Effect of isometric quadriceps exercise on local microcirculation of the infrapatellar fat pad in female patients with knee osteoarthritis.

OBJECTIVE: To elucidate the local microcirculation of the infrapatellar fat pad (IFP) in patients with knee osteoarthritis (KOA) by determining the changes in IFP hardness and hemoglobin concentration during isometric quadriceps exercise (IQE). DESIGN: In this observational cross-sectional study, patients diagnosed with bilateral KOA were included in the KOA group (30 knees), healthy older adults in the control group (20 knees), and younger adults in the young group (20 knees). Ultrasonography was performed at rest and during IQE to measure IFP hardness based on shear wave velocity. Near-infrared spectroscopy was performed to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) in the IFP before (Baseline), during (IQE task), and after IQE (Post). IFP hardness and O2Hb, HHb, and cHb concentration were analyzed using a linear mixed model for the groups and measurement points. RESULTS: During IQE, IFP hardness changes were significantly less in the KOA group than in the other groups (KOA: 95 % confidence intervals (CIs) [-0.854, 0.028]; control: 95 % CI [-0.941, -0.341]; and young: 95 % CI [-2.305, -1.706]). In the KOA group, O2Hb concentration exhibited no significant changes at Post compared with Baseline; however, significant changes were observed in the other groups (KOA: 95 % CI [-1.176, 0.423]; control: 95 % CI [-1.452, -0.276]; and young: 95 % CI [-4.062, -2.102]). CONCLUSIONS: During IQE, changes in hardness and hemoglobin concentration in the IFP were not significant in the KOA group, suggesting impaired local microcirculation of the IFP.

Analyzing muscle thickness changes in lateral abdominal muscles while exercising using virtual reality.

[Purpose] Virtual reality (VR) rehabilitation has become popular in the medical field. VR-guided exercises (VR-ge) have demonstrated positive effects on gait and trunk control. Trunk muscle activation, particularly that of the transversus abdominis (TrA), is responsible for these improvements. However, the difference in muscle activation between VR and real space remains unclear. Therefore, this study aimed to clarify the differences in trunk muscle activation during exercise therapy performed in VR and real space. [Participants and Methods] A total of 22 healthy male volunteers were divided into two equal groups: VR-ge and Control exercise (C-e) groups. Both groups performed reaching exercises in a seated position. Ultrasound imaging was used to measure the thicknesses of the right external oblique, internal oblique, and TrA muscles, both at rest and during the reaching exercises performed in six different directions. [Results] No significant differences were observed in TrA muscle thickness changes between the groups before the intervention. However, after the intervention, the VR-ge group showed significantly greater TrA muscle thickness changes during reaching compared to that of the C-e group. [Conclusion] VR-ge increased TrA activation during reaching compared to exercising in real space.

Effects of low-intensity pulsed ultrasound on the infrapatellar fat pad in knee osteoarthritis: a randomized, double blind, placebo-controlled trial.

[Purpose] We investigated the effects of low-intensity pulsed ultrasound (LIPUS) irradiation of the infrapatellar fat pad (IFP) combined with therapeutic exercise for management of knee osteoarthritis (knee OA). [Participants and Methods] The study included 26 patients with knee OA, who were randomized into the LIPUS group (patients underwent LIPUS + therapeutic exercise) and the therapeutic exercise group (patients underwent sham LIPUS + therapeutic exercise). We measured changes in the patellar tendon-tibial angle (PTTA) and in IFP thickness, IFP gliding, and IFP echo intensity after 10 treatment sessions to determine the effects of the aforementioned interventions. We additionally recorded changes in the visual analog scale, Timed Up and Go Test, the Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores, as well as range of motion in each group at the same end-point. [Results] Compared with patients in the therapeutic exercise group, those in the LIPUS group showed significant post-treatment improvements in PTTA, VAS, and Kujala scores, as well as in range of motion. [Conclusion] The combined use of LIPUS irradiation of the IFP and therapeutic exercise is a safe and effective modality to reduce IFP swelling, relieve pain, and improve function in patients with knee OA.

