Results of definitive radiotherapy with concurrent chemotherapy for maxillary sinus carcinomas with neck lymph node metastasis

The purpose of this study was to describe the results of definitive radiotherapy (RT) with concurrent chemotherapy for maxillary sinus carcinomas (MSCs) with neck lymph node metastasis to clarify its limitation. Local control (LC), progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan–Meier method and were compared between subgroups using the log rank test. Toxicity was classified using common terminology criteria of adverse events version 5.0. Eighteen patients with inoperable MSC with neck lymph node metastasis including 12 men and 6 women with a median age of 67 years were analyzed. The histologic diagnoses were as follows: 16 patients had squamous cell carcinomas and 2 had other histology. Four patients had stage T3 MSC, 6 had T4a and 8 had T4b. Among 18 patients, 7 received concurrent systemic chemotherapy and 11 received selective arterial chemo-infusion. The median follow-up period was 17 months. The 2-year LC, PFS and OS rates for the entire cohort were 34, 31 and 46%, respectively. No significant differences were observed for LC, PFS and OS rates between systemic chemotherapy and selective arterial chemo-infusion cohorts. Grade 3 or higher acute toxicity, including both non-hematological and hematological, was observed in nine patients (50%), while no grade 3 or higher late toxicity was observed. In conclusion, we described the results of definitive RT for MSCs with neck lymph node metastasis. Local recurrence of primary tumor was a frequent pattern of failure and it should be addressed in future study.     

A multi-institutional survey of the quality of life after treatment for uterine cervical cancer: a comparison between radical radiotherapy and surgery in Japan

This study aimed to research the post-treatment quality of life (QOL) between radiotherapy (RT)- and operation (OP)-treated early cervical cancer survivors, using separate questionnaires for physicians and patients. We administered an observational questionnaire to patients aged 20–70 years old with Stages IB1–IIB cervical cancer who had undergone RT or OP and without recurrence as outpatients for ≥6 months after treatment. We divided 100 registered patients equally into two treatment groups (n = 50 each). The average age was 53 and 44 years in the RT and OP groups, respectively. The RT group included 34 and 66% Stage I and II patients, respectively, whereas the OP group included 66 and 34% Stage I and II patients, respectively. The OP group included 58% of patients with postoperative RT. Combination chemotherapy was performed in 84 and 48% of patients in the RT and OP groups, respectively. On the physicians’ questionnaire, we observed significant differences in bone marrow suppression (RT) and leg edema (OP). On the patients’ questionnaire, significantly more patients had dysuria and leg edema in the OP group than in the RT group, and severe (Score 4–5) leg edema was significantly higher in the post-operative RT group than in the OP only group. The frequency of sexual intercourse decreased after treatment in both groups. On the patients’ questionnaire, there were no significant differences between the two groups regarding sexual activity. These findings are useful to patients and physicians for shared decision-making in treatment choices. The guidance of everyday life and health information including sexual life after treatment is important.     

Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

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Carbon-ion beams induce production of an immune mediator protein,high mobility group box 1, at levels comparable with X-ray irradiation

X-ray radiotherapy activates tumor antigen-specific T-cell responses, and increases in the serum levels of high mobility group box 1 (HMGB1) induced by X-ray irradiation play a pivotal role in activating anti-tumor immunity. Here, we examined whether carbon-ion beams, as well as X-rays, can induce HMGB1 release from human cancer cell lines. The study examined five human cancer cell lines: TE2, KYSE70, A549, NCI-H460 and WiDr. The proportion of cells surviving X- or carbon-ion beam irradiation was assessed in a clonogenic assay. The D₁₀, the dose at which 10% of cells survive, was calculated using a linear–quadratic model. HMGB1 levels in the culture supernatants were assessed by an ELISA. The D₁₀ dose for X-rays in TE2, KYSE70, A549, NCI-H460 and WiDr cells was 2.1, 6.7, 8.0, 4.8 and 7.1 Gy, respectively, whereas that for carbon-ion beams was 0.9, 2.5, 2.7, 1.8 and 3.5 Gy, respectively. X-rays and carbon-ion beams significantly increased HMGB1 levels in the culture supernatants of A549, NCI-H460 and WiDr cells at 72 h post-irradiation with a D₁₀ dose. Furthermore, irradiation with X-rays or carbon-ion beams significantly increased HMGB1 levels in the culture supernatants of all five cell lines at 96 h post-irradiation. There was no significant difference in the amount of HMGB1 induced by X-rays and carbon-ion beams at any time-point (except at 96 h for NCI-H460 cells); thus we conclude that comparable levels of HMGB1 were detected after irradiation with iso-survival doses of X-rays and carbon-ion beams.     

