Long-Term Clinical Outcome of Carbon Ion Radio Therapy for Hepatocellular Carcinoma in the Caudate Lobe

PURPOSE/OBJECTIVE(S)

Surgical resection is the first-line treatment for hepatocellular carcinoma in the caudate lobe (caudate HCC), but it is often difficult due to the tumor's location. In addition, radiofrequency ablation and transcatheter arterial chemoembolization are also difficult for the same reason. This study aimed to evaluate the safety and efficacy of carbon-ion radiation therapy (C-ion RT) for caudate HCC.

MATERIALS/METHODS

We performed a retrospective cohort study of patients with hepatocellular carcinoma treated by C-ion RT between April 2000 and March 2020 in our institution. The eligibility criteria for this study were: (1) located mainly in the caudate lobe (2) the treatment protocols of 45.0-48.0 Gy/2 fractions or 52.8-60.0 Gy/4 fractions, which proved the safety and efficacy in the past clinical trials; (3) N0M0 status; (4) an Eastern Cooperative Oncology Group performance status (PS) of 0 to 2; (5) controllable ascites. The prescribed dose (Gy) used in this study is relative biological effectiveness (RBE) weighted dose. Overall survival (OS), progression-free survival (PFS), and local control rate (LC) were calculated by the Kaplan-Meier method. Adverse events were evaluated by NCI-CTCAE ver. 5.0. SPSS software version 27.0 (IBM Inc.) was used for all analyses. We defined p-value < 0.05 as statistically significant.

RESULTS

A total of 25 patients met the criteria and were evaluated. The median patient age was 73 years (range 58-89), and 21 of 25 patients were male. The number of patients with PS 0 was 22, PS 1 was 1, and PS 2 was 2. The number of HBV-related HCC cases was in 8, HCV-related HCC cases was in 11, and non-B and non-C cases was in 6. The median maximum tumor diameter was 3.0 cm (1.1-4.8 cm). In 6 patients, identification of vascular invasion to the main trunk of the portal vein and/or major hepatic vein was confirmed. The Child-Pugh (CP) grade was A in 21 patients and B in 4. The modified albumin-bilirubin (mALBI) grade 1 is in 17 patients, 2a in 4, 2b in 4. Prescribed doses were 45 Gy / 2 fr in 3 cases, 48 Gy / 2 fr in 12 cases, 52.8 Gy / 4 fr in 7 cases, and 60 Gy / 4 fr in 3 cases. With a median follow-up period of 43.6 months (range 0.3-85.0), 3-year OS, PFS, and LC were 74% (95% confidence interval [CI], 54.8-93.8%), 32% (95% CI, 11.8-51.4%), and 93% (95% CI, 79.4-106%), respectively. All patients had no Grade 2 or higher adverse events during the observation period.

CONCLUSION

The safety and efficacy of C-ion RT for caudate HCC were demonstrated. These results suggested that C-ion RT may be a promising treatment option for patients with caudate HCC.

SAT0542 UTILITY OF QUANTITATIVE ANALYSIS OF 18FDG-PET/CT in IgG4-RELATED DISEASE

Background:

In IgG4-related diseases (IgG4-RD), usefulness of18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging for detecting the organ involvement of IgG4-RD have been shown and,18FDG PET/CT was more accurate and appeared to be more sensitive as compared to other imaging technics1,2. However, until now, the studies regarding about quantitative analysis of PET/CT imaging in IgG4-RD were few. To avoid unnecessary biopsy and select suitable lesion for biopsy on multi-organ involvement disease such as IgG4-RD, the information which lesion is suspected as disease-involvement lesion in a non-invasive test is important.

Objectives:

The purpose of this work is to evaluate the usefulness of18FDG-PE/CT imaging in management of IgG4-RD using quantitative analysis of PET/CT imaging.

Methods:

21 patients with IgG4-RD, in whom PET/CT was undertaken at the time of diagnosis between December 2009 and July 2018, were enrolled. We retrospectively investigated the association between histological findings in which biopsy was performed for diagnosis of IgG4-RD and findings of PET/CT.18FDG uptake was assessed in site of major organ involvement of IgG4-RD which could be differentiated from the normal uptake of background tissue with18FDG-PET/CT. For quantitative analysis, we measured the highest standardized uptake value (SUV) of the pixels within the region of interest (ROI) (SUVmax) and the average SUV within ROI (SUVmean). We also measured SUVmeanof liver as reference tissue. Then, we calculated ratio between SUVmeanof ROI and SUVmean/liver.

Results:

The age at diagnosis was 64.5 ± 11.9 years, serum IgG4 was 743.8 ± 584.1 mg/dl, and biopsy was performed at 24 sites (Submandibular gland 10, prostate gland 4, pancreas 2, thyroid gland 1, lung 1, retroperitoneum 1, kidney 1). Histological findings were consistent with IgG4RD (positive) at 19 sites.

