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F Giammarile

Publications and source records attributed to F Giammarile.

At least 19 recordsLinked to original sources
PubMed2001

Lack of evidence of osteo-medullary metastases at diagnosis in patients with high grade gliomas.

High grade gliomas usually show a transient response to standard therapy by radiation. A local evolution leads to patient death in most of the cases. Necropsic series suggest that metastatic evolution is rather frequent in lungs, lymph nodes, bones or bone marrow. Are these metastatic deposits present initially? The authors retrospectively reviewed the bone marrow smears performed in 20 patients and the bone scans in 10 patients with high grade gliomas at time of diagnosis. None of these investigations showed metastatic deposits. It is thus suggested that metastatic deposits are probably a late event in the natural history of high grade gliomas. However, if local treatment could reach local control, metastases would probably become a major problem. Thus definitive cure of high grade glioma may require multidisciplinary approach.

Astrocytoma↗
PubMed2001

Hodgkins disease.

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Combined Modality Therapy↗
PubMed2001

Osteosarcoma.

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Bone Neoplasms↗
PubMed2001

Bone pain palliation with strontium-89 in cancer patients with bone metastases.

Strontium-89 is a pure beta-emitting radioisotope, a chemical analogue of calcium, and it is therefore avidly concentrated by areas of high osteoblastic activity. Selective uptake and prolonged retention at sites of increased bone mineral turnover provide precise bone lesions targeting. 89Sr chloride (commercialised as Metastron) is typically administered in a single 150 MBq parenteral dose. Its radioactive emission poses very little radioprotection concerns. Overall, studies show pain relief in up to 80% of patients, of which 10 to 40% became effectively pain free. The mean duration of palliation was 3-4 months. The mechanism of pain relief is controversial ; it is probably, but not only, related to the absorbed dose in the tumour and bone. There is no clear dose-response relationship. The only reported toxicity is temporary myelosuppression. WBC and platelets should be monitored at least on a weekly basis until they return to baseline. It seems that only patients with a reasonably good general condition stand to benefit from this treatment. In conclusion, systemic radionuclide therapy using 89Sr represents a feasible, safe, effective, well tolerated and cost-effective palliative treatment in patients with refractory bone pain.

Bone Neoplasms↗
PubMed2000

Metaiodobenzylguanidine assessment of metastatic neuroblastoma: observer dependency and chemosensitivity evaluation. The SFOP Group.

BACKGROUND: In children over 1 year of age with metastatic neuroblastoma, clearance of metaiodobenzylguanidine (MIBG) skeletal uptake after four courses of induction chemotherapy is one of the most powerful prognostic factors. How subjective is quantification of MIBG uptake, and can earlier MIBG scintigraphy separate good and bad responders? PROCEDURE: The data from 47 patients who received uniform induction therapy were reviewed. A novel scoring system of MIBG update intensity was proposed. Initial, intermediate (after two courses), and final (after four courses) intensities were scored (0 to 21 points) independently by six different observers. The initial global score and the relative score (calculated by dividing the global score after two courses by the initial score) were compared to the final score. Good responders were those who scored 0 at final MIBG. RESULTS: Between two observers, the correlation coefficient for the global score was superior to 0.80, in nine of ten comparisons established between observers 1-5. The initial score did not predict the final score insofar as only nine of fourteen patients with low initial scores were good responders. The relative score also failed to predict outcome; only six of ten patients with favorable relative score (i.e., <20%), were good responders. CONCLUSIONS: This scoring system is reliable and may be used in multicentric trials. However, both initial and relative scores failed to predict final outcome. Thus, intermediate MIBG may be omitted during induction therapy assessment.

