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1.
Purpose
To assess the effect of a shrinking rectal balloon implant (RBI) on the anorectal dose and complication risk during the course of moderately hypofractionated prostate radiotherapy.Methods
In 15 patients with localized prostate cancer, an RBI was implanted. A weekly kilovolt cone-beam computed tomography (CBCT) scan was acquired to measure the dynamics of RBI volume and prostate–rectum separation. The absolute anorectal volume encompassed by the 2?Gy equieffective 75?Gy isodose (V75Gy) was recalculated as well as the mean anorectal dose. The increase in estimated risk of grade 2–3 late rectal bleeding (LRB) between the start and end of treatment was predicted using nomograms. The observed acute and late toxicities were evaluated.Results
A significant shrinkage of RBI volumes was observed, with an average volume of 70.4% of baseline at the end of the treatment. Although the prostate–rectum separation significantly decreased over time, it remained at least 1?cm. No significant increase in V75Gy of the anorectum was observed, except in one patient whose RBI had completely deflated in the third week of treatment. No correlation between mean anorectal dose and balloon deflation was found. The increase in predicted LRB risk was not significant, except in the one patient whose RBI completely deflated. The observed toxicities confirmed these findings.Conclusions
Despite significant decrease in RBI volume the high-dose rectal volume and the predicted LRB risk were unaffected due to a persistent spacing between the prostate and the anterior rectal wall.2.
Anouchka Modesto Anne Laprie Laure Vieillevigne Pierre Graff Jérôme Sarini Sébastien Vergez Jean-Pierre Delord Jean-Claude Farenc Emmanuelle Vigarios Thomas Filleron Michel Rives 《Strahlentherapie und Onkologie》2015,191(3):225-233
Purpose
The purpose of this work was to retrospectively determine the value of intensity-modulated radiotherapy (IMRT) in patients with laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC), on outcome and treatment-related toxicity compared to 3-dimensional conformal radiotherapy (3D-CRT).Materials and methods
A total of 175 consecutive patients were treated between 2007 and 2012 at our institution with curative intent RT and were included in this study: 90 were treated with 3D-CRT and 85 with IMRT. Oncologic outcomes were estimated using Kaplan–Meier statistics; acute and late toxicities were scored according to the Common Toxicity Criteria for Adverse Events scale v 3.0.Results
Median follow-up was 35 months (range 32–42 months; 95% confidence interval 95?%). Two-year disease-free survival did not vary, regardless of the technique used (69?% for 3D-CRT vs. 72?%; for IMRT, p?=?0.16). Variables evaluated as severe late toxicities were all statistically lower with IMRT compared with 3D-CRT: xerostomia (0 vs. 12?%; p?<?0.0001), dysphagia (4 vs. 26?%; p?<?0.0001), and feeding-tube dependency (1 vs 13?%; p?=?0.0044). The rates of overall grade ≥?3 late toxicities for the IMRT and 3D-CRT groups were 4.1 vs. 41.4?%, respectively (p?<?0.0001).Conclusion
IMRT for laryngeal and hypopharyngeal cancer minimizes late dysphagia without jeopardizing tumor control and outcome.3.
Luciana Lastrucci Silvia Bertocci Vittorio Bini Simona Borghesi Roberta De Majo Andrea Rampini Paola Pernici Pietro Giovanni Gennari 《La Radiologia medica》2017,122(4):303-308
Purpose
To analyze quality of life (QoL) and functional state (FS) by patient-reported outcome (PRO) questionnaires (FACT-G, FACT-NP, PSS-HN, XeQOLS, and EQ-5D-3L) in long-term survivors nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy (RT) and intensity modulated radiotherapy (IMRT).Methods
25 patients answered to five questionnaires about QoL and FS. All patients were assessed also for late toxicity.Results
Functional Assessment of Cancer Therapy-General (FACT-G) and Performance Status Scale Head and Neck (PSS-HN) scores were significantly elevated (better QoL) in age <50 years (p = 0.03). PSS-HN score was higher in IMRT group. The observed xerostomia was lower in the IMRT group and in patients who received conventional RT had worse QoL according to XeQOLS (University of Michigan Xerostomia-Related Quality of Life Scale) score questionnaire. Lower PSS-HN score and higher XeQOLS score were significantly related with the late xerostomia (p = 0.009 and 0.002, respectively).Conclusions
Our preliminary data suggest that age, older techniques, xerostomia, and hearing loss are negative predictors of QoL.4.
