This report describes two cases of pseudoaneurysms of the peroneal artery which were successfully treated by transluminal platinum coil embolization. A pseudoaneurysm developed following a ...penetrating wound of the calf, and another did following thromboembolectomy of the occluded femoropopliteal bypass with a Fogarty balloon catheter. The coils were guided and released into the proximal peroneal arteries via the placed catheters on the ipsilateral and contralateral femoral arteries, respectively. The pseudoaneurysms disappeared in both cases and the patients have been doing well until now.
We devised a magnetic resonance imaging (MRI) method for visualizing hepatocellular carcinoma (HCC) and vessel thrombus using a three-dimensional balanced sequence (balanced turbo field echo: B-TFE) ...with a T2 preparation pulse (T2 prep) after enhanced superparamagnetic iron oxide (SPIO) administration. At 1.5T, the following parameters were used: 350mm field of view, 4.3ms repetition time, 2.2ms echo time, 70degree flip angle, 1.0mm slice thickness, and low-to-high k-space profile order. Signal intensity and contrast were assessed in a phantom, and healthy volunteer images were acquired with different prep times. The signal to noise ratio (SNR) was assessed in healthy volunteers. The method was evaluated using optimal prep times from clinical cases: a prep time of 40ms provided the best definition in images of HCC and vessel thrombosis. SPIO-enhanced B-TFE with T2 prep enabled clear and simultaneous visualization of HCC and vessel thrombus.
To evaluate the efficacy and safety of definitive proton beam therapy (PBT) for primary sacral chordoma.
We conducted a retrospective analysis of the clinical outcomes of eligible patients with ...primary sacral chordoma who had undergone definitive PBT with 70.4 Gy (relative biological effectiveness) in 32 fractions at our institution from September 2009 to October 2015. Local progression-free survival, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival were evaluated. To explore the factors that influenced local progression, the following parameters were analyzed: sex, the presence of a spacer (Gore-Tex sheets), gross tumor volume, and extent of cranial tumor extension. Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. To assess the impact of PBT on pain relief, the change in pain grades was investigated between the initiation of PBT and the last follow-up visit.
Thirty-three eligible patients were analyzed. The median follow-up period was 37 months. The 3-year estimated local progression-free survival, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival rates were 89.6%, 88.2%, 81.9%, 95.7%, and 92.7%, respectively. No significant association was between the patients' clinicopathologic characteristics and local progression-free survival. Four patients developed grade 3 adverse events, including acute dermatitis (n = 1), ileus (n = 1), and pain due to sacral insufficiency fractures (n = 2). The pain grades had improved, were unchanged, or had deteriorated in 15, 7, and 11 patients, respectively.
Definitive PBT with 70.4 Gy (relative biological effectiveness) in 32 fractions is an effective treatment with acceptable toxicity for primary sacral chordoma and has the potential to reduce pain.
Particle beam therapy (PT) is a potentially promising approach to the treatment of extrahepatic biliary cancer (EBC) because of its unique dose distribution using the Bragg peak. However, the ...superiority of PT to photon radiotherapy (XT) remains unclear. Therefore, we conducted a systematic review and meta-analysis to compare PT and XT for the treatment of EBC. The primary endpoint was overall survival (OS), which was pooled using a random-effects model. Nine articles comprising a total of 1558 patients (seven XT articles, n = 1488 patients; two PT articles, n = 70 patients) were screened. In addition, we compared the outcomes of XT and PT with the outcomes available from a prospective data registry (proton-net). The 1-year OS probability rates were 55, 65 and 72% for the XT group, PT group and PT registry, respectively. The 2-year OS probability rates were 26, 38 and 38% for the XT group, PT group and PT registry, respectively. The 3-year OS probability rates were 12, 35 and 18% for the XT group, PT group and PT registry, respectively. Although the difference between the 1-year OS rates of the XT group and PT registry was statistically significant, no other significant superiority was observed among these groups. In conclusion, the efficacy of PT was not superior to that of XT during this meta-analysis.
