Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report.

BACKGROUND: In the last years, Selective Internal Radiation Therapy (SIRT), using biocompatible Yttrium-90 (90Y) labeled microspheres have emerged for the treatment of malignant hepatic tumors. Unfortunately, a significant part of 90Y-labeled microspheres may shunt to the lungs after intraarterial injection. It can be predictable by infusing technetium-99 m-labeled macro-aggregated albumin particles through a catheter placed in the proper hepatic artery depending on the lobe to be treated with performing a quantitative lung scintigraphy. Radiation pneumonitis (RP) can occur 1 to 6 months after the therapy, which is a rare but severe complication of SIRT. Prompt timing of steroid treatment is important due to its high mortality rate. On the other hand, pulmonary diffusion capacity measured by carbon monoxide (DLCO) is an excellent way to measure the diffusing capacity because carbon monoxide is present in minimal amount in venous blood and binds to hemoglobin in the same manner as oxygen. Some authors reported that the most consistent changes after radiation therapy (RT) are recorded with this quantitative reproducible test. The relationship between the proportional reductions in DLCO and the severity of RP developing after this therapy may prove to be clinically significant. CASE PRESENTATION: We herein present a patient who developed RP after SIRT that could be quantified using DLCO. To the best of our knowledge, this case is the first who developed unexpected RP after SIRT with significant decrease in DLCO with internal radiation exposure. CONCLUSIONS: RP is a very rare complication and may lead to a fatal outcome. Decline in DLCO could be a valuable parameter for follow-up and to identify potential candidates for RP and could be also another trigger for administration of steroid therapy with prompt timing in this patient group.

Observation of therapeutic effect of 125I seed implantation combined with chemotherapy and antiviral therapy on HBV-related liver cancer.

PURPOSE: To investigate the therapeutic effect of 125I seed implantation combined with chemotherapy and antiviral therapy on hepatitis B virus (HBV)-related liver cancer. METHODS: A total of 126 patients with HBV-related liver cancer were selected and divided into observation group (n=63) and control group (n=63). The patients in the control group were treated with transcatheter arterial chemoembolization (TACE) and antiviral therapy, while those in the observation group were treated with 125I seed implantation combined with TACE and antiviral therapy. The therapeutic effect, liver function, serum HBV DNA and tumor marker levels, and changes in Child-Pugh score and Karnofsky performance status (KPS) score before and after treatment were compared between the two groups. RESULTS: After treatment in the observation group, the serum alanine aminotransferase (ALT), HBV DNA, alpha fetoprotein (AFP) levels and Child-Pugh score were lower than those in the control group, while the KPS score was significantly higher than in the control group (p<0.05). There was no statistically significant difference in the control rate of liver cancer after treatment between the two groups (p>0.05). The remission rate in the observation group was obviously higher than in the control group (p<0.05). CONCLUSION: 125I seed implantation combined with chemotherapy and antiviral therapy can effectively eliminate HBV DNA, improve liver function, increase quality of life and enhance the therapeutic effect in patients with HBV-related liver cancer, so it is worthy of clinical popularization.

Yttrium-90 Glass-Based Microsphere Radioembolization in the Treatment of Hepatocellular Carcinoma Secondary to the Hepatitis B Virus: Safety, Efficacy, and Survival.

PURPOSE: To evaluate outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV). MATERIALS AND METHODS: A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 (age 62 y ± 10; 91% male) received glass-based radioembolization for HCC secondary to HBV. All patients were stratified according to previous therapy (naive, n = 14; 31.1%), Child-Pugh class (class A, n = 41; 91%), Eastern Cooperative Oncology Group (ECOG) performance status (PS; < 1, n = 21; 47%), solitary (n = 26; 58%) and unilobar (n = 37; 82%) tumor distribution, tumor size < 5 cm (n = 29; 64%), portal vein thrombosis (n = 14; 31%), α-fetoprotein level > 400 ng/mL (n = 17; 38%), and Barcelona Clinic Liver Cancer stage (A, n = 8; B, n = 9; C, n = 28). RESULTS: A total of 50 radioembolization treatments were performed, with a 100% technical success rate (median target dose, 120 Gy). Clinical toxicities included pain (16%), fatigue (12%), and nausea (4%). Grade 3/4 laboratory toxicities included bilirubin (8%) and aspartate aminotransferase (4%) toxicities. Observed toxicities were independent of treatment dose. The objective response rates were 55% per modified Response Evaluation Criteria In Solid Tumors and 21% per World Health Organization criteria, and the disease control rate was 63%. Disease progression was secondary to new, nontarget HCC in 45% of cases. Median time to progression and overall survival were 6.0 mo (95% confidence interval [CI], 4.4-8.0 mo) and 19.3 mo (95% CI, 11.2-22.7 mo), respectively. Multivariate analysis demonstrated ECOG PS ≥ 1 and AFP level > 400 ng/mL to be independent predictors of inferior overall survival. CONCLUSIONS: Glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival.

[The application of pulsed infrared laser radiation with autoresonant amplification for the treatment of patients with acute viral hepatitis B].

A group of 59 patients presenting with acute viral hepatitis B was available for examination. A single course of pulsed infrared laser irradiation with autoresonant amplification resulted in the improvement of clinical conditions of the patients and normalization of ALAT activity, total and direct bilirubin levels.

Factores asociados a la infección de Hepatitis B y Hepatitis C en pacientes con enfermedades Hematoonedogicas Hospital Infantil "Manuel de Jesús Rivera" 1ero de agosto al 31 de diciembre 1998

En el Hospital Infantil MANUEL DE JESUS RIVERA, se realizó el presente estudio de investigación que se basó en conocer los factores asociados a la infección de hepatitis B y hepatitis C, en los pacientes con enfermedades hematooncológicas, considerándose éste grupo de alto riesgo para la adquisición de enfermedades infecciosas como el caso de la hepatitis viral. El universofue de 444 pacientes y la muestra de 439 pacientes. Encontrándose en el grupo estudiado predominio de la hepatitis C 238 pacientes (52.2). No se encontró diferencia porcentual significativa respecto a la distribución por grupo etáreo entre hepatitis B y hepatitis C. Se encontró que la hospitalización es un factor importante asociado a la infección tanto de hepatitis B como hepatitis C. (99.04 respectivamente). El número de hospitalización y el número de transfusión no influye en la infección hepatitis B o hepatitis C...

[The effect of the siting of exposure to decimeter-range electromagnetic waves on the function of the hypophyseal-thyroid and adrenal systems in viral hepatitis]. / Vliianie lokalizatsii vozdeistviia élektromagnitnymi volnami detsimetrogo diapazona na funktsional'noe sostoianie gipofizarno-tireoidnoi i nadpochechnikovoi sistem pri virusnykh gepatitakh.

The author studied time course of changes in the thyroid and adrenal systems as shown by the levels of T3, T4, T3/T4, TTH, hydrocortisone, ACTH in response to exposure to decimetric microwaves (460 MHz, 30 mW/cm2). The microwaves were directed to the area of hepatic, thyroid, adrenal projections and combinations thereof. An optimal effect was achieved at the course exposure of the adrenal projection.