Evaluation of autonomic nervous system responses during isometric handgrip exercise using nonlinear analysis of heart rate variability.

[Purpose] The purpose of this study was to examine, using a plethysmogram of the fingertips, autonomic responses at motor intensities of 30% or 50% of maximum voluntary contraction (MVC) during isometric handgrip exercise (IHG). [Participants and Methods] The participants of this study were 15 healthy persons. The finger volume pulse wave of each participant was measured continuously, using a BACS Advance equipment (TAOS Co.), for a total of 17 minutes: 5 minutes before IHG (Pre), 2 minutes during IHG (IHG), the first 5 minutes after IHG (Post 5), and then the second 5 minutes after IHG (Post 10). To evaluate autonomic nervous system activity, we used the Detrended fluctuation analysis (DFA) and Approximate Entropy (ApEn). [Results] During IHG, the pulse rate was significantly higher and the ApEn value was significantly lower than during the other periods of measurement. Compared to other analyzed parameters, ApEn decreased during IHG, but returned to its initial Pre period level during the Post 5 period. The α1 value derived from the DFA analysis remained at a value of 1 during each measurement time point, indicating the absence of malfunctions in autonomic response. [Conclusion] Isometric handgrip exercise with 30% MVC seemed to be useful for the assessment of autonomic nervous system response.

Long-term outcomes of combining prostate brachytherapy and metastasis-directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study.

BACKGROUND: Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial showed the survival benefit for prostate radiotherapy in newly diagnosed prostate cancer patients with a low metastatic burden. The result raises the next question whether additional radiotherapy to metastatic sites could improve the survival in those with a low metastatic burden. METHODS: We evaluated the efficacy and safety of prostate-directed radiotherapy (PDRT) with or without metastasis-directed radiotherapy (MDRT) in newly diagnosed oligometastatic patients who underwent combination of high-dose-rate prostate brachytherapy, external beam radiotherapy, and androgen deprivation therapy. Forty patients with bone metastasis and node positive prostate cancer were retrospectively analyzed. Of these, 22 (55%), 3 (7%), and 15 (38%) patients had N1M0, M1a, and M1b, respectively. Eighteen patients (45%) received MDRT to all metastatic sites. All patients initially underwent ≧6 months of androgen deprivation therapy. Oligometastatic disease was defined as presence of five or fewer metastatic lesions. Median follow-up period was 62.5 months. RESULTS: Of the 40 patients, the 5-year castration-resistant prostate cancer (CRPC)-free survival rate and cancer-specific survival was 64.4% and 87.9%, respectively. Pre- or post-treatment predictive value including prostate-specific antigen (PSA) at diagnosis ≥20 ng/mL, Gleason grade group 5, positive biopsy core rate ≥51%, PSA nadir level of ≥0.02 ng/mL after the radiotherapy, and no MDRT were significantly associated with progression to CRPC. Patients with MDRT had significantly higher probability of achieving a PSA level of <0.02 ng/mL than those without the therapy (88.8% vs 54.5%, P = 0.0354) and consequently had a better CRPC-free survival than those without the therapy (HR 0.319, 95%CI: 0.116-0.877). Comparing PDRT alone, PDRT with MDRT did not significantly increase the incidences of genitourinary and gastrointestinal toxicities. CONCLUSIONS: This single-institutional study revealed the feasibility of combining prostate brachytherapy and MDRT for newly diagnosed oligometastatic prostate cancer. This combined approach has potential to prolong CRPC-free survival.

Impact of five-tiered Gleason grade groups on prognostic prediction in clinical stage T3 prostate cancer undergoing high-dose-rate brachytherapy.

