Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer

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.

     

Apparent diffusion coefficient is a prognostic factor of head and neck squamous cell carcinoma treated with radiotherapy

Purpose

To evaluate the correlation between apparent diffusion coefficient (ADC) and prognosis in head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy.

Materials and methods

We retrospectively studied 41 patients (38 male and 3 female, ages 37–85 years) diagnosed with HNSCC (14 oropharynx, 22 hypopharynx, 4 larynx, 1 oral cavity) and treated with radiotherapy, with radiation dose to gross tumor volume over 60 Gy. The association between age, gender, performance status, tumor location, T stage, N stage, stage, dose, overall treatment time, treatment method, adjuvant therapy, or ADC and prognosis was analyzed using a Cox proportional hazard test.

Results

ADC calculated with b-values of 300, 500, 750, and 1,000 s/mm² (ADC 300–1,000) alone showed a significant correlation with all of the analyses (p = 0.022 for local control, p = 0.0109 for regional control, p = 0.0041 for disease-free survival, and p = 0.0014 for overall survival). ADC calculated with b-values of 0, 100, and 200 s/mm² (ADC 0–200) showed a significant correlation with overall survival (p = 0.0012). N stage showed a significant correlation with regional control (p = 0.0241). Performance status showed significant association with local control (p = 0.0459), disease-free survival (p = 0.023), and overall survival (p = 0.0151), respectively.

Conclusion

ADC is an independent predictor of prognosis in HNSCC treated with radiotherapy.

     

Three-dimensional conformal versus intensity modulated radiotherapy in breast cancer treatment: is necessary a medical reversal?

Objectives

Aim of the present study is to compare three-dimensional conformal RT (3D-CRT) and 4-fields intensity modulated radiation therapy (4f-IMRT) treatment plans, in terms of target dose coverage, integral dose and dose to Organs at risk (OARs) in early breast cancer (BC).

Methods

Twenty consecutive BC patients, after lumpectomy, were selected for the present analysis. A total dose of 50 Gy and a simultaneous dose of 60 Gy in 25 fractions was prescribed to Planning Target Volume of the whole breast (PTV_breast) and of the surgical bed, respectively. For each patient, a 3D-CRT plan and a sliding-window 4f-IMRT plan were generated. Conformity and homogeneity indexes (CI, HI) and various organ specific V_xGy values were analyzed for PTVs, OARs and normal tissue (NT), respectively.

Results

In terms of HI, 4f-IMRT was superior to 3D-CRT for the PTV_breast (p < 0.0001), and a significant difference for CI was observed in favor of 4f-IMRT (p < 0.0001).In terms of dose to OARs, a superiority of 4f-IMRT was shown. For NT, all parameters are in favor of IMRT, except the V _5Gy for which the difference was not statistically significant. The average NT-D_mean was 2.7 ± 0.7 for 3D-CRT and 1.8 ± 0.5 for 4f-IMRT (p < 0.0001).

Conclusions

4f-IMRT technique significantly reduced the dose to OARs and NT, with a better target coverage compared to 3D-CRT.

     

Postoperative radiotherapy for prostate cancer

Purpose

The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer.

Materials and methods

Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups.

Results

For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7?Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3?Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5?year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5?year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%.

Conclusions

Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4?field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects.

     

Dosimetric comparison of 3-dimensional conformal radiotherapy,volumetric modulated arc therapy,and helical tomotherapy for postoperative gastric cancer patients

Purpose

To compare dosimetric data for the planning target volume (PTV) and organs at risk (OARs) between 3-dimensional conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy [1].

Materials and methods

The dosimetric data for 15 gastric cancer patients treated with 3DCRT, VMAT, or HT techniques were used. Cumulative dosimetric parameters, homogeneity index (HI), and conformal index (CI) were compared for the PTV and OARs.