•Carbon ion radiotherapy (CIRT) is useful to treat head and neck tumors.•Radiation-induced brain injury (RIBI) is an adverse effect of irradiation.•The tolerance dose of the brain in CIRT is ...unclear.•Risk factors for RIBI in long-term survivors following CIRT were determined.•CIRT variables were used to generate a probability profile for RIBI treatment.
We aimed to determine the risk factors for radiation-induced brain injury (RIBI11Abbreviations: RIBI, radiation-induced brain injury; CIRT, carbon ion radiotherapy; HNC/SBT, head and neck cancers and skull base tumors; AE, adverse event; DVH, dose volume histogram; LQ, linear–quadratic; MRI, magnetic resonance imaging; CT, computed tomography; GTV, gross tumor volume; CTV, clinical target volume; OAR, organs at risk; RBE, relative biological effectiveness; CTCAE, Common Terminology Criteria for Adverse Events; EUD, equivalent uniform dose; AIC, Akaike Information Criterion; SOBP, Spread-Out Bragg Peak; IMRT, intensity-modulated radiotherapy) after carbon ion radiotherapy (CIRT) to predict their probabilities in long-term survivors.
We evaluated 104 patients with head, neck, and skull base tumors who underwent CIRT in a regimen of 32 fractions and were followed up for at least 24 months. RIBI was assessed using the Common Terminology Criteria for Adverse Events.
The median follow-up period was 45.5 months; 19 (18.3 %) patients developed grade ≥2 RIBI. The maximal absolute dose covering 5 mL of the brain (D5ml) was the only significant risk factor for grade ≥2 RIBI in the multivariate logistic regression analysis (p = 0.001). The tolerance doses of D5ml for the 5% and 50% probabilities of developing grade ≥2 RIBI were estimated to be 55.4 Gy (relative biological effectiveness RBE) and 68.4 Gy (RBE) by a logistic model, respectively.
D5ml was most significantly associated with grade ≥2 RIBI and may enable the prediction of its probability.
Background
The optimal treatment for isolated local recurrence (ILR) of pancreatic adenocarcinoma (PDAC) after surgical resection remains unclear. This study aimed to evaluate the safety and efficacy ...of proton radiotherapy (PRT) for ILR of PDAC after surgery.
Methods
The medical records of patients with ILR of PDAC after surgery who underwent proton beam therapy between 2011 and 2015 at Hyogo Ion Beam Medical Center were retrospectively studied.
Results
The study analyzed 30 patients (14 women and 16 men) with a median age of 65 years (range 38–81 years) who had initially undergone pancreatoduodenectomy (
n
= 23) or distal pancreatectomy (
n
= 7) for their primary tumors. Upon ILR, PRT was administered with a median total cumulative dose of 67.5 gray equivalent (GyE) (range 50–67.5 GyE) using 19 to 25 fractions. For 25 patients, concurrent chemotherapy was administered using gemcitabine (
n
= 18) or S-1 (
n
= 7). Four patients (13.3%) experienced acute grade ≥ 3 gastrointestinal toxicities. After a median follow-up period of 17.6 months (range 2.1–50.4 months), 23 patients had experienced tumor progression and 10 had died. Nine patients (30%) experienced local tumor progression. The median overall, progression-free, and local progression-free survival rates were 26.1, 12.3, and 41.2 months, respectively. Pre-PRT serum levels of cancer antigen 19-9 higher than 100 U/mL and duke pancreatic monoclonal antigen type 2 higher than 150 U/mL were significantly associated with shorter progression-free survival rates.
Conclusions
Proton radiotherapy for ILR of PDAC after surgery is well tolerated and produces good locoregional control and should be considered for eligible patients.