BACKGROUND: We evaluated a five-tiered Gleason grade groups arising from the 2014 International Society of Urological Pathology consensus conference on prognostic prediction in clinical stage T3a (extracapsular invasion) and T3b (seminal vesicle involvement) prostate cancer undergoing high-dose-rate brachytherapy (HDR-BT). METHODS: From November 2003 to December 2012, 283 patients with stage T3 prostate cancer received HDR-BT and external beam radiation therapy (EBRT) with long-term androgen deprivation therapy (ADT). Of these, 203 (72%) and 80 (28%) patients had stage T3a and T3b disease, respectively. The mean dose to 90% of the planning target volume was 7.5 Gy/fraction of HDR-BT. After five fractions, EBRT with 10 fractions of 3 Gy was administered. All patients first underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT continued for 36 months. Median follow-up was 74 months from the start of radiotherapy. RESULTS: The 10-year biochemical recurrence (BCR) -free rate for stage T3a and T3b disease was 79% and 64%, respectively (P = 0.0083). The 10-year cancer-specific survival (CSS) rate for stage T3a and T3b was 96% and 91%, respectively (P = 0.0305). Although grade groups ≥4 were independent predictors for BCR in cT3a patients (P = 0.0270), they failed to significantly predict prostate cancer-specific mortality (PCSM) among cT3a patients. Among cT3b patients, grade group 5 was a significant predictor of both BCR (P = 0.0017) and PCSM (P = 0.0233). Among stage T3a patients, no significant difference existed in 10-year CSS between grade groups 5 and 4 (94% vs 97%, P = 0.3960). In contrast, grade group 5 had a significantly worse outcome in 10-year CSS than grade group 4 among stage T3b patients (74% vs 100%, P = 0.0350). CONCLUSIONS: Stage T3a patients with grade groups 4/5 and stage T3b with grade group 4 had fairly low PCSM risk. Approximately one of four patients among stage T3b patients with grade group 5 showed PCSM after combined HDR-BT and EBRT with long-term ADT. Stage T3b patients with grade group 5 may have a greater risk for PCSM.

Perioperative Search for Circulating Tumor Cells in Patients Undergoing Prostate Brachytherapy for Clinically Nonmetastatic Prostate Cancer.

Despite the absence of local prostate cancer recurrence, some patients develop distant metastases after prostate brachytherapy. We evaluate whether prostate brachytherapy procedures have a potential risk for hematogenous spillage of prostate cancer cells. Fifty-nine patients who were undergoing high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy participated in this prospective study. Thirty patients with high-risk or locally advanced cancer were treated with HDR brachytherapy after neoadjuvant androgen deprivation therapy (ADT). Twenty-nine patients with clinically localized cancer were treated with LDR brachytherapy without neoadjuvant ADT. Samples of peripheral blood were drawn in the operating room before insertion of needles (preoperative) and again immediately after the surgical manipulation (intraoperative). Blood samples of 7.5 mL were analyzed for circulating tumor cells (CTCs) using the CellSearch System. While no preoperative samples showed CTCs (0%), they were detected in intraoperative samples in 7 of the 59 patients (11.8%; preoperative vs. intraoperative, p = 0.012). Positive CTC status did not correlate with perioperative variables, including prostate-specific antigen (PSA) at diagnosis, use of neoadjuvant ADT, type of brachytherapy, Gleason score, and biopsy positive core rate. We detected CTCs from samples immediately after the surgical manipulation. Further study is needed to evaluate whether those CTCs actually can survive and proliferate at distant sites.

Characteristics of ulnar neuropathy in baseball players: Focusing on the entrapment point of the ulnar nerve and valgus instability.

Background: The region where the ulnar nerve (UN) is swollen in baseball players with ulnar neuropathy is not apparent. This study investigated the UN's cross-sectional area (CSA) at each entrapment point in baseball players. We also aimed to clarify the relationship between valgus instability and the CSA of the UN. Methods: Forty baseball players were separated into healthy and ulnar neuropathy groups. The CSA and valgus instability were measured using ultrasonography (US). Relative to the medial epicondyle (MEC), the arcade of Struthers (SA) was 5 cm proximal, the cubital tunnel was the posterior part, and Osborne's ligament was defined as 3 cm distal. The ulnohumeral joint space was imaged as a low-echo space between the distal-medial corner of the trochlea and the proximal edge of the sublime tubercle. Results: The UN in the ulnar neuropathy group had significant swelling in the cubital tunnel and Osborne's ligament. We found a weak positive correlation between the CSA and ulnohumeral joint space, and the ulnohumeral joint space at rest and valgus stress. Conclusion: Evaluation and treatment of UN, especially cubital tunnel and Osborne's ligament, are necessary for the rehabilitation of baseball players presenting with ulnar neuropathy and valgus instability.

