Quantitative Assessment of Skull-Base Invasion in Nasopharyngeal Carcinoma Patients with Signal Intensity Index Based on Magnetic Resonance Imaging / 鼻咽癌杂志

Purpose: To evaluate the use of signal intensity index (SII) of skull-base invasion in nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI), select a best cut-off SII value to predict the outcome of NPC. Materials and Methods: One hundred and twenty-two NPC patients (92 men, 30 women) with skull-base invasion were included. All patients underwent MRI, signal intensities on T1-weighted imaging (T1WI) were measured for each invaded site and its contralateral normal counterpart. The SIIs were calculated, receiver operating characteristic curves were constructed. The optimal cut-off values were extracted. The overall survival (OS) rates of 5-year follow-up were performed. Results: Sensitivities for differentiating skull-base invasion from normal contralateral anatomy were 98.9%, 88.5% and 70.0%, and specificities were 98.9%, 96.0% and 74.4%, respectively. There were three cut-off values for differentiating invasion from normal anatomy of skull-base, 49%, 98%, and 60%. Significant difference in OS rates (84.2% vs. 57.1%, p=0.007) was seen for SII threshold values > 60% and those ≤ 60%. Conclusions: The SII might be a useful means of differentiating invasion from normal tissue at the skull-base in NPC. The cut-off value of quantitative SII at the skull-base may aid in monitoring the response to treatment of NPC patients.

Efficacy of minimally invasive therapies on unresectable pancreatic cancer / 癌症

For patients with unresectable pancreatic cancer, current chemotherapies have negligible survival benefits. Thus, developing effective minimally invasive therapies is currently underway. This study was conducted to evaluate the efficacy of transarterial chemoembolization plus radiofrequency ablation and/or 125I radioactive seed implantation on unresectable pancreatic cancer. We analyzed the outcome of 71 patients with unresectable pancreatic carcinoma who underwent chemoembolization plus radiofrequency ablation and/or radioactive seed implantation. Of the 71 patients, the median survival was 11 months, and the 1-, 2-, and 3-year overall survival rates were 32.4%, 9.9%, and 6.6%, respectively. Patients who had no metastasis, who had oligonodular liver metastases (≤3 lesions), and who had multinodular liver metastases (>3 lesions) had median survival of 12, 18, and 8 months, respectively, and 1-year overall survival rates of 50.0%, 68.8%, and 5.7%, respectively. Although the survival of patients without liver metastases was worse than that of patients with oligonodular liver metastasis, the result was not significant (P = 0.239). In contrast, the metastasis-negative patients had significantly better survival than did patients with multinodular liver metastases (P < 0.001). Patients with oligonodular liver lesions had a significant longer median survival than did patients with multinodular lesions (P < 0.001). In conclusion, combined minimally invasive therapies had good efficacy on unresectable pancreatic cancer and resulted in a good control of liver metastases. In addition, the number of liver metastases was a significant factor in predicting prognosis and response to treatment.

Serum alpha-fetoprotein measurement in predicting clinical outcome related to autologous cytokine-induced killer cells in patients with hepatocellular carcinoma undergone minimally invasive therapy / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>In patients with hepatocellular carcinoma (HCC) receiving potentially curative minimally invasive therapy, autologous cytokine-induced killer (CIK) cells were used to reduce recurrence. In this study we observed the changes in serum alpha-fetoprotein (AFP) after the treatment with CIK cells to explore if AFP could serve as a marker for predicting immunotherapeutic clinical outcome.</p><p><b>METHODS</b>A total of 122 patients with HCC and elevated AFP (>25 ng/mL) received a curative treatment of transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) at the Sun Yat-sen University Cancer Center. Of these patients, 83 patients without residual tumor or extrahepatic metastasis and with AFP level less than 1.5 times the normal range (AFP<37.5 ng/mL) were randomly assigned to the study group (n=42) and the control group (n=41). In the study group, CIK cells were transfused intravenously or via common hepatic arteries every week for at least 4 times, and the T-lymphocyte subset data before and after CIK cell infusions was examined by flow cytometry. All the two groups of patients were screened by tomography every 2 months to observe tumor recurrence. Serum AFP was collected at baseline and at different time points after treatment in parallel with radiologic response and clinical outcome.</p><p><b>RESULTS</b>Two patients in the control group were lost to follow-up after treatment. After CIK cell infusions, the downtrend of the AFP level was observed in the study group and not in the control group. There was a significant difference in the level of AFP between different time points after CIK infusions in both groups. The 1-year recurrence rate was 7.14% for the study group and 23.1% for the control group (P=0.044). In subgroup analysis, for patients with a slightly high level of AFP (25 ng/mL<AFP<37.5 ng/mL) after curative TACE plus RFA treatment, the 1-year recurrence rate was 28.57% for the study group and 80% for the control group. The time to recurrence in the study group was also longer than that in the control group (mean 10.2 months vs. 6.8 months). After CIK cell infusions, the percent of CD3+CD4+ T cells and CD4+ /CD8+ T cells increased from 28.1+/-5.9% and 0.9+/-0.3% to 32.7+/-3.6% and 1.2+/-0.2% (P<0.001 and=0.004, respectively), while the percent of CD3+CD8+ T cells decreased from 32.9+/-8.4% to 28.8+/-2.2% (P=0.046). Also the percentage of patients with hepatitis B virus (HBV)-DNA content less than 1x10(3) copies/mL was 73.5% in the study group and 9.1% in the control group.</p><p><b>CONCLUSIONS</b>CIK cells transfusion may reduce the level of serum AFP and anti-HBV and decrease the 1-year recurrence rate of patients with HCC after curative TACE plus RFA. Serum AFP decrease after CIK cell treatment may serve as a useful marker for predicting immunotherapy clinical outcome in patients with HCC undergone curative minimally invasive therapy.</p>