Results

The average maximum doses of PTV were significantly higher in VMAT plans than in 3DCRT (p = 0.04) and HT (p = 0.02) plans, whereas minimum dose values were significantly lower in 3DCRT plans compared with VMAT (p < 0.001) and HT (p = 0.02) plans. Liver mean dose (D _mean) and D _mean values for both kidneys were significantly lower in HT plans than in 3DCRT and VMAT plans. The doses in high dose regions (V30–V45) using 3DCRT plans were significantly higher compared to both VMAT and HT plans. The bowel V5–V30 and V45 was significantly less in HT plans compared to VMAT plans. There were no significant differences in dose sparing of the spinal cord.

Conclusions

The HT plans reduced the maximum dose applied to the target and improved the conformality and homogeneity of radiation, while providing sufficient PTV coverage.

     

The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS)

Objectives

Vascular complications are one of the most common causes of early kidney transplant dysfunction. Contrast enhanced ultrasound increases sensitivity to vascular changes. The aim of this study was to assess the prevalence and size of vascular abnormalities in early renal transplants using 3D CEUS and the significance of perfusion defects on renal function.

Methods

Ninety-nine renal transplant patients underwent 3D CEUS after surgery to quantify perfusion defects as percentage total renal volume (TRV). Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded up to 3 months post-surgery.

Results

Twenty participants had focal perfusion defects (0.2–43%TRV). There was a meaningful difference in patients with perfusion defects in eGFR at 1 month (90% CI 2.7–19.2 mL/min/1.73 m²) and 3 months (90% CI 1.9-19.6 mL/min/1.73 m²) and creatinine at 3 months (90% CI -56 – -8 μmol/L) using a predetermined clinical threshold. Perfusion defect size correlated well with both serum creatinine and eGFR at 3 months (R?=?0.80, p?≤?0.000 and 0.58, p?=?0.038). No correlation was seen prior to 3 months.

Conclusions

Perfusion defects in kidney transplants were more common than expected and were highly likely to reduce renal function at 1-3 months, and the size of the defect affected the degree of functional change at 3 months.

Key Points

? Perfusion defects were more common than previously thought. ? Perfusion defects could be quantified using 3D CEUS. ? The presence of even small perfusion defects may affect kidney function. ? Size of perfusion defects correlated with subsequent kidney function at 3 months. ? Potentially useful in informing clinician expectations of kidney function post-surgery.

     

Effect of adjuvant lithium on thyroxine (T4) concentration after radioactive iodine therapy

Purpose

To study the effect of adjuvant lithium on serum thyroxine (T4) concentrations in patients treated with radioactive iodine (RAI) therapy in our environment.

Methods

This was a prospective simple randomized comparative, experimental cohort study of patients with hyperthyroidism referred for RAI ablation therapy in the two main academic hospitals in Johannesburg between February 2014 and September 2015.

Results

Amongst the 163 participants in the final analysis, 75 received RAI alone and 88 received RAI with lithium. The difference in mean T4 concentrations at 3 months between the RAI-only group (17.67 pmol/l) and the RAI with lithium group (11.55 pmol/l) was significant with a small effect size (U?=?2328.5, Z?=??2.700, p?=?0.007, r?=?0.01). Significant decreases in T4 concentrations were observed as early as 1 month after RAI (p?=?0.0001) in the RAI with lithium group, but in the RAI-only group, significant decreases in T4 concentrations were observed only at 3 months after RAI therapy (p?=?0.000). Women and patients with Graves’ disease who received RAI with adjuvant lithium also showed significant decreases in T4 concentrations at 1 month (p?=?0.002 and p?=?0.003, respectively).

Conclusion

Adjuvant lithium leads to an earlier and better response to RAI therapy with lower T4 concentrations that are achieved earlier. This earlier response and decrease in T4 concentrations were noted in patients with Graves’ disease and nodular goitre, and in women with hyperthyroidism who received adjuvant lithium therapy.