Silvia Scoccianti Marco Krengli Livia Marrazzo Stefano Maria Magrini Beatrice Detti Vincenzo Fusco Luigi Pirtoli Daniela Doino Alba Fiorentino Laura Masini Daniela Greto Michela Buglione Giovanni Rubino Federico Lonardi Fernanda Migliaccio Salvino Marzano Riccardo Santoni Umberto Ricardi Lorenzo Livi 《La Radiologia medica》2018,123(1):48-62
Introduction
A multicenter phase II study for assessing the efficacy and the toxicity of hypofractionated radiotherapy with SIB plus temozolomide in patients with glioblastoma was carried out by the Brain Study Group of the Italian Association of Radiation Oncology.Methods
Twenty-four patients with newly diagnosed glioblastoma belonging to Recursive Partitioning Analysis classes III and IV were enrolled. The prescribed dose was 52.5 Gy in 15 fractions of 3.5 Gy and 67.5 in 15 fractions of 4.5 Gy to the SIB volume. Dose constraints for the hypofractionated schedule were provided. Radiotherapy was associated with concomitant and sequential temozolomide.Results
Median overall survival (OS) was 15.1 months, while median progression-free survival (PFS) was 8.6 months. Actuarial OS at 12 months was 65.6% ± 0.09, whereas actuarial PFS at 12 months was 41.2% ± 0.10. Status of methylation of MGMT promoter resulted to be a significant prognostic factor for OS. Radiotherapy-related acute toxicity was not relevant. Three patients (12.5%) had G3 myelotoxicity that required temozolomide temporary interruption or dose reduction during the chemotherapy. However, chemotherapy was not definitely discontinued for toxicity in any case. One patient out of 24 (4.2%) developed radionecrosis that required surgical resection with no evidence of disease in the surgical specimen.Conclusions
This trial confirms that hypofractionated radiotherapy with SIB and association with temozolomide may be a reasonable and feasible option for good prognosis patients with GBM.5.
Purpose
Dysphagia is one of the most important treatment-related side effects in head and neck cancer (HNC), as it can lead to severe life-threating complications such as aspiration pneumonia and malnutrition. Intensity-modulated radiotherapy (IMRT) could reduce swallowing dysfunction by producing a concave dose distribution and reducing doses to the swallowing-related organs at risk (SWOARs). The aim of this study was to review the current literature in order to compare swallowing outcomes between IMRT and three-dimensional conformal radiotherapy (3DCRT).Methods
A search was conducted in the PubMed and Embase databases to identify studies on swallowing outcomes, both clinically and/or instrumentally assessed, after 3DCRT and IMRT. Dysphagia-specific quality of life and objective instrumental data are summarized and discussed.Results
A total of 262 papers were retrieved from the searched databases. An additional 23 papers were retrieved by hand-searching the reference lists. Ultimately, 22 papers were identified which discussed swallowing outcomes after 3DCRT and IMRT for HNC. No outcomes from randomized trials were identified.Conclusion
Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing.6.
Background
This treatment planning study analyzes dose coverage and dose to organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) of rectal cancer and compares prone vs. supine positioning as well as the effect of dose optimization for the small bowel (SB) by additional dose constraints in the inverse planning process.Patients and methods
Based on the CT datasets of ten male patients in both prone and supine position, a total of four different IMRT plans were created for each patient. OAR were defined as the SB, bladder, and femoral heads. In half of the plans, two additional SB cost functions were used in the inverse planning process.Results
There was a statistically significant dose reduction for the SB in prone position of up to 41% in the high and intermediate dose region, compared with the supine position. Furthermore, the femoral heads showed a significant dose reduction in prone position in the low dose region. Regarding the additional active SB constraints, the dose in the high dose region of the SB was significantly reduced by up to 14% with the additional cost functions. There were no significant differences in the dose distribution of the planning target volume (PTV) and the bladder.Conclusion
Prone positioning can significantly reduce dose to the SB in IMRT for rectal cancer and therefore should not only be used in 3D conformal radiotherapy but also in IMRT of rectal cancer. Further protection of the SB can be achieved by additional dose constraints in inverse planning without jeopardizing the homogeneity of the PTV.7.