Although SUVmaxat the biopsy site was not correlated with the biopsy results, SUVmeanat the biopsy site were significantly higher in the biopsy-positive group (figure 1). As similar, SUVmean/liver SUVmeanwere also higher in the biopsy-positive group (2.17 vs 1.52, respectively P<0.05). To establish cut-off value of SUVmeanto consider biopsy, A receiver operating characteristics (ROC) curve was constructed. ROC curve analysis indicated SUVmean=4.074 as cut-off value which discriminate IgG4-RD related lesion.

Conclusion:

Our present study suggested that quantitative analysis of18FDG-PET/CT imaging is useful for selecting the biopsy site in IgG4-related disease.

Figure 1.

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References:

[1]Ebbo M, Grados A, Guedj E, et al. Usefulness of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography for staging and evaluation of treatment response in IgG4-related disease: a retrospective multicenter study. Arthritis Care Res (Hoboken) 2014; 66(1): 86-96.

[2]Zhang J, Chen H, Ma Y, et al. Characterizing IgG4-related disease with (1)(8)F-FDG PET/CT: a prospective cohort study. Eur J Nucl Med Mol Imaging 2014; 41(8): 1624-34.

Disclosure of Interests:

None declared

Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement

Background:

The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.

Methods:

We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.

Results:

Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077, P =0.007), albumin (ρ=−0.22, P <0.001), gait speed (ρ=−0.28, P <0.001), and grip strength (ρ=−0.26, P <0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%, P <0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49; P <0.001).

Conclusions:

In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.

[A pathomorphological study on atherosclerotic regression with references between apoptosis and atherosclerotic plaque with central depression in rabbit aorta]

Atherosclerotic plaque with central depression (depressed lesions) have been proposed as one morphological feature of atherosclerotic regression in the elderly. We have also revealed that depressed lesions have been found not only in the aorta of elderly human but also in rabbit aorta. In this study a relationship between apoptosis and atherosclerotic regression was immunohistochemically studied to clarify the possibility of the pathogenesis of depressed lesion in rabbit aorta. Twenty male New Zealand White rabbit (NZW) were fed with a 1.0% cholesterol diet during a 12-week atherogenic induction period. Then they were fed only with a basic diet for 36-week (n = 6) and 48-week (n = 6, experimental group) regression periods. A control group was fed with 1.0% cholesterol diet for 12-week (n = 2) and 60-week (n = 6). They were killed and aortas were fixed with formalin. Sections obtained from aortas were processed for histological and immunohistochemical studies including the TUNEL method, staining with Ki-67 and others. Several depressed lesions were found in the aortas of NZW animal, but none were noted in control aortas. Results of surface involvement in the experimental groups were significantly lower than in the control, and the aortas of the experimental group had atherosclerotic regression. Apoptosis was found in the depressed lesions, which had more apoptotic cells than non-regressed atherosclerotic plaques. Furthermore, the apoptotic cells were significantly greater in the center of depressed lesions than in marginal areas. Ki-67 staining was positive in the atherosclerotic plaque, but negative in the depressed lesions. It appears that the NZW aortic atherosclerotic plaques may transform to depressed lesions with apoptosis. Atherosclerotic regression has been associated with apoptosis.

Association between hyperhomocysteinemia and ischemic heart disease in Sri Lankans

OBJECTIVE

The objective of this study was to examine the relation between hyperhomocysteinaemia and ischemic heart disease in a cohort of Sri Lankan patients with ischemic heart disease.

METHOD

Serum homocysteine, cysteine and cysteinylglyceine were measured in 54 patients with a definite diagnosis of ischemic heart disease and compared with those of an age and sex matched control group.

RESULTS

Patients with coronary ischaemia had significantly higher mean concentrations of homocysteine and its metabolite cysteine (P<0.01). Of the 54 patients with ischemic heart disease 14 (35%) had fasting homocysteine concentrations above the 90th percentile of the controls (odds ratio 3.2, 95% CL 1.0-11.3).

CONCLUSION

Hyperhomocysteinaemia is associated with a three fold increase in coronary risk.

[Regression of atherosclerosis and centrally depressed lesions in rabbit aortas]

Atherosclerotic plaque with central depression (depressed lesion) has been hypothesized to be a morphological feature of atherosclerosis regression. We tested this hypothesis in New Zealand white rabbits. After the animals were fed a diet containing 1% cholesterol for three months, they were changed to a normal diet for 6 to 9 months. Several aortas had centrally depressed lesions similar to those found in elderly people, and the animals had low serum cholesterol levels. Immunohistochemical study showed that the depressed lesions contained more smooth muscle cells and collagen type IV, and fewer macrophage-derived foam cells than did common atherosclerotic elevated lesions found in rabbits. We know of no other report of depressed lesions in rabbits with atherosclerosis. Thus we believe that the centrally depressed lesion is a histological characteristic of regression of atherosclerosis.

