Unexpected change in hydrogel spacer volume during external-beam radiation therapy.

PURPOSE: To reduce the rectal radiation dose during local radiation therapy of prostate cancer, a hydrogel spacer is typically implanted between the prostate and rectum. However, the spacer volume can change during external beam radiation therapy (EBRT). Therefore, we used magnetic resonance imaging (MRI) to determine changes in the spacer volume during EBRT and analyzed the data to identify patient factors influencing this change. MATERIALS AND METHODS: A hydrogel spacer was implanted in each enrolled patient diagnosed with prostate cancer (n = 22, age = 69-86 years) for EBRT with a total dose of 70 Gy over 35 fractions. T2-weighted MRI images were acquired before (median = 8 days) and during EBRT, when the radiation dose of 48 Gy (median) was given at 55 days (median) after implantation. MRI images were used to determine the spacer volume as well as the maximum and minimum distances between the prostate and anterior wall of the rectum at the middle height of the prostate. Scatterplots were created to determine whether correlations existed between changes in the spacer volume and these two distances, while uni- and multivariate analyses were conducted to determine if the spacer volume change was influenced by the following patient factors: age, body mass index, estimated glomerular filtration rate, and visceral fat areas at the umbilical and femoral head positions. RESULTS: The spacer volume increased in all 22 patients, with the smaller spacer volume before EBRT increasing by a larger amount during EBRT. This increase in the spacer volume was unaffected by other patient factors. However, it correlated with the change in the maximum distance between the prostate and anterior wall of the rectum. CONCLUSION: To avoid adverse changes in the rectal radiation dose during EBRT, hydrogel spacer volume should be monitored, especially if the pre-EBRT volume is small.

Next-generation sequencing of primary testicular lymphoma and relapse in the glans penis after prophylactic radiation therapy: a rare case report.

BACKGROUND: Primary testicular lymphoma (PTL) is relatively rare. The contralateral testis is a common site of PTL relapse; therefore, once complete remission is achieved, radiation therapy (RT) is administered to the contralateral testis to prevent relapse. CASE PRESENTATION: A 76-year-old man was diagnosed with PTL and received RT as described above. However, despite achieving and maintaining complete remission, a mass diagnosed as diffuse large B-cell lymphoma by tissue biopsy developed in the glans penis 6.5 years after prophylactic RT. We investigated whether the glans penile lymphoma was PTL relapse or a new malignancy by genomic analysis using next-generation sequencing of DNA extracted from two histopathological specimens. CONCLUSIONS: We found the same variant allele fraction in four somatic genes (MYD88, IL7R, BLNK, and FLT3) at similar frequencies, indicating that the glans penile lymphoma had the same origin as the PTL. To the best of our knowledge, this is the first case report of PTL relapse in the glans penis.

Factors associated with cavity formation after stereotactic body radiation therapy for peripheral early-stage lung cancer.

PURPOSE: This retrospective study aimed to identify the factors associated with cavity formation after SBRT in peripheral early-stage lung cancer patients. We analyzed the occurrence of cavity changes after SBRT. MATERIALS AND METHODS: We examined 99 cases with T1-T2aN0 peripheral non-small cell lung cancer treated with SBRT from 2004 to 2021. Patients underwent respiratory function tests, including diffusing capacity for carbon monoxide (DLco), before treatment. The median observation period was 35 months (IQR 18-47.5 months). Treatment involved fixed multi-portal irradiation in 67% of cases and VMAT in 33%. The total radiation doses ranged from 42 to 55 Gy, delivered over 4 to 5 fractions. RESULTS: Cavity formation occurred in 14 cases (14.1%), appearing a median of 8 months after SBRT. The cavity disappeared in a median of 4 months after formation. High DLco and total radiation dose were identified as factors significantly associated with cavity formation. There have been no confirmed recurrences to date, but one patient developed a lung abscess. CONCLUSION: Although cavity formation after SBRT for peripheral early-stage lung cancer is infrequent, it can occur. This study showed high DLco and total radiation dose to be factors significantly associated with cavity formation. These findings can be applied to optimizing radiation therapy (RT) and improving patient outcomes. Further research is needed to determine the optimal radiation dose for patients with near-normal DLco for whom surgery is an option. This study provides valuable insights into image changes after RT.

Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery.

BACKGROUND: Administration of adjuvant or salvage radiotherapy (RT) after prostate cancer (PCa) surgery is supported by clinical evidence and is a widely adopted strategy. On occasion, we detect changes in prostate-specific antigen (PSA) levels, such as a transient elevation or decline, during RT. Thus, we retrospectively investigated the frequency of changes in PSA levels, their associations with histopathological parameters, PSA doubling time (PSADT), and biochemical recurrence (BR) of PCa. METHODS: This study included 23 consecutive patients who underwent surgery for PCa between 2012 and 2019, received salvage RT without hormone therapy, and exhibited changes in PSA levels during RT. The prostatic bed was irradiated with a total dose of 64 to 66 Gy. BR was defined as consecutive PSA levels exceeding 0.2 ng/mL or having to start hormone therapy because of PSA elevation after salvage RT. RESULTS: During salvage RT after PCa surgery, PSA levels transiently increased in 11 patients (47.8%) and decreased in 12 (52.2%). When factors associated with BR were examined in patients with transient PSA elevation, seminal vesicle invasion and preoperative PSA values were identified as being statistically significant. When factors for BR were examined in patients with a decline in PSA levels, the Gleason score and PSADT were identified as being significant. Among the cases of a decline in PSA levels during salvage RT, those who received a radiation dose of less than 36 Gy did not experience BR. Similarly, patients who exhibited changes in PSA levels during salvage RT and did not have perineural invasion did not experience BR. CONCLUSION: This is the first study to examine the histopathological factors possibly affecting BR in patients undergoing salvage RT after PCa surgery. The results indicate that in patients with transient PSA elevation, seminal vesicle invasion is a significant risk factor. On the other hand, in patients with a decline in PSA levels during irradiation, the Gleason score and perineural invasion were found to be potential risk factors for BR. These findings suggest that a thorough examination of postoperative histopathological results may be necessary for the optimal management of patients with PCa.

Pulmonary Veno-Occlusive Disease after Autologous Stem Cell Transplantation.

Pulmonary veno-occlusive disease (PVOD) is an extremely rare condition in oncology practice. Although PVOD is clinically similar to pulmonary arterial hypertension, the conditions differ in terms of pathophysiology, management, and prognosis. This report discusses the case of a 47-year-old woman who developed dyspnea and fatigue after high-dose cyclophosphamide chemotherapy and autologous hematopoietic stem cell transplantation for relapsed lymphoma. The patient exhibited tachycardia, tachypnea, and hypotension, but other findings in the physical examination were unremarkable. The imaging studies showed no evidence of pulmonary embolism, but multiple ground-glass opacities and bilateral pleural effusions were observed on chest high-resolution computed tomography scans. In the right heart catheterization study, the mean pulmonary artery pressure and pulmonary vascular resistance were 35 mm Hg and 5.93 Wood units, respectively, with a normal pulmonary capillary wedge pressure of 10 mm Hg. Pulmonary function tests revealed a remarkable reduction in the percentage predicted value of diffusing capacity of the lungs for carbon monoxide to 31%. Lymphoma progression, collagen diseases, infectious diseases such as human immunodeficiency virus or parasitic infections, portal hypertension, and congenital heart disease were carefully excluded as these are also capable of causing pulmonary arterial hypertension. Thereafter, we reached a final diagnosis of PVOD. The patient was treated with supplemental oxygen and a diuretic during 1 month of hospitalization, which relieved her right heart overload symptoms. Herein, we present the patient's clinical course and diagnostic workup because misdiagnosis or inappropriate treatment can lead to unfavorable outcomes in patients with PVOD.