     

Pilot study of a new comprehensive radiology report categorization (RADCAT) system in the emergency department

Purpose

The purpose of this study was to describe a new, broadly applicable radiology report categorization (RADCAT) system that was developed collaboratively between radiologists and emergency department (ED) physicians, and to establish its usability and performance by interobserver variation.

Methods

In collaboration with our ED colleagues, we developed the RADCAT system for all imaging studies performed in our level-1 trauma center, including five categories that span the spectrum of normal through emergent life-threatening findings. During a pilot phase, four radiologists used the system real-time to categorize a minimum of 400 reports in the ED. From this pool of categorized studies, 58 reports were then selected semi-randomly, de-identified, stripped of their original categorization, and recategorized based on the narrative radiology report by 12 individual reviewers (6 radiologists, and 6 ED physicians). Interobserver variation between all reviewers, radiologists only, and ED physicians only was calculated using Cohen’s Kappa statistic and Kendall’s coefficient of concordance.

Results

Altogether, agreement among radiologists and ED physicians was substantial (κ = 0.73, p < 0.0001) and agreement for each category was substantial (all κ > 0.60, p < 0.0001). The lowest agreement was observed with RADCAT-3 (κ > 0.61, p < 0.0001) and the highest agreement with RADCAT-1 (κ > 0.85, p < 0.0001). A high trend in agreement was observed for radiologists and ED physicians and their combination (all W > 0.90, p < 0.0001).

Conclusions

Our RADCAT system is understandable between radiologists and ED physicians for categorizing a wide range of imaging studies, and warrants further assessment and validation. Based upon these pilot results, we plan to adopt this RADCAT scheme and further assess its performance.

     

Palliative radiotherapy for Japanese patients with malignant melanoma: a single-institution experience

Purpose

This study aimed to clarify the significance of palliative radiotherapy for Japanese patients with malignant melanoma based on the experience of our institution.

Materials and methods

Twenty-nine patients with malignant melanoma who underwent palliative radiotherapy at our facility were included in the investigation. Median radiation dose was 30 Gy (4–30).

Results

Median follow-up time was 4.2 months (range 2.7–40.5 months). Twenty-two patient (75.9 %) died during the follow-up. The response rate of overall symptoms to radiotherapy was 63.0 %. The rate of completely resolved hemorrhage was relatively high (81.8 %). The median time of freedom from progression in completely resolved symptoms was 3.1 months (range 0.2–27.8 months). Radiation dose <30 Gy and poor performance status tended to be associated with poor symptomatic relief in treatment site (p = .080 and p = .068, respectively). There were very few severe toxic events.

Conclusion

Two thirds of symptoms were safely alleviated by palliative radiotherapy for Japanese patients with malignant melanoma. The therapeutic effect was retained for a substantial duration. Further domestic studies are warranted.

     

GRASE Revisited: breath-hold three-dimensional (3D) magnetic resonance cholangiopancreatography using a Gradient and Spin Echo (GRASE) technique at 3T

Objective

To evaluate the clinical feasibility and image quality of breath-hold (BH) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) using a gradient and spin-echo (GRASE) technique compared to the conventional 3D respiratory-triggered (RT)-MRCP using a turbo spin-echo (TSE) sequence at 3 T.

Methods

Sixty-six patients underwent both 3D RT-TSE-MRCP and 3D BH-GRASE-MRCP at 3 T. Three radiologists independently reviewed the visualisation of biliary and pancreatic ducts, image blurring, and overall image quality of the two data sets using four- or five-point scales. The numbers of scans with non-diagnostic or poor image quality were compared between the two scans.

Results

The 3D BH-GRASE-MRCP had a significantly better image quality (3.69 ± 0.77 vs. 3.30 ± 1.18, p = 0.005) and less image blurring (3.23 ± 0.94 vs. 3.65 ± 0.57, p = 0.0003) than the 3D RT-TSE-MRCP. In detail, 3D BH-GRASE-MRCP better depicted the common bile duct, cystic duct, and bilateral first intrahepatic duct (all ps < 0.05). The number of scans with non-diagnostic or poor image quality significantly decreased with 3D BH-GRASE-MRCP compared with 3D RT-TSE-MRCP [19.7% (13/66) vs. 1.5% (1/66), p = 0.002].

