Everolimus versus placebo in Japanese patients with advanced pancreatic neuroendocrine tumors (pNET): Japanese subgroup analysis of RADIANT-3

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Background: Everolimus demonstrated a statistically and clinically significant improvement in PFS over placebo in a multi-national, randomized, placebo-controlled, phase III trial in patients with advanced low- or intermediate-grade pNET with disease progression within the prior 12 months (RADIANT-3) (Ann Oncol [2010] 21[suppl 6]: NP doi:10.1093/annonc/mdq340). Forty patients were enrolled from Japanese sites and randomized (n=23: everolimus; n=17: placebo) in that study. The purpose of this report is to investigate the efficacy and safety in the Japanese subgroup.

Methods: Subgroup analysis for the Japanese patients was performed comparing the efficacy and safety between everolimus 10mg/d orally plus best supportive care (BSC) and matching placebo plus BSC. The primary efficacy endpoint was progression-free survival (PFS). The safety was evaluated based on the incidence of adverse events (AEs).

Results: Treatment with everolimus resulted in a significant prolongation by 16.62 months in median PFS (19.45 months for everolimus, 2.83 months for placebo), with 81% reduction in the hazard ratio of progression/death (HR 0.19 [95% CI: 0.08, 0.48]; one-sided unstratified log-rank test: p<.001). The most common AE was stomatitis (73.9% everolimus vs 23.5% placebo); mostly grade 1/2. Grade 3/4 AEs occurred in 69.5% of the everolimus arm and 29.4% of the placebo arm, and amongst the most frequent included (% in everolimus vs % in placebo): neutropenia (17.4% vs 3%); anemia (8.7% vs 0%); pneumonitis (8.7% vs 0%); leukopenia (8.7% vs 0%). The remainder of grade 3/4 AEs was less than 3%. Median duration of exposure to everolimus was 57 weeks vs 47 weeks on placebo. Treatment discontinuation for AEs was 17% in the everolimus arm vs 0% in the placebo arm.

Conclusions: Everolimus demonstrated a clinically meaningful improvement in PFS over placebo in Japanese patients. Everolimus was well tolerated in Japanese patients, and no new safety concerns were noted. This result suggests that everolimus can be a standard treatment for Japanese patients with advanced pNET.

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Conservative management of decidualized ovarian endometriotic cyst during pregnancy mimicking malignancy: case report and a review of the literature

We report here the case of a 30-year-old woman with a decidualized ovarian endometriotic cyst (DOEC) during pregnancy mimicking malignancy occurring after fertility-preserving surgery for ovarian carcinoma arising from an endometriotic cyst. Intracystic excrescences appeared in the left ovarian endometriotic cyst at five weeks and three days of gestation. The serum CA-125 level rose to 676.7 U/ml (normal, 0-35). Based on these findings, ovarian carcinoma arising from the left ovarian cyst was strongly suspected. Frequent sonographic examinations revealed that the sizes and quality of the intracystic excrescences remained essentially unchanged. The cyst was evaluated for DOEC during pregnancy. The patient eventually delivered a male infant by normal vaginal delivery. After the delivery, the intracystic excrescences in the left ovarian endometriotic cyst disappeared. Close observation may be a reasonable alternative to antepartum surgery in patients with a DOEC during pregnancy.

Intense high-contrast femtosecond K-shell x-ray source from laser-driven Ar clusters

Bright Ar quasimonochromatic K-shell x ray with very little background has been generated using an Ar clustering gas jet target irradiated with a 30 fs ultrahigh-contrast laser, with a measured flux of 2.2×10(11)   photons/J into 4π. This intense x-ray source critically depends on the laser contrast and intensity. The optimization of source output with interaction length is addressed. Simulations point to a nonlinear resonant mechanism of electron heating during the early stage of laser interaction, resulting in enhanced x-ray emission. The x-ray pulse duration is expected to be only 10 fs, opening the possibility for single-shot ultrafast keV x-ray imaging applications.

High temporal and spatial quality petawatt-class Ti:sapphire chirped-pulse amplification laser system

Optical parametric chirped-pulse amplification (OPCPA) operation with low gain by seeding with high-energy, clean pulses is shown to significantly improve the contrast to better than 10(-10) to 10(-11) in a high-intensity Ti:sapphire laser system that is based on chirped-pulse amplification. In addition to the high-contrast broadband, high-energy output from the final amplifier is achieved with a flat-topped spatial profile of filling factor near 77%. This is the result of pump beam spatial profile homogenization with diffractive optical elements. Final pulse energies exceed 30 J, indicating capability for reaching peak powers in excess of 500 TW.

