R Formánek

Palacký University of Olomouc, Olmütz, Olomoucký, Czech Republic

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Publications (6)4.09 Total impact

  • K Vomackova · C Neoral · R Aujeský · R Vrba · M Stasek · M Myslivecek · R Formánek ·
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    ABSTRACT: Introduction: To evaluate the significance of PET/CT for the initial staging of esophageal cancer with emphasis on metastatic lymph node affection and detection of distant metastases. Furthermore, the aim of the work was to analyze the significance of PET/CT examination when evaluating the effect of neoadjuvant therapy. Methods: A set of 354 patients with esophageal cancer treated at the 1st Department of Surgery, University Hospital Olomouc and Medical Faculty at Palacky University in Olomouc between the years 20062012 were analyzed in a prospective study. The initial PET/CT examination was performed in 349 patients. We analyzed the benefit of this examination in regard to disease staging and based on the result, therapeutic strategy was determined. The initial PET/CT showed varying degrees of disease generalization in 102 patients, these patients were indicated for palliative or symptomatic therapy. In 247 patients, the disease was limited only to the esophagus and /or regional lymph nodes. After considering the patients overall condition and taking into account the wishes of the patient, 188 patients were indicated for neoadjuvant chemoradiotherapy (CRT); 32 patients did not complete this treatment. In 156 patients a follow-up PET/CT scan was performed after an average of 8.4 weeks following completion of neoadjuvant therapy. Based on this examination, a complete response- CR, was observed in 38 patients (24.4%), regression of the tumor in 89 (57.0%), stationary findings were seen in 10 (6.4%), and progression in 19 (12.2%). Ninety-seven patients were indicated for surgical resection; however, esophagectomy was only possible in 85 patients, in the remaining 12 patients only an explorative laparotomy was performed due to disease progression. Results: The initial PET/CT examination performed in 349 patients correctly described the extent of the disease in accordance with the histologically confirmed diagnosis in virtually all patients. A false positive result was seen in only 5 patients (1.43%). When evaluating the effect of neoadjuvant therapy, the patients were divided into groups based on the findings of the follow-up PET/CT after neoadjuvant therapy and their overall survival was evaluated. A significant difference (p=0.0004) in survival was observed between the groups based on the different reactions to neoadjuvant therapy (CR (n=38), regression (n=89), stationary findings (n=10), progression (n=19)) without taking into account the following treatment the patient received after neoadjuvant therapy. Patients who had a better response to neoadjuvant therapy had better survival results. There was also a significant difference in survival between the group of patients who completed neoadjuvant therapy and underwent radical surgical resection (n=85) versus those patients who completed neoadjuvant therapy but did not undergo subsequent surgery (n=59). The operated group had a significantly higher overall survival (p=0.003). The longest mean survival, 38.6 months (median 29.0 months), was achieved by the group of patients who completed neoadjuvant therapy, showed a complete response on the follow-up PET/CT, and underwent surgical resection. However, a significant difference was not observed (p=0.587) between the groups who underwent surgical resection and whose follow-up PET/CT results differed (regression or stationary findings). To date, the number of cases in the individual groups is not great enough to consider the obtained results conclusive, and we will continue to include more patients into the study and continue with the analysis. Conclusion: The work documents the significance and benefit of PET/CT in the initial staging of esophageal cancer, especially in detecting metastatic disease- positive lymph nodes as well as distant metastases. PET/CT has great importance in determining therapeutic strategy. Furthermore, the significance of PET/CT in evaluating the effect of neoadjuvant therapy was also studied.Key words: esophageal cancer PET/CT neoadjuvant therapy esophagectomy.
    Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2015; 94(1):8-16.