The effects of short foot exercises to treat flat foot deformity: A systematic review.

BACKGROUND: Studies on the effects of performing short foot exercises (SFEs) on the medial longitudinal arch (MLA) have been inconclusive. OBJECTIVE: This study aimed to conduct a systematic review of the effects of SFEs. METHODS: 'SFE' and 'intrinsic foot muscle' were keywords used to search for randomized controlled trials. One researcher screened relevant articles based on their titles and abstracts, and two independent researchers closely read the texts, accepting nine studies for inclusion. Outcomes, intervention duration, frequency, and the number of interventions were investigated. RESULTS: Of 299 potential studies identified, the titles and abstracts of 211 studies were reviewed, and 192 were excluded. The full texts of 21 studies were obtained and evaluated according to inclusion and exclusion criteria. Nine studies met the inclusion criteria. Six studies concerning the MLA were identified, with four reporting MLA improvement. There was no consensus concerning the number and frequency of SFEs performed, and the mechanism of MLA improvement was unclear. MLA improvement was observed in participants who undertook ⩾ 5 weeks of interventions. CONCLUSIONS: The results suggest that performing SFEs for ⩾ 5 weeks is effective in improving the MLA. Randomized controlled trials with details concerning the number and frequency of treatments are required.

Characteristics of the descending genicular artery blood flow velocity in patients with knee osteoarthritis.

BACKGROUND: In patients with knee osteoarthritis (KOA), the descending genicular artery (DGA) showed abnormal angiogenesis. However, the non-invasive assessment method of DGA remains unclear. The aim of this study was to clarify the characteristics of blood flow velocity of the DGA in patients with KOA and to examine the factors involved in the changes. METHODS: The KOA group included 22 knees of 22 patients with KOA (4 males, 18 females; mean age, 72.3 ± 7.5 years) and the control group included 22 knees (4 males, 18 females; mean age, 71.3 ± 5.4 years) of 22 healthy adults. The peak systolic blood flow velocity (PSV) in each group was measured using ultrasonography. The KOA group was classified into the effusion group and the non-effusion group based on observed effusion, and the PSV was compared between the two groups. The relationships between PSV and suprapatellar bursa intracavitary distance, pain, femorotibial angle, Japanese Knee Osteoarthritis Measure were also investigated. RESULTS: The PSV in the KOA group (51.5 ± 12.9 cm/s) was significantly higher than that in the control group (29.3 ± 4.4 cm/s) (P < 0.01). In the KOA group, PSV in the effusion group (55.5 cm/s (51.2-59.4 cm/s)) was significantly higher than that in the non-effusion group (39.1 cm/s (35.1-44.4 cm/s)) (P < 0.01). The PSV was positively and significantly correlated with both suprapatellar bursa intracavitary distance (r = 0.81: P < 0.01) and pain (r = 0.48: P < 0.05). CONCLUSIONS: The PSV measurement in the DGA is useful for the evaluation of non-invasive synovitis of patients with KOA.

Validity and reproducibility of foot motion analysis using a stretch strain sensor.