Suppression of immunoglobulin production in human peripheral blood mononuclear cells by monocytes via secretion of heavy-chain ferritin

In vitro antigen stimulation of peripheral blood mononuclear cells (PBMCs) does not induce immunoglobulin (Ig) production. However, pretreatment of PBMCs with l-leucyl-l-leucine methyl ester (LLME) prior to in vitro stimulation removes the suppression of Ig production. In the present study, we attempted to identify the target cells of LLME and determine the mechanisms by which Ig production in PBMCs is suppressed. We found that CD14⁺ monocytes are involved in the suppression of Ig production in PBMCs. Furthermore, we confirmed that heavy-chain ferritin derived from CD14⁺ monocytes suppresses Ig production in PBMCs, possibly through iron sequestration.     

In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, "Endo-Cytoscopy system"

A catheter-type endomicroscope has been developed with a maximum magnifying power of 1100 times. Living cancer cells in the esophagus, stomach, and colon were successfully observed in high-resolution images. The "Endo-Cytoscopy system" (prototype,Olympus Optical, Co., Tokyo, Japan) is a catheter-based probe capable of passage through the accessory channel of the endoscope(GIF-1T, Olympus). Methylene blue solution was used for vital staining of the in vivo gastrointestinal mucosa. Living cells in both normal mucosa and malignant tissue were clearly demonstrated in luminal organs. In particular, the nucleus, cell body, and nucleolus were clearly demonstrated with high-quality images similar to those of conventional cytology. This novel technology has the potential to provide an in vivo histologic diagnosis via "optical biopsy" and virtual histology.     

CT air-contrast enema as a preoperative examination for colorectal cancer

BACKGROUND/AIMS: We conducted a study on three-dimensional computed tomography (CT) images, in particular CT air-contrast enema (CT enema), using multidetector-row CT (MDCT), to see whether CT enema is useful as a preoperative examination for colorectal cancer. We aimed to evaluate the detectability of lesions and the depth of cancer invasion using CT enema. METHODS: 292 patients (328 lesions) with colorectal cancer were enrolled. After an adequate insufflation of the large intestine, MDCT scans were performed. With the data obtained by MDCT, we reconstructed CT enema images. CT enema images were assessed for the detectability of lesions. The depth of invasion was evaluated by the deformity of the lesion on profile images. The deformities were divided into five groups: no deformity, slight deformity, mild deformity, moderate deformity and severe deformity. RESULTS: The detectability of lesions was 97.3%. The reasons for undetectability were due to residual fluid in 8 cases and insufficient colonic distention in 1 case. As the depth of invasion increased, the grade of the deformity became severer (p < 0.0001). CONCLUSIONS: CT enema proved to be an excellent examination tool to detect lesions. The deformity demonstrated by CT enema could be an additional source of information to predict the depth of invasion.     

Proper arrangement of the lines and cables in the setup of the laparoscopic surgery: development of new device "Line-Hanger"

Recently, with the rapid progress and introduction of new machineries and instruments for endoscopic surgery, the connecting lines and cables connecting machineries around the operating field are becoming more and more complicated. The lines and cables are often very troublesome, especially when the operator and assistant change their positions, and sometimes they are not only annoying but also potentially dangerous during the operative procedure. We feel there is a pressing need to develop a device to regulate the lines and cables. We developed a device for regulating the lines and cables in cooperation with Olympus Optical Co, Ltd (Tokyo, Japan) and named it "Line-Hanger." We have used it in more than 30 cases of various kinds of endoscopic surgery. In this study, we compare the usefulness of the "Line-Hanger" with the conventional method: fixation of lines and cables to the drapes with Velcro(R). The girth of the operative personnel are freed from a jumble of cables, and they become ergonomically comfortable. Especially when operator and assistant are changing their position, it becomes very smooth. "Line-Hanger" is extremely useful for endoscopic surgery.