Tanja?Sprave Vivek?Verma Robert?F?rster Ingmar?Schlampp Thomas?Bruckner Tilman?Bostel Stefan?Ezechiel?Welte Eric?Tonndorf-Martini Rami?El Shafie Nils?Henrik?Nicolay Jürgen?Debus Harald?Rief
Purpose
Radiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT).Methods
This was a prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases. A total of 60 patients were randomized between November 2016 and May 2017. In both cohorts, RT was delivered in 10 fractions of 3?Gy each. The primary endpoint was radiation-induced toxicity at 3 months.Results
Median follow-up was 4.3 months. Two patients suffered from grade 3 acute toxicities in the IMRT arm, along with 1 patient in the 3DCRT group. At 12 weeks after treatment (t2), 1 patient reported grade 3 toxicity in the IMRT arm vs. 4 patients in the 3DCRT group. No grade 4 or 5 adverse events occurred in either group. In the IMRT arm, the most common side effects by the end of irradiation (t1) were grade 1–2 xerostomia and nausea in 8 patients each (29.6%), and dyspnea in 7 patients (25.9%). In the 3DCRT group, the most frequent adverse events (t1) were similar: grade 1–2 xerostomia (n?=?10, 35.7%), esophagitis (n?=?10, 35.8%), nausea (n?=?10, 35.8%), and dyspnea (n?=?5, 17.9%).Conclusion
This is the first randomized trial to evaluate radiation-induced toxicities after IMRT versus 3DCRT in patients with vertebral metastases. This trial demonstrated an additional improvement for IMRT in terms of acute side effects, although longer follow-up is required to further ascertain other endpoints.8.
Ming-Hui Mao Jian-Guo Zhang Lei Zheng Hong Gao Jie Zhang Shu-ming Liu Ming-wei Huang Yan Shi 《Strahlentherapie und Onkologie》2015,191(1):26-33
Background
We studied the incidence and dose–response relationship of radioepidermitis in parotid gland carcinoma patients treated with [125I] seed brachytherapy in the hopes of designing an optimized pre-implant treatment plan that would reduce the incidence and severity of radioepidermitis in patients receiving this therapy.Patients and methods
Between January 2007 and May 2010, 100 parotid gland cancer patients were treated postoperatively with [125I] seed brachytherapy. The matched peripheral dose (MPD) was 80–140 Gy, and [125I] seed activity was 0.7–0.8 mCi. The mean dose delivered to the skin was calculated in the post-implant CT on day 0 following implantation. Grades of acute and late dermatitis were evaluated at 2, 6, 12, and 18 months post-implantation.Results
Most patients experienced grade 0–2 acute and late skin side effects (86 and 97?%, respectively), though a small subset developed severe complications. Most grade 1–3 effects resolved within 6 months of implantation, though some grade 1–3 effects and all grade 4 effects remained unchanged throughout the 18-month follow-up period. Grade 3 and 4 effects were most prominent (75 and 25?%, respectively) with doses of 110–140 Gy; doses higher than 140 Gy produced only grade 4 effects.Conclusion
[125I] seed brachytherapy produced acceptable levels of acute and late radioepidermitis with a good clinical outcome. A mean dose under 100 Gy delivered to the skin was safe, though doses of 110–140 Gy should be given with caution and extra monitoring; doses greater than 140 Gy are dangerous and likely to produce grade 4–5 effects.9.
