Damage Effect of Amorphous Carbon Black Nanoparticle Aggregates on Model Phospholipid Membranes: Surface Charge, Exposure Concentration and Time Dependence.

Commercial nano-scale carbon blacks (CB) are being harnessed widely and may impose potentially hazardous effects because of their unique properties, especially if they have been modified to grow reactive functional groups on their surface. Cytotoxicity of CB has been well studied but the membrane damage mechanisms and role of surface modification are still open to debate. Negatively and positively charged giant unilamellar vesicles (GUVs) were prepared using three lipids as model cell membranes to examine the mechanistic damage of CB and MCB (modified by acidic potassium permanganate) aggregates. Optical images showed that both anionic CB and MCB disrupted the positively charged but not the negatively charged GUVs. This disruption deteriorated with the rise and extension of exposure concentration and time. Lipids extraction caused by CBNs (CB and MCB together are called CBNs) was found. MCB caused more severe disruption than CB. MCB was enveloped into vesicles through an endocytosis-like process at 120 mg/L. MCB mediated the gelation of GUVs, perhaps through C-O-P bonding bridges. The lower hydrodynamic diameter and more negative charges may have been responsible for the distinction effect of MCB over CB. The adhesion and bonding of CBNs to the membrane were favored by electrostatic interaction and the practical application of CBNs warrants more attention.

Combined toxicity of functionalized nano-carbon black and cadmium on Eisenia fetida coelomocytes: The role of adsorption.

Little is known about the potential threats of functionalized nano-carbon black (FNCB) combined with cadmium (Cd) to soil invertebrates. In this study, immunocompetent coelomocytes from Eisenia fetida are harnessed, and the joint cytotoxicity types of FNCB and Cd co-exposure are analyzed. The extracellular interaction mechanisms of FNCB and Cd were completely explored using adsorption kinetics and thermodynamics accompanied by isotherm batch experiments and Fourier infrared spectroscopy. The results indicated that functional amorphous carbon nanoparticles up to certain dose may injure cells due to their surface oxygen-containing groups. The MIXTOX model and the combination index suggested that the combined action of FNCB and Cd exhibited antagonism at the low dose/effect-level and synergism at the high dose/effect-level. FNCB decreased the intracellular free Cd2+ content at a low mixture dose, while it increased it at a high mixture dose. The adsorption of Cd on FNCB followed pseudo-second-kinetics and the Langmuir isotherm, hence better indicating a chemisorption, which was also supported by the activation energy (Ea = 36.6 kJ/mol), enthalpy change (ΔH = -98.4 kJ/mol), and functional group changes. Coordination binding should be responsible for the subsequent interaction of toxicity.

Effect of Nano-Carbon Black Surface Modification on Toxicity to Earthworm (Eisenia fetida) Using Filter Paper Contact and Avoidance Test.

Engineered nanomaterials (NMs) may enter the soil through various channels and pose potential harm to soil animals, especially those proactively applied for soil heavy metal remediation. Effects of nano-carbon black (CB) and surface modified carbon black (MCB) on catalase (CAT) activity and malondialdehyde (MDA) content in earthworms exposed on filter paper for 48 h were tested. Avoidance test was used to determine hazard of soil treated with 0.015% and 1.5% CB and MCB. Surface properties of NMs were also characterized. MCB has a significant effect on CAT activity at 70 and 1000 mg/L (1.1 and 15.7 µg/cm2), but has no impact on MDA content in earthworm. Strongly avoidance behavior of worms was also found in soil added 1.5% MCB. Negative charges and oxygen functional groups increased for MCB and its adverse effect on earthworm was higher than CB. The application of MCB in soil remediation warrants more attention.

Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma.

