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FDG PET/CT found useful in certain lung cancer patients

FDG PET/CT is a valuable imaging tool for treatment assessment of patients with lung cancer, though systematic evidence for its comparative effectiveness with conventional imaging, such as chest CT, is still evolving. Authors of the study titled “The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer[1]” published their findings in the February 2017 issue of the American Journal of Roentgenology. In this review, the authors summarized the existing evidence in the literature concerning use of PET/CT for both assessing the efficacy of [2] and performing posttreatment follow-up of lung cancer.

“FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases,” said study coauthor Rathan M. Subramaniam, of the department of radiology, University of Texas Southwestern Medical Center, Dallas. “Using FDG PET/CT for routine surveillance without any clinical suspicion should be discouraged until its value for patient survival outcomes is fully established.” The National Comprehensive Cancer Network (NCCN) recommends the use of FDG PET/CT for appropriately staging lung cancer and avoiding futile thoracotomies.

It also recommends the imaging for accurate radiation therapy (RT) planning for both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). However, NCCN does not recommend routine use of FDG PET/CT for treatment response evaluation and follow-up in lung cancer. According to the study authors, FDG PET/CT is usually recommended to be performed 12 weeks after completion of concurrent chemoradiation therapy to minimize radiation-related inflammatory uptake leading to false-positive studies.

In some cases, radiation-related therapy changes, especially with stereotactic body radiotherapy, can last for many months. In these circumstances, a follow-up FDG PET/CT in 3 months is suggested to ensure resolution of therapy-related FDG uptake. FDG PET/CT can be performed 4 weeks after completion of chemotherapy or surgery (without concurrent radiation), because the therapy-related inflammatory uptake is less and subsides within a shorter time.

The sequencing, cost analysis, and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated. Lung cancer remains the leading cause of cancer-related mortality worldwide, accounting for about 1.6 million deaths yearly. Despite significant advances in both diagnostic and therapeutic approaches, the overall 5-year survival rate for lung cancer is 17.4%.

However, this is largely dependent on the stage of diagnosis, with a survival rate of 54.8% for localized and 4.2% for disease that has metastasized in other parts of the body. Lung cancer has historically been divided into two main types: NSCLC (85% of cases) and SCLC (10-15% of cases). A multidisciplinary approach including the use of advanced imaging techniques for early accurate staging of disease and delivery of treatment is needed to avoid futile treatments and improve overall survival, which, in turn, influence the patient’s quality of life.

Surgery is usually the primary treatment modality for localized disease in patients with lung cancer. Even after curative surgery, patients remain at risk for the development of recurrence or a secondary pulmonary malignancy. Posttreatment follow-up usually consists of a combination of physical examination, laboratory tests, and imaging.

No single modality is simultaneously sensitive, specific, and cost effective; thus, a combined approach is needed for the detection of tumor recurrence. PET is a noninvasive imaging modality that is promising in the evaluation of [3] and is currently used clinically for initial antitumor treatment strategy (for staging, treatmentplanning, and delivery of radiation treatment) and for subsequent antitumor treatment strategy ([4] response assessment and detection of recurrence in follow-up).

Explore further: Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer[5] More information: Sara Sheikhbahaei et al, The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer, American Journal of Roentgenology (2017). DOI: 10.2214/AJR.16.16532
[6]

Journal reference: American Journal of Roentgenology[7]

Provided by: American Roentgen Ray Society[8]

References

  1. ^ The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer (www.ajronline.org)
  2. ^ (medicalxpress.com)
  3. ^ (medicalxpress.com)
  4. ^ (medicalxpress.com)
  5. ^ Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer (medicalxpress.com)
  6. ^ DOI: 10.2214/AJR.16.16532 (dx.doi.org)
  7. ^ American Journal of Roentgenology (medicalxpress.com)
  8. ^ American Roentgen Ray Society (medicalxpress.com)

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‘Linda’ Theater Review: Why It’s Tough Being a Feminist at a Cosmetics Company

Linda is a marketing executive who, a decade ago, created an award-winning campaign that made Swan beauty products famous “for making women feel good.” Linda was also responsible for spearheading the Confidence Building Workshops that changed “the world one girl at a time. And next: One 50-year-old woman at a time!” she boasts with brimming confidence. The title character in Penelope Skinner’s play “Linda,” which had its American premiere Tuesday at the Manhattan Theatre Club, keeps referring to this groundbreaking ad campaign throughout the production’s two-and-a-half-hour running time.

Skinner and her character (Janie Dee) never reveal exactly how such marketing would make older women feel good about cellulite and crow’s feet. Linda definitely believes the malarkey of her campaign. She’s in advertising, after all.

But what is Skinner’s audience supposed to believe? That anti-aging creams do anything but exploit women’s insecurities?

Also Read: ‘The Penitent’ Theater Review: David Mamet Finds New Ways to Present an Argument[1] Linda is shocked, truly shocked, that anyone could disagree with the feminism of her award-winning campaign.

She, in fact, clutches her trophy like it’s an Oscar or, at the very least, a Golden Globe. Linda is the woman who has it all — until she loses it all. Dee gives an uncanny impression in looks and manner of Annette Bening’s go-getter realtor in “American Beauty.” What’s missing is any sense of irony regarding Linda’s success in the phoniest and most exploitative of businesses.

A woman who spearheaded Confidence Building Workshops would have begun those confabs by quitting her job at Swan. Linda talks a lot about ageism and how women begin to feel invisible after a certain age. But ageism cuts the other way, too.