Conclusion

The 3D BH-GRASE-MRCP provided better image quality and a reduced number of non-diagnostic images compared to 3D RT-TSE-MRCP.

Key points

? The GRASE technique enabled 3D MRCP acquisition within a single breath-hold. ? The short acquisition time of 3D BH-GRASE-MRCP significantly reduced image blurring. ? The 3D BH-GRASE-MRCP had a better image quality than 3D RT-TSE-MRCP. ? The number of non-diagnostic scans was reduced with 3D BH-GRASE-MRCP.

     

Evaluation of chronic inflammatory demyelinating polyneuropathy: 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI)

Objective

To evaluate the usefulness of 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

Methods

This institutional review board-approved retrospective study included 14 CIDP patients and nine normal subjects. The signal-to-noise ratio (SNR), contrast ratio (CR), and the size of the cervical ganglions and roots were measured by two raters.

Results

The SNRs of the ganglions and roots were larger in patients with CIDP (9.55?±?3.87 and 9.81?±?3.64) than in normal subjects (7.21?±?2.42 and 5.70?±?2.14, P?<?0.0001, respectively). The CRs of the ganglions and roots were larger in patients with CIDP (0.77?±?0.08 and 0.68?±?0.12) than in normal subjects (0.72?±?0.07 and 0.53?±?0.11, P?<?0.0001, respectively). The sizes of the ganglions and the roots were larger in patients with CIDP (6.44?±?1.61 mm and 4.89?±?1.94 mm) than in normal subjects (5.24?±?1.02 mm and 3.39?±?0.80 mm, P?<?0.0001, respectively).

Conclusions

Patients with CIDP could be distinguished from controls on 3D SHINKEI.

Key points

? 3D SHINKEI could visualize brachial plexus with high spatial resolution.? CIDP patients showed increased SNR, CR, and the size of brachial plexus.? 3D SHINKEI could discriminate CIDP patients from normal subjects.

     

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial

Purpose

Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack.

Methods

Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed.

Results

Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026).

Conclusions

Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder.

Level of evidence

II.

     

Intra-vesical Prostatic Protrusion (IPP) Can Be Reduced by Prostatic Artery Embolization

Background

Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS.

Objective

To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change.

Material and Methods

Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30–500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months.

Results

PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q _max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045).

Conclusion

Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

     

Transperineal Prostate Core Needle Biopsy: A Comparison of Coaxial Versus Noncoaxial Method in a Randomised Trial

Purpose

To compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy.

Materials and Methods

Transperineal prostate biopsy with coaxial (first group, n = 120) and noncoaxial (second group, n = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods.

Results

The procedural time was significantly shorter in the first group (p < 0.001). In the first group, pain occurred less frequently (p = 0.002), with a significantly lower VAS score being experienced (p < 0.002). No patient had post procedural fever. Haematuria (p = 0.029) and haemorrhage from the site of biopsy (p < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups (p = 0.059). Urinary retention occurred less commonly in the first group (p = 0.029). No significant difference was seen in the rate of dysuria between the two groups (p = 0.078).

Conclusions

Transperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.

     

Early prediction of anticancer effects with diffusion-weighted MR imaging in patients with colorectal liver metastases following selective internal radiotherapy

Objective:

To prospectively evaluate diffusion-weighted imaging (DWI) for early prediction of tumour response in patients with colorectal liver metastases following selective internal radiotherapy (SIRT).