AIM: To retrospectively evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in the treatment of patients with advanced intrahepatic cholangiocarcinoma (ICC). METHODS: All patients treated with ultrasound-guided percutaneous MWA combined with simultaneous TACE for advanced ICC at our institution were included. Posttreatment contrast-enhanced computed tomography and/or magnetic resonance imaging were retrieved and reviewed for tumor response to the treatment. Routine laboratory studies, including hematology and liver function tests were collected and analyzed. Procedure-related complications were reviewed and survival rates were analyzed. RESULTS: From January 2011 to December 2014, a total of 26 advanced ICC patients were treated at our single institute with ultrasound-guided percutaneous MWA combined with simultaneous TACE. There were 15 males and eleven females with an average age of 57.9±10.4 years (range, 43-75 years). Of 26 patients, 20 (76.9%) patients were newly diagnosed advanced ICC without any treatment, and six (23.1%) were recurrent and treated with surgical resection of the original tumor. The complete ablation rate was 92.3% (36/39 lesions) for advanced ICC. There were no major complications observed. There was no death directly from the treatment. Median progression-free survival and overall survival were 6.2 and 19.5 months, respectively. The 6-, 12-, and 24-month survival rates were 88.5%, 69.2%, and 61.5%, respectively. CONCLUSION: The study suggests that ultrasound-guided percutaneous MWA combined with simultaneous TACE therapy can be performed safely in all patients with advanced ICC. The complete ablation rate was high and there was no major complication. The overall 24-month survival was 61.5%.

Transcatheter arterial chemoembolization with gemcitabine and oxaliplatin for the treatment of advanced biliary tract cancer.

BACKGROUND: The aim of this study was to determine the therapeutic efficacy and safety of transarterial chemoembolization (TACE) with gemcitabine and oxaliplatin in patients with advanced biliary tract cancer (BTC). METHODS: We retrospectively analyzed the outcomes for 65 patients with advanced BTC treated by TACE with gemcitabine 1,000 mg/m(2) and oxaliplatin 100 mg/m(2). Follow-up laboratory tests and computed tomography or magnetic resonance imaging were performed routinely to evaluate the response of the tumor to treatment. All patients were assessed for adverse effects. RESULTS: Of the 65 patients, 19 (29.2%) achieved a partial response, 36 (55.4%) showed stable disease, and ten (15.4%) showed progressive disease. The overall response rate was 29.2%. At the end of this study, five patients were still alive. The median overall survival was 12.0 months (95% confidence interval 8.5-15.5). There were no serious complications after TACE. CONCLUSION: The disease control rate and overall survival in this retrospective study were consistent with those in previous reports. TACE with gemcitabine and oxaliplatin was well tolerated and highly effective in patients with advanced BTC.

Effects of surface-modified nano-scale carbon black on Cu and Zn fractionations in contaminated soil.

Cu contamination soil (547 mg kg(-1)) was mixed separately with the surface-modified nano-scale carbon black (MCB) and placed in the ratios (w/w) of 0, 1%, 3%, and 5% in pots, together with 0.33 g KH2PO4 and 0.35 g urea/pot. Each pot contained 20 ryegrass seedlings (Lolium multiflorum). Greenhouse cultivation experiments were conducted to examine the effect of the MCB on Cu and Zn fractionations in soil, accumulation in shoot and growth of ryegrass. The results showed that the biomass of ryegrass shoot and root increased with the increasing of MCB adding amount (p < 0.05). The Cu and Zn accumulation in ryegrass shoot and the concentrations of DTPA extractable Cu and Zn in soil were significantly decreased with the increasing of MCB adding amount (p < 0.05). The metal contents of exchangeable and bound to carbonates (EC-Cu or EC-Zn) in the treatments with MCB were generally lower than those without MCB, and decreased with the increasing of MCB adding amount (p < 0.05). There was a positive linear correlation between the Cu and Zn accumulation in ryegrass shoot and the EC-Cu and EC-Zn in soil. The present results indicated the MCB could be applied for the remediation the soils polluted by Cu and Zn.

Transarterial infusion with gemcitabine and oxaliplatin for the treatment of unresectable pancreatic cancer.