Radiation-pressure acceleration of ion beams driven by circularly polarized laser pulses

We present experimental studies on ion acceleration from ultrathin diamondlike carbon foils irradiated by ultrahigh contrast laser pulses of energy 0.7 J focused to peak intensities of 5x10(19) W/cm2. A reduction in electron heating is observed when the laser polarization is changed from linear to circular, leading to a pronounced peak in the fully ionized carbon spectrum at the optimum foil thickness of 5.3 nm. Two-dimensional particle-in-cell simulations reveal that those C6+ ions are for the first time dominantly accelerated in a phase-stable way by the laser radiation pressure.

Enhancement of photon number reflected by the relativistic flying mirror

Laser light reflection by a relativistically moving electron density modulation (flying mirror) in a wake wave generated in a plasma by a high intensity laser pulse is investigated experimentally. A counterpropagating laser pulse is reflected and upshifted in frequency with a multiplication factor of 37-66, corresponding to the extreme ultraviolet wavelength. The demonstrated flying mirror reflectivity (from 3 x 10(-6) to 2 x 10(-5), and from 1.3 x 10(-4) to 0.6 x 10(-3), for the photon number and pulse energy, respectively) is close to the theoretical estimate for the parameters of the experiment.

Prostate cancer detection: the value of performing an MRI before a biopsy

BACKGROUND

In recent years, prostate-specific antigen (PSA) screening has been widely performed. As a result, patients who need to undergo a complete physical examination for an elevated PSA level have been rapidly increasing. Magnetic resonance imaging (MRI) examination has previously been reported to be effective for the detection of prostate cancer.

PURPOSE

To evaluate the detectability of prostate cancer by performing MRI before biopsy, and to evaluate the relationship between detectability with MRI and cancer location, Gleason score (GS), and tumor size.

MATERIAL AND METHODS

MRI was performed at 1.5 Tesla in 122 consecutive patients before biopsy. The detectability of prostate cancer, including sensitivity and positive predictive value (PPV) of transrectal ultrasonography (TRUS), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) (b=2000 s/mm(2)), apparent diffusion coefficient (ADC) map, and biopsy, was calculated using whole-mount section histopathology as a gold standard. In addition, the relationship between the detectability on each MRI sequence and factors such as cancer location (peripheral zone vs. transition zone), GS 5-10, short-axis diameter (< or =4 mm, 5-9 mm, > or =10 mm), and long-axis diameter (< or =9 mm, 10-19 mm, > or =20 mm) were also evaluated.

RESULTS

The sensitivities of TRUS, T2WI, DWI, ADC map, and biopsy were 26.9%, 41.2%, 56.7%, 57.7%, and 75.1%, respectively, and the PPVs of those modalities were 73.0%, 83.0%, 86.4%, 87.2%, and 91.5%, respectively. There was no correlation between the sensitivity of each MRI sequence and cancer location. The sensitivity of each MRI sequence increased as GS and short- and long-axis diameters of cancer lesions increased.

CONCLUSION

MRI before a biopsy has a high detectability of prostate cancer, particularly with tumor size of more than 5 mm in short-axis diameter or 10 mm in long-axis diameter.

A novel mutation (V101A) of the LHX4 gene in a Japanese patient with combined pituitary hormone deficiency

OBJECTIVE

LHX4, a LIM-homeodomain transcription factor, is required for development of the pituitary and nervous system. Several mutations of the LHX4 gene have been identified in patients with combined pituitary hormone deficiency (CPHD). The objective of the study was to clarify the molecular basis of a Japanese patient of CPHD with a small anterior pituitary and an ectopic posterior pituitary.

METHODS

Genomic DNA was extracted from blood samples of the patient. Exons and exon-intron junctions of the LHX4 gene were amplified and sequenced. An expression vector of the mutant LHX4 protein was constructed and its function was analyzed in vitro.

RESULTS

A novel missense mutation (V101A) was identified. IN VITRO transfection studies demonstrated that V101A mutant LHX4 was unable to activate the POU1F1 and FSHbeta subunit gene promoter, indicating a loss of function mutation.

CONCLUSION

Our results identify a novel loss of function mutation of the LHX4 gene in a Japanese patient with CPHD.

Energy increase in multi-MeV ion acceleration in the interaction of a short pulse laser with a cluster-gas target

An approach for accelerating ions, with the use of a cluster-gas target and an ultrashort pulse laser of 150-mJ energy and 40-fs duration, is presented. Ions with energy 10-20 MeV per nucleon having a small divergence (full angle) of 3.4 degrees are generated in the forward direction, corresponding to approximately tenfold increase in the ion energies compared to previous experiments using solid targets. It is inferred from a particle-in-cell simulation that the high energy ions are generated at the rear side of the target due to the formation of a strong dipole vortex structure in subcritical density plasmas.