Objectives
We evaluated the rate of late recanalisation beyond 24 h after intravenous thrombolysis (IVT) and its relationship with haemorrhagic transformation and outcome.Methods
We reviewed prospectively collected clinical and imaging data from acute ischaemic stroke patients with distal internal carotid artery or proximal middle cerebral artery occlusion who underwent angiography on admission, 24 h and 1 week after IVT. Patients were trichotomised according to vascular status: timely recanalisation (<24 h), late recanalisation (24 h-7 days), and no recanalisation.Results
Non-invasive angiography revealed timely recanalisation in 52 (50.0 %) patients, late recanalisation in 25 (24.0 %) patients, and no recanalisation in 27 (26.0 %) patients. Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation (odds ratio 6.674; 95 % CI: 1.197 to 37.209; p?=?0.030). In patients without timely recanalisation, shift analysis indicated that late recanalisation led to a worse modified Rankin Scale score (odds ratio 6.787; 95 % CI: 2.094 to 21.978; p?=?0.001).Conclusions
About half of all patients without recanalisation by 24 h after IVT may develop late recanalisation within 1 week, along with higher mRS scores by 3 months. Pre-existing atrial fibrillation is an independent predictor for late recanalisation.Key Points
? About half of patients may develop late recanalisation within 1 week. ? Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation. ? Late recanalisation led to a higher mRS score than no recanalisation.10.
Stéphanie Smet Maarten Lambrecht Bianca Vanstraelen Sandra Nuyts 《Strahlentherapie und Onkologie》2015,191(1):43-50
Background
Several planning studies have already proven the substantial dosimetric advantages of RapidArc (RA) over standard intensity-modulated radiotherapy. We retrospectively compared RapidArc and standard sliding window IMRT (swIMRT) in locally advanced head and neck cancer, looking both at dosimetrics as well as toxicity and outcome.Methods
CT datasets of 78 patients treated with swIMRT and 79 patients treated with RA were included. To compare the resulting dose distributions, the dose–volume parameters were evaluated for the planning target volumes (PTVs), clinical target volumes (CTVs), and organs at risk (OARs), and the number of MU were calculated. Acute toxicity was assessed by the Common Toxicity Criteria version 3.0.Results
PTV coverage with the 95?% isodose was slightly better for RA. Dose distribution has proven to be significantly more homogenous with RA and led to a reduction of 62?% in MU with better OAR sparing. As for toxicity, more grade 3 mucositis and dysphagia was observed for swIMRT, though we observed more grade 3 dermatitis for RA.Conclusion
In our retrospective analysis, RA had better target coverage and better sparing of the OAR. Overall, the grade of acute toxicity was lower for RA than for swIMRT for the same types of tumor locations, except for the grade of dermatitis.11.
Noah Nakanishi Taro Shimono Akira Yamamoto Yukio Miki 《Japanese journal of radiology》2016,34(1):10-15
Purpose
Delayed colonic perforation after acute pancreatitis (AP) is a potentially lethal complication. This study investigated the frequency and predictors of delayed colonic perforation (DCP) following AP by reviewing the earliest laboratory data and computed tomography (CT) examination findings after pancreatitis onset.Materials and methods
This retrospective study examined 75 consecutive cases of AP treated between April 2009 and April 2014. Laboratory data after onset and imaging features from earliest CT examinations (Balthazar grade, CT Severity Index) were reviewed. To clarify relationships between these data and DCP, univariate analyses were undertaken between perforated and nonperforated groups.Results
Delayed colonic perforation occurred in four of the 75 patients (5.3 %). Median duration to perforation after onset was 13 days (range 6–47). All four patients with DCP showed grade E according to Balthazar grade (≥2 peripancreatic collections and/or gas bubbles in or adjacent to pancreas). Univariate analyses identified Balthazar grade E as a risk factor for DCP (p = 0.0087).Conclusion
Delayed colonic perforation is not uncommon and can occur a week or more after AP. Balthazar grade E on earliest CT after onset represents a risk factor for DCP.12.
Objective
This study aims to evaluate local control and intermediate-term cosmetic outcome in patients with cancer of the nose treated with intensity-modulated radiotherapy (IMRT).Methods
From June 2008 to September 2015, 36 consecutive patients presenting with nasal cavity, ala of the nose, or nasal vestibule tumors were treated at the Department of Radiation Oncology, University Hospital Zurich either postoperatively (n = 14; 3/14 with nasal ablation) or with definitive IMRT (n = 22). Of these 36 patients, 8 presented with recurrent disease after surgery only and 1/36 with N1 disease. Concurrent systemic therapy was administered in 18/36 patients (50%). Nasal follow-up (FU) imaging documentation of 13 patients with preserved organ and >6 months FU offers a pre/post IMRT FU comparison. In addition, these patients’ subjective evaluation of cosmesis was assessed.Results
Mean/median FU was 41/33 months (range 5–92 months). Salvage ablation with curative intent was undergone by 3 patients with local relapse after definitive (n = 2) and postoperative (n = 1) IMRT. The 3?year local control, ultimate local control, and overall survival rates were 90, 97, and 90?%, respectively. Subjective and objective cosmetic outcome after IMRT is very satisfying so far.Conclusion
IMRT for nasal tumors was found to be effective and well tolerated. Intermediate-term cosmetic results are good. Radical surgical procedures may be saved for curative salvage treatment.13.