The aim of this study was to evaluate the therapeutic efficacy and the safety of transarterial infusion (TAI) with gemcitabine and oxaliplatin in patients with unresectable pancreatic cancer (PC). After celiac arteriogram and super-mesenteric arteriography, 1000 mg/m gemcitabine and 100 mg/m oxaliplatin were infused through 4- or 5-Fr catheters in arteries supplying blood to the tumor. In cases in which the blood-supplying artery could be selectively catheterized, the infusion was performed through a 3-Fr catheter placed in the tumor-supplying artery. Therapeutic courses were repeated every 4 weeks. The tumor response, the overall survival, and adverse effects were monitored. Thirty-two patients with unresectable PC were enrolled in this study, including 20 male and 12 female patients. A total of 105 cycles of TAI (mean=3.3 cycles/patient) were performed. Of 32 patients, partial remission was achieved in eight (25.0%), stable disease in 13 (40.6%), and progressive disease in 11 (34.4%). The overall response rate was 25.0%. The median survival time was 10.0 months (range=4-21 months). Grade III-IV toxicity, vomiting, occurred with a rate of 21.9%. Grade I-II neutropenia, thrombocytopenia, peripheral nerve toxicity, elevated serum transaminases levels, and serum total bilirubin were observed. TAI with gemcitabine and oxaliplatin is well tolerated and highly effective in patients with unresectable PC.

Fine needle aspirating and cutting is superior to Tru-cut core needle in liver biopsy.

BACKGROUND: Liver biopsy is the "gold standard" for evaluating liver disorders, but controversies over the potential risk of complications and patient discomfort still exist. Using a 21G fine needle, we developed a new biopsy procedure, fine needle aspirating and cutting (FNAC). Our procedure obtains enough tissue for pathological examination and meanwhile, reduces the risk of biopsy complications. The present study was to determine the safety and efficiency of 21G FNAC compared with 18G Tru-cut core needle (TCN) in liver tumor biopsies. METHODS: Ninety-four patients with unresectable malignant tumors were included in this study. Patients were divided into 2 groups: 18G TCN and 21G FNAC. The total positive rate (TPR) and safety of both groups were compared. RESULTS: TPR was not different between the two groups. Liver puncture track subcapsular hemorrhage and arteriovenous shunt were reported with 18G TCN but not with 21G FNAC. The incidence of pain caused by biopsy was higher for the 18G TCN group compared to the 21G FNAC group (P<0.05). About 82.6% of the patients in the 18G TCN group had a sample length >0.5 cm, but 52.1% in the 21G FNAC group (P<0.05). More than 50% of patients in both groups had sufficient tissue for immunohistochemical examination. CONCLUSIONS: TPR is not different between the 21G FNAC and 18G TCN biopsy procedures, but the safety of 21G FNAC is superior to that of 18G TCN. Tissues obtained by either of these two procedures are sufficient for a pathological diagnosis.

Damage to pig bile duct caused by intraluminal brachytherapy using a (125)I ribbon.

BACKGROUND: Stent occlusion by tumor ingrowth or overgrowth is the main cause of jaundice recurrence after metal stent insertion in patients with malignant obstructive jaundice (MOJ). The application of intraluminal brachytherapy (ILBT) in patients with MOJ results in local control of malignant tumors, which prolong stent patency. PURPOSE: To evaluate the safety of ILBT in pig bile ducts using ribbons of iodine-125 ((125)I) seeds. MATERIAL AND METHODS: Sixteen healthy pigs were randomly assigned to four groups of four pigs each. A (125)I seed ribbon was implanted into the common bile duct of each animal through an incision in the duct wall, and was fixed by suturing. The four groups of animals were sacrificed at 15, 30, 60, and 120 days after ribbon implantation, respectively. Serum bilirubin concentrations, alanine aminotransferase concentrations, and white blood cell counts before and after implantation were compared within each group. Pathological changes to the bile duct wall were observed using a light microscope. Morphological changes in biliary epithelial cells and organelles were observed with electron microscopy. RESULTS: (125)I ribbons were successfully implanted in all animals without surgery-related death. We found no significant difference in pre- and post-implant serum bilirubin, alanine aminotransferase, or white blood cell counts. Light and electron microscopy showed that the most severe bile duct damage occurred in the 15-day group, which exhibited necrosis and detachment of numerous epithelial cells, and infiltration of inflammatory cells. Repair and proliferation of the bile duct epithelium began 30 days after implantation and was nearly complete at 60 days. CONCLUSION: This study demonstrated the safety of ILBT using a (125)I ribbon in the pig bile duct. (125)I seed ribbons may be used in the treatment of MOJ in humans.

The use of ¹²5I seed strands for intraluminal brachytherapy of malignant obstructive jaundice.