Bone scan index on bone scintigraphy and radiation therapy for bone metastases from cancers other than prostate and breast cancers: A retrospective observational study.

Objective: In this study, we aimed to use new automatic analysis software (VSBONE bone scan index (BSI); Nihon Medi-Physics, Tokyo, Japan) to investigate whether the pre-radiation therapy (RT) BSI, derived from bone scintigraphy (BS) images, is a prognostic indicator in patients undergoing RT for bone metastases from cancers other than breast or prostate cancer. Materials and Methods: In this retrospective single-institution study, we analyzed data of 51 patients who had undergone whole-body scintigraphy before receiving RT for bone metastases from cancers other than breast and prostate cancer between 2013 and 2019. Their bone metastases preradiation BSI were automatically calculated using newly developed software (VSBONE BSI; Nihon Medi-Physics, Tokyo, Japan). Univariate and multivariate analyses were performed to identify associations between selected clinical variables and overall survival (OS). Results: We did not find a significant association between BSI and OS. However, we did find that younger patients had significantly better OS than older patients (P = 0.016 and P = 0.036, respectively). In addition, BSI were significantly lower in patient with solitary or osteolytic bone metastases than in those with osteoblastic or mixed bone metastases (P = 0.035 and P ≤ 0.001, respectively), and significantly higher in those with lung cancer than in those with other types of cancer (mean BSI 3.26% vs. 1.97%; P = 0.009). Conclusion: The only significant association with survival identified in this study was for age at the time of BS and at time of diagnosis of bone metastases.

Coronavirus disease 2019 (COVID-19) in patients before, during, or after lung irradiation, and serum SP-A and SP-D levels.

BACKGROUND: The correlation between COVID-19 and RT has not been determined to date and remains a clinical question. The aim of this study was to evaluate coronavirus disease 2019 (COVID-19) pneumonia before, during, and after radiation therapy (RT) regarding the radiation doses, radiation pneumonitis, and surfactant protein levels. METHODS: We evaluated patients diagnosed with COVID-19 before, during, or after RT for the lung between August 2020 and April 2022. In patients with breast cancer, the RT dose to the ipsilateral lung was determined. In all other patients, bilateral lung RT doses were determined. Patients diagnosed with COVID-19 after RT were evaluated to determine whether radiation pneumonitis had worsened compared with before RT. The serum levels of the surfactant proteins SP-A and SP-D were measured before, during, and after RT. RESULTS: The patients included in the study comprised three men (27.3%) and eight women (72.7%). The primary cancer sites were the breast (n = 7; 63.7%), lung (n = 2; 18.1%), esophagus (n = 1; 9.1%), and tongue (9.1%). COVID-19 was diagnosed before RT in four patients, during RT in two patients, and after RT in five patients. Six (54.5%) patients developed COVID-19 pneumonia. Radiation pneumonitis grade ≥2 was not identified in any patient, and radiation pneumonitis did not worsen after RT in any patient. No rapid increases or decreases in SP-A and SP-D levels occurred after the diagnosis of COVID-19 in all patients regardless of RT timing. CONCLUSIONS: COVID-19 did not appear to result in lung toxicity and surfactant protein levels did not change dramatically.

Radiation therapy for pelvic recurrent colorectal or gynecological cancer: is whole pelvic irradiation necessary?

BACKGROUND: Preoperative whole pelvic radiation therapy (RT) is used commonly for rectal cancer and is the standard field postoperatively in gynecological cancer. However, the ideal field (local vs. whole pelvis) has not been determined for local recurrence of these cancers. METHODS: We retrospectively reviewed the data for 52 patients who developed local tumor recurrence of rectal or gynecological cancer treated from 2013 to 2021. The initial treatment for all patients was total excision of the primary tumors without radiation therapy. Radiation therapy targets were surgical stumps, perianastomosis sites, and pelvic lymph nodes, classified according to the pelvic nodal volume atlas for radiation therapy. Patients were divided into the local recurrent tumor only radiation therapy group and the whole pelvis radiation therapy group. Whole pelvis radiation therapy included the common iliac lymph nodes or prophylactic lymph nodes below the L5/S1 junction. We recorded second recurrence after RT and the affected site(s) in each group. We also compared disease-specific survival using uni- and multivariate analyses. RESULTS: We found no significant differences between the groups regarding second recurrence or regarding the site(s) of recurrence. We also found no significant differences in disease-specific survival between the two RT groups. However, patients who did not receive chemotherapy after the initial surgery and before RT had significantly longer survival (P=0.015). CONCLUSIONS: In patients with locally recurrent rectal or gynecological cancer, we found no significant difference in second recurrence or survival between the local tumor only RT field and the whole pelvic RT field.

