Association between PET-CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study.

BACKGROUND: Research on the relationship between neuron-specific enolase (NSE) levels and normal organs, particularly the central nervous system, in small cell lung cancer is limited. Therefore, this study aimed to investigate the relationship between positron emission tomography-computed tomography (PET-CT) accumulation at hypothalamic/pituitary regions, tumor activity, and NSE level in limited-stage small cell lung cancer. We retrospectively analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019, and May 31, 2023, and were treated with chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples obtained before treatment initiation. The maximum standardized uptake value (SUVmax), volume, and total lesion glycolysis (TLG) of each hypothalamic /pituitary region, primary tumor, and lymph node metastases were extracted from PET-CT images. The total tumor volume (primary tumor volume plus lymph node metastases volume) and total TLG (primary tumor TLG plus lymph node metastases TLG) were calculated. RESULTS: This study included 19 patients (mean age, 70.1 ± 8.8 years; 13 men and 6 women); the pathology in all patients was small cell lung cancer. Patients were classified into two groups according to the NSE reference value (16.3 ng/mL): six patients having NSE level below the reference value and 13 having NSE level above the reference value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE < 16.3 ng/mL group and 4.10 in the NSE > 16.3 ng/mL group, with a statistically significant difference (p = 0.03). The total tumor volume was 17.8 mL in the NSE < 16.3 ng/mL group and 98.9 mL in the NSE > 16.3 ng/mL group, with a statistically significant difference (p < 0.01). A correlation coefficient of r = 0.458 (p = 0.0486) was observed between SUVmax in the hypothalamus/pituitary and NSE level. A correlation coefficient of r = 0.647 (p < 0.01) was also observed between total tumor volume and NSE level. Finally, a correlation coefficient of r = 0.53 (p = 0.01) was observed between hypothalamic/pituitary TLG and primary tumor TLG. CONCLUSIONS: The findings demonstrated a correlation between hypothalamic/pituitary activity and tumor activity, suggesting the prognostic significance of NSE.

PET/CT findings and dose distribution during radiotherapy in T1N0M0-T2N0M0 glottic cancer.

OBJECTIVE: To investigate the positron emission tomography/computed tomography (PET/CT) findings of T1/T2N0M0 glottic cancer (hereafter referred to as T1/T2) and dose distribution in radiotherapy. SUBJECTS AND METHODS: We retrospectively collected data from patients diagnosed with T1/T2N0M0 glottic cancer who received radiotherapy. The extent of fluorine-18-fluorodeoxyglucose (18F-FDG) accumulation in primary tumors, maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), tumor volume of primary tumors on PET/CT were compared. Furthermore, the tumor identified on PET/CT was incorporated into the radiotherapy plans. A dummy plan (radiation field 6x6cm, prescription point facing the vertebral body, maximum dose ≤107%, T1/T2 66Gy/33 fractions) was developed for three-dimensional conformal radiotherapy, and the dose distribution of primary tumors was calculated. RESULTS: Twenty-nine patients (27 men and two women) were included; their mean age was 67.2±15.0 years. Increased 18F-FDG accumulation in primary tumors was observed on PET/CT in 22/29 (78.5%; T1: 14/21 [67%], T2: 8/8 [100%]) patients. The median SUVmax, TLG, and primary tumor volume were significantly different between T1 and T2 (SUVmax, T1: 4.56 vs. T2: 8.43, P=0.035; TLG, T1: 1.01 vs. T2: 3.71 SUVxmL, P<0.01; primary tumor volume, T1: 0.38mL vs. T2: 0.80mL, P=0.01). At a TLG cut-off value of 3.470, the area under the curve was 0.875, sensitivity was 0.875, and specificity was 0.929 for T1-T2 differentiation. In 20 patients with 18F-FDG accumulation, the minimum radiation dose was significantly different between T1 and T2 (66Gy vs. 64Gy, P<0.01) at the same 66Gy prescription. The minimum radiation dose and primary tumor volume show the correlation value (r=-0.516, P=0.02). CONCLUSION: In glottic cancer, T1 and T2 can be differentiated by the extent of 18F-FDG accumulation in primary tumors on PET/CT. The minimum radiation dose rate decreases as volume increases.

The Preventive Effect of Melatonin on Radiation-Induced Oral Mucositis.