Dalton A. dos Anjos Angelita Habr-Gama Bruna B. Vailati Cecilia B. Rossi Adelina E. Coturel Rodrigo O. Perez Guilherme P. São Julião João B. de Sousa Carlos A. Buchpiguel 《Annals of nuclear medicine》2016,30(8):513-517
Purpose
PET/CT has been considered limited for the evaluation of mucinous colorectal tumors due to low 18F-FDG uptake. The aim of our study was to compare PET/CT variables in mucinous (MC) and nonmucinous (NMC) rectal adenocarcinomas.Methods
Consecutive patients with cT2-4N0-2M0 rectal cancer included in a prospective clinical trial were reviewed. PET/CT was performed for primary baseline staging. Visual and quantitative analysis included SUVmax and SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). PET/CT parameters were compared according to histological subtypes.Results
Overall, 73 patients were included (18 mucinous and 55 nonmucinous). SUVmax values were similar between MC and NMC (19.7 vs. 16.6; p = 0.5). MTV and TLG values were greater in the MC group (103.9 vs. 54.1; p = 0.007 and 892.5 vs. 358.8; p = 0.020) due to larger tumor volumes of MC.Conclusions
Metabolic parameters at baseline PET/CT for patients with rectal cancer are similar in mucinous and nonmucinous histological subtypes.14.
Aim
This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.Methods
Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.Results
Several large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.Conclusion
Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.15.
Objective
To examine the outcomes of reirradiation for recurrent head and neck cancers using different modalities.Methods
This retrospective study included 26 patients who received charged particle radiotherapy (CP) and 150 who received photon radiotherapy (117 CyberKnife radiotherapy [CK] and 36 intensity-modulated radiotherapy [IMRT]). Inverse probability of treatment weighting (IPTW) involving propensity scores was used to reduce background selection bias.Results
Higher prescribed doses were used in CP than photon radiotherapy. The 1?year overall survival (OS) rates were 67.9% for CP and 54.1% for photon radiotherapy (p = 0.15; 55% for CK and 51% for IMRT). In multivariate Cox regression, the significant prognostic factors for better survival were nasopharyngeal cancer, higher prescribed dose, and lower tumor volume. IPTW showed a statistically significant difference between CP and photon radiotherapy (p = 0.04). The local control rates for patients treated with CP and photon radiotherapy at 1 year were 66.9% (range 46.3–87.5%) and 67.1% (range 58.3–75.9%), respectively. A total of 48 patients (27%) experienced toxicity grade ≥3 (24% in the photon radiotherapy group and 46% in the CP group), including 17 patients with grade 5 toxicity. Multivariate analysis revealed that younger age and a larger planning target volume (PTV) were significant risk factors for grade 3 or worse toxicity.Conclusion
CP provided superior survival outcome compared to photon radiotherapy. Tumor volume, primary site (nasopharyngeal), and prescribed dose were identified as survival factors. Younger patients with a larger PTV experienced toxicity grade ≥3.16.