This study is sought to evaluate the feasibility and safety of using ¹²5I seed strands for intraluminal brachytherapy (ILBT) in the treatment of malignant obstructive jaundice (MOJ), and its clinical effect on stent patency. A total of 34 patients found to have MOJ were randomly assigned to an ILBT treatment group or a control group before biliary stent insertion. For the ILBT group, ¹²5I seed strands were implanted into the obstructive segment of the bile duct after stent insertion. For the control group, only the biliary stent was inserted. Alimentary and hematologic complications were examined for patients in the ILBT group. The stent patency of the two groups were compared. In the ILBT group, the number of ¹²5I seeds per strand varied from 6 to 16 (mean, 10.9), and were successfully implanted in 17 patients. Serum levels of bilirubin, alanine aminotransferase, granulocytes, and platelets assayed 2 and 4 weeks following the procedure demonstrated no significant difference between the ILBT group and the control group. The mean stent patency for ILBT group (10.2 months) was significantly longer than that of the control group (7.2 months, p=0.032). ¹²5I seed strands for ILBT is a feasible and safe palliative therapy for the treatment of MOJ, and may prolong stent patency.

Identifying serum biomarkers for TACE therapy efficiency of hepatocellular carcinoma.

Transcatheter Arterial Chemoembolization (TACE) is the first line of treatment in inoperable hepatocellular carcinoma. Magnetic affinity beads can be used to extract peptides from un-fractionated serum samples. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) can detect the presence and the molecular mass of peptides. In this study, we used a highly optimized ClinProt-matrix-assisted laser desorption/ionization time-of flight mass spectrometer (MALDI-TOF-MS) to screen hepatocellular carcinoma markers for TACE. 40 sera from 20 patients, including before and after TACE to explore those biomarkers, might be related with therapy efficiency, and some of the patients who received another therapy were analyzed as well. The spectra were analyzed statistically using FlexAnalysis™ and Clin-Prot™ bioinformatic software. The seven most significant differential peaks (p < 0.0.5) were selected out by ClinProTool software to identify hepatocellular carcinoma markers for TACE therapy. Furthermore, the differential peptide of 3883Da was identified as plasma serine protease inhibitor precursor (Protein C inhibitor). This study provides a direct link between peptide marker profiles and TACE therapy, and the markers may have clinical utility for monitoring efficiency of therapy.

Surface-modified nanoscale carbon black used as sorbents for Cu(II) and Cd(II).

Commercial carbon blacks often have low adsorption capacity for metal ions. Surface modification of them by appropriate physical and chemical treatments could improve their absorption capacities, and hence extend their environmental application. A surface-modified nanoscale carbon black was prepared by oxidizing the carbon black with 65% HNO(3). Batch experiments showed that the adsorption quantities of Cu(II) or Cd(II) on this modified carbon black (MCB) were significantly increased compared with those on the parent one, and the maximum adsorption quantities of Cu(II) and Cd(II) on the MCB were 438 and 282 mmol kg(-1), respectively. The desorption percentages of Cu(II) or Cd(II) from the MCB increased with the increasing quantities initially adsorbed. In the binary system of Cu(II) and Cd(II), these two metal ions exhibited competition on the MCB, preferential for Cu(II). It could be concluded that the MCB had very good adsorption properties for the metal ions, and could be applied in the purification of wastewater containing such metal ions.

Roles of abiotic losses, microbes, plant roots, and root exudates on phytoremediation of PAHs in a barren soil.

Phytoremediation is an emerging technology for the remediation of polycyclic aromatic hydrocarbons (PAHs). In this study, pot experiments were conducted to evaluate the efficacy of phytoremediation of phenanthrene and pyrene in a typical low organic matter soil (3.75 g kg(-1)), and the contribution proportions of abiotic losses, microbes, plant roots, and root exudates were ascertained during the PAHs dissipation. The results indicated that contribution of abiotic losses from this soil was high both for phenanthrene (83.4%) and pyrene (57.2%). The contributions of root-exudates-enhanced biodegradation of phenanthrene (15.5%) and pyrene (21.3%) were higher than those of indigenous microbial degradation. The role of root exudates on dissipation of phenanthrene and pyrene was evident in this experiment. By the way, with the increasing of ring numbers in PAHs structures, the root-exudates-enhanced degradation became more and more important. BIOLOG-ECO plate analysis indicated that microbial community structure of the soil receiving root exudates had changed. The removal efficiency and substrate utilization rate in the treatment with plant roots were lower than the treatment only with root exudates, which suggested that possible competition between roots and microbes for nutrients had occurred in a low organic matter soil.