Methods:

We evaluated 41 metastases in 21 patients, age 62.9?±?9.9 years. All patients underwent magnetic resonance imaging (MRI) including breath-hold echoplanar DWI sequences. Imaging was performed before therapy (baseline MRI), 2 days after SIRT (early MRI) as well as 6 weeks later (follow-up MRI). Tumour volume (TV) and intratumoural apparent diffusion coefficient (ADC) were measured independently by two radiologists at all time points.

Results:

Metastases were categorised as responding lesions (RL; n?=?33) or non-responding lesions (NRL; n?=?8) according to changes in TV after 6 weeks. We found an inverse correlation of changes in TV and ADC at follow-up MRI with a Pearson’s correlation coefficient of r?=??0.66 (p?<?0.0001). On early MRI, no significant changes in TV were found for either RL or NRL. Conversely, ADC decreased significantly in RL by 10.7?±?8.4% (p?<?0.0001). ADC increased in NRL by 9.6?±?20.8%, which was not statistically significant (p?=?0.40).

Conclusion:

DWI was capable of predicting therapy effects of SIRT in patients with colorectal hepatic metastases as early as 2 days following treatment.

     

Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy

Background

In patients with prostate cancer (PCa) and biochemical progression (BP) after radical prostatectomy (RP), salvage radiotherapy (sRT) improves prostate cancer-specific survival (PCSS), but this evidence is based only on retrospective data.

Patients and methods

In addition to our previous study of 151 patients with PCa and BP after RP, we performed univariate analyses of prostate-specific antigen (PSA) kinetics during sRT. In 11 patients with BP or initiation of hormonal treatment (HT) within 180 days after sRT, risk factors were assessed using Mann–Whitney U tests. PSA doubling times (PSADT) before and after sRT in 82 patients with BP after sRT were compared by a Wilcoxon test.

Results

After a median follow-up of 82 months, analysis of PSA kinetics during sRT did not show a statistically significant impact on a subsequent BP, PCSS, or overall survival at an administered dose of 30 or 45?Gy. The subgroup analysis of patients with early BP or early HT revealed higher Gleason scores (p = 0.008) and preoperative PSA values (p = 0.005), shorter PSADT prior to sRT (p < 0.0005), and longer time intervals from RP until the start of sRT (p = 0.005) compared to all other patients. In patients with subsequent BP, PSADTs were significantly prolonged after sRT (median PSADT 4.5 months before and 9.9 months after sRT, p < 0.0005).

Conclusion

PSA monitoring during sRT did not predict the therapeutic success. Subgroup analysis suggests a lower probability of benefit for patients with the abovenamed risk factors . However, the prolonged PSADT after sRT reflects a benefit of sRT for the vast majority of patients.

     

Spinal multiparametric MRI and DEXA changes over time in men with prostate cancer treated with androgen deprivation therapy: a potential imaging biomarker of treatment toxicity

Objectives

To explore changes in bone mineral density (BMD) measured by DEXA and MRS fat fraction (FF), Dixon FF, and ADC in lower spinal vertebral bodies in men with prostate cancer treated with androgen deprivation therapy (ADT).

Methods

Twenty-eight men were enrolled onto a clinical trial. All received ADT. DEXA imaging was performed at baseline and 12 months. L-spine MRI was done at baseline and 6 months.

Results

The number of patients who underwent DEXA, Dixon, ADC, and MRS at baseline/follow-up were 28/27, 28/26, 28/26, and 22/20. An increase in FF was observed from T11 to S2 (average 1 %/vertebra). There was a positive correlation between baseline MRS FF and Dixon FF (r?=?0.85, p?<?0.0001) and a negative correlation between MRS FF and ADC (r?=?-0.56, p?=?0.036). Over 6 months, MRS FF increased by a median of 25 % in relative values (p?=?0.0003), Dixon FF increased (p?<?0.0001) and ADC values decreased (p?=?0.0014). Men with >5 % BMD loss after 1 year had triple the percentage increase in MRS FF at 6 months (61.1 % vs. 20.9 %, p?=?0.19).