Melatonin exerts various physiological effects through melatonin receptors and their ability to scavenge free radicals. Radiotherapy is a common treatment for head and neck tumors, but stomatitis, a side effect affecting irradiated oral mucosa, can impact treatment outcomes. This study investigated the preventive effect of melatonin, a potent free radical scavenger, on radiation-induced oral mucositis. Mice were irradiated with 15 Gy of X-ray radiation to the head and neck, and the oral mucosa was histologically compared between a melatonin-administered group and a control group. The results showed that radiation-induced oral mucositis was suppressed in mice administered melatonin before and after irradiation. It was suggested that the mechanism involved the inhibition of apoptosis and the inhibition of DNA damage. From these findings, we confirmed that melatonin has a protective effect against radiation-induced oral mucositis.

Usefulness of Percutaneous Drainage in Determining the Causative Microorganism in Patients with Spondylodiscitis: A Retrospective Cross-Sectional Study.

Purpose: To determine the usefulness of CT-guided percutaneous drainage for the causative microorganism detection in patients with spondylodiscitis. Materials and Methods: Data of patients who underwent CT-guided percutaneous drainage for spondylodiscitis from January 2014 to April 2022 were extracted from the radiological database of our hospital and investigated. The administration rate of antibiotics prior to blood culture and CT-guided percutaneous drainage (CTPD) were analyzed. The detection rate of microorganisms via blood culture and CT-guided percutaneous drainage were compared using the Mann-Whitney's U test with the SPSS software. Results: In this study, a total of 30 (20 male and 10 female) patients were analyzed. A total of 13 patients (43%) were administered antibiotics prior to blood culture. Of them, microorganisms were detected via blood culture in only one patient (7%). A total of 25 patients (83%) were administered antibiotics prior to CTPD. Of them, the causative microorganisms in 19 patients (76%) were detected. Overall, the causative microorganism could be detected in 24 out of 26 patients (92%) via CT-guided percutaneous drainage. There was a statistical significance in the detection rate of microorganisms between blood culture and CTPD (P = 0.004) in favor of CTPD. Conclusion: CT-guided percutaneous drainage showed a high positive rate of microorganism detection in patients with spondylodiscitis regardless of antibiotic administration prior to the procedure. CT-guided percutaneous drainage can be a solution for the detection of the causative microorganism in spondylodiscitis patients who received antibiotics before obtaining any culture.

Predicting risk factors for hypothyroidism after definitive radiotherapy for early glottic carcinomas.

Hypothyroidism may occur after definitive radiotherapy in rare cases of early glottic carcinoma. However, to the best of our knowledge, no study to date has examined the risk factors for hypothyroidism specifically after definitive radiotherapy in patients with early glottic carcinoma. The present study determined risk factors for hypothyroidism after definitive radiotherapy in patients with early glottic carcinoma. This was a retrospective study that included 73 patients with T1 or T2, N0 glottic squamous cell carcinoma who underwent radiotherapy between June 3, 2009 and December 25, 2020. Demographic and clinical characteristics, including age, sex, tumor stage and pretreatment thyroid volume, were examined to elucidate the clinical risk factors for hypothyroidism. Field size, total prescribed dose and thyroid receiving dose were evaluated as dosimetric risk factors for hypothyroidism. Irradiated underlying thyroid volumes of more than 5, 10, 20, 30, 40, 50, 60 and 65 Gy (V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, V60Gy and V65Gy) and mean thyroid dose were included as thyroid receiving doses. The median follow-up duration was 61 months (range, 7-150 months). Hypothyroidism was present in 15 (21%) of the 73 patients, including 12 and 3 patients with grade 1 and 2 hypothyroidism, respectively. Among the demographic and clinical factors, sex and pretreatment thyroid volume were significantly associated with hypothyroidism (P=0.007 and P<0.001, respectively). Among the dosimetric factors, the presence of hypothyroidism was significantly associated with V5Gy (P=0.012), V10Gy (P=0.015), V20Gy (P=0.020), V30Gy (P=0.024), V40Gy (P=0.028), V50Gy (P=0.028), V60Gy (P=0.027) and mean thyroid dose (P=0.023). In conclusion, sex, pretreatment thyroid volume and thyroid receiving dose were associated with hypothyroidism after definitive radiotherapy in patients with early glottic carcinoma. Particularly, the receiving dose to the thyroid gland should be reduced in female patients and in those with small thyroid volumes who are at higher risk for hypothyroidism following radiotherapy.

Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery: Two case reports.