Effects of short chain fatty acids on the production of heat-labile enterotoxin from enterotoxigenic Escherichia coli

Each addition of some short chain fatty acids (SCFAs) into casamino acids-yeast extract culture media at a concentration of 2 mg/ml reduced the production of heat-labile enterotoxin (LT) from enterotoxigenic Escherichia coli in proportion to the elongation of carbon chain from C-2 to C-7. The LT-production was inversely recovered by the addition of longer chain fatty acids. The reduction of LT-production by SCFAs seems to depend on the disturbance of the biosynthesis of LT itself, since LT was not detected in the cells treated with n-heptyric acid at 2 mg/ml, which abolished the LT-production.

Reproductive and sexual risk factors and human papilloma virus infection in cervical cancer among Hong Kong Chinese

In this case-control study of cervical neoplasia in Hong Kong, 48 dysplasia and 68 cancer patients were matched with 116 surgical in-patient controls. The cases had an earlier age at first intercourse and more sex partners than the controls. The cases' husbands also had more sex partners and were less likely to use condoms regularly. In a multiple regression model the odds ratio were 6.0 (95% Confidence Interval 2.5-14.6) for the husband having more than one sex partner, 4.0 (1.5-10.7) for the woman having more than one sex partner, and 1.15 (1.05-1.28) per year younger for the woman's age at first intercourse. The odds ratio of 5.4 for women whose partners did not habitually use condoms was not significantly different from 1.0. In a sub-sample, 37% of cancer patients and 18% of dysplasia patients, but only 6% of gynaecological controls, showed a positive DNA hybridization to Human Papilloma Virus (Type 16). These findings suggest that cervical cancer and dysplasia are sexually transmitted in our population, with a possible viral aetiology.

[Studies on the relationship between desmosomes and the mode of infiltration and metastasis of esophageal cancer]

To define highly metastatic esophageal cancers morphologically, desmosomes were evaluated numerically and morphologically under electron microscope. Twenty-six esophageal cancers were analyzed. The prognosis of patients was also analysed with reference to the findings of desmosomes. The number of desmosomes per cell perimeter was significantly reduced in cancer cells (8.9 +/- 3.4/cell), as compared with normal esophageal epithelia (21.0 +/- 2.6/cell), especially in epidermoid carcinoma invading as thin irregular cords of cells or with metastasis to lymph nodes (7.8 +/- 3.1/cell) and distant organs (4.8 +/- 4.3). A positive correlation was found between desmosomes and prognosis. These results suggested that the number of desmosomes was a good parameter for malignancy of esophageal cancer.

Involvement of GABAergic systems and benzodiazepine receptors in the jumping behavior induced by harmine and apomorphine in rats

Harmine (HA) induces a jumping behavior in rats when the central dopaminergic function has been activated. Possible involvement of the GABAergic systems and the benzodiazepine receptors (BZA-R) in the jumping behavior induced by HA and apomorphine (APO) was investigated. Pretreatment with GABAergic agonists, muscimol (0.05-0.2 mg/kg) and diazepam (0.2-1.0 mg/kg), and antagonists, picrotoxin (0.1-0.5 mg/kg) and bicuculline (0.1-0.5 mg/kg), suppressed the jumping behavior in a dose-dependent manner in rats treated with HA (10 mg/kg) and APO (2 mg/kg). After treatment with 2, 5 or 10 mg/kg of HA in combination with 2 mg/kg of APO, a decrease in 3H-diazepam binding to the brain regional membranes was observed in the corpus striatum (CS) in a dose-dependent manner, but not in the other brain regions. The decrease in the 3H-diazepam binding to the CS membranes was proportional to the increase in the HA levels in the CS, and the HA levels were correlated with the intensity of jumping behavior. Pretreatment with Ro 15-1788, an antagonist of BZA-R, suppressed the jumping behavior induced by HA and APO. These results indicated the involvement of the GABAergic systems in the jumping behavior and suggested that HA induced the jumping behavior partly as a result of interacting with the BZA-R.

Role of brain monoamine systems in the jumping behavior induced in rats by the combination of harmine and apomorphine

The role of brain monoamine systems in the jumping behavior induced by the combination of harmine and apomorphine was studied by using a MT pick-up to assess jumping behavior in rats. The jumping induced by the combination of harmine 10 mg/kg and apomorphine 2 mg/kg was enhanced by pretreatment with p-chlorophenylalanine, methysergide and by treatment with clonidine, while, it was reduced by pretreatment with 5-hydroxytryptophan, haloperidol, perphenazine, atropine and pilocarpine. The combination of harmaline or harmane and apomorphine also induced jumping with the aid of p-chlorophenylalanine. The combination of benserazide, L-DOPA and harmine induced jumping similar to that induced by harmine and apomorphine. Despite pretreatment with p-chlorophenylalanine the combination of apomorphine and benzylhydrazine, iproniazid, tranylcypromine or pargyline failed to induce jumping. These results suggest that this jumping behavior is induced not by the monoamine oxidase inhibitory effect of harmine but probably by the specific central action of harmine and on condition that the dopaminergic system is activated. The activation of this system appears to be essential, the noradrenergic system plays a facilitatory role, the serotonergic system an inhibitory role and the cholinergic system probably a specific role.