Comparison of conservative treatment versus transcatheter arterial embolisation for the treatment of spontaneously ruptured hepatocellular carcinoma

Purpose: To elucidate the prognostic factors in the spontaneous rupture of hepatocellular carcinoma (HCC) and to determine whether transcatheter arterial embolisation (TAE) is associated with better prognosis compared to conservative treatment. Material and methods: A retrospective multicentre study was conducted involving 71 patients with spontaneous rupture of HCC. A conservative treatment group (Cons T group) included 20 patients, while a transcatheter arterial embolisation group (TAE group) included 51 patients. Results: The median survival time (MST) in the Cons T group was only 16 days and the survival rate was 39% at one month, whereas the MST in the TAE group was 28 days and the one month survival rate was 63%. However, there is no statistically significant difference in the overall survival between Cons T and TAE groups (p = 0.213). Multivariable analysis identified only the presence of distant metastasis as an independent prognostic factor (p = 0.023). A subanalysis including patients without distant metastasis showed that the presence of portal vein tumour thrombosis was a significant prognostic factor (p = 0.015). Conclusions: Distant metastasis appears to be a prognostic factor in spontaneous rupture of HCC. In cases without distant metastasis, portal vein tumour thrombosis could influence the prognosis. Our data failed to prove any benefit of TAE as the primary management

Changes in volume of stage I non-small-cell lung cancer during stereotactic body radiotherapy

BACKGROUND: The overall treatment time of stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer is usually 3 to over 10 days. If it is longer than 7 days, tumor volume expansion during SBRT may jeopardize the target dose coverage. In this study, volume change of stage I NSCLC during SBRT was investigated. METHODS: Fifty patients undergoing 4-fraction SBRT with a total dose of 48 Gy (n = 36) or 52 Gy (n = 14) were analyzed. CT was taken for registration at the first and third SBRT sessions with an interval of 7 days in all patients. Patient age was 29–87 years (median, 77), and 39 were men. Histology was adenocarcinoma in 28, squamous cell carcinoma in 17, and others in 5. According to the UICC 7th classification, T-stage was T1a in 9 patients, T1b in 27, and T2a in 14. Tumor volumes on the first and 8th days were determined on CT images taken during the exhalation phase, by importing the data into the Dr. View/LINAX image analysis system. After determining the optimal threshold for distinguishing tumor from pulmonary parenchyma, the region above -250 HU was automatically extracted and the tumor volumes were calculated. RESULTS: The median tumor volume was 7.3 ml (range, 0.5-35.7) on day 1 and 7.5 ml (range, 0.5-35.7) on day 8. Volume increase of over 10% was observed in 16 cases (32%); increases by >10 to ≤20%, >20 to ≤30%, and >30% were observed in 9, 5, and 2 cases, respectively. The increase in the estimated tumor diameter was over 2 mm in 3 cases and 1–2 mm in 6. A decrease of 10% or more was seen in 3 cases. Among the 16 tumors showing a volume increase of over 10%, T-stage was T1a in 2 patients, T1b in 9, and T2a in 5. Histology was adenocarcinoma in 10 patients, squamous cell carcinoma in 5, and others in 1. CONCLUSIONS: Volume expansion >10% was observed in 32% of the tumors during the first week of SBRT, possibly due to edema or sustained tumor progression. When planning SBRT, this phenomenon should be taken into account

A method for assessing metabolic information on liver and bone marrow by use of double gradient-echo with spectral fat suppression

Our aim in this study was to create a noninvasive and practical method for evaluating metabolic information on the liver (iron content and lipid infiltration) and spine (bone mineral density and marrow fat degeneration) using double gradient-echo with and without the spectral fat suppression technique (double-GRE-FS). We arranged phantoms made of various concentrations of superparamagnetic iron oxide solution adjacent to neutral fat to obtain slice planes with various fat fractions using the partial volume effect. We obtained double-GRE-FS images and calculated the T2* values. The fat fraction was calculated from signal intensities of double-GRE-FS images after T2* decay, baseline, and slope corrections. We assessed the fat fraction and the relationship between R2* of the water component and the iron concentration. In addition, we evaluated those values in human bone marrow and liver, including a patient with liver steatosis. The actual fat fraction value was consistent with the fat fraction obtained with the double-GRE-FS method, and the calculated fat fraction was unaffected by the iron concentration. There was a strong positive correlation between R 2* of the water component and the iron concentration. There was a negative correlation between the fat fraction and the bone mineral density, and the R2* was correlated with the bone mineral density. The calculated fat fraction in the liver steatosis patient was significantly higher than that in healthy volunteers. The double-GRE-FS makes it possible to assess the fat fraction and R2* simultaneously, and to obtain metabolic information on the liver and bone marrow. © 2014 Japanese Society of Radiological Technology and Japan Society of Medical Physics

Helical tomotherapy for asymptomatic chemotherapy-refractory or -unfit multiple (3 or more) metastases