Eisaku Yoden Takayuki Nose Yuki Otani Shuuji Asahi Iwao Tsukiyama Takushi Dokiya Toshiaki Saeki Ichirou Fukuda Hiroshi Sekine Naoto Shikama Yu Kumazaki Takao Takahashi Ken Yoshida Tadayuki Kotsuma Norikazu Masuda Kazutaka Nakashima Taisei Matsumura Shino Nakagawa Seiji Tachiiri Yoshio Moriguchi Jun Itami Masahiko Oguchi 《Japanese journal of radiology》2017,35(7):381-388
Purpose
We conducted a multi-institutional prospective study on accelerated partial breast irradiation (APBI) using interstitial brachytherapy. The clinical results over a minimum follow-up period of 30 months are presented here.Materials and methods
Forty-six patients with breast cancer were treated with breast-conserving surgery and postoperative APBI. After confirmation of negative surgical margins and negative lymph nodes, a high-dose-rate brachytherapy protocol of 36 Gy/6 fractions was carried out. All clinical data were prospectively collected using the Common Terminology Criteria for Adverse Events ver. 3.0.Results
No recurrence was observed. Cumulative rates of grade 2 or higher late sequelae were 25% for fibrosis, 2% for fractures, 9% for pain, and 9% for soft tissue necrosis. Rates of excellent or good cosmetic results as assessed by the physician and patient were 93 and 89% at the 12-month follow-up and 76 and 74% at the 30-month follow-up, respectively. Large volumes of resected tissue in small breasts were associated with fibrosis of grade 2 or higher.Conclusion
APBI in Japanese women provides satisfactory clinical results except for cosmetic outcomes. There is some difficulty with the assessment of fibrosis and cosmetic outcomes, especially in patients with small breasts.Clinical Trial Registration Number
UMIN000001677.17.
Purpose
The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation.Methods
Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder.Results
All patients had follow-up times of 36 months (range 6–60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P < 0.05). Preoperative VAS scores were 5.1 ± 1.7, and the VAS scores at the last review were 0.7 ± 1.4 (P < 0.05). Follow-up radiographs showed anatomical reduction in 20 patients and slight loss of reduction in 4 patients. Calcification of CC ligament in 4 patients, degenerative change around the AC joint in 2 patient and clavicular osteolysis around screws in one patient were found.Conclusions
LARS artificial ligament for reconstruction of CC can provide immediate stability and allow early shoulder mobilization with good functional results and few complications. This procedure was an effective and safe method to treat grade III and more AC joint dislocations.Level of evidence
IV.18.
Purpose
To clarify the frequency, severity, and risk factors for acute pancreatitis after percutaneous biliary stent placement across the papilla of Vater for malignant biliary obstruction.Materials and Methods
This retrospective study included 95 patients who underwent percutaneous biliary metallic stent placement (64 [67.4%] bare stents and 31 [32.6%] covered stents) across the papilla of Vater for malignant biliary obstruction between January 2010 and December 2012. The incidence of acute pancreatitis (Atlanta classification of acute pancreatitis) and its severity (Common Terminology Criteria for Adverse Events, version 4) were reviewed. Additionally, the characteristics of the patients and biliary stents, and the computed tomography findings of the pancreas were evaluated.Results
Grade 3 acute pancreatitis was observed in 23 patients (24.2%); acute pancreatitis of grade 4 or higher was not observed. The incidence of acute pancreatitis was lower in patients with atrophic pancreas than in those with non-atrophic pancreas (7.5 vs. 36.4%, p = 0.004). It was also lower in patients with main pancreatic duct (MPD) obstruction than in those without MPD obstruction (12.5 vs. 36.2%, p = 0.026). There was no difference in the incidence of acute pancreatitis between bare and covered stents.Conclusion
Percutaneous biliary stent placement across the papilla of Vater for malignant biliary stricture caused acute pancreatitis requiring medication in 24.2% of patients. Atrophy of the pancreas and the presence of a dilated MPD may be associated with a decreased risk of acute pancreatitis.Level of Evidence
Level 4, Case Series.19.
Background
Post-transplant lymphoproliferative disorders (PTLDs) are aggressive malignancies which represent one of the major post-transplant complications. However, treatment options vary significantly and localized disease may be curatively treated with radiotherapy (RT) or surgery. We report a case of recurrent rectal PTLD, which was successfully treated by chemoimmunotherapy followed by RT.Case presentation
We describe a patient who developed a rectal lymphoproliferative lesion 11 years after kidney transplant, which was successfully treated with consolidative RT using 25.4 Gy sequential to chemoimmunotherapy (R-CHOP). RT was well tolerated and the patient showed no signs of grade 3 or 4 toxicity. This patient is free of recurrence 52 months after RT, with an overall survival of 62 months since diagnosis.Conclusion
Conventionally fractionated moderate-dose RT appears to be a tolerable and effective treatment option for localized PTLD if a sufficient systemic treatment cannot be applied.20.