BACKGROUND: The ascending pharyngeal artery (APhA) comprises the pharyngeal trunk (PT) and neuromeningeal trunk. The PT feeds the nasopharynx and adjacent tissue, which potentially connects with the sphenopalatine artery (SPA), branched from the internal maxillary artery (IMA). Due to its location deep inside the body, the PT is rarely injured by trauma. Here, we present two cases that underwent transcatheter arterial embolization (TAE) of the PT of the APhA due to trauma and iatrogenic procedure. CASE SUMMARY: Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical check-up. The nasal airway was inserted as glossoptosis occurred during sedation. Bleeding from the nasopharynx was observed during the endoscopic procedure. As the bleeding continued, the patient was referred to our hospital for further treatment. Contrast-enhanced computed tomography (CT) demonstrated extravasation in the nasopharynx originating from the right Rosenmuller fossa. TAE was performed and the extravasation disappeared after embolization. Case 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our hospital. Contrast-enhanced CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the nasopharynx. Angiography demonstrated an irregular third portion of the IMA. As angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA, additional TAE to the artery was performed. The bleeding stopped after the procedure. CONCLUSION: Radiologists should be aware that the PT of the APhA can be a bleeding source, which has a potential connection with the SPA.

Brachiocephalic to left brachial vein thrombotic vasculitis accompanying mediastinal pancreatic fistula: A case report.

BACKGROUND: Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage, with clinical manifestations of abdominal pain, nausea, fever, and fluid collections. Healthy persons with less symptomatic pancreatitis are quite rare. Herein, we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein. CASE SUMMARY: A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days. She was diagnosed with cellulitis on the left arm due to left elbow tenderness. Intravenous antibiotics administration did not improve symptoms and laboratory data worsened; thus, chest and abdominal computed tomography (CT) was performed. CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum. Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed, which could be the cause of left elbow pain. A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography, so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst. Cyst content culture was positive for Escherichia coli infection. Clinical symptoms, imaging findings, and inflammatory reactions resolved gradually after starting therapeutic intervention. The mediastinal pancreatic pseudocysts shrunk, and the venous thrombi remained but shrunk. CONCLUSION: The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported. Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.

Tracheobronchial chondritis as an immune-related adverse event occurring during the administration of nivolumab for recurrent hypopharyngeal squamous cell carcinoma.

Tracheobronchial chondritis is a rare immune-related adverse event (irAE) associated with immune checkpoint inhibitors. We report a case wherein tracheobronchial chondritis occurred while administering nivolumab for recurrent hypopharyngeal squamous cell carcinoma (SCC) in a man diagnosed with T2N3bM0 stage IVB hypopharyngeal SCC. After treatment with cisplatin and radiotherapy followed by left and right neck dissection, local recurrence was observed in the hypopharynx. Because of the difficulty of salvage surgery, we administered 240 mg/body of nivolumab. After 9 cycles of nivolumab, the patient was judged to have complete response. After 10 cycles, he had cough and sputum, for which prompting us to perform imaging tests. Computed tomography (CT) showed edematous thickening around the trachea and bilateral bronchi and elevated amounts of adjacent subcutaneous fat tissue. Positron emission tomography-CT showed diffuse fluorodeoxyglucose uptake in the trachea and bilateral bronchi, bronchial endoscopy showed redness and swelling throughout the bronchi, and biopsy showed partial mucosal erosion, inflammatory cell (lymphocyte) infiltration, interstitial edema, and desmoplasia. The patient was diagnosed with tracheobronchial chondritis as an irAE resulting from administering anti-programmed death-1 monoclonal antibody. After four-day prednisolone treatment, his cough and sputum disappeared; after two weeks, tracheobronchial chondritis no longer appeared on CT.

Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging: A case report.

BACKGROUND: Relapsing polychondritis (RP) is a rare inflammatory disease involving the systemic cartilage, such as the auricle, trachea, and bronchiole, among others. A patient with RP shows variable symptoms based on the involved cartilage. CASE SUMMARY: A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician. The clinician prescribed antibiotics to the patient; however, the symptoms worsened; thus, she was referred to our hospital. Head and neck magnetic resonance imaging (MRI) showed edematous auricle with remarkable contrast, fluid collection in the bilateral mastoid cells, suggesting otitis media. The eustachian tube (ET) on the right side was also edematous with contrast enhancement. The patient was suspected of RP according to the diagnostic criteria. A biopsy of the auricular cartilage was performed by an otorhinolaryngologist, confirming pathological proof of RP. Treatments with steroids were immediately administered thereafter. CONCLUSION: We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.

Sarcopenia at the infrahyoid level as a prognostic factor in patients with advanced-stage non-virus-related head and neck carcinoma.