Percutaneous radiofrequency ablation approach through the spleen: initial case report for pancreatic tail gastrinoma / 癌症

Gastrinoma has a low incidence, and the pancreas-originated gastrinoma is rare. Pancreatic gastrinoma patients with liver metastases have poor prognosis and short survival. Local treatment to reduce the tumor burden helps to improve symptoms and slows down tumor progression for patients with unresectable tumors. We report a case of pancreatic tail gastrinoma with unresectable liver metastases. The patient received a comprehensive minimally invasive interventional treatment, that is, chemoembolization and radiofrequency ablation for liver metastases, and percutaneous transplenic radiofrequency ablation combined with radioactive 125I seed implantation for pancreatic tail gastrinoma. The patient was followed up for more than 20 months, and showed no clear evidence of tumor recurrence. We explored the safety and feasibility of percutaneous transplenic radiofrequency ablation for unresectable pancreatic tail gastrinoma. This transplenic approach allow more indications for minimally invasive therapy and provides a new treatment option not only for patients with unresectable pancreatic tail tumor but also for patients refusing surgery.

Three-dimensional white matter tractography based on diffusion-tensor magnetic resonance imaging / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of white matter fiber tractography based on magnetic resonance diffusion-tensor imaging (MR-DTI), a new noninvasive technique that helps estimate the structural connectivity of the brain, in understanding the anatomy of the white matter fiber tract.</p><p><b>METHODS</b>Six consecutive volunteers received MR-DTI examination using a GE 1.5T Sign CV/I whole-body MR system and version 2.0 Functool software for image processing. The protocol included T1WI for localization and single-shot echo-planner diffusion tensor imaging of the entire brain in axial, sagittal, and /or coronal sections.</p><p><b>RESULTS</b>White matter fiber tracts imaged by MR-DTI were consistent with known white matter fiber anatomy. The major fiber tracts were well observed in all the cases. The tracts visualized included the corpus callosum, anterior commissure, uncinate fasciculus superior and inferior longitudinal fascicules, inferior occipito-frontal fasciculus, internal capsule and corona radiate.</p><p><b>CONCLUSION</b>A set of detailed white matter fiber anatomy maps of the normal brain is obtained by means of single-shot echo-planner diffusion tensor imaging at high resolution. This technique allows rapid visualization of the white matter tracts in vivo, and provides a new reliable means for studying fiber connectivity in the brain.</p>

Diffusion tensor imaging of the white matter tracts in preoperative patients with cerebral neoplasm / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the quantitative relationship between white matter tract (WMT) variation resulting from cerebral tumors and shifting of the fractional anisotropy (FA) index in magnetic resonance (MR) diffusion tensor imaging (DTI).</p><p><b>METHODS</b>Four female and 8 male patients aged from 21 to 62 years with brain malignancies (2 malignant lymphomas, 2 low-grade astrocytomas, and 8 high-grade cerebral gliomas) underwent conventional contrast-enhanced MR and DTI examinations before operation. Routine T(2)-weighted image, fractional anisotropic (FA) map, color-coded directional map, three-dimensional white matter tractography (WMT), and the FA index of bilateral internal capsule were obtained in every patient.</p><p><b>RESULTS</b>Fiber tractography derived from DTI was consistent with known white matter fiber anatomy. The DTI patterns in WMT altered by the tumor were categorized on the basis of FA1/FA2 ratio as follows: pattern 1, FA1/FA2> or =75% with normal or only slightly decreased FA; pattern 2, 50%< or =FA1/FA2<75% with WMT displacement; pattern 3, 25%< or =FA1/FA2/50% with WMT involvement; pattern 4, FA1/FA2<25% with WMT destruction.</p><p><b>CONCLUSIONS</b>DTI allows for visualization of WMT and benefits surgical planning for patients with intrinsic brain tumor. There is a positive relationship between the bilateral FA ratio (FA1/FA2) variation and WMT alterations resulting from the tumor.</p>