Dose-escalated Salvage Whole-pelvic Radiotherapy for Biochemical Recurrence After Radical Prostatectomy for High-risk Prostate Cancer.

Background/Aim: To investigate the institutional experience of dose-escalated salvage whole-pelvic radiotherapy (WPRT) with the simultaneous integrated boost (SIB) technique in patients with biochemical recurrence (BCR) after radical prostatectomy for high-risk prostate cancer. Patients and Methods: This retrospective study included 21 patients with BCR who received radical prostatectomy for high-risk prostate cancer and underwent salvage RT. Clinical target volume (CTV) of the whole pelvis (CTV56) included the prostate bed, common iliac, external iliac, internal iliac, and obturator lymph node regions. The boost CTV (CTV66) included the prostate bed. Planning target volumes (PTV) were generated by adding a margin of 6-8 mm to CTV (PTV56 and PTV66). Doses of 56.1 and 66 Gy in 33 fractions were delivered to PTV56 and PTV66, respectively. Results: The 5-year biochemical progression-free survival, overall survival, and cause-specific survival rates were 72%, 94%, and 94%, respectively. A grade 3 late genitourinary toxicity event of gross hematuria was observed in one patient (4%). Acute and late toxicities of grade ≥3, other than gross hematuria, were not observed in any patient. Conclusion: Dose-escalated salvage WPRT using the SIB technique provides appropriate tumor control without increasing the incident of significant toxicities.

[Development and Usefulness of Support Package for Learning of Image Interpretation Assistance Using CT and MRI Image in Emergency Medicine].

The Japanese Ministry of Health, Labour and Welfare announced about the expansion of duties by the radiological technologists in team medical care in April, 2010, and the importance of image interpretation assistance by the radiological technologists became higher. In that respect, for improvement in ability of image interpretation assistance by the radiological technologists in emergency medicine, we developed a support package for learning of image interpretation assistance (support package) and evaluated the usefulness for learning of image interpretation assistance by questionnaires. The support package included digital imaging and communications in medicine (DICOM) data of case, explainer video of urgent imaging findings, and DICOM viewer. In 100% of evaluators, the support package was useful for urgent imaging findings in emergency medicine. Moreover, 68.9% of the evaluators had an experience helped by learning to use the support package in the clinical site. In conclusion, we confirmed that the support package was useful for learning of image interpretation assistance by the radiological technologists.

Clinical Outcomes of Stereotactic Body Radiation Therapy for Early-stage Non-small Cell Lung Cancer.

BACKGROUND/AIM: To investigate the clinical outcomes of stereotactic body radiotherapy (SBRT) in patients with early-stage non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Among consecutive patients with early-stage NSCLC who received SBRT between November 2009 and September 2019, those with cT1-2N0M0 staged by the UICC TNM classification and staging system for lung cancer were retrospectively analyzed. RESULTS: Fifty-three patients with early-stage NSCLC received SBRT. The median follow-up period was 29 months (range=2-105 months). Twenty-one lung tumors were clinically diagnosed as early-stage primary lung cancers without histological confirmation. Histological examinations revealed adenocarcinoma in 24 patients and squamous cell carcinoma in 8. Two- and 5-year local control, cancer-specific survival, progression-free survival (PFS), and overall survival (OS) rates were 94.4 and 94.4%; 94.6 and 90.8%; 69.0 and 43.3%; and 80.0 and 59.3%, respectively. In a univariate analysis, the T stage, histology, and type of pulmonary nodule correlated with PFS and OS. CONCLUSION: Good clinical outcomes were achieved by patients with early-stage NSCLC who received SBRT.

Clinical Outcomes of Definitive Chemoradiotherapy for Cervical Esophageal Cancer.

BACKGROUND/AIM: To investigate the clinical outcomes of concurrent chemoradiotherapy (CCRT) in patients with cervical esophageal carcinoma and analyze the prognostic factors. PATIENTS AND METHODS: Thirty-nine patients with cervical esophageal carcinoma were retrospectively identified among consecutive patients who received CCRT between November 2009 and September 2019 at our institution. The patients were treated by intensity-modulated radiation therapy (N=13) or three-dimensional conformal radiotherapy (N=26). RESULTS: The median follow-up period was 35 months (range=2-158 months). There were 32 men and 7 women with a median age of 66 years (range=50-83 years). Clinical stages were I in 6 patients, II in 4, III in 19, and IV in 10. Hypopharyngeal invasion was noted in 8 patients. The initial treatment responses were evaluated 3-6 weeks after the final session of CCRT: a complete response (CR) in 24 patients, a partial response (PR) in 13, and stable disease (SD) in 2. Two- and 5-year overall survival (OS) rates were 73.8 and 59.4%, respectively. Two- and 5-year progression-free survival (PFS) rates were 57.8 and 48.0%, respectively. A univariate analysis identified the initial treatment response (CR or non-CR) as a significant factor for OS (p=0.0002) and PFS (p=0.0026). The CR rate was 81.0% in patients with T1-3 and 33.3% in those with T4 (p=0.0038). CONCLUSION: Patients with cervical esophageal carcinoma in Nagasaki University Hospital in Japan achieved superior outcomes compared with previous studies. CR rate was higher in patients with T1-3 and correlated with better OS.