PURPOSE: The purpose of this study was to assess whether the infrahyoid skeletal muscle index (IHSMI) can be used instead of the L3 skeletal muscle index (L3SMI) to define sarcopenia and predict prognosis in patients with locally advanced head and neck squamous cell carcinoma (LHNSCC). METHODS: Patients treated for LHNSCC between January 2009 and April 2018 were assessed. The muscular area at the L3 transverse process and infrahyoid was contoured on absorption-corrected computed tomography prior to treatment. Sarcopenia based on L3SMI (S-L) was defined as values of < 52.4 cm2/m2 for men and < 38.5 cm2/m2 for women. Sarcopenia based on IHSMI (S-I) was determined via receiver operating curve analysis. Overall survival (OS) and cause-specific survival (CSS) curves were constructed using the Kaplan-Meier method. RESULTS: In total, 101 patients were analyzed. The median follow-up period was 19 months (range 3-101 month). S-L and S-I were identified in 74 (73.3%) and 56 patients (55.4%), respectively. The 5-year OS rate did not differ between patients with and without S-L (64.9% vs. 79.2%, p = 0.635), whereas the rate was lower in patients with S-I than without S-I (57.1% vs. 93.0%, p = 0.006). Similarly, the 5-year CSS rate did not differ between patients with and without S-L (77.0% vs. 82.3%, p = 0.523), but the rate was lower in patients with S-I (61.2% vs. 93.0%, p = 0.02). CONCLUSION: Pretreatment S-I, but not S-L, was a good predictor of OS and CSS in patients with LHNSCC.

Predicting factors for primary cervical cancer recurrence after definitive radiation therapy.

OBJECTIVES: The study aimed to retrospectively investigate the apparent diffusion coefficient (ADC) of primary cervical cancer to examine the recurrence correlations in patients treated with radiotherapy (RT). METHODS: The ADC of 31 patients with cervical cancer treated with RT were analyzed as possible risk factors for recurrence. A receiver operating characteristic (ROC) curve of the mean ADC (ADCmean) for the recurrence was generated to determine the cut-off value that yielded optimal sensitivity and specificity. The patient population was subdivided according to the risk factors for recurrence, and the disease-free survival (DFS) was analyzed. The following were investigated to explore the risk factors for recurrence: age, performance status, stage, pelvic lymph node metastasis, histologic tumor grade, maximal diameter of the primary tumor, chemotherapy, and ADCmean. RESULTS: The median follow-up duration of the patients was 25 months. The recurrence was recognized in 9 (29%) of the 31 cases. The ROC analysis of recurrence showed that the area under the ADCmean curve was 0.889 (95% CI, 0.771-1.000; p = 0.001). The cut-off value of ADC mean was 0.900 × 10- 3 mm2/s, with a sensitivity of 86.4% and a specificity of 88.9%. By univariate analysis, the ADCmean was the only factor significantly associated with recurrence. CONCLUSION: The ADCmean of the primary tumor is a potential predictive factor for the recurrence in of cervical cancer. ADVANCES IN KNOWLEDGE: The ADCmean of the primary tumor is a predictor of recurrence in patients with pre-treatment cervical cancer evaluation.

Usefulness of texture analysis in 123I-FP-CIT for the differentiation of AD and DLB subtypes.

OBJECTIVE: I-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) is well known to be a useful tracer for differentiating dementia with Lewy bodies (DLB) and Alzheimer disease (AD). However, clinically, there are some cases in which these diseases cannot be differentiated by ordinary quantitative methods. Therefore, in this study, we established an index that reflects not only the total count but also the distribution and heterogeneity of tracer uptake. We investigated whether assessment of the heterogeneous depletion of 123I-FP-CIT is useful for the differentiation of various types of dementia, i.e., probable DLB, possible DLB, and AD, using texture analysis. MATERIALS AND METHODS: A total of 122 patients with either probable DLB (n=35), possible DLB (n=23), AD (n=44), and normal controls (n=20) were analyzed. Summated single photon emission computed tomography (SPECT) images (7 to 10 slices) of the patients, including the bilateral striatum, were analyzed using the gray-level histogram method (GLHM) of texture analysis. Mean, variance, skewness, and kurtosis of GLHM were compared with the specific binding ratio by Livia Tossici-Bolt's method (SBR). RESULTS: The sensitivity and specificity for differentiating probable DLB from possible DLB, AD, and normal controls were 97.1% and 77.0%, respectively, for skewness, using a cut-off point of 6.8%, and 97.1% and 81.6%, respectively, for kurtosis, using a cut-off point of 53.4%. The sensitivity and specificity for differentiating probable and possible DLB from AD and normal controls was 65.5% and 98.4%, respectively, for skewness, using a cut-off point of 6.4%, and 79.3% and 93.8%, respectively, for kurtosis, using a cut-off point of 53.4%. CONCLUSION: In the assessment of the efficacy of 123I-FP-CIT to differentiate AD and DLB subtypes, mean, variance, skewness, and kurtosis by GLHM was as useful as the SBR method. Moreover, possible DLB and probable DLB could be differentiated by skewness and kurtosis. Our results demonstrate that texture analysis is more useful than conventional quantitative methods for obtaining valuable information of the brain. Textural features as such may have considerable potential as imaging biomarkers of DLB progression.