BACKGROUND: Multi-segment foot analysis is traditionally challenging to perform while subjects are wearing footwear or a foot orthosis and is difficult to apply in the clinical setting. A recently developed stretch strain sensor (STR), that is thin and highly flexible, may solve this limitation because it does not require observation using a camera and is highly portable. RESEARCH QUESTION: This study aimed to examine the reproducibility and validity of foot motion analysis using the STR during walking and running by comparing it with a conventional motion capture system. METHODS: Twenty-one healthy participants were examined in this study. The STR was placed on the participant's foot in one of two locations in separate experiments (spring ligament; SL and navicular drop; ND methods). Foot kinematic data during walking and running were simultaneously recorded using the STR and a three-dimensional motion capture system. Intra-class correlation (ICC) was used to assess test-retest reproducibility of the STR method. Cross-correlation coefficient evaluated the similarity of the pattern of the signals between the two systems. Pearson and Spearman correlation analysis was used to evaluate the relationships between the STR measurement and angular excursion of the forefoot or hindfoot. RESULTS: The ICCs of the SL method were 0.95 and 0.96, and those of the ND method were 0.93 and 0.71 during walking and running, respectively. In the SL method, the pattern of the signals between the STR and forefoot frontal motion was strongly correlated. The STR measurement was significantly correlated with forefoot eversion excursion (walking: r=-0.67, running: r=-0.64, p < 0.01 each). In the ND method, the STR signal was not associated with forefoot and hindfoot kinematics. SIGNIFICANCE: Our results showed that the STR has acceptable reproducibility and validity of foot motion analysis. This system may enable measurement of foot motion while subjects are wearing shoes and outside the laboratory.

Seated Virtual Reality-Guided Exercise Improved Gait in a Postoperative Hallux Valgus Case.

Virtual reality (VR)-guided exercise therapy using mediVR KAGURA has been reported to improve gait function by extending the arm to spatial targets while sitting. We aimed to investigate toe and trunk-pelvic function and plantar sensation during gait in a postoperative patient with hallux valgus. A 60-year-old woman, whose foot deformities had improved 6 months earlier, participated in the study. The exercise therapy interventions were performed twice weekly for 15 min. This study used an A-B-A design: 1-week pre-phase, 3-week intervention phase, and 2-week post-phase. The plantar pressure distribution and thoracic and pelvic displacements during gait were recorded at the end of each phase. The tactile pressure thresholds of the foot were determined before and after each exercise. The maximum force and impulse under the hallux increased after the intervention. The sensory threshold of the hallux was reduced. The amplitude of the thoracic and pelvic displacement was shortened in lateral and extended in the vertical and progressional directions after the intervention. We found that a 3-week VR-guided exercise improved toe function, plantar sensation, and postural adjustment of the trunk and pelvis during gait in a patient who had undergone surgery for hallux valgus, and the effects continued for 2 weeks.

The Effect of Functional Biomechanics Garment for Walking.

The purpose of this study was to investigate the effects of a functional biomechanics garment (FBG) with a lower extremity assist function. 32 healthy male participants were included in this study. Participants were divided into an FBG with taping function group (FBG group) and a compression garment group (CG group). Cadence (steps/min), step length (m), and usual walking speed (m/s) were measured as spatio-temporal data. Kinetics, kinematics data, and dynamic joint stiffness (DJS) of the lower extremity were calculated using a three-dimensional gait analysis system. The FBG group showed significantly faster walking speed (FBG, 1.54 ± 0.12 m/s; CG, 1.42 ± 0.15 m/s, p < 0.05) and reduced hip DJS in terminal stance (FBG, 0.033 ± 0.014 Nm/kg/degree; CG: 0.049 ± 0.016 Nm/kg/degree, p < 0.05) compared to the CG group. The FBG decreased hip DJS in the terminal stance and affected walking speed. The passive elastic moment generated by the high elasticity part of the hip joint front in the FBG supported the internal hip flexion moment. Therefore, our FBG has a biomechanical effect. The FBG may be useful as a tool to promote health activities.

Difference in Movement between Superficial and Deep Parts of the Infrapatellar Fat Pad during Knee Extension.