Background: Despite chemotherapy innovations, prognosis of patients with chemotherapy-refractory or -unfit multiple metastases (CRMM/CUMM) remains poor. In this prospective study, the efficacy and toxicity of helical tomotherapy for CRMM/CUMM were evaluated. Materials and methods: Between 2014 and 2020, asymptomatic patients with CRMM/CUMM with ≥ 3 lesions and no prior radiotherapy of the targets were enrolled. Patients who had intolerable toxicities to chemotherapy and those who refused chemotherapy were included in the CRMM and CUMM groups, respectively. Prostate cancer patients and patients with metastases mainly localized in the liver, lung, or brain were excluded. By helical tomotherapy, up to 10 lesions per patient were irradiated in order of volume. The standard dose was 50–60 Gy in 25–30 fractions. Results: Forty-five patients (median age, 63 years; 35 CRMM/10 CUMM) were enrolled. Primary tumors included lung, gynecological, and gastrointestinal cancers. The most frequently treated targets were lymph node metastases, followed by peritoneal/pleural disseminations and bone tumors. The 1-year survival rate was 51% (median, 12.5 months). In the 35 patients with CRMM, the median survival time was 12.5 months, and the median pre-radiation chemotherapy period was 8.8 months (p > 0.05). The 6-month target control rate was 78%. Acute adverse events (grade ≥ 2) occurred in 33 patients: hematologic toxicities in 23, dermatitis in 6, and others in 8. Late grade ≥ 2 toxicities occurred in 6 patients: pneumonitis in 4 and gastric hemorrhage in 2. Conclusion: Tomotherapy for CRMM/CUMM resulted in median survival times > 1 year. This treatment should be investigated further in larger prospective studies

Long-Term Outcome of Proton Therapy and Carbon-Ion Therapy for Large (T2a–T2bN0M0) Non–Small-Cell Lung Cancer

IntroductionAlthough many reports have shown the safety and efficacy of stereotactic body radiotherapy (SBRT) for T1N0M0 non–small-cell lung cancer (NSCLC), it is rather difficult to treat T2N0M0 NSCLC, especially T2b (>5 cm) tumor, with SBRT. Our hypothesis was that particle therapy might be superior to SBRT in T2 patients. We evaluated the clinical outcome of particle therapy for T2a/bN0M0 NSCLC staged according to the 7th edition of the International Union Against Cancer (UICC) tumor, node, metastasis classification.MethodsFrom April 2003 to December 2009, 70 histologically confirmed patients were treated with proton (n = 43) or carbon-ion (n = 27) therapy according to institutional protocols. Forty-seven patients had a T2a tumor and 23 had a T2b tumor. The total dose and fraction (fr) number were 60 (Gray equivalent) GyE/10 fr in 20 patients, 52.8 GyE/4 fr in 16, 66 GyE/10 fr in 16, 80 GyE/20 fr in 14, and other in four patients, respectively. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, Version 4.0.ResultsThe median follow-up period for living patients was 51 months (range, 24–103). For all 70 patients, the 4-year overall survival, local control, and progression-free survival rates were 58% (T2a, 53%; T2b, 67%), 75% (T2a, 70%; T2b, 84%), and 46% (T2a, 43%; T2b, 52%), respectively, with no significant differences between the two groups. The 4-year regional recurrence rate was 17%. Grade 3 pulmonary toxicity was observed in only two patients.ConclusionParticle therapy is well tolerated and effective for T2a/bN0M0 NSCLC. To further improve treatment outcome, adjuvant chemotherapy seems a reasonable option, whenever possible

Bulk motion-independent analyses of water diffusion changes in the brain during the cardiac cycle

金沢大学医薬保健研究域保健学系We evaluated dynamic changes in water diffusion in the brain during the cardiac cycle by using cine diffusion MRI. On a 1.5-T MRI, ECG-triggered single-shot diffusion echo planar imaging was used with sensitivity encoding, halfscan, and rectangular field of view techniques for minimizing bulk motion effects such as brain pulsation, with a data-sampling window of 3 ms. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in the white matter zone were determined in ten healthy volunteers and then compared with the intracranial volume change (ICVC) revealed by phase-contrast cine MRI during the cardiac cycle. In addition, a frequency analysis of these waveforms was performed. ADC and FA values changed significantly during the cardiac cycle, despite minimizing the effect of bulk motion, i.e., independent of bulk motion. The ADC was synchronized with the ICVC during the cardiac cycle. A significant positive correlation was noted among their amplitudes. Analysis of the dynamic change of water diffusion by use of cine diffusion MRI facilitates the assessment of intracranial conditions. © 2009 Japanese Society of Radiological Technology and Japan Society of Medical Physics

Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation

Purpose: The purpose of this study is to assess the feasibility and usefulness of time-resolved magnetic resonance angiography (TR-MRA) for follow-up of visceral artery aneurysms (VAAs) after embolotherapy. Material and methods: Twenty-one VAAs (11 splenic, six renal, three internal iliac, and one superior pancreaticoduodenal artery aneurysms) in 18 patients (median age, 64 years; range, 36-88 years) previously treated by embolisation with platinum coils, were evaluated. The mean size of the aneurysm was 10.5 cm3 (range, 0.3-132 cm3). Among them, 19 lesions were treated by aneurysmal packing with or without distal-to-proximal embolisation. For the remaining two lesions, distal-to-proximal embolization alone was performed. The mean observation period after embolotherapy was 35 weeks (range, 4-216). All patients underwent TR-MRA following an intravenous bolus injection of gadolinium chelate. Recanalisation was diagnosed when any portion of the aneurysmal sac was enhanced in the arterial phase. Results: On TR-MRA, two lesions were diagnosed as recanalised. They were confirmed by transcatheter arteriography and re-treated by embolotherapy. For the remaining 19 lesions, there were no findings of recanalisation on TR-MRA. Conclusions: TR-MRA appears to be a feasible method for follow-up examination of VAAs treated by embolotherapy