Intrathoracic lipoma in the horizontal fissure of the right lung: a case report.

Lipomas are benign tumors that originate from mesenchymal tissue, such as subcutaneous tissue. Intrathoracic lipomas are rare, and they can occur in the chest wall, mediastinum and bronchi. In the present case, the patient had an intrathoracic lipoma that was located in the horizontal fissure of the right lung. Retrospective review of chest radiographs taken at a previous health checkup confirmed that the tumor was growing. The patient had no symptoms, and computed tomography and magnetic resonance imaging suggested that the tumor was a hamartoma. The tumor was resected by video-assisted thoracic surgery, and was diagnosed by pathological analysis as an intrathoracic lipoma consisting of no atypical fats.

Laryngeal Cancer With Lung Metastases Showing Long-Term Complete Response and Delayed Immune-Related Adverse Event After Nivolumab Discontinuation.

We report a case of laryngeal cancer with multiple lung metastases that maintained a complete response (CR) for 18 months after discontinuing nivolumab treatment, with colitis developing 5 months after drug discontinuation. A 65-year-old man was diagnosed with T3N2cM0 stage IVA right supraglottic squamous cell carcinoma that progressed after 1 course of TPF (cisplatin, docetaxel, and 5-fluorouracil) as induction chemotherapy. He underwent total laryngectomy, bilateral neck dissection, pharyngeal reconstruction with anterolateral thigh flap, and creation of a permanent tracheostoma; extranodal extension was detected in the right cervical lymph node metastasis, and the patient underwent adjuvant radiotherapy. Multiple lung metastases occurred during radiotherapy, and the patient was deemed platinum refractory; nivolumab treatment was thus initiated. The tumor proportion score for programmed death-ligand 1-evaluated via antibody testing of the laryngeal tumor-was <1. The patient received 240 mg/body nivolumab every 2 weeks; a computed tomography performed after course 16 of nivolumab treatment confirmed a CR. He exhibited grade 2 thyroid dysfunction, grade 1 interstitial pneumonia, and grade 2 colitis after 6, 7, and 14 months of receiving nivolumab, respectively; treatment was discontinued as despite maintaining a CR, interstitial pneumonia occurred twice. Colitis appeared 5 months after nivolumab discontinuation; nevertheless, a CR was maintained after 18 months.

Evaluation of the relationship between the range of radiation-induced lung injury on CT images after IMRT for stage I lung cancer and dosimetric parameters.

BACKGROUND: This study evaluated the correlation between radiation-induced lung injury (RILI) and dosimetric parameters on computed tomography (CT) images of stage I non-small cell lung cancer (NSCLC) patients undergoing intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Sixty-three stage I NSLC patients who underwent IMRT were enrolled in the study. The patients underwent CT within 6 months (acute phase) and 1.5 years (late phase) after radiotherapy. These were fused with the planned irradiation CT. The range of RILI was measured from 10% to 100%, with an IC in 10% increments. RESULTS: The median interval from completion of radiotherapy to acute and late phase CT was 92 and 440 days, respectively. The median RILI ranges of the acute and late phases were in the 80% (20-100%) and 70% dose regions (20-100%), respectively. The significantly narrower range of RILI when lung V20 in the acute phase was less than 19.2% and that of V5 in the late phase was less than 27.6% at the time of treatment planning. CONCLUSIONS: This study showed that RILI occurred in a localized range in stage I NSCLC patients who underwent IMRT. The range of RILI was correlated with V20 in the acute phase and V5 in the late phase. KEY MESSAGES RILI correlated with V20 in acute and V5 in late phase. The shadow of RILI occurred in 80% dose region in acute and 70% in late phase. No relationship exists between radiographic changes in RILI and PTV volume.