3-Iodobenzylguanidine↗
PubMed1999

[Standards, options and recommendations (SOR) for diagnosis, treatment and follow-up of osteosarcoma. Groupe de travail SOR].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. For pediatric issues, this project is a collaboration between the FNCLCC and the French Society of Pediatric Oncology (SFOP). The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the clinical care of osteosarcoma in children and adult. METHODS: Data have been identified by literature search using Medline (1985-december 1998) and the expert groups personal reference lists. The main criteria considered were incidence, risk factors, prognostic factors and efficacy of treatment. Once the guidelines were defined, the document was submitted for review to 27 national and international independent reviewers, and to the medical committees of the 20 French Cancer Centres and, in particular, the 4 which have particular expertise in pediatric cancer management. RESULTS: The main recommendations for osteosarcoma management are that: 1) the clinical diagnosis is based on appropriate clinical and radiological findings; 2) the final diagnosis is pathological and the biopsy should be performed by the surgeon who will subsequently perform the definitive surgery; 3) surgical biopsy must be of adequate size and performed by an experienced surgeon; 4) the therapeutic strategy for osteosarcoma is based on surgery with neoadjuvant and adjuvant chemotherapy given in experienced centres. Inclusion of high dose methotrexate is recommended for children, and the dose of methotrexate must be adapted for adults. Inclusion of children in SFOP protocols and adults in EORTC and FNCLCC clinical trials is recommended; 5) treatment of metastatic osteosarcoma is based on chemotherapy and surgery to lung metastases which may be curative. Amputation is rarely appropriate. Inclusion of children in SFOP and of adult in EORTC and FNCLCC clinical trials for metastatic osteosarcoma is recommended; 6) at the present time, there are no clear data on which to base guidelines for timing and duration of follow-up studies in this condition.

Antineoplastic Agents↗
PubMed1999

Bone pain palliation with 85Sr therapy.

UNLABELLED: The aim of this retrospective study was to evaluate the efficacy of 85Sr in the palliation of metastatic bone pain. 85Sr decays by electron capture with a gamma emission of 514 keV and associated x-ray emissions of 10-15 keV; physical half-life is 64 d. METHODS: Between 1977 and 1992, 119 doses of 85Sr chloride (mean activity 335 MBq [9 mCi]) were intravenously administered to 108 patients with hyperalgic generalized bone metastases from prostatic carcinoma (52 patients), breast carcinoma (41) or other cancers (15). Pain, performance status, blood and urinary excretion values were investigated during follow-up, and survival time was recorded. Strontium bone scans were obtained up to 8 wk after injection to document isotope biodistribution and to estimate absorbed doses. RESULTS: At 12 wk, 72.2% of patients showed significant benefit from treatment, i.e., enhanced quality of life and pain relief; 49.1% became free of pain. These beneficial effects lasted from 1 to 36 mo (mean 4.3 mo). The best symptomatic improvement was seen in patients treated at an early stage of metastatic skeletal disease and in prostate cancer patients. No evidence of a significant dose-response relationship was found in the data analysis. The mean absorbed dose ratio of metastases to marrow was estimated at 8.2. We found no evidence that hematological toxicity was a major problem; however, all patients experienced a reduction in blood counts, especially in platelets. CONCLUSION: Systemic radionuclide therapy using 85Sr is a feasible, effective and well-tolerated palliative treatment in patients with refractory bone pain. We attained at least the same response rate as that reported with bone-seeking beta-emitting radionuclides such as 89Sr. The patients who benefited the most from 85Sr treatment were in an early stage of metastatic disease or had prostate cancer. Our clinical findings could not be linked to either the total injected activity of 85Sr or the estimated absorbed dose delivered to metastases.

Bone Neoplasms↗
PubMed1998

The MIBG super scan.

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3-Iodobenzylguanidine↗
PubMed1997

False positive MIBG scan.

The fortuitous discovery of a left posterior cervico-mediastinal mass during hospitalization for hemolytic anemia in an 18 month old baby is reported. Metaiodobenzylguanidine (MIBG) uptake suggested a sympathetic tissue origin of the mass despite negative catecholamines excretion, but histopathologic examination revealed a juvenile capillary angioma within a normal sympathic ganglion.

3-Iodobenzylguanidine↗
PubMed1997

The mIBG super scan.

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3-Iodobenzylguanidine↗
PubMed1996

Comparison of octreotide scintigraphy and conventional imaging in medullary thyroid carcinoma.