Bladder filling volume variation between the first and second day of planning computed tomography for prostate cancer radiation therapy and correlation with renal function.

AIM: During radiation therapy (RT) for prostate cancer, bladder filling helps exclude the organ from irradiation and reduces adverse effects. For RT planning, we performed computed tomography (CT) for 2 consecutive days to evaluate inter-day variations in organs such as the bladder. However, the patient factors that are associated with large intra-patient variations in bladder filling volume prior to RT are not known. METHODS: This was a retrospective study of 97 prostate cancer patients who underwent CT for 2 consecutive days for RT planning between March 2015 and March 2020 and with confirmed water intake volume before the scans. Patients consumed 500 ml of water immediately after urination and underwent CT 30 min after the start of water intake; CT was performed under similar conditions over 2 consecutive days. Patient information was collected from the medical records taken before CT. RESULTS: The median bladder filling volume was 102.8 cm3 (range: 31.7-774.0), and the median intra-patient bladder filling volume variation was 23.4 cm3 (range: 0.4-277.7). Univariate analysis revealed that the intra-patient variation was significantly larger in patients with an eGFR higher than the median (p = 0.003). No other factor showed correlations with the variation. As the larger bladder filling volume of the 2 consecutive days in patients increased (median 121.5 cm3 , range: 47.8-774.0), the intra-patient variation also increased. CONCLUSION: Patients with a higher eGFR show greater variation in bladder filling volume, and caution should be exercised when applying RT in these patients.

Bladder mucosa-associated lymphoid tissue lymphoma progressed from chronic cystitis along with a comparative genetic analysis during long-term follow-up: a case report.

The pathogenesis of bladder marginal zone/mucosa-associated lymphoid tissue (MALT) lymphoma, which is the most common type of primary bladder lymphoma, has not been clarified. There are no reports that described histological and molecular time course of MALT lymphoma occurring in the bladder and the importance of the score on the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale during and after radiation therapy (RT). We present a case of MALT lymphoma with long-term comparative genetic analysis. A 77-year-old Japanese woman with hematuria and severe perineal pain was found to have a tumor-like lesion in the bladder trigone. She was diagnosed with cystitis based on the results of pathological examination and immunostaining after transurethral resection of the lesion. The second transurethral resection procedure was performed approximately 4 years after the first procedure because of recurrence of the hematuria and enlargement of a lesion in the left bladder wall. Postoperative pathologic examination confirmed a diagnosis of MALT lymphoma. Genetic analysis of immunoglobulin heavy chain (IGH) gene rearrangements showed more clonal progression from the first biopsy to the second. The patient then underwent RT, during which her perineal pain was exacerbated by radiation cystitis but finally decreased to a level less severe than that before treatment. The PUF patient symptom scale was useful to monitor her pain throughout the clinical course. No recurrence was detected more than 2 years after completion of RT.

Whole-brain Radiation Therapy for Intracranial Metastases as Initial or Late Treatment.