It can be an attack by the old on the young. And what a full-frontal assault “Linda” is on the show’s 25-year-old career woman, Amy (Molly Griggs). Amy not only upends Linda’s career (with a sharp eye on her office with its river view) but also masterminds the online humiliation years ago of Linda’s recluse daughter, Alice (Jennifer Ikeda), who has been reduced to living at home and never taking off a onesie that makes her look like a giant skunk.

If that seems like a lot for one character to undertake, you’re right. Amy should have been edited by a dramaturg into a few characters. Worse, Amy’s nothing more than a total prick as written and performed here. (The B-word doesn’t begin to describe her.)

Also Read: ‘Wakey, Wakey’ Theater Review: Will Eno Picks the Wrong Man to Die[2]

What’s more heinously ageist: old people thinking they’re invisible or young people being stereotyped as entitled, rude, technology-obsessed, materialistic and downright maniacal in their ambitions? There’s not much arc to Skinner’s characters or Lynne Meadow’s direction. Most of the characters orbit around Linda so that Skinner can make points about 21st-century women.

Linda’s husband (Donald Sage Mackay) has an affair with a much younger woman (Meghann Fahy) so that Linda can question her physical attractiveness. Linda’s younger daughter (Molly Ranson) fancies playing Hamlet because men have all the good roles, not only in life but art. Linda’s drive is explained by a tragic backstory about her mother.

Linda has sex in a stock room with an office assistant (Maurice Jones) because, well, he’s there and she’s upset. It’s obvious that playwrights don’t work in offices. In the second act, Linda has a very public melt-down where she rips into Amy’s new ad campaign for Swan.

It’s the kind of big theatrical moment that should end with armed guards escorting her out of the building. Skinner, however, gives Linda a few more scenes, including the office sex, before the ax falls. You will sympathize with her boss (John C.

Vennema).

Also Read: ‘Kid Victory’ Theater Review: Life Is Not a Cabaret in John Kander’s New Musical[3] Meadow does establish a quiet center with Ikeda’s understated performance. The truly disturbed can sometimes be the most morally responsible.

Unfortunately, Ranson emerges as the polar opposite to that half-sister for all the wrong reasons. Walt Spangler’s lavish set design presents very detailed office and home spaces that revolve around and around on a turntable. Linda’s evaporation into invisibility might benefit from a less literal design.

Instead, Meadow keeps that set spinning.

On one trip around, we pass what appears to be Linda’s entire universe just to get to her applying cold cream in anguished silence.

15 Top-Grossing Broadway Musicals of All Time From ‘Hairspray’ to ‘The Lion King’

  • Lion King, Phantom of the Opera, Wicked broadway
  • 15. “Hairspray”
    Opened: Aug.

    15, 2002
    Closed: Jan.

    4, 2009
    Gross: £252.2 million

  • Rent

    14. “Rent”
    Opened: April 29, 1996
    Closed: Sept.

    7, 2008
    Gross: £274.2 million

  • Miss Saigon

    13. “Miss Saigon”
    Opened: April 11, 1991
    Closed: Jan.

    28, 2001
    Gross: £285.8 million

  • 12. “The Producers”
    Opened: April 19, 2001
    Closed: April 22, 2007
    Gross: £288.4 million

  • Mary Poppins Broadway

    11. “Mary Poppins”
    Opened: Nov.

    16, 2006
    Closed: March 3, 2013
    Gross: £294.6 million

  • 10. “Cats”
    Opened: Oct.

    7, 1982
    Closed: Sept.

    10, 2000
    Gross: £366.4 million

  • 8. “Les Mis?rables” (original production)
    Opened: March 12, 1987
    Closed: May 18, 2003
    Gross: £406.3 million

  • 7. “Beauty and the Beast”
    Opened: April 18, 1994
    Closed: July 29, 2007
    Gross: £429.2 million

  • 9. “The Book of Mormon”
    Opened: March 24, 2011
    Closed: Still running
    Gross to date: £455.7 million

  • 6. “Jersey Boys”
    Opened: Nov.

    6, 2005
    Closed: January 15, 2017
    Gross: £548.4 million

  • 5. “Chicago” (revival)
    Opened: Nov.

    14, 1996
    Closed: Still running
    Gross: £568.4 million

  • Mamma Mia!

    4. “Mamma Mia!”
    Opened: Oct.

    18, 2001
    Closed: Sept.

    12, 2015
    Gross: £624.4 million

  • 3. “Wicked”
    Opened: Oct.

    30, 2003
    Closed: Still running
    Gross: £1.06 billion

  • 2. “The Phantom of the Opera”
    Opened: Jan.

    26, 1988
    Closed: Still running
    Gross to date: £1.08 billion

  • 1. “The Lion King”
    Opened: Nov.

    13, 1997
    Closed: Still running
    Gross to date: £1.32 billion

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A ranked list of the biggest hits on the Great White Way, as of November 2016

References

  1. ^ ‘The Penitent’ Theater Review: David Mamet Finds New Ways to Present an Argument (www.thewrap.com)
  2. ^ ‘Wakey, Wakey’ Theater Review: Will Eno Picks the Wrong Man to Die (www.thewrap.com)
  3. ^ ‘Kid Victory’ Theater Review: Life Is Not a Cabaret in John Kander’s New Musical (www.thewrap.com)