(1): The superficial and deep parts of the infrapatellar fat pat (IFP) have different morphological and functional characteristics. Knee pain often occurs during movement, and it is important to clarify the movement of the IFP during knee joint movement. The purpose of this study is to clarify that the movement of the superficial and deep parts of the IFP are different during knee extension in vivo using ultrasonography (US). (2): US was performed on 15 knees of 15 healthy adults. The probe was placed longitudinally at the center of the patellar tendon and the IFP was imaged. Measurements were taken during active extension of the knee from 90 degrees to 10 degrees of knee flexion at a rate of 30 times/min. The captured US videos were analyzed using Flow particle image velocimetry (Flow PIV) fluid measurement software. The region-of-interest (ROI) was set at the superficial part and the deep part of the IFP, and the flow velocity was calculated for each. (3): The flow velocity of the deep part (1.37 ± 0.13 cm/s) of the IFP was significantly faster than that of the superficial part (0.80 ± 0.23 cm/s). (4): Our results show that the flow velocity of the IFP is different between the superficial and deep parts and that US may be a better assessment tool for the movement of the IFP.

Prostate-specific antigen 'bounce' after permanent 125I-implant brachytherapy in Japanese men: a multi-institutional pooled analysis.

OBJECTIVE: To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level 'bounce' after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer. PATIENTS AND METHODS: A multi-institutional pooled analysis was carried out in 388 consecutive patients with T1-T2N0M0 prostate cancer treated with (125)I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had >or=1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall. RESULTS: The actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after (125)I-BT. Among the before and after (125)I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001). CONCLUSIONS: PSA bounce is a common phenomenon after (125)I-BT and occurred at a rate of 19-51% in the Japanese men who underwent (125)I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after (125)I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.

Four-year experience of interstitial permanent brachytherapy for Japanese men with localized prostate cancer.

OBJECTIVE: To report 4 year results obtained with our initial 100 patients with localized prostate cancer treated by interstitial permanent brachytherapy. METHODS: One-hundred Japanese men with clinically localized prostate cancer underwent interstitial permanent prostate brachytherapy using (125)I seeds. Median follow-up was 36 months (range, 30-42 months). Median initial prostate-specific antigen (PSA) level was 6.7 ng/ml (range, 1.5-25.2 ng/ml). Of these 100 patients, 31 received neoadjuvant hormone therapy for several months. Treatment morbidities were assessed using Radiation Therapy Oncology Group (RTOG) scale and National Cancer Institute Common Toxicity Criteria. RESULTS: A mean of 95 seeds (range, 48-123 seeds) were successfully implanted in patients with prostate cancer. Mean prostate volume receiving at least 100% dose (V100) and dose to 90% of prostate volume (D90) for the 100 patients were 96.6% and 166.1 Gy, respectively. Urinary morbidity was common, but was usually not severe. Only four patients needed catheterization for urinary retention (Grade 3) during follow-up. Most patients displayed no rectal morbidity after implantation, with only 3% of patients showing RTOG Grade 2 rectal morbidity and no patients showing morbidity of Grade 3 or more. Three patients experienced biochemical failure according to Phoenix consensus definition during follow-up. One patient displayed clinical failure with lymph node recurrence. CONCLUSIONS: These results indicate that interstitial permanent brachytherapy is safe and effective for Japanese patients with localized prostate cancer. The import of matured techniques developed in Western countries might allow bypass of the trial-and-error process in Japanese institutions.

Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels.

OBJECTIVES: To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs). METHODS: Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model. RESULTS: The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum alpha-fetoprotein level of >1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014). CONCLUSION: RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease.

Difference in rectal dosimetry between pre-plan and post-implant analysis in transperineal interstitial brachytherapy for prostate cancer.