UNLABELLED: We evaluated the clinical utility of positive somatostatin receptor scintigraphy in patients with medullary thyroid cancer (MTC). METHODS: Twenty-four MTC patients with increased calcitonin levels underwent somatostatin receptor scintigraphy using 111In-pentetreotide (120-200 MBq) with early (4 hr after injection) and delayed (24 hr) whole-body scans and liver SPECT imaging. In Group 1 (12 patients), conventional imaging modalities demonstrated the presence of tumor sites prior to somatostatin receptor scintigraphy; in Group 2 (12 patients), conventional imaging modalities were negative or inconclusive. RESULTS: Somatostatin receptor scintigraphy had positive results in 9 of 24 patients (37%): of Group 1 patients, 7 of 12 had positive somatostatin receptor scintigraphy results. Of these patients cases, somatostatin receptor scintigraphy demonstrated several involved organs and tumor sites either identical (two patients) or smaller (five patients) in size than conventional imaging modalities. Only two patients in Group 2 had positive somatostatin receptor scintigraphy results which demonstrated significant mediastinal uptake previously classified as indeterminate on conventional imaging modalities. No new tumor site was identified nor were therapeutic options modified by the somatostatin receptor scintigraphy results. CONCLUSION: Somatostatin receptor scintigraphy only demonstrates part of tumor sites and cannot visualize small tumor sites (< or = 1 cm). We believe that somatostatin receptor scintigraphy has a limited role in the management of MTC patients.

Adult↗
PubMed1995

Radioiodinated metaiodobenzylguanidine in neuroblastoma: influence of high dose on tumour site detection.

For more than a decade radioiodinated metaiodobenzylguanidine (mIBG) has been commonly used for neuroblastoma imaging. The accuracy of this scintigraphic method in detecting both primary and secondary tumour sites is crucial when evaluating the extent of disease. The aim of our study was to assess the impact of high-activity mIBG scintigraphy on neuroblastoma staging. Eighteen scans (TS) were obtained in 15 children after a therapeutic dose of iodine-131 mIBG and compared to diagnostic mIBG scans (DS) (in eight cases with 131I-mIBG and in ten cases with 123I-mIBG). The superiority of TS over DS was confirmed by the overall results: a total of 220 lesions were disclosed with TS and 171 with DS. However, in only one case did the TS findings, namely skeletal involvement not evidenced on corresponding DS, have an impact on clinical staging. In contrast, neither TS nor DS detected proven bone involvement in four patients. The dose-related sensitivity of mIBG scintigraphy in detecting neuroblastoma tumour sites was confirmed. The ultimate impact of high-dose scans on neuroblastoma management, however, seems limited.

3-Iodobenzylguanidine↗
PubMed1995

Diffuse bone marrow uptake [123I]MIBG in neuroblastoma: an "MIBG super scan" case report.

We present the case of a 3-year-old child with neuroblastoma metastatic to the bone marrow. [123I]MIBG total body scintigraphy revealed a diffuse pattern of intense fixation throughout the skeleton. This was analogous to the "super scan" described with 99mTc-MDP bone scintigraphy when extensive metastatic or metabolic bone disease is present. Essentially, a high bone-to-soft tissue ratio was found without uptake in the liver, kidney and bladder, owing to a "steal" mechanism caused by the avid bone metastases.

3-Iodobenzylguanidine↗
PubMed1995

Upper clavicular and cardiac meta-[123I]iodobenzylguanidine uptake in children.

In order to clarify some of the particularities and pitfalls of the MIBG thoracic scan, we report our experience with 5 children with Stage III or IV neuroblastoma who presented equivocal scans. The physiological thoracic distribution of MIBG in children differs from that in adults and has to be taken in account in the accurate interpretation of the scans.

3-Iodobenzylguanidine↗
PubMed1995

Somatostatin receptor imaging: a preliminary experience in forty-nine patients.

We report our experience with the 111In-pentetreotide scanning of 47 adult patients presenting with neuroendocrine tumors (n = 38) or malignant pheochromocytomas or related tumors (n = 9), and 2 children with metastatic neuroblastomas. A dynamic study was performed after i.v. administration of 50-190 MBq of 111In-pentetreotide followed by a whole body scan at 1.5-4 hours and at 24 hours. Where indicated, tomoscintigraphy or a dual isotope bone, liver or kidney scan was performed in order to improve the anatomical definition. Lesions were visualized in the earliest phases of the examination but contrast was enhanced on delayed images due to an improved signal to background ratio. In 9/49 patients, octreotide scan (OS) detected unknown tumors sites. On the other hand, the lesion uptake of 111In-pentetreotide varied, and not all the sites shown by other imaging modalities were visualised, probably due to differences in membrane receptor expression. In conclusion, OS can be useful in the diagnosis, follow-up and therapeutic management of neuro-endocrine tumors. Further investigations are required to assess the role of OS in other pathologies. Short title: Somatostatin receptor imaging.

Adolescent↗