BACKGROUND/AIM: We examined the difference between whole-brain radiation therapy (WBRT) for intracranial metastases (IM) from lung cancer as an initial and as a late treatment affecting overall survival (OS). PATIENTS AND METHODS: Thirty-three patients who presented with IM at initial examination who received WBRT as the initial treatment (initial WBRT group) and 47 patients without IM or with asymptomatic IM at initial examination who received WBRT after systemic therapy, between January 2014 and December 2020, were retrospectively analyzed. Patients' OS after WBRT were compared. RESULTS: Median OS was significantly longer in patients treated with systemic anticancer therapy after WBRT than in patients who were not (176 vs. 47 days, respectively; p<0.001), and systemic anticancer therapy after WBRT was a significant prognostic factor (p<0.001). CONCLUSION: Treatment with systemic anticancer therapy after WBRT may prolong the survival of patients who present with IM at initial examination.

Association between unintentional splenic radiation and lymphopenia and high neutrophil/lymphocyte ratio after radiotherapy in patients with esophageal cancer.

BACKGROUND: Unintentional irradiation of the spleen may reduce absolute lymphocyte count (ALC), which can affect tumor immunity. Therefore, in the present study, we evaluated spleen dose-volume parameters associated with ALC and neutrophil/lymphocyte ratio (NLR) in patients with esophageal cancer. METHODS: This retrospective study evaluated patients who were diagnosed with stage I-IV esophageal cancer and who received radiotherapy at Nihon University Itabashi Hospital between January 2015 and March 2020. Spleen V5, V10, V20, and V30 and mean spleen dose, which are dose-volume histogram parameters correlated with ALC and NLR, were analyzed. RESULTS: In total, 89 esophageal cancer patients with a median age of 72 years (range, 51-92 years) were included in this research. Results showed that spleen V5, V10, and V20 and mean splenic dose were significantly correlated with a low ALC. Meanwhile, a significant association was observed between spleen V5 and V10 and a high NLR (P<0.05). In the linear regression analysis, spleen V5 and V10 were remarkably associated with a low ALC (P=0.006 and 0.008). Further, a correlation was noted between spleen V5 and a high NLR (P=0.019). Spleen V5 and V10 were remarkably associated with greater than grade 3 lymphopenia (P=0.024 and P=0.031). CONCLUSIONS: A correlation was observed between the irradiated volume of the spleen and ALC and NLR in patients with esophageal cancer. Furthermore, the spleen should be regarded as a high-risk organ, and the use of techniques in reducing spleen V5, V10 for the preservation of tumor immunity may be beneficial.

The role of palliative radiation therapy in treating pleural or peritoneal disseminated tumors: 22 cases and a review of the literature.

BACKGROUND: Local radiation therapy (RT) can provide pain relief and reduce bleeding resulting from pleural or peritoneal dissemination of primary tumors. However, the optimal RT exposure dose for such tumors is unclear and the response rate is unknown. In this study, we examined the effectiveness of palliative RT for pleural or peritoneal disseminated tumors to determine the optimal dose in these patients. METHODS: The data of 22 patients with pleural- or peritoneal-disseminated tumors who were treated with local RT at our institution between 2011 and 2019 were retrospectively reviewed. RESULTS: Among these patients, 9 (40.9%) had pleural tumors, 13 (59.1%) had peritoneal tumors and 2 had tumors in the peritoneum and umbilicus. The most common primary tumors were lung (22.8%) and pancreatic cancer (18.2%). RT was mainly administered for pain alleviation (72.7%). Three patients (13.6%) received RT for hemostasis. Thirteen patients (59.1%) received a regimen of 30 Gy/10 fractions (fr), with the total dosage for all patients ranging from 27 to 56 Gy. No grade 2 or higher RT-related adverse events occurred. Three and four patients obtained complete and partial responses, respectively. The timing of the measurement of response to pain relief ranged from 0 to 232 (median, 21) days upon completion of RT. Overall response to pain relief occurred in nine of 16 patients (56.3%) with pain before RT. Hemostasis was confirmed in 2 of the 3 patients (66.7%) with bleeding before RT. Twelve of 20 (60%) patients with symptoms before RT responded to RT. Disease-specific survival (DSS) time after RT ranged from 1 to 656 (median, 106) days. CONCLUSIONS: Prompt palliative administration of RT to patients with advanced disease to alleviate pain from disseminated tumors may achieve therapeutic efficacy.