TAS0314, a novel multi-epitope long peptide vaccine, showed synergistic antitumor immunity with PD-1/PD-L1 blockade in HLA-A*2402 mice.

Cancer peptide vaccines are a promising cancer immunotherapy that can induce cancer-specific cytotoxic T lymphocytes (CTLs) in tumors. However, recent clinical trials of cancer vaccines have revealed that the efficacy of the vaccines is limited. Targeting single antigens and vaccination with short peptides are partly the cause of the poor clinical outcomes. We synthesized a novel multi-epitope long peptide, TAS0314, which induced multiple epitope-specific CTLs in HLA knock-in mice. It also showed superior epitope-specific CTL induction and antitumor activity. We also established a combination treatment model of vaccination with PD-1/PD-L1 blockade in HLA-A*2402 knock-in mice, and it showed a synergistic antitumor effect with TAS0314. Thus, our data indicated that TAS0314 treatment, especially in combination with PD-1/PD-L1 blockade, is a promising therapeutic candidate for cancer immunotherapy.

Predictive factors for local control of early glottic squamous cell carcinomas after definitive radiotherapy.

The aim of the present study was to retrospectively investigate the risk factors of local failure for T1 glottic carcinoma irradiated with a prescription dose of 66 Gy. Between July 2006 and December 2017, 64 patients with T1 glottic squamous cell carcinoma treated with 66 Gy/33 fractions were analyzed for risk factors of local failure. The sex, age, performance status, T stage, overall treatment time, anterior commissure involvement, smoking status during/after treatment, histological tumor grade and pretreatment hemoglobin level were investigated. The maximum, mean and minimum doses, and the homogeneity index for the glottic larynx were calculated for dosimetric risk factors of local failure. The median follow-up duration was 51 months. Local failure was observed in 6 patients (9.5%). Among all risk factors, only the minimum dose to the glottic larynx was found to be significantly associated with local failure (P=0.025). The 5-year local control rates for a minimum dose to the glottic larynx of <65 and ≥65 Gy were 79 and 95%, respectively, with a statistically significant difference (P=0.015). No patients exhibited grade ≥3 late adverse effects. The minimum dose to the glottic larynx was the only factor significantly associated with local failure. Thus, local control of T1 glottic carcinoma may improve with a minimum dose of ≥65 Gy to the glottic larynx. In conclusion, radiotherapy with a minimum prescription dose of ≥65 Gy to the glottic larynx appears to be safe and achieves a high local control rate for T1 glottic carcinoma.

Prognostic impact of solid tumor component diameter in early-stage non-small cell lung carcinoma treated with intensity-modulated fractionated radiotherapy: a retrospective analysis impact of solid tumor component diameter in NSCLC treated with IMRT.

OBJECTIVE: To investigate the suitability of the new diameter-based subgroupings of the eighth edition Tumor Node Metastasis (TNM) classification system regarding radiotherapy treatment for early-stage non-small-cell lung cancer (NSCLC), we retrospectively re-analyzed the clinical data of patients treated with intensity-modulated radiotherapy using non-coplanar beams (ncIMRT) for Stage I NSCLC. METHODS: Between March 2011 and March 2018, 92 patients with 94 tumors who were diagnosed with Stage I NSCLC according to the seventh edition TNM classification system were enrolled and underwent ncIMRT of 75 Gy in 30 fractions. Local control (LC), progression-free survival (PFS), and overall survival (OS) were retrospectively investigated according to the T-classification subdivisions of the eighth edition and maximal solid tumor component diameter. RESULTS: The median follow-up period was 32.5 months. The median maximum tumor and solid tumor component diameters were 22 mm and 18 mm, respectively. 3-year LC, PFS, and OS rates were 84.1%, 69.4%, and 85.3%, respectively. The 3-year LC rates were 91.0 and 76.8% in the groups with tumor diameter ≤2 cm and >2 cm, corresponding to the T1c and T1b subdivisions of the eighth edition, respectively (p = 0.24). In the ≤2 cm and >2 cm solid tumor component groups, the 3 year LC rates were 93.6 and 63.2%, respectively, which were significantly different (p = 0.007). CONCLUSION: LC rates after radiotherapy in patients with Stage I NSCLC were correlated with solid tumor component diameter. High LC rates in patients with solid tumor components <2 cm in diameter were associated with high PFS and OS rates. ADVANCES IN KNOWLEDGE: This study suggests that the eighth edition TNM classification system, which focuses on solid tumor components rather than tumor diameter, can be applied to radiotherapy.