[Prognostic analysis of 669 liver metastasis of colorectal cancer cases].

OBJECTIVE: To evaluate the relation between different therapy and survival rate of liver metastasis of colorectal cancer (LMCC). METHODS: Clinical data of 669 LMCC patients,collected from Fudan University Zhongshan Hospital from January 2000 to July 2008, were analyzed retrospectively. RESULTS: Of the 669 cases, 379 cases were synchronous liver metastases(SLM) and 290 cases were metachronous liver metastases(MLM). There were no significant differences in age, gender and position of primary tumor between SLM and MLM groups(P>0.05), but as to liver metastasis characteristics(liver lobe involved, focus number and maximal focus diameter) and CEA, CA19-9 before therapy,there were significant differences(P<0.05). Two hundred and fifty-three cases underwent curative hepatic resection, including 123 cases in SLM and 130 cases in MLM. Until October 31, 2008, all the cases were followed up. The median survival time of SLM was(11+/-1) months and of MLM(23+/-2) months(P<0.01). Five-year survival rate of SLM was 6.4% and of MLM 11.4%(P<0.01). As to different treatments, median survival time and 5-year survival rate of curative hepatic resection group were 37 months and 35.6%, and of non-operation groups(i.e. intervention, chemotherapy, radiofrequency therapy and percutaneous ethanol injection) were 5 to 26 months and 0 to 3.6% respectively(P<0.05). CONCLUSIONS: Curative hepatic resection is the first choice of liver metastasis of colorectal cancer, which can improve the survival rate. Resection rate and survival of MLM are better than those of SLM.

Prognostic analysis of pulmonary metastases from hepatocellular carcinoma.

PURPOSE: To analyze the prognostic factors for the patients with lung metastases from hepatocellular carcinoma (HCC). METHODS AND MATERIALS: One hundred and five patients with lung metastases from HCC were analyzed retrospectively. We analyzed the impact factors, including the gender, age, liver function, serum AFP and gamma-GT level, the status of intrahepatic tumor and pulmonary metastases and treatment for them, the distant metastases beyond the lung, as well as the causes of death. The overall cumulative probability of survival was calculated by the Kaplan-Meier method, and the difference between the groups was compared using the Log-rank test. Univariate and multivariate analyses using the Cox-regression proportional hazard model were performed to evaluate the prognostic parameters for survival. RESULT: The survival after the lung metastases was influenced by clinical parameters, such as the status and the treatment for both the intrahepatic tumor and the pulmonary lesions. The causes of death were respiratory failure due to metastatic lesions from HCC in 16 patients (20.0%), liver failure caused by the progressive intrahepatic lesions in 54 (67.5%). The mean and median survival times were 684 and 487 days after HCC diagnosis and 264 and 179 days after lung metastases, respectively. CONCLUSION: It was very important to treat the intrahepatic tumor because its worsening was still the major cause of death. The progressive treatment for pulmonary metastases may also be advised for possible prolongation of survival.

[Survival of patients with liver metastasis from colorectal cancer by different modes of therapy: a report of 363 cases].

OBJECTIVE: To evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer ( LMCC) , and to compare the clinical outcome of synchronous liver metastasis (SLM) with that of metachronous liver metastasis (MLM). METHODS: The clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival. RESULTS: Of these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site (P > 0. 05 ), but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy(P <0. 05). Ninety-one patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4. 5% (1/22) in SLM group and 2. 9% (2/69) in MLM group( P < 0.05). All patients were followed until 31/6/2005. The 3-year survival rate was 5. 2% with a median survival time of 10 +/- 1 months for the SLM group, and it wasl6. 4% and 17 +/- 1 months for the MLM group (P<0.01). Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16. 7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs (P <0. 05, P <0. 01 ). CONCLUSION: Curative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase II resection rate. Metachronous liver metastasis has higher resection rate and better survival than the synchronous liver one.