Successful treatment of nonsmall cell lung cancer patients with leptomeningeal metastases using whole brain radiotherapy and tyrosine kinase inhibitors.

The efficacy of treatments in patients with nonsmall cell lung cancer (NSCLC) with leptomeningeal metastases (LMs) remains unclear. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) play an important role in the treatment of patients with NSCLC. However, few studies have investigated the efficacy of combination therapy with TKIs and whole brain radiotherapy (WBRT) in patients with NSCLC/LM. We report here the case of a male patient in his 60s with adenocarcinoma who underwent lobectomy of the right upper lobe. The cancer was classified as pT1bN1M0 Stage IIA, and a mutational analysis revealed the presence of an EGFR mutation. However, 6 months after standard chemotherapy, LM had developed and WBRT was administered. Gefitinib (250 mg/day) was administered after WBRT. The patient remained free of significant recurrent disease for 57 months after WBRT was administered. Combination therapy with TKIs and WBRT is associated with relatively long survival times in patients with LM.

Computed Tomography of Lymph Node Metastasis Before and After Radiation Therapy: Correlations With Residual Tumour.

BACKGROUND: Computed tomography (CT) performed after radiation therapy (RT) is used to detect residual lymph node (LN) metastasis. Here, we investigated which LN parameters on pre- and post-RT CT images correlated with residual tumour in patients with head and neck cancer. PATIENTS AND METHODS: We enrolled 23 patients who received RT. A total of 50 LNs were evaluated. Correlations between quantitative and qualitative findings and residual tumours were evaluated. RESULTS: The median patient age was 61 years. Thirty-one LNs were histologically confirmed to contain residual tumour. LNs with residual tumour had significantly longer short and long axes on post-RT CT images. A new finding of obscured margins after RT were significantly associated with the presence of residual tumour by univariate and multivariate analyses. CONCLUSION: Comparison of qualitative, LN parameters on pre- and post-RT CT images may improve the detection of residual tumour in patients with suspected residual or recurrent LN metastasis.

What motivated medical students and residents to become radiation oncologists in Japan?-Questionnaire report by the radiotherapy promotion committee of JASTRO.

This study aimed to clarify the motivations and timing of the decision to become radiation oncologists. MATERIALS AND METHODS: We conducted an online survey for new members of the Japanese Society for Radiation Oncology (JASTRO). RESULTS: The response rate was 43.3%. Data of the 79 respondents who wanted to obtain a board-certification of JASTRO were analysed. We divided the respondents into two groups: Group A, those who entered a single radiation oncology department, and Group B, those who joined a radiology department in which the radiation oncology department and diagnostic radiology department were integrated. The most common period when respondents were most attracted to radiation oncology was "5th year of university" in Group A and "2nd year of junior residency" and "senior residency" in Group B. Furthermore, 79.5% of Group A and 40% of Group B chose periods before graduation from a university with a significant difference. The most common period when respondents made up their minds to become radiation oncologists was "2nd year of junior residency" in both groups. Internal medicine was the most common department to consider if they did not join the radiation oncology or radiology department. CONCLUSION: To increase the radiation oncologists, it is crucial to enhance clinical training in the fifth year of university for Group A and to continue an active approach to maintain interest in radiation oncology until the end of junior residency. In Group B facilities, it is desirable to provide undergraduates more opportunities to come in contact with radiation oncology.

Partial chest wall radiation therapy for positive or close surgical margins after modified radical mastectomy for breast cancer without lymph node metastasis.