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    ABSTRACT: Abstract The significance of PET/CT in chronic lymphocytic leukemia (CLL) has not been systematically studied yet. This prospective study aimed at assessing the benefit of PET/CT in patients with newly diagnosed or relapsed CLL and Richter's transformation (RT). PET/CT examination was performed in twenty-three patients with newly diagnosed disease, thirteen with relapsed disease and eight with suspected or histopathologically confirmed RT. In all patients, maximum standardized uptake value (SUVmax) was calculated. The median SUVmax was 3.4 (range; 1.5 - 6.3) and 3.1 (range; 1.2 - 5.9) in newly diagnosed and relapsed patients, respectively. The median SUVmax of patients with suspected or confirmed RT reached 16.5 (range; 7.2 - 25.3), a value different from the previous groups (p < 0.001). (18)F-FDG PET/CT revealed inflammatory lesions in 7 patients (16%) and synchronous tumors in 2 newly diagnosed patients.(18)F-FDG PET/CT may be a beneficial imaging method when used in individuals with CLL and suspected RT.
    Leukemia & lymphoma 05/2013; DOI:10.3109/10428194.2013.802313 · 2.89 Impact Factor
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    ABSTRACT: Aim: To analyse sensitivity and specificity of SPECT and to assess the diagnostic potential of quantitative parameters of perfusion, left ventricular function and calcium score to identify high risk patients with multivessel coronary artery disease. Methods: 702 patients underwent stress gated SPECT study and then coronary angiography. We quantified% of ischemic myocardium, left ventricular ejection fraction, end-diastolic and end-systolic volumes and transient ischemic dilatation ratio. Results: Sensitivity and specificity of SPECT were 91 % (456/502) and 76 % (151/200), respectively, without significant difference between men and women. In quantitative analysis, % of ischemic myocardium rose with a number of diseased vessels: 11 % ± 11 %, 15 % ± 12 % and 19 % ± 14 % in patients with 1-, 2- and 3-vessel disease, respectively. We observed the sign of postischemic left ventricular stunning in 46%, 49 % a 63 % of patients with 1-, 2- and 3-vessel disease, respectively. In the subgroup of 81 patients with a dilated left ventricle, combining SPECT with calcium score (at a cutoff of 1 000) improved sensitivity from 80 % to 91 % and negative predictive value from 66 % to 81 % (p < 0.05), in association with not significant change in specificity and positive predictive value. Conclusions: Quantitative SPECT enables identification of high risk patients with a large ischemia and postischemic stunning with probable multivessel disease. In patients with a dilated left ventricle, the accuracy of SPECT has been improved by combination with calcium score.
    Intervencni a Akutni Kardiologie 01/2013; 12(2):66-69.
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    ABSTRACT: To evaluate the ability of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to predict histopathological response and overall survival (OS) after preoperative neoadjuvant chemoradiotherapy (CRT) in patients with the esophageal carcinoma. 73 patients with locally advanced esophageal carcinoma were included in the study. All were treated with CRT and 34 subsequently underwent surgical resection of the esophagus. (18)F-FDG PET/CT was carried out prior to (PET/ CT1) and 6 weeks after (PET/CT2) completion of the CRT. PET/CT2-determined complete metabolic response (CMR) was achieved in 6 (17.6%) out of 34 operated patients, the metabolic response was incomplete (NCMR) in 28 (82.4%) patients. A histopathological complete response (CR) to CRT was discovered in 7 patients (20.6%). The median OS in operated patients was 17.1 months, 95% CI:12.9-23.3 months. In a group of 39 non-operated patients, CMR after neoadjuvant CRT was achieved in 12 patients (30.8%), while NCMR was found in 28 (82.4%). The median OS was 13.5 months in this group, 95% CI: 4.4-22.7 months. No statistically significant correlation was found between the (18)F-FDG metabolic response after the neoadjuvant CRT and histopathological response. Presently, the contribution of (18)F-FDG PET/CT as a marker of the potential result of CRT cannot be considered definite. Another study with a larger sample of patients and standardized algorithms for the examining protocols would be necessary for reaching definitive conclusions.
    Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 11/2011; 156(2):171-9. DOI:10.5507/bp.2011.048 · 1.20 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate added value of coronary artery calcium score (CAC) measurement as an adjunct to cardiac gated SPECT for risk stratification in population of patients with diabetes mellitus (DM) and/or chronic renal failure on hemodialysis (CHRF-HD). Retrospective analysis of 67 patients, who were referred for stress gated myocardial perfusion SPECT and CAC. Characteristics of study population: 40 men, mean age 59 +/- 12 years, DM (n = 28), CHRF-HD (n = 22), DM and CHRF-HD simultaneously (n = 17). Perfusion summed stress and different scores (SSS, SDS), the left ventricle ejection fraction (LVEF) and enddiastolic/endsystolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT software. The hard cardiac event was defined as sudden cardiac death or myocardial infarction (MI); angina or other symptoms requiring coronary revascularization were also calculated. During the average period of 18 +/- 10 months, we registered 8 cardiac deaths, 4 nonfatal MI and 7 patients underwent revascularization. In the subgroup of 19 patients with cardiac events, the observed parameters were significantly worse concerning perfusion (SSS 9 +/- 11 vs 2 +/- 3 and SDS 6 +/- 9 vs 1 +/- 2, P < 0.05), the left ventricle function (stress LVEF 53% +/- 13% vs 59% +/- 13%, rest LVEF 55% +/- 14% vs 59% +/- 12%, stress EDV/ESV 144 ml/71 ml vs 128 ml/59 ml, P < 0.05), and CAC score (1 965 +/- 1 772 vs 387 +/- 740, P < 0.05) in comparison with patients without cardiac event. In patients without a reversible perfusion abnormality (SDS < 2), we observed lower annual hard event rate (8% vs 19.6%, P < 0.05) and revascularization procedures (4% vs 19.6%, P < 0.05) in comparison with patients with SDS > or = 2. In patients with or without reversible defects, we registered significantly higher annual hard event rate in the setting of post-stress worsening of the LVEF > 5% and/or severe CAC score > or = 709 (23.8% vs 1.9% in patients with SDS < 2, and 26.7% vs 9.5% in patients with SDS > or = 2, P < 0.05). The findings of highly elevated CAC score as well as the post-stress left ventricle stunning enable further risk stratification in patients with or without reversible perfusion abnormalities.
    Vnitr̆ní lékar̆ství 11/2010; 56(11):1122-9.
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    ABSTRACT: Newer imaging modalities, such as 18F-FDG PET/CT and 99mTc-MIBI scintigraphy, have been recently introduced to assess the activity and extent of disease in patients with multiple myeloma (MM) and gammopathy of undetermined significance (MGUS). The aim of our study was to compare the impact of these imaging modalities in the evaluation of MM and MGUS patients. A total of 101 patients with MM (81 patients) and MGUS (20 patients) were enrolled in the study (21 newly diagnosed and 44 relapsed patients with symptomatic MM, 16 with asymptomatic MM and 20 with MGUS). All patients were without therapy and underwent 18F-FDG PET/CT and 99mTc-MIBI scintigraphy within a maximum interval of 14 days. The scans were classified as normal (N), diffuse (D), and focal or combined (F-FD) pattern. There was no significant difference in the detection of newly diagnosed MM and relapsed patients between the compared methods. 18F-FDG PET/CT performed better than 99mTc-MIBI scintigraphy in the detection of focal lesions (p < 0.039), whereas 99mTc-MIBI scintigraphy was superior in the visualization of diffuse disease (p = 0.042). 18F-FDG PET/CT visualised significantly more focal lesions than 99mTc-MIBI scintigraphy (p = 0.002), both generally in the cohort and when comparing the number of focal lesions per patient. Both the imaging modalities singly or in combination influenced the subsequent clinical management in 17% of patients. In our study, 18F-FDG PET/CT predicted asymptomatic MM and MGUS transformation into more aggressive forms with the necessity to start therapy more often than 99mTc-MIBI scintigraphy. 18F-FDG PET/CT appeared to be a better imaging technique than 99mTc-MIBI scintigraphy in the detection of focal lesions in patients with symptomatic MM. 99mTc-MIBI was superior in the visualization of diffuse disease. On the other hand, despite its limited capacity in detecting focal lesions, 99mTc-MIBI scintigraphy still remains the most rapid and inexpensive technique for whole-body evaluation and may be an alternative option when a PET/CT facility is not available.
    Klinická onkologie: casopis Ceské a Slovenské onkologické spolecnosti 01/2010; 23(5):325-31.