BACKGROUND AND PURPOSE: To investigate differences in rectal dosimetry between pre-plan ultrasonography (US) and post-implant computed tomography (CT). PATIENTS AND METHODS: Subjects comprised 49 patients who underwent prostate brachytherapy using (125)I seed implants. Prescribed dose was 145Gy to the periphery of the prostate. Differences in rectal dosimetry between pre-plan US and post-implant CT analysis were evaluated. In addition, patients were divided into two groups according to timing of pre-planning (pre-plan group, n=28; intraoperative pre-plan group, n=21), and differences in rectal dosimetry between groups were assessed. RESULTS: The average of volume differences between pre-plan and post-implant analysis (pre-plan minus post-implant analysis) for all patients were follows: -0.08 cm(3) in V60 (volume of rectal wall receiving 60% of prescribed dose); -0.05 cm(3) in V70; -0.16 cm(3) in V80; -0.38 cm(3) in V90; -0.40 cm(3) in V100; -0.32 cm(3) in V110; -0.22 cm(3) in V120; -0.15 cm(3) in V130; -0.10 cm(3) in V140; -0.07 cm(3) in V150; and -0.05 cm(3) in V160. Apparent differences between pre-plan US and post-implant CT in rectal dosimetry were small. However, considering the steep curve of the relationship between tolerable volume and dose, a large actual difference should be assumed. No advantage was identified for the intraoperative pre-plan group. Safe volume to avoid proctitis tended to be smaller on ultrasonography than on CT at 1 month. CONCLUSIONS: The present work shows that direct comparison of CT analysis and pre-plan US is unfavorable due to large differences in these modalities and overestimation of tolerable volume. However, by comprehending the degree of difference, comparison of data from CT analysis with a US pre-plan may be feasible and useful for providing feedback between these modalities.

[Cranial nerve palsies due to skull base metastases in patients with prostate cancer: a report of two cases].

Two patients with prostate cancer showed cranial nerve palsies due to skull base metastases. Case 1: A 64-year-old man had prostate cancer (T4 N0 M1, Gleason score 7, prostate-specific antigen [PSA] level 372 ng/mL) with multiple bone metastases. Seventy-seven months after initiation of therapy, he had an articulation disorder and palsy of the left side of the tongue, with 12th cranial nerve palsy. Case 2: A 75-year-old man had a prostate cancer (T3b N0 M1, Gleason score 7, PSA level 177 ng/mL) with multiple bone metastases. Sixty-six months after initiation of therapy, he had hearing loss, noise in the right ear, and dizziness, with 8th cranial nerve deficits. Magnetic resonance imaging showed low intensity in the clivus in both cases, and all over the skull in case 2. The first patient was treated with radiation therapy and intravenous steroids at an early date. His symptoms improved.

Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer.

PURPOSE: To evaluate the prognostic value of prostate-specific antigen nadir (nPSA) after high-dose-rate (HDR) brachytherapy in clinically non-metastatic high-risk prostate cancer patients. MATERIAL AND METHODS: Data from 216 patients with high-risk or locally advanced prostate cancer who underwent HDR brachytherapy and external beam radiation therapy with long-term androgen deprivation therapy (ADT) between 2003 and 2008 were analyzed. The median prostate-specific antigen (PSA) level at diagnosis was 24 ng/ml (range: 3-338 ng/ml). The clinical stage was T1c-2a in 55 cases (26%), T2b-2c in 48 (22%), T3a in 75 (35%), and T3b-4 in 38 (17%). The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After 5 fractions, external beam radiation therapy with 10 fractions of 3 Gy was administered. All patients initially underwent neoadjuvant ADT for at least 6 months, and adjuvant ADT was continued for 36 months. The median follow-up was 7 years from the start of radiotherapy. RESULTS: The 7-year PSA relapse-free rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 94%, compared with 23% for patients with higher nPSA values (HR = 28.57; 95% CI: 12.04-66.66; p < 0.001). Multivariate analysis revealed that the nPSA value after radiotherapy was a significant independent predictor of biochemical failure, whereas pretreatment predictive values for worse biochemical control including higher level of initial PSA, Gleason score ≥ 8, positive biopsy core rate ≥ 67%, and T3b-T4, failed to reach independent predictor status. The 7-year cancer-specific survival rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 99%, compared with 82% for patients with higher nPSA values (HR = 32.25; 95% CI: 3.401-333.3; p = 0.002). CONCLUSIONS: A post-radiotherapy nPSA value of ≤ 0.02 ng/ml was associated with better long-term biochemical tumor control even if patients had pretreatment predictive values for worse control.