Hepatic falciform ligament artery in patients with chronic liver diseases: detection on computed tomography hepatic arteriography

BACKGROUND

The detection rate of hepatic falciform ligament artery (FLA) has been reported as ranging from 2-25%. The rate of FLA on laparotomy, however, is reported to be higher, at 68%.

PURPOSE

To compare the detection rate of FLA on computed tomography hepatic arteriography (CTHA) with that on angiography and dynamic CT, and to clarify the clinical significance of FLA in patients with chronic liver disease.

MATERIAL AND METHODS

126 consecutive patients underwent CTHA angiography and dynamic CT to evaluate suspected liver tumors. Liver function was classified as follows: normal, n=5; Child-Pugh class A, n=94; B, n=21; and C, n=6. All CT images were obtained using multidetector (MDCT) scanners (Aquilion; Toshiba, Tokyo, Japan). For CTHA, CT images were obtained during contrast material injection through the left hepatic, proper, or common hepatic artery. On CT, FLAs were retrospectively identified within the hepatic falciform ligament and the hepatic round ligament by the paging method on a workstation (TWS-5000; Toshiba, Tokyo, Japan). The detection rates were compared among the three modalities (hepatic arterial phase of dynamic CT, CTHA, and angiography). The calibers of FLA were also correlated with the hepatic function of the patients.

RESULTS

The detection rates of FLA by angiography, dynamic CT, and CTHA were 37% (47/126), 10% (13/126), and 77% (97/126), respectively. The calibers of FLA increased as the hepatic function deteriorated (P=0.001).

CONCLUSION

The detection rates of FLA with CTHA are far higher than those with angiography and dynamic CT. Careful interpretation with recognition of FLA on CTHA images is important, as inadvertent embolization or chemotherapeutic infusion of the FLA may result in supraumbilical skin rash.

Microcoil embolization through a downsized coaxial catheter system: an experimental study

BACKGROUND

Most of the recently developed microcatheters for abdominal angiography still have large diameters at their trailing ends, and thus cannot be used for microcoil embolization in combination with a 3-French (F) system.

PURPOSE

To evaluate the in vitro passage of microcoils through a newly developed 2-F microcatheter (Meister Cath Superselective Plus, MC6) that is compatible with a downsized coaxial catheter system (3-F system) in an experimental study.

MATERIAL AND METHODS

We evaluated the passage of microcoils through MC6 within a blood vessel model using the saline flush technique. Six types of microcoils and 17 size variations (maximal curled diameter 2-10 mm, total length 20-140 mm) were used. We evaluated the passage and post-deployment shape of the microcoils as well as the volume of saline required to flush them.

RESULTS

In the experimental study, all microcoils passed through the MC6 and deployed in a satisfactory manner without catheter occlusion. The mean volumes of saline required to flush the TORNADO (n=1), Reverse TORNADO (n=6), HILAL (n=1), Micronester (n=3), VortX (n=4), and C-Stopper Coil (n=2) were 0.7 ml, 0.58+/-0.20 ml, 0.5 ml, 0.57+/-0.058 ml, 3.5+/-1.5 ml, and 0.70+/-0.14 ml, respectively. There was a statistically significant difference in the mean volume of saline required between the VortX and Reverse TORNADO (P=0.029), and between the VortX and C-Stopper Coil (P=0.031). The VortX required the greatest volume of saline.

CONCLUSION

Microcoil embolization through a 3-F system appears to be feasible for the coils examined in this study.

Sub-MeV tunably polarized X-ray production with laser Thomson backscattering

Reported in this article is the generation of unique polarized x-rays in the sub-MeV region by means of the Thomson backscattering of the Nd:YAG laser photon with a wavelength of 1064 nm on the 150 MeV electron from the microtron accelerator. The maximum energy of the x-ray photons is estimated to be about 400 keV. The total energy of the backscattered x-ray pulse is measured with an imaging plate and a LYSO scintillator. The angular divergence of the x-rays is also measured by using the imaging plate. We confirm that the x-ray beam is polarized according to the laser polarization direction with the Compton scattering method. In addition, we demonstrate the imaging of the object shielded by lead with the generated x-rays.

Study of x-ray emission enhancement via a high-contrast femtosecond laser interacting with a solid foil

We observed the increase of the conversion efficiency from laser energy to Kalpha x-ray energy (eta(K)) produced by a 60 fs frequency doubled high-contrast laser pulse focused on a Cu foil, compared to the case of the fundamental laser pulse. eta(K) shows a strong dependence on the nonlinearly modified rising edge of the laser pulse. It reaches a maximum for a 100 fs negatively modified pulse. The hot electron efficient heating leads to the enhancement of eta(K). This demonstrates that high-contrast lasers are an effective tool for optimizing eta(K), via increasing the hot electrons by vacuum heating.