Death related to pleural and pericardial effusions following chemoradiotherapy in a patient with advanced cancers of the esophagus and stomach.

Chemoradiotherapy improves therapeutic outcome in many different types of cancer. However, there is concern about the occurrence of delayed complications, as patients are surviving longer. Because patients with esophageal cancer receive a wide range of irradiation field to the mediastinum and the heart, they may have delayed complications of heart and lung functions as previously reported in Hodgkin's disease. We presented a case of death related to uncontrollable pleural and pericardial effusions in a patient with advanced cancers of the esophagus and stomach who achieved a complete remission following chemoradiotherapy and salvage gastric resection, focusing on detailed pathophysiological conditions related to concurrent chemoradiotherapy.

The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis.

The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP.

Small lung tumors: long-scan-time CT for planning of hypofractionated stereotactic radiation therapy--initial findings.

PURPOSE: To prospectively use long-scan-time computed tomography (CT) to visualize the trajectory of tumor movements or the internal target volume. MATERIALS AND METHODS: The study was approved by the institutional review board. Written informed consent was obtained from participants after the study and the role of procedures were explained fully. During the planning of stereotactic radiation therapy for 10 patients (nine men, one woman; mean age, 77 years; range, 69-89 years) with small lung tumors (mean volume, 9.0 cm3; range, 3.6-24.9 cm3), fluoroscopic imaging, long-scan-time CT, and thin-section CT were performed. The tumor and the partial-volume-averaging effects that resulted from tumor movement were delineated on each section at long-scan-time CT performed during the patient's steady breathing with scan time of 8 seconds per image. Visualized internal target volume was defined by integrating the sections. A simple model was examined for estimating internal target volume on the basis of respiratory motion and gross target volume delineated on thin-section CT images. Visualized internal target volume and estimated internal target volume were compared quantitatively and graphically. The Mann-Whitney test was used to analyze the relation between gross target volume delineated on thin-section CT images and the ratio of visualized internal target volume to the defined gross target volume. RESULTS: The correlation coefficient between visualized internal target volume and estimated internal target volume was r = 0.98 (P < .001). The mean relative error +/- standard deviation was 1.9% +/- 19.0 (range, -11.0% to 56.4%). Excluding one case with an irregularly shaped tumor (56.4%), the mean relative error was -4.1% +/- 4.1. In patients with small tumors (defined gross target volume, < or = 10 cm3), the ratio of the visualized internal target volume to the defined gross tumor volume was significantly larger than that in patients with larger tumors (1.2-2.0 vs 1.0-1.2; P < .05). In some cases in which marginal spiculation depicted on thin-section CT images was blurred on long-scan-time CT images, the blurred area was erroneously excluded from the target volume. CONCLUSION: In most cases, values for visualized internal target volume and estimated internal target volume were similar and long-scan-time CT depicted virtually the entire tumor trajectory.

Radiation injury after hypofractionated stereotactic radiotherapy for peripheral small lung tumors: serial changes on CT.

OBJECTIVE: We studied the serial changes and CT manifestations of pulmonary radiation injury after hypofractionated stereotactic radiation therapy for peripheral small lung tumors. SUBJECTS AND METHODS. Hypofractionated stereotactic radiation therapy was applied to 20 patients with proven primary (n = 11) or metastatic (n = 9) lung cancer, for a total of 22 lesions of 3 cm or less in diameter located within 3 cm from the parietal pleural surface. Follow-up CT was scheduled at 1 and 3 months, and every 3 months thereafter. RESULTS: Ground-glass opacities were observed around four (18%) of 22 lesions at 3-6 months. The opacities nearly corresponded to the planned target volume, but half of them were unevenly distributed. Ground-glass opacities gradually disappeared or evolved into dense consolidation while shrinking. Dense consolidations developed in 16 (73%) of 22 lesions, including seven in the center of the planned target volume and nine in the periphery of the planned target volume. Dense consolidations moved in six of these 16 lesions and gradually shrank, becoming fixed as solid or linear opacities approximately 12 months later. CONCLUSION: The pulmonary opacities observed after hypofractionated stereotactic radiation therapy for peripheral small lung tumors may not precisely correspond to the planned target volume (unlike those with conventional radiation therapy) and may change in shape and location dynamically during the first year. Knowledge of these findings is necessary to avoid misunderstandings concerning tumor regrowth or new tumors.