Conclusions

Changes are observed on L-spine MRI after 6 months of ADT. Further investigation is warranted of MRS change as a potential predictive biomarker for later BMD loss.

Key Points

? Spinal marrow fat fraction increases after 6 months of androgen deprivation therapy. ? More inferior vertebral bodies tend to have higher fat fractions. ? MRS fat fraction changes were associated with later changes in DEXA BMD.

     

The role of computed tomography (CT) in predicting diplopia in orbital blowout fractures (BOFs)

Purpose

The management of orbital blowout fractures (BOFs) is controversial: the evaluation of diplopia is the most important criterion for planning whether to undertake surgery.Our aim was to determine CT findings that may suggest the presence of diplopia when patients with BOFs cannot be adequately examined to plan an orbital repair.

Method and materials

We retrospectively evaluated CT of all patients presented to our Emergency Department for blunt craniofacial trauma (N = 3334) from January 2014 to March 2016, selecting patients with CT-demonstrated BOFs.The following CT variables were assessed: fracture location, fracture multifocality, bone fragments displacement, extraocular muscles (EOM) thickening, EOM entrapment, EOM displacement, EOM hooking, intraconal and extraconal emphysema, intraconal and extraconal hematoma, and fat herniation.All patients underwent Hess-Lancaster test, to establish the presence of diplopia.After performing group comparison with Pearson χ2 test, we derived our prediction model by using logistic regression, with diplopia as the prediction and CT variables as predictors.

Results

We observed 299 patients with BOFs, 46 (15.4%) with a Hess Lancaster test-proven diplopia.The CT variables with statistically significant difference between the group with diplopia and the group without diplopia were as follows: floor fracture (p = .014), bone fragments displacement (p = .001), multifocality (p = .005), EOM thickening (p = .001), EOM entrapment (p < .001), EOM displacement (p < .001), fat herniation (p = .003).The CT variables with significance as predictors of diplopia at multivariate analysis were as follows: orbital floor fracture (p value 0.015; odds ratio 2.871, 95% confidence interval of odds ratio 0.223–6.738), EOM displacement (p value 0.001; odds ratio 10.693, 95% confidence interval of odds ratio 3.761–30.401), EOM entrapment (p value 0.001; odds ratio 11.510, 95% confidence interval of odds ratio 3.059–43.306).

Conclusion

The presence of diplopia can be suggested on the basis of CT findings after an orbital trauma.

     

Role of curative treatment in patients with intermediate-stage hepatocellular carcinoma

Purpose

To retrospectively evaluate the role of curative treatment in patients with intermediate-stage hepatocellular carcinomas (HCCs), and to identify the subgroup having benefit from curative treatment.

Methods

From April 2000 to December 2014, 100 patients with intermediate-stage HCCs underwent either curative treatment (hepatectomy: n = 23, radiofrequency ablation (RFA); n = 29, both: n = 4) or transarterial chemoembolization (TACE): n = 44) as initial treatments for HCCs. Overall survival, influence of treatment allocation on prognosis, and factors affecting treatment allocation were evaluated.

Results

The 5-year survival rate was 59.2% [95% confidence interval (CI) 51.6–66.8%] in the curative group, and 25.1% (95% CI 11.5–38.7%) in the TACE group. Treatment allocation was the only significant prognostic factor (p = 0.014, hazard ratio: 0.382, 95% CI 0.177–0.821). The curative group consisted of more patients with Child-Pugh A (p = 0.0016) than the TACE group, a tumor number of 3 or fewer (p < 0.0001), a unilobar tumor location (p = 0.02), within 4 of 7 cm criterion (p = 0.001), and within up-to-7 criterion (p = 0.04). Child-Pugh A, within the 4 of 7 cm criterion, and a unilobar tumor location were significantly linked with treatment allocation in multivariate analysis.

Conclusions

Curative treatment can prolong survival in selected patients with intermediate-stage HCCs.