The aim of this retrospective study was to report long‐term clinical outcomes in patients treated with proton therapy (PT) for localized prostate cancer. Between 2001 and 2014, 1375 consecutive ...patients were treated with PT. Patients were classified into prognostic risk groups based on the National Comprehensive Cancer Network criteria. Freedom from biochemical relapse (FFBR), cancer‐specific survival (CSS) and incidence of late gastrointestinal (GI)/genitourinary (GU) toxicities were calculated. Multivariate analysis was performed to identify clinical prognostic factors for FFBR and late toxicities. The median follow‐up period was 70 months (range, 4–145 months). In total, 99% of patients received 74 Gy (relative biologic effectiveness RBE); 56% of patients received neoadjuvant androgen deprivation therapy. For the low‐, intermediate‐, high‐, and very high‐risk groups, 5‐year FFBR was 99% (95% confidence intervals CI, 96–100%), 91% (95% CI, 88–93%), 86% (95% CI, 82–89%), and 66% (95% CI, 53–76%), respectively, and 5‐year CSS was 100% (95% CI, 100–100%), 100% (95% CI, 100–100%) , 99% (95% CI, 97–100%), and 95% (95% CI, 94–98%), respectively. Patient age, T classification, Gleason score, prostate‐specific antigen, and percentage of positive cores were significant prognostic factors for FFBR. Grade 2 or higher GI and GU toxicities were 3.9% and 2.0%. Patient age was a prognostic factor for both late GI and GU toxicities. This study represents the largest cohort of patients treated with PT for localized prostate cancer, with the longest follow‐up to date. Our results demonstrate that the biochemical control of PT is favorable particularly for high‐ and very high‐risk patients with lower late genitourinary toxicity and indicates the necessity of considering patient age in the treatment protocols.
Proton therapy for localized prostate cancer demonstrates favorable biochemical control particularly for high‐ and very high‐risk patients and a lower incidence of late genitourinary toxicity. Our findings indicate the necessity of considering patient age in the treatment protocols.
This retrospective study aimed to determine the clinical outcomes following particle monotherapy (ie, proton therapy PT or carbon ion therapy CIT) in patients with sinonasal squamous cell carcinoma ...at a single institution.
Between August 2001 and March 2012, 59 patients were treated with definitive PT or CIT; none underwent chemotherapy or surgery. Of the patients, 22 (37%) had unresectable disease. PT was used in 38 patients (64%); CIT, 21 patients (36%). Almost half of the patients (n = 29, 47%) received 65.0 Gy (relative biological effectiveness) in 26 fractions.
The median follow-up period was 30 months (range, 8-127 months) for all patients and 65 months (range, 9-127 months) for the survivors. The 3- and 5-year overall survival rates were 56.2% and 41.6%, respectively; progression-free survival rates, 42.9% and 34.7%, respectively; and local control rates, 54.0% and 50.4%, respectively. Late toxicities of grade ≥3 occurred in 13 patients (22%).
To our knowledge, this is the largest retrospective study of sinonasal squamous cell carcinoma treated with particle therapy alone. The efficacy of PT and CIT indicated that particle therapy can serve an important role in treating this disease.
Owing to the high objective response rate of atezolizumab plus bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC), the concept of sequential conversion to local treatment has recently become ...mainstream. The conversion concept is mainly applied to Barcelona Clinic for Liver Cancer (BCLC) stage B cases, and radiotherapy is rarely considered as a conversion local treatment. We herein report three patients who were treated with the novel concept of “sequential particle radiotherapy,” consisting of Atez/Bev therapy followed by particle radiotherapy (PRT) for HCC with advanced portal vein tumor thrombus (Vp3/4 PVTT). All patients achieved partial response radiologically and were switched to PRT. All patients were recurrence free at 1 year after the introduction of Atez/Bev therapy without any additional treatment. This upcoming combination strategy includes the advocacy of sequential concepts for BCLC stage C cases and the introduction of PRT as a local treatment after Atez/Bev.
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