC liver metastases.

To investigate whether high body mass index (BMI) increases the risk of recurrence and corre-lates with higher glucose uptake in recurrent lesions in post-menopausal female patients with breast cancer. The hospital database was searched to retrieve breast cancer patients, who had undergone an [18F]FDG PET/CT scan before neoadjuvant chemotherapy and curative-intent sur-gery. BMI was calculated at the baseline [18F]FDG PET/CT scan. There was a median follow-up of 5 years after the baseline PET/CT scan to identify: recurrence in the breast (T_rec); lymph nodes (N_rec); distant locations (M_rec). Furthermore, SUVmax was measured in the sites of recur-rence. A chi-square test was used to investigate any difference in the frequency of any recur-rence, T_rec, N_rec, and M_rec between overweight women (BMI≥25 kg/m2) and women with a BMI<25 kg/m2 (p<0.05). SUVmax, was compared using a t-test (p<0.05) between the two groups. A total of post-menopausal 142 women (BMI: 26.84±5.59; 84 overweight and 58 with normal weight) were retrieved. There were 48 recurrences at the follow-up. The chi-square test demon-strated in overweight women an increased frequency of any recurrence (35 vs. 13; p=0.025) and T_rec (15 vs. 2; p=0.018) and a higher T_rec SUVmax (4.74±2.90 vs. 1.85 ± 0.63; p=0.09) compared to women with a BMI<25 kg/m2. BMI seems to correlate with an increased rate of recurrence, espe-cially in the breast, and a higher glucose uptake in post-menopausal patients with recurrent breast cancer.