AIM: Whole-breast radiation therapy after breast-conserving surgery can control local recurrence with a long-term survival rate equivalent to that of radical mastectomy for patients with early breast cancer. However, the significance of radiation therapy for patients with positive/close margins after mastectomy remains controversial. Following radical mastectomy, no residual breast parenchyma remains, and thus radiation therapy of the entire chest wall may represent overtreatment in the patients, especially those without lymph node metastasis (N0). We therefore implemented partial chest wall radiation therapy for patients with N0 breast cancer and positive and/or close margins after mastectomy. METHODS: A total of 22 patients with N0 status but positive/close margins underwent partial chest wall radiation therapy to irradiate the predetermined clinical target volume, which had margins of at least 2 cm medial, lateral, superior, and inferior to the primary tumor bed. With reference to chest wall thickness, 4-10-MV photons or 5-8-MeV electrons with/without a bolus were delivered. The total dose was 50-66 Gy. We compared the results with those from 18 nonradiation therapy patients using Pearson's χ2 test. RESULTS: All patients in the partial chest wall radiation therapy group achieved good local control despite having a significantly higher proportion of positive margins (77.3%) compared with the nonradiation therapy group (27.8%) (P = 0.002). Both groups showed 100% recurrence- and disease-free survival. CONCLUSION: Partial chest wall radiation therapy may offer recurrence- and disease-free survival without local recurrence in N0 mastectomy patients with positive/close surgical margins.

Diameter of External Carotid Arteries in Patients With Mandibular Osteoradionecrosis.

BACKGROUND/AIM: To evaluate the association between osteoradionecrosis (ORN) of the mandible and stenosis of the external carotid artery after radiation therapy (RT) for head and neck cancer. PATIENTS AND METHODS: The computed tomography images of 42 patients (36 men, six women; median age, 64.5 years) treated with RT for head and neck cancer between January 2011 and December 2015 were reviewed. The cross-sectional diameters of the bilateral external carotid arteries were measured on contrast-enhanced images taken after completion of RT. RESULTS: Nine of the 42 included patients (21.4%) developed ORN after a median interval of 34 months from completion of RT. Univariate analysis revealed that external carotid artery diameter ≤ the median diameter was significantly associated with ORN development (p=0.008 and 0.013). In multivariate analysis, left external carotid artery diameter ≤ the median was significantly associated with ORN development (p=0.023). CONCLUSION: External carotid artery stenosis was significantly associated with ORN development.

Serum tumor marker levels at the development of intracranial metastasis in patients with lung or breast cancer.

BACKGROUND: Intracranial metastasis (IM) is observed in various cancers, including in lung and breast cancer, and its timely diagnosis is required for successful patient treatment. Various tumor serum markers, such as carcinoembryonic antigen (CEA), pro-gastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), and cancer antigen 15-3 (CA15-3), serve not only as prognostic indicators in lung and breast cancer but also as risk factors for IM development. This study is the first to assess a subgroup of cancer patients with IM that did not show elevated serum tumor marker levels. METHODS: This retrospective study included 53 patients with lung or breast cancer in which IM was detected by enhanced brain magnetic resonance imaging between January 2013 and December 2018. IM was classified into three types [parenchymal metastasis (PM), leptomeningeal metastasis and dural metastasis]. Serum CEA level was measured using an electrochemiluminescence immunoassay (ECLIA) or chemiluminescent immunoassay. Plasma ProGRP level was measured using a chemiluminescent enzyme immunoassay (CLEIA), and the serum NSE level was measured using ECLIA. The serum CA15-3 level was measured using CLEIA. Univariate and multivariate analyses were performed using Pearson's χ2 test and logistic regression analysis, respectively. RESULTS: Among the total 53 patients, 15 patients (28.3%) did not show elevated serum tumor marker levels. Univariate analysis showed that the patients with PM only significantly correlated with no increasing tumor marker level compared with other IM types (P=0.030), as well as female patients and patients without symptoms (P=0.010 and 0.046, respectively). Multivariate showed that the patients with PM only and female patients significantly correlated with no increasing tumor marker level (P=0.038 and 0.014, respectively). CONCLUSIONS: Our findings describe a subgroup of lung and breast cancer patients with IM that do not show elevated tumor marker levels, indicating the need for the identification of novel indicators for IM or increased monitoring of these patients.