[Epirubicin in the treatment of malignant obstructive jaundice].

OBJECTIVE: To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ). METHODS: Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up. RESULTS: Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months). CONCLUSION: Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.

[Preoperative hepatic and regional arterial infusion chemotherapy in the prevention of liver metastasis after colorectal cancer surgery].

OBJECTIVE: To investigate the effects of preoperative hepatic and regional arterial infusion chemotherapy (PHRAIC) in the prevention of liver metastasis of colorectal cancer after surgery. METHODS: 110 patients of colorectal cancer underwent perfusion of 3 anti-tumor drugs into the hepatic artery and nutrient artery of the tumor respectively, radical surgery of the colorectal cancer 7 days after, and then general venous chemotherapy 3 weeks after operation, 112 patients underwent radical surgery of the colorectal cancer and general venous chemotherapy 3 weeks after operation. Follow-up was carried out every month with a follow-up period of 34 months +/- 3 months. RESULTS: There were no significant difference in post-operational complications between these 2 groups. The 3-year liver metastasis rate, 3-year tumor-free survival rate, overall survival rate, and median survival time of the stage III patients in the PHRAIC group were 12.7%, 82.3%, 87.7%, and 40 months +/- 5 months, all significantly better than those in the control group (28.3%, 58.7%, 75.5%, and 36 months +/- 3 months respectively, P < 0.05 or P < 0.01). CONCLUSION: PHRAIC reduces the liver metastasis of colorectal cancer after radical surgery and improves the survival of the stage III patients.

Radiation therapy for adrenal gland metastases from hepatocellular carcinoma.

BACKGROUND: The adrenal gland is a common site of extrahepatic metastases from hepatocellular carcinoma. However, it has been the subject of few studies, and the optimal treatment remains unclear. Methods previously tried for the management of adrenal gland metastasis of hepatocellular carcinoma included surgical resection, transarterial chemoembolization or percutaneous ethanol injection, on the basis of case reports. External beam radiation therapy has seldom been applied for patients with adrenal gland metastases. METHODS: We retrospectively studied 22 patients with adrenal metastases from hepatocellular carcinoma who were treated with limited-field external beam radiation therapy. The radiation dose to the adrenal lesion ranged from 36 to 54 (median 50) Gy, while the intrahepatic lesions were treated with either surgical resection or transarterial chemoembolization. RESULTS: Among the 14 patients who had pain related to adrenal metastases, 11 (78.6%) had complete pain relief without medication that lasted until death. Two (14.3%) patients had marked pain relief, but still required analgesics. Partial responses were observed in 73% of the patients. The median survival period for all patients was 10 months. No patient died from complications related to adrenal metastasis. Adverse effects were mild. CONCLUSION: Adrenal metastases from hepatocellular carcinoma are sensitive to radiation treatment. Radiation therapy with 50 Gy for adrenal gland metastases is a good palliative therapy with reasonable safety.

HDR-192Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice.

AIM: To determine the feasibility and safety of intraluminal brachytherapy in treatment of malignant obstructive jaundice (MOJ) and to evaluate the clinical effect of intraluminal brachytherapy on stent patency and patient survival. METHODS: Thirty-four patients with MOJ were included in this study. Having biliary stent placed, all patients were classified into intraluminal brachytherapy group (group A, n = 14) and control group (group B, n = 20) according to their own choice. Intraluminal brachytherapy regimen included: HDR-192Ir was used in the therapy, fractional doses of 4-7 Gy were given every 3-6 d for 3-4 times, and standard points were established at 0.5-1.0 cm. Some patients of both groups received transcatheter arterial chemoembolization (TACE) after stent placement. RESULTS: In group A, the success rate of intraluminal brachytherapy was 98.0%, RTOG grade 1 acute radiation morbidity occurred in 3 patients, RTOG/EORTC grade 1 late radiation morbidity occurred in 1 patient. Mean stent patency of group A (12.6 mo) was significantly longer than that of group B (8.3 mo) (P<0.05). There was no significant difference in the mean survival (9.4 mo vs 6.0 mo) between the two groups. CONCLUSION: HDR-192Ir intraluminal brachytherapy is a safe palliative therapy in treating MOJ, and it may prolong stent patency and has the potentiality of extending survival of patients with MOJ.