Benefits of adrenal venous sampling with preoperative four-dimensional CT imaging.

BACKGROUND: The effects of adrenal venous sampling (AVS) may be limited by the anatomical variants of adrenal veins. PURPOSE: To investigate the benefits of AVS for patients who underwent four-dimensional computed tomography (4D CT) before AVS. MATERIAL AND METHODS: We reviewed the images of contrast-enhanced four phase three-dimensional (3D) and 4D CT in patients who received AVS between February 2010 and February 2021. A total of 112 patients (59 women; mean age = 55.3 ± 11.8 years) were enrolled. Of the entire population, 49.1% (55/112) underwent 4D CT, whereas 50.9% (57/112) underwent 3D CT. The anatomical features of adrenal veins and procedural data were obtained. Simple linear regression analyses were performed to determine the relationship between imaging protocols and AVS. RESULTS: On comparison of the two groups, the 4D cohort had a higher success rate (98.2% vs. 78.9%; P = 0.001), shorter procedure and fluoroscopy time (73.6 ± 37.3 min vs. 110.5 ± 47.9 min; P < 0.001 and 28.7 ± 31.2 min vs. 97.4 ± 251.7 min; P = 0.047, respectively), lower radiation exposure (243.5 ± 315.5 mGycm2 vs. 613.4 ± 674.6 mGycm2; P < 0.001) and less contrast volume (46.2 ± 42.7 ml vs. 68.3 ± 47.4 ml vs; P = 0.014). In simple linear regression analysis, positive and negative identification of right adrenal vein before AVS significantly influenced the success rate (unstandardized coefficients [UC] = 0.304, standardized coefficients [SC] = 0.304; P = 0.001) and operation duration (UC = -46.124, SC = -0.318; P = 0.001). CONCLUSION: Pre-procedural 4D CT may facilitate successful AVS. Compared with four-phase 3D CT, this protocol is better to shorten the operation and fluoroscopy time, and to reduce the radiation dose and contrast consumption.

Phase I study of amrubicin plus cisplatin and concurrent accelerated hyperfractionated thoracic radiotherapy for limited-disease small cell lung cancer: protocol of ACIST study.

BACKGROUND: Etoposide plus cisplatin (EP) combined with concurrent accelerated hyperfractionated thoracic radiotherapy (AHTRT) is the standard treatment strategy for unresectable limited-disease (LD) small cell lung cancer (SCLC), which has remained unchanged for over two decades. Based on a previous study that confirmed the non-inferiority of amrubicin (AMR) plus cisplatin (AP) when compared with EP for extensive-disease (ED) SCLC, we have previously conducted a phase I study assessing AP with concurrent TRT (2 Gy/time, once daily, 50 Gy in total) for LD-SCLC therapy. Our findings revealed that AP with concurrent TRT could prolong overall survival to 39.5 months with manageable toxicities. Therefore, we plan to conduct a phase I study to investigate and determine the effect of AP combined with AHTRT, recommended dose (RD), maximum tolerated dose (MTD), and dose-limiting toxicity (DLT) of AP in patients with LD-SCLC. METHODS: Treatment-naive patients with LD-SCLC, age between 20 and 75 years, who had a performance status of 0 or 1 and adequate organ functions will be enrolled. For chemotherapy, cisplatin 60 mg/m2 /day (day 1) and AMR (day 1 to 3) will be administered with AHTRT (1.5 Gy/time, twice daily, 45 Gy in total). The initial AMR dose is set to 25 mg/m2 /day. RD and MTD will be determined by evaluating toxicities. DISCUSSION: Based on our previous study, the initial dose of AMR 25 mg/m2 is expected to be tolerated and acceptable. Here, we aim to determine whether treatment with AP and concurrent AHTRT would be an optimal choice with manageable toxicities for LD-SCLC.

The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients.

The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ±â